Why Saying No is Hard

In retrospect, I'm a little surprised that it took me as long as it did to start protecting my time.  I've known from the very beginning of my training that, in order for my career to be sustainable, I need to have some time to recharge.  And I've done very well at protecting my time when it comes to vacations.  I've taken all of my allowed vacation days, and I've refused to do any work or studying when on vacation.  But when it comes to the day to day, I've let myself take on far more work than I can handle permanently without being miserable.  So why?

Conditioning:
I spent nine years in medical training (4 years medical school, 3 years residency, and 2 years fellowship), and seven years in undergraduate/graduate school before that.  As a trainee, I got very limited choice about things.  My courses were mostly decided for me, someone else set my schedule, and saying no to things was almost never an option.  So I just sucked it up.  For years.  I suppressed my desire to sleep and eat healthy food and have strong relationships as much as I possibly could, and I survived in a sugar- and caffeine-fueled haze because I had to.

And then, I came out on the other side, and it took a while to occur to me that I was in charge for once.  Since starting my job, I've somewhat reflexively said yes to things, because that's simply what I've always done.  But I actually don't have to do that.  For once, I get to make the decisions. 

Denial (It'll Get Better Soon):
Whenever I look at my schedule, I think "Once <insert current thing that is taking up too much of my time> is over, I'll get a chance to catch up".  Except I never do.  Current thing gets replaced by next thing, and my schedule stays busy and overwhelming.  It has been like this for almost four years, and yet it is only now that I'm really waking up to the fact that my schedule will always be overwhelming unless I deliberately take steps to slow down.

Money:
I really have absolutely zero to complain about when it comes to my money.  I am paid very well, and since I started working in 2015, I've paid off my six-figure student line of credit and accumulated almost 1/3 of what I need to retire.  I am doing great, and I know there are a lot of people who would be very happy to swap financial situations with me.  I recognize how fortunate I am financially, and I am incredibly grateful for that.

And yet...I still worry.  What will happen if I become disabled*?  If my province radically cuts healthcare funding and my job changes or disappears?  If I burn out and am no longer able to work?

The worry drives me to accumulate.  To build up my cash savings and my investments as protection against all of the uncertainty of life.  Working less means earning less, and while it would still be more than enough, it feels scary to someone who is as security-focused as I am.

Shame: 
Other people do more than me.  They see more patients, do (waaaay) more research, and have more administrative responsibilities.  Lots of them have spouses and/or children, so they have a whole second set of duties to take care of when they go home.  And when I look at these people, I wonder "Why am I complaining about my much emptier schedule?  Why can't I do as much as they do without complaining so much?"

It is hard to accept that I simply can't.  Whether it's because of my anxiety, or being an introvert, or my perfectionism, or some combination of that fabulous trifecta, I simply cannot do as much as other people do.  And more importantly, I don't want to.  I want to not panic if I have to add an extra patient to a clinic because of an emergency.  I want to sleep through the night without experiencing anxiety-induced insomnia.  I want to have unstructured time at home to just breathe and exist, without having to constantly run through my to-do list in my head.

I want to be happy, at least most of the time.

What makes it hard for you to say no?

*I have some, but not enough, disability insurance right now.  This is one of those "important but not urgent" things that I've been putting off for too long.

When the Body Says No

Overwork crept up on my slowly.

Work has always felt busy to me, but over the past six months, the intensity has been increasing.  An extra patient or two added to each clinic.  A new computer system that is supposed to, but doesn't, make things easier.  An extra trainee to supervise each week.  Nothing particularly time-consuming on its own, but the cumulative effect has been a few extra hours of work every week.

At the same time, life outside of work has become busier.  I've invested a lot of energy into meeting people, and my social circle has expanded.  And on New Year's Day, I met my new girlfriend!  And I've started doing yoga.  And while all of these things are good (some of them really good), they all take time.

I started to notice the effects of being too busy right before my Christmas break.  At the end of yoga class, lying in shavasana (aka "corpse pose"), I'd often fall asleep.  On a particularly bad day, I'd cry.  I thought that I just needed a good break, but I felt just as tired and overwhelmed after my 10-day break as I had before.  The same thing was true when I returned from a recent week of vacation in Mexico.

The lowest point came the first week back from Mexico.  I was in the middle of my usual Thursday paperwork day when I started having an anxiety attack.  I couldn't focus on anything I was supposed to do, and all I could think about was how I could never possibly get done everything I needed to do.  I ended up having to leave early, because I was just desperately spinning my wheels while accomplishing absolutely nothing.

That night, I took a long and serious look at what had gotten me to that place.  (Also a long and serious look at my bank balance.  If it had been high enough for FIRE, that might have been the moment for me.  But alas, it's not even close.)  And I realized that I haven't done anything to protect my time and energy, even though I know that I am someone who gets (relatively) easily overwhelmed.

So my new phrase is "fuck no".  (The "fuck" part said inside my head, because of the aforementioned lack of enough money to retire.)  I have put an absolute moratorium on saying yes to anything else, and I've been getting rid of any commitment that I can possibly get rid of.  I've put a firm cap on my clinics, and when people say "Can't you just squeeze in one more patient?", the answer is "Noooooo".

Better to pare back now, when I'm not totally burnt out, than to be forced to do it when I am.

(I have so much more to say about this, but I'm exhausted.  Hopefully soon!)