You may recall that I set some pretty ambitious (for me) goals at the beginning of the year. So how is it going one month in?
The Good:
"meditating every day" I have done this! I was pretty well established with my weekday morning practice, so my main challenge here was finding a way to meditate on the weekends. Initially, I thought that I would meditate first thing in the morning like I do on weekdays, but this literally never happened. Turns out, I really enjoy sleeping in and getting a lazy slow start to weekend days, and there is no part of me that wants to start the day on a meditation cushion. So I have been doing it before I go to bed on weekends, and it has gone perfectly so far.
"I mostly just want to keep working and
hoarding money for the future" I had nine days of very busy call this month, so I have done a lot of hoarding of money. It's lovely for the net worth, but I would honestly like to do a little less earning and a little more resting.
"I want to keep building on
the friendships I have." I've also been doing this! Even though it's been a busy month, I've made time to go with friends to see our local queer choir, to visit my godson and his family, to go for dinner with my brother, and to go out for dinner and a play with my mom and her partner. (I think there has been more? It's a bit of a blur.) For an introvert who has been busy with work, it has been about the maximum amount I can expect of myself.
The Not As Good:
"I would like to work on keeping up with everything." This has been very mixed. One of my proposed ways of achieving this was "just doing the shit now", and I have definitely incorporated this approach into my life, to good effect. I am constantly trying to spend a few extra minutes to do all the nagging little tasks as they come up, and as a result I'm getting a lot more done without it feeling overwhelming or like a giant burden. And I'm worrying less about missing things. Perfect example - I got an application for reimbursement of a work expense, which isn't due until April. My initial instinct was to put it in my to do pile (I had three months to do it, after all), but instead I took the five minutes required to fill it out, put it in the return envelope, and put it in the mailbox. And now it's done, and I don't have to worry about missing the deadline for getting money back.
The biggest challenge has simply been that work has been really busy. In addition to nine busy (and really emotionally exhausting) days of call, I had a week of teaching, and I've taken on a new volunteer position with a national organization (You know. Because that helps with burnout.) I've worked at least part of one weekend day every week since the beginning of the year, and still things are slowly starting to build up. It's frustrating.
And as for my "go to work earlier and stay later" approach?
Ha.
Ha.
Ha.
When I was writing my original post, I had the (utterly ridiculous, I don't know where it came from) idea in my head that I sometimes go to work late or leave early because I'm lazy. This past month has reminded me that it's actually because I'm tired. I have a limited number of productive work hours in me every day, and once they are finished, there is no value in me sitting in front of a computer trying to work. I need a mental break. So those days when I leave early are usually because I'm mentally shutting down and ready for the day to be over. And the days when I arrive late are usually because I've been suffering from insomnia and have allowed myself an extra hour to catch up on some sleep.
This has been an important reminder to not be too hard on myself and to extend myself a bit of grace. I am human, and I can only do so much. It's also a really important reminder to set boundaries and to not apologize for doing so. At the moment, I'm having to set some boundaries on fun things in my personal life, but I'm hoping as the year goes on and my call schedule settles down a bit that the boundaries will be more towards work. I've also firmly decided that I'm going to give up a volunteer commitment at the end of the year (I reeeeealy should've given it up at the beginning of the year, but I got talked into agreeing to another year), which will free up one precious evening every month.
The Total Nope:
"I'm aiming for a regular practice of four yoga
classes per week" At best so far I've made it to three classes in one week. Things have just been busy, and in some cases (call) I've had to skip yoga, and in other cases (social life) I've chosen to skip yoga. Part of me is sad, because I really do love it and am seeing a lot of progress, but I'm also making peace with it. I have a really full life, in mostly good ways, so it's okay that I'm not being absolutely perfect at everything.
So that's the one-month check in. As for February? I have three more weeks off call (yay!), during which I'm fully intending to get caught up on everything work related (plausible if I do some work on weekends), after which I have one week on, one off, and one on. Ugh. I'm intending to keep up with the daily meditations, as I do think they help keep me present and calm, even though my brain feels squirrely while I'm doing them. I'm going to try to do three yoga classes a week, as I think it's more realistic than four right now. And, perhaps mostly importantly, I'm going to keep learning from the process and being kind to myself. I'm actually doing pretty well at things that are hard, and I deserve to be proud of myself for that.
Showing posts with label Balance. Show all posts
Showing posts with label Balance. Show all posts
Friday, January 31, 2020
Friday, December 27, 2019
2019 - The Year of Breaking Open
I'm not big into dates, but for some reason I love the start of the new year. Even though there's nothing magical about the transition from December 31 to January 1, it always gets me reflecting on the previous year and thinking ahead to the next. When I re-read my New Year's post from this year, I had to laugh at my intention for 2019:
"And what for 2019? Mostly, I want to keep going on the path that I'm already on. I want to remain in the present moment, enjoying it when I can and learning from it when I can't."
Learning from it when I can't describes so much of the past year. I existed in a state of near-constant stress for months, and then I basically fell apart when the chronic stress became too much. For weeks, I wasn't certain if I would choose to (or even be able to) stay at work. It was horrible.
Probably the wisest thing I did, and something that was only possible because of my mindfulness practice, was stay present in the tough moments. My mantra through that time, which I would sometimes recite multiple times in a day, was "Be patient. Be present." I somehow knew that, if I could just show up for those moments, that I would learn something important from them.
And I have learned an incredible amount over the past year. I've learned that I am limited in how much I can do well (as is everyone), and more importantly, I've learned that I have the support of my institution to set limits on my work. I don't have to overbook all of my clinics. I don't have to work through weekends most of the time. I don't have to say yes to every administrative task that comes my way. I can (and absolutely must) say no.
I've also learned that I am very hard working, even though I don't always feel that way when I compare myself to the overachievers who seem to be everywhere in medicine. I regularly go beyond what I need to for my patients, and I show up for them even on the days when I would rather pull the covers over my head. I'm committed to the work that I do, and I put in the effort needed to be a really good doctor.
Overall, as hard as a lot of the past year has been, I'm really proud of myself for getting through it. And for not quitting my job! Because it's generally a pretty good one, and I do a pretty good job at it, if I may say so myself.
"And what for 2019? Mostly, I want to keep going on the path that I'm already on. I want to remain in the present moment, enjoying it when I can and learning from it when I can't."
Learning from it when I can't describes so much of the past year. I existed in a state of near-constant stress for months, and then I basically fell apart when the chronic stress became too much. For weeks, I wasn't certain if I would choose to (or even be able to) stay at work. It was horrible.
Probably the wisest thing I did, and something that was only possible because of my mindfulness practice, was stay present in the tough moments. My mantra through that time, which I would sometimes recite multiple times in a day, was "Be patient. Be present." I somehow knew that, if I could just show up for those moments, that I would learn something important from them.
And I have learned an incredible amount over the past year. I've learned that I am limited in how much I can do well (as is everyone), and more importantly, I've learned that I have the support of my institution to set limits on my work. I don't have to overbook all of my clinics. I don't have to work through weekends most of the time. I don't have to say yes to every administrative task that comes my way. I can (and absolutely must) say no.
I've also learned that I am very hard working, even though I don't always feel that way when I compare myself to the overachievers who seem to be everywhere in medicine. I regularly go beyond what I need to for my patients, and I show up for them even on the days when I would rather pull the covers over my head. I'm committed to the work that I do, and I put in the effort needed to be a really good doctor.
Overall, as hard as a lot of the past year has been, I'm really proud of myself for getting through it. And for not quitting my job! Because it's generally a pretty good one, and I do a pretty good job at it, if I may say so myself.
Friday, November 8, 2019
How to Rest
As a resident, I had almost no time off. I worked as much as 100 hours in some weeks, often in 24-hour-plus stretches, so I was basically always either at work or collapsed half dead on my couch. I didn't have to think about the concept of work-life balance, because there wasn't any. I worked, and I did what I could to survive the five years relatively unscathed*.
And then it ended. And I was an attending! With a better schedule! And money! And completely no idea of how to take care of myself in a long-term, I want to be happy and not die of a heart attack kind of way.
I knew that having a life outside of work was a priority for me, but because it had been so long since I had had one, I had no idea how to make that happen. I also faced the new challenge of always having work to do. Labs to review, patients to call, prescriptions to renew, presentations to prepare - I live in a giant game of medical Whack-A-Mole. For the longest time, I tried to get everything done before I would "allow" myself to rest, which meant that I was always trying to work and never actually resting.
Except....I was wasting a shit tonne of time. Like most people, I have a limited amount of mental and physical energy every day (spoons!), and once I use it up, I can pretend to be working, but I'm really not. I'm checking Twitter. Or Instagram. Or Facebook. Or going to Starbucks for another tea. It feels like work time, and I resent it, but I'm accomplishing very little.
Earlier this year, when work seemed to occupy every waking and sleeping moment of my life, I was finally forced to acknowledge that I can only accomplish a finite amount of things. And this amount is never as much as I want it to be. Yet I was working myself beyond a sustainable limit, and for what? Desire for more money that I didn't need? A sense of obligation? Conditioning from the medical system to never rest? I was failing miserably at having a good life for really no reason at all.
I am incredibly lucky to have flexibility in my job and to earn much more than I need to, which as I've mentioned over and over again has allowed me to back off from work and regain some much needed time. But just as importantly, recognizing my limits has given me permission to rest. To designate evenings and weekends and long stretches of holidays as "not working" time, rather than "working but not actually accomplishing anything because I keep Tweeting about marshmallow peanut butter squares" time.
Which makes all the difference. Because distracting myself on the Internet while I'm supposed to be working isn't restful. Sleep is. Yoga is. Meditation is**.
Not doing is restful.
Next week I'm on call again, and I have a long list of things I would like to get done before I go back on call. Some of which I will get done tomorrow morning, but once my designated work time is over, I'm going to stop. I'm going to go to the theatre with my mom, and then I'm going to eat and drink more than is doctor recommended. On Sunday I'm taking myself to a Nordic spa, and I can guarantee that I will spend the whole day moving from heated bed to hot tub to wet sauna to dry. Because I will need all my spoons next week, and trying to work all weekend is not going to give any of them back.
*By the end, I had raging anxiety, was socially isolated, and had lost all self-care habits. "Unscathed" is defined very loosely here.
** When my f-ing monkey brain isn't wandering all over the place, which it always is, so I take this back, meditation is not restful, dammit.
And then it ended. And I was an attending! With a better schedule! And money! And completely no idea of how to take care of myself in a long-term, I want to be happy and not die of a heart attack kind of way.
I knew that having a life outside of work was a priority for me, but because it had been so long since I had had one, I had no idea how to make that happen. I also faced the new challenge of always having work to do. Labs to review, patients to call, prescriptions to renew, presentations to prepare - I live in a giant game of medical Whack-A-Mole. For the longest time, I tried to get everything done before I would "allow" myself to rest, which meant that I was always trying to work and never actually resting.
Except....I was wasting a shit tonne of time. Like most people, I have a limited amount of mental and physical energy every day (spoons!), and once I use it up, I can pretend to be working, but I'm really not. I'm checking Twitter. Or Instagram. Or Facebook. Or going to Starbucks for another tea. It feels like work time, and I resent it, but I'm accomplishing very little.
Earlier this year, when work seemed to occupy every waking and sleeping moment of my life, I was finally forced to acknowledge that I can only accomplish a finite amount of things. And this amount is never as much as I want it to be. Yet I was working myself beyond a sustainable limit, and for what? Desire for more money that I didn't need? A sense of obligation? Conditioning from the medical system to never rest? I was failing miserably at having a good life for really no reason at all.
I am incredibly lucky to have flexibility in my job and to earn much more than I need to, which as I've mentioned over and over again has allowed me to back off from work and regain some much needed time. But just as importantly, recognizing my limits has given me permission to rest. To designate evenings and weekends and long stretches of holidays as "not working" time, rather than "working but not actually accomplishing anything because I keep Tweeting about marshmallow peanut butter squares" time.
Which makes all the difference. Because distracting myself on the Internet while I'm supposed to be working isn't restful. Sleep is. Yoga is. Meditation is**.
Not doing is restful.
Next week I'm on call again, and I have a long list of things I would like to get done before I go back on call. Some of which I will get done tomorrow morning, but once my designated work time is over, I'm going to stop. I'm going to go to the theatre with my mom, and then I'm going to eat and drink more than is doctor recommended. On Sunday I'm taking myself to a Nordic spa, and I can guarantee that I will spend the whole day moving from heated bed to hot tub to wet sauna to dry. Because I will need all my spoons next week, and trying to work all weekend is not going to give any of them back.
*By the end, I had raging anxiety, was socially isolated, and had lost all self-care habits. "Unscathed" is defined very loosely here.
** When my f-ing monkey brain isn't wandering all over the place, which it always is, so I take this back, meditation is not restful, dammit.
Thursday, October 31, 2019
The Return of Happiness
Years ago, when I was early in residency training, I wrote a post on the first version of this blog called "Fundamentally Happy"*. In it, I talked about how, despite the many challenges of residency, at my core I was happy. Satisfied with where I was in life and with where I was going.
Earlier this year, I lost that feeling. Not just for a moment, but for months on end. I felt like I was working constantly and as if life was a perpetual slog through overbooked clinics and piles of paperwork. In the beginning, I was having trouble staying caught up for more than the briefest of moments, and eventually I lost the ability to ever catch up. I was slowly drowning.
It has taken a lot to come back. I have drawn on every resource available to me to get through this, and I have been so lucky to have been met by nothing but support everywhere I went. Support from friends, colleagues (remember the one who took three weeks of summer call for me?), and even my department head. I am so thankful to have had a good experience, because I know that many physicians who burn out don't.
Life is different now. My clinics are capped, so even on days when everyone shows up, I usually run (at least close to) on time. I don't run over too often, and some days I finish early. I still get behind on paperwork sometimes, but it's usually because I've taken something extra on (like travelling to a remote community to share my knowledge with a group of rural physicians) and not because the work load is too much. And when I get behind, I can catch up again.
I can finally breathe again. Not the shallow, panicked, desperate breaths that I was breathing for months. Deep, calm, happy breaths.
Things are so much better.
*I think. My memory is crappy.
Earlier this year, I lost that feeling. Not just for a moment, but for months on end. I felt like I was working constantly and as if life was a perpetual slog through overbooked clinics and piles of paperwork. In the beginning, I was having trouble staying caught up for more than the briefest of moments, and eventually I lost the ability to ever catch up. I was slowly drowning.
It has taken a lot to come back. I have drawn on every resource available to me to get through this, and I have been so lucky to have been met by nothing but support everywhere I went. Support from friends, colleagues (remember the one who took three weeks of summer call for me?), and even my department head. I am so thankful to have had a good experience, because I know that many physicians who burn out don't.
Life is different now. My clinics are capped, so even on days when everyone shows up, I usually run (at least close to) on time. I don't run over too often, and some days I finish early. I still get behind on paperwork sometimes, but it's usually because I've taken something extra on (like travelling to a remote community to share my knowledge with a group of rural physicians) and not because the work load is too much. And when I get behind, I can catch up again.
I can finally breathe again. Not the shallow, panicked, desperate breaths that I was breathing for months. Deep, calm, happy breaths.
Things are so much better.
*I think. My memory is crappy.
Monday, August 5, 2019
How FIRE led me to Burnout
For a physician, I think and talk and write a lot about taking time off. Two years ago, I committed to taking vacation every three months, and I have done a pretty good job of sticking to that ever since (I even took an extra vacation this year!). I talk to trainees all the time about taking time away from work in order to maintain their mental health and have some joy in their lives. So, until recently, I really thought I had the right mindset with respect to so-called work-life balance.
Except...underlying everything has been the idea of FIRE. Work my ass off for a few years, save as much as possible, and then run away to a life of complete freedom and constant joy. The dream! While I still allowed myself vacations, the desire to have enough money to retire as soon as possible led me to make other bad decisions that were perhaps worse than never taking time off. Sure, I'll add more patients to my already overbooked clinic. Sure, I'll take on some lucrative contract work that I don't have time for. Sure, I can do an extra Friday afternoon clinic even though I'm barely clawing my way to the end of the week as it is. I convinced myself that I was being a good doctor by seeing more patients, but if I'm being honest, the real driver was the extra money that could go directly into my retirement savings.
And so, as I've already written about, I crashed in a somewhat spectacular way.
I'm actually kind of thankful for the crash (or, at least I think I will be when I look back on it someday), because it has forced me to reevaluate my decisions. And two big things have come out of my months of self reflection. First, continuing to work at as a physician is the best option for me, at least in the present. I have contemplated taking a significant chunk of time off or quitting to pursue another career altogether, but when I look at it in the most practical of ways, doing so doesn't make any financial sense. I could go part-time as a physician and earn more than I would doing most other jobs. In the years it would take me to study to do something else, I could work full-time as a physician and save up most of what I need to retire. My current reality is that I need to work to pay bills and save for the future, and medicine is by far the most efficient way of doing that. As an added bonus, I also often like my job, at least when things aren't as overwhelming as they have been recently.
Second, and probably the more important, is that I need to stop making my decisions from a place of fear. While part of my motivation for achieving financial independence has been a desire to not work, most of it has been a desire to not need to work. To know that, whatever illness or mental health crisis or government overhaul of the healthcare system may hit, I am going to be okay. Because as a single person with no one else to rely on, I worry a lot about my financial future, even when there's zero necessity to do so. And that is a really unpleasant and unhealthy approach to money.
Thankfully, things at work are starting to get better. I have only one slightly overbooked clinic left, and my clinics are going to continue to get lighter over the next few months until I achieve a point of actually being slightly underbooked. I'm at the point where I can usually get my work done within the 45 hour a week maximum I've set for myself. I'm scheduled to start six days of call tomorrow, and I'm not having panic attacks or suffering from intractable insomnia.
There are moments when I'm actually enjoying my work and remembering why I became a physician in the first place.
So I am going to keep practicing at letting go of all the things that have been driving me to burnout. Letting go of my obsessive tracking of my net worth. Letting go of the countdown to retirement. Letting go of the belief that the future is going to be so much better than the present, and the desire to burn through time in order to get there.
I'm going to try, as much as I can, to live in the now. To enjoy what I have, to be grateful for all the good, and to simply breathe.
Except...underlying everything has been the idea of FIRE. Work my ass off for a few years, save as much as possible, and then run away to a life of complete freedom and constant joy. The dream! While I still allowed myself vacations, the desire to have enough money to retire as soon as possible led me to make other bad decisions that were perhaps worse than never taking time off. Sure, I'll add more patients to my already overbooked clinic. Sure, I'll take on some lucrative contract work that I don't have time for. Sure, I can do an extra Friday afternoon clinic even though I'm barely clawing my way to the end of the week as it is. I convinced myself that I was being a good doctor by seeing more patients, but if I'm being honest, the real driver was the extra money that could go directly into my retirement savings.
And so, as I've already written about, I crashed in a somewhat spectacular way.
I'm actually kind of thankful for the crash (or, at least I think I will be when I look back on it someday), because it has forced me to reevaluate my decisions. And two big things have come out of my months of self reflection. First, continuing to work at as a physician is the best option for me, at least in the present. I have contemplated taking a significant chunk of time off or quitting to pursue another career altogether, but when I look at it in the most practical of ways, doing so doesn't make any financial sense. I could go part-time as a physician and earn more than I would doing most other jobs. In the years it would take me to study to do something else, I could work full-time as a physician and save up most of what I need to retire. My current reality is that I need to work to pay bills and save for the future, and medicine is by far the most efficient way of doing that. As an added bonus, I also often like my job, at least when things aren't as overwhelming as they have been recently.
Second, and probably the more important, is that I need to stop making my decisions from a place of fear. While part of my motivation for achieving financial independence has been a desire to not work, most of it has been a desire to not need to work. To know that, whatever illness or mental health crisis or government overhaul of the healthcare system may hit, I am going to be okay. Because as a single person with no one else to rely on, I worry a lot about my financial future, even when there's zero necessity to do so. And that is a really unpleasant and unhealthy approach to money.
Thankfully, things at work are starting to get better. I have only one slightly overbooked clinic left, and my clinics are going to continue to get lighter over the next few months until I achieve a point of actually being slightly underbooked. I'm at the point where I can usually get my work done within the 45 hour a week maximum I've set for myself. I'm scheduled to start six days of call tomorrow, and I'm not having panic attacks or suffering from intractable insomnia.
There are moments when I'm actually enjoying my work and remembering why I became a physician in the first place.
So I am going to keep practicing at letting go of all the things that have been driving me to burnout. Letting go of my obsessive tracking of my net worth. Letting go of the countdown to retirement. Letting go of the belief that the future is going to be so much better than the present, and the desire to burn through time in order to get there.
I'm going to try, as much as I can, to live in the now. To enjoy what I have, to be grateful for all the good, and to simply breathe.
Saturday, December 23, 2017
What I Will Be Doing Instead of Writing a Play
Remember when Christmas was still a month away and I was freaking out because I thought I wouldn't have enough to do? And then I decided that I was going to use some of my spare holiday time to write a play?
Hahahahaha.
Yeah. About that. As the holidays approached, my list of things to do slowly grew. At the current time, I am absolutely committed to the following activities:
Dinner and a movie with my new friend tonight*
Christmas Eve dinner with family tomorrow night
Christmas Eve sleepover with my Mom
Christmas Day dinner with more family
Counseling session with my performance coach on Thursday**
French lesson on Thursday
Dinner and a show with friends at the Art Gallery on Friday
And this is with minimal effort actually put into making plans. I still have a list of multiple other friends with whom I'm hoping to make plans in the next ten days. I have made so many plans that I actually managed to double book myself for Friday night, and for the third year in a row I will not be attending my residency group's annual party. (Is it surprising that an introvert would pick an intimate evening with friends over a big party? Zero surprising.)
Until about a week ago, I was still thinking about writing a play. But the more I thought about it, the more it seemed like a burden that I would resent, rather than a fun activity to keep me busy over the holidays. And then I had an insanely busy week on call, which has left me with a desk covered in unfinished work, and I thought "nope". No. No play this year. Rest.
Over the next ten days, I'm just going to recharge and get my life back on track. I'm going to empty the dishwasher that has been clean since Monday and refill it with the week's worth of dishes that are on the counter. I'm going to replenish my freezer stores so that I won't go hungry the next time I'm on call. And I'm going to do a little (lot) of work stuff so that I will not feel too horribly overwhelmed when I go back to work.
And I'm going to do fun stuff! I saved season two of Stranger Things, so there will be some serious binge watching. And books. And drinking peppermint hot chocolate. And drinking all of the wine I couldn't drink while I was on call. And sleep. Glorious, glorious sleep.
It may not be the same as Christmas with my ex's family, but I think it's going to be lovely all the same.
*I made a new friend this year! As an introvert who treats friends like precious heirlooms and keeps them forever, this is exciting.
**I need to write a post about this, because this has been life-changing.
Hahahahaha.
Yeah. About that. As the holidays approached, my list of things to do slowly grew. At the current time, I am absolutely committed to the following activities:
Dinner and a movie with my new friend tonight*
Christmas Eve dinner with family tomorrow night
Christmas Eve sleepover with my Mom
Christmas Day dinner with more family
Counseling session with my performance coach on Thursday**
French lesson on Thursday
Dinner and a show with friends at the Art Gallery on Friday
And this is with minimal effort actually put into making plans. I still have a list of multiple other friends with whom I'm hoping to make plans in the next ten days. I have made so many plans that I actually managed to double book myself for Friday night, and for the third year in a row I will not be attending my residency group's annual party. (Is it surprising that an introvert would pick an intimate evening with friends over a big party? Zero surprising.)
Until about a week ago, I was still thinking about writing a play. But the more I thought about it, the more it seemed like a burden that I would resent, rather than a fun activity to keep me busy over the holidays. And then I had an insanely busy week on call, which has left me with a desk covered in unfinished work, and I thought "nope". No. No play this year. Rest.
Over the next ten days, I'm just going to recharge and get my life back on track. I'm going to empty the dishwasher that has been clean since Monday and refill it with the week's worth of dishes that are on the counter. I'm going to replenish my freezer stores so that I won't go hungry the next time I'm on call. And I'm going to do a little (lot) of work stuff so that I will not feel too horribly overwhelmed when I go back to work.
And I'm going to do fun stuff! I saved season two of Stranger Things, so there will be some serious binge watching. And books. And drinking peppermint hot chocolate. And drinking all of the wine I couldn't drink while I was on call. And sleep. Glorious, glorious sleep.
It may not be the same as Christmas with my ex's family, but I think it's going to be lovely all the same.
*I made a new friend this year! As an introvert who treats friends like precious heirlooms and keeps them forever, this is exciting.
**I need to write a post about this, because this has been life-changing.
Monday, July 24, 2017
Happiness on the Path to FIRE
Back in February, I was at one of the lowest points emotionally that I've been at in a long time. I was burnt out from work, but in a very different way from the burnout I had experienced in residency. In residency, difficult times were made easier by the knowledge that I was only days to weeks away from a new rotation; as an attending, I could take no such comfort from the knowledge that I would be doing the same work for years to decades.
So I took a vacation. In late January, M and I decided last minute to book a trip to Cuba, and it was a bit of a lifesaver. For the first time in months, I had a prolonged break from the incessant stress of work. I stopped waking in the middle of the night to ruminate about patient care decisions. I stopped calculating how many more days I would have to work until I would be financially independent. I started laughing again. For the ten days that I was away from work, I felt like myself again.
And when I went back, everything felt easier. Not always easy, and certainly not free from stress, but at the very least far more manageable than it had before the vacation. The whole experience made it clear to me that, while some physicians can go for years without a vacation, I am not one of those physicians. To be happy, and to be of much use to my patients, I need to take breaks.
So I've decided to aim for at least one week off every three months. By three months my neck is starting to stiffen and my sleep is getting more interrupted, and time away from the office feels really, really good. I could work longer without a vacation, but I don't want to.
As someone who is interested in financial independence/retire early, or FIRE, it's tempting at times to want to reach financial independence as early as possible. I sometimes think about taking extra call weekends and not taking time off and never eating out again so that I can squirrel away every possible penny for retirement. But the reality is that I'm at least seven years away from achieving financial independence, and probably ten years away from feeling comfortable enough to retire, which is a long time to be unhappy. I don't want to white knuckle my way to retirement; I want to be happy in the process. Heck, I would love it if I were so happy in the process that when I reach the point of being able to retire I won't want to.
So I will take vacations. And sleep through the night. And laugh. And be happy in my pursuit of FIRE.
(At the moment, I'm happily taking a week off of work to participate in our local theatre festival. And I am loving my life.)
So I took a vacation. In late January, M and I decided last minute to book a trip to Cuba, and it was a bit of a lifesaver. For the first time in months, I had a prolonged break from the incessant stress of work. I stopped waking in the middle of the night to ruminate about patient care decisions. I stopped calculating how many more days I would have to work until I would be financially independent. I started laughing again. For the ten days that I was away from work, I felt like myself again.
And when I went back, everything felt easier. Not always easy, and certainly not free from stress, but at the very least far more manageable than it had before the vacation. The whole experience made it clear to me that, while some physicians can go for years without a vacation, I am not one of those physicians. To be happy, and to be of much use to my patients, I need to take breaks.
So I've decided to aim for at least one week off every three months. By three months my neck is starting to stiffen and my sleep is getting more interrupted, and time away from the office feels really, really good. I could work longer without a vacation, but I don't want to.
As someone who is interested in financial independence/retire early, or FIRE, it's tempting at times to want to reach financial independence as early as possible. I sometimes think about taking extra call weekends and not taking time off and never eating out again so that I can squirrel away every possible penny for retirement. But the reality is that I'm at least seven years away from achieving financial independence, and probably ten years away from feeling comfortable enough to retire, which is a long time to be unhappy. I don't want to white knuckle my way to retirement; I want to be happy in the process. Heck, I would love it if I were so happy in the process that when I reach the point of being able to retire I won't want to.
So I will take vacations. And sleep through the night. And laugh. And be happy in my pursuit of FIRE.
(At the moment, I'm happily taking a week off of work to participate in our local theatre festival. And I am loving my life.)
Sunday, January 22, 2017
What is Done, and What is Left to Do
It will probably come as no surprise to anyone who reads my blog that I am feeling pretty burnt out at the moment, as the few posts that I've had the mental energy to write over the past few months have been all about work stress and feeling exhausted and being too much of a grouch to even want to buy Christmas gifts. I think I've done a decent job of hiding my dissatisfaction at work, but my poor partner, M, has had to put up with some pretty spectacular wallowing when I haven't been working. It is frustrating, and frightening, to have put 16 years into training only to find myself feeling this level of unhappiness with my work.
So I've been thinking a lot (i.e. pretty much all the time) about what to do about it. I've been reading blogs and journaling and talking M's ears off in an attempt to figure out some way of becoming happier. (I haven't been exercising or meditating, of course, because those things might actually work.) I even bought a book about physician burnout, despite absolutely hating the last physician burnout book I read. And, much to my surprise, the book has been kind of helpful.
One of the ideas in the book is that, as physicians, we are always focused on what remains to be done: how many letters we need to dictate, how many patients we need to see, how many bloody multi-page forms we need to fill out. By constantly thinking about what still needs to be done, however, we inevitably feel like we aren't accomplishing anything, and we get discouraged by the seemingly neverending to-do list. Instead, we'd be much better off putting our focus on what we've already done, so that we are positively celebrating our accomplishments instead of always negatively dreading the work to come.
It's a pretty simple idea, and it requires pretty minimal energy and absolutely zero time, so I decided to try it out this week. No longer was I going to count the patient files on my desk that needed to be dictated (about 20 at current count); instead, I was going to count the ones in my outbox that were already done. Instead of focusing on the number of patients remaining to be seen, I was going to focus on the ones that had already been dealt with. Pay attention to the positive, not the negative.
It sounds cheesy to even write this...but it kind of helped. It made me realize that my list of things that I have already accomplished is pretty enormous, and it dwarfs the few hours of paperwork that I left undone at work on Friday. It felt surprisingly good to be a bit of a cheerleader for myself, instead of the evil taskmaster who is always yelling at myself to work harder! and faster! and better!
It worked so well that I decided to apply this mindset to an area of my life that causes my unnecessary anxiety: my finances. I'm in pretty good financial shape for being 17 months into practice, yet I waste a lot of energy thinking about how far away I am from being able to retire. This week, instead of constantly thinking about the minimum of 10 years of work that I will have to do to save up a decent retirement fund, I took a few minutes to list the major financial accomplishments I've made over the past 17 months:
I know that there are still a lot of things that I need to do to feel happier with my work, but I think that changing my mindset has been an important first step. Despite being on call again this week**, I've been in a much better mood than I have been since my really stressful department meeting. I now have six weeks of no call, which includes a one-week trip to Cuba, so hopefully there are even better things ahead.
*My job isn't actually all that miserable. I'm just feeling so exhausted by it that I am having a hard time seeing the good things. Which I'm working on.
**I sat down this week and figured out just how much call I've been doing lately, and I realized that I've been on call 1/3 of the time for the past 3.5 months. That's the amount of call that I should be doing in a 6-month period, and it's equal to the maximum amount of call that a resident is allowed to do. Suddenly I don't feel so guilty for feeling tired! As a result of this realization, I've reviewed my call schedule for the upcoming year and identified a few similar problem periods that can hopefully be improved by a bit of swapping with my colleagues.
So I've been thinking a lot (i.e. pretty much all the time) about what to do about it. I've been reading blogs and journaling and talking M's ears off in an attempt to figure out some way of becoming happier. (I haven't been exercising or meditating, of course, because those things might actually work.) I even bought a book about physician burnout, despite absolutely hating the last physician burnout book I read. And, much to my surprise, the book has been kind of helpful.
One of the ideas in the book is that, as physicians, we are always focused on what remains to be done: how many letters we need to dictate, how many patients we need to see, how many bloody multi-page forms we need to fill out. By constantly thinking about what still needs to be done, however, we inevitably feel like we aren't accomplishing anything, and we get discouraged by the seemingly neverending to-do list. Instead, we'd be much better off putting our focus on what we've already done, so that we are positively celebrating our accomplishments instead of always negatively dreading the work to come.
It's a pretty simple idea, and it requires pretty minimal energy and absolutely zero time, so I decided to try it out this week. No longer was I going to count the patient files on my desk that needed to be dictated (about 20 at current count); instead, I was going to count the ones in my outbox that were already done. Instead of focusing on the number of patients remaining to be seen, I was going to focus on the ones that had already been dealt with. Pay attention to the positive, not the negative.
It sounds cheesy to even write this...but it kind of helped. It made me realize that my list of things that I have already accomplished is pretty enormous, and it dwarfs the few hours of paperwork that I left undone at work on Friday. It felt surprisingly good to be a bit of a cheerleader for myself, instead of the evil taskmaster who is always yelling at myself to work harder! and faster! and better!
It worked so well that I decided to apply this mindset to an area of my life that causes my unnecessary anxiety: my finances. I'm in pretty good financial shape for being 17 months into practice, yet I waste a lot of energy thinking about how far away I am from being able to retire. This week, instead of constantly thinking about the minimum of 10 years of work that I will have to do to save up a decent retirement fund, I took a few minutes to list the major financial accomplishments I've made over the past 17 months:
- Saved up enough money in my investments that I could pay off my line of credit if I wanted to;
- Saved up enough money that, between M and me, we can make a 20% downpayment on a nice house in our chosen neighbourhood; and
- Saved up enough money in my investments that I could live at my current level of spending for approximately one year (or for a very long time if I stopped eating out so frequently).
I know that there are still a lot of things that I need to do to feel happier with my work, but I think that changing my mindset has been an important first step. Despite being on call again this week**, I've been in a much better mood than I have been since my really stressful department meeting. I now have six weeks of no call, which includes a one-week trip to Cuba, so hopefully there are even better things ahead.
*My job isn't actually all that miserable. I'm just feeling so exhausted by it that I am having a hard time seeing the good things. Which I'm working on.
**I sat down this week and figured out just how much call I've been doing lately, and I realized that I've been on call 1/3 of the time for the past 3.5 months. That's the amount of call that I should be doing in a 6-month period, and it's equal to the maximum amount of call that a resident is allowed to do. Suddenly I don't feel so guilty for feeling tired! As a result of this realization, I've reviewed my call schedule for the upcoming year and identified a few similar problem periods that can hopefully be improved by a bit of swapping with my colleagues.
Sunday, January 8, 2017
2017 - The Year of Saying No
I suspect that I'm not the only person in medicine who is a people pleaser. Since elementary school, I've always been very academically successful, and the resultant praise from teachers and relatives has given me a lot of pleasure and personal satisfaction. Going to medical school and becoming a doctor took this to the next level, as suddenly patients and even strangers were regularly praising me for the work I did.
The big problem with getting so much validation externally is that you start to be dependent upon it. You need people to tell you how important you are and how no one else can do what you're doing. And so you constantly seek ways to keep that validation coming. You say yes to giving one more presentation or fitting another patient into your clinic or teaching one more tutorial. Even when you don't really want to be doing any of those things.
Over the past few months, I've been feeling depleted, as I keep telling my partner. I've been feeling overwhelmed by work; I've been having difficulty sleeping; and I've been hit with a bone-weary exhaustion that reminds me of my residency days. I had hoped that a recent trip to a cabin would fix things, but four days away just wasn't enough. I'm tired.
And despite this, people keep asking for more. Start a research project. Do more training. Teach another academic half day. More, more, more, when all I want to do is stay in bed with my cats. It has reached the point where I feel anxious not only when my pager goes off, but also when my inbox pings, signalling the arrival of another email asking for my time and energy.
So this year, I'm going to learn to say no. Thank you for the opportunity, but that isn't my priority. My priority needs to be finding balance, a level of work and engagement that I can happily sustain for the next 20 years, not saying yes to every single request that comes my way. I need downtime and sleep and yoga classes and running and home-cooked food and time with the people I love, not another item on my to-do list.
No.
It sounds straightforward, but it goes against the very essence of medical culture. Physicians pride themselves on being able to work a 28-hour shift and then go climb a mountain on their post-call day. Medicine is the North American worship of busyness and achievement taken to the extreme. Saying no means being inadequate and not measuring up to the standard.
And Medicine doesn't always listen to no. A few weeks ago, I was emailed a request to help someone out with a presentation. My stomach sunk when I read the email, because it was something that I really didn't want to do, even if I had had an abundance of time in which to do it. So I sat on the email for weeks, debating the merits of saying yes versus no, until I finally got up the guts to sent a polite email declining the request.
The response? Within seconds, a return email that basically said "Can you do part of the work for me?".
No!
I'm still completely flabbergasted by the response. Why is my attempt to protect my happiness and my time not respected? Why am I expected to say yes to every request that comes into my inbox?
Learning to say no isn't going to be easy. It's going to mean letting go of the need for other people to tell me how wonderful I am and what a good job I'm doing. It's going to mean letting go of the belief that if I were just better, just like every other physician, that I would be able to say yes to everything. It's going to mean ignoring the blogs of the overachievers, who have a medical practice and children and exercise daily and cook healthy food, and setting my own standards for achievement. Because ultimately no one cares about my happiness as much as I do. And no one else in Medicine is looking out for my well-being as much as I am.
The big problem with getting so much validation externally is that you start to be dependent upon it. You need people to tell you how important you are and how no one else can do what you're doing. And so you constantly seek ways to keep that validation coming. You say yes to giving one more presentation or fitting another patient into your clinic or teaching one more tutorial. Even when you don't really want to be doing any of those things.
Over the past few months, I've been feeling depleted, as I keep telling my partner. I've been feeling overwhelmed by work; I've been having difficulty sleeping; and I've been hit with a bone-weary exhaustion that reminds me of my residency days. I had hoped that a recent trip to a cabin would fix things, but four days away just wasn't enough. I'm tired.
And despite this, people keep asking for more. Start a research project. Do more training. Teach another academic half day. More, more, more, when all I want to do is stay in bed with my cats. It has reached the point where I feel anxious not only when my pager goes off, but also when my inbox pings, signalling the arrival of another email asking for my time and energy.
So this year, I'm going to learn to say no. Thank you for the opportunity, but that isn't my priority. My priority needs to be finding balance, a level of work and engagement that I can happily sustain for the next 20 years, not saying yes to every single request that comes my way. I need downtime and sleep and yoga classes and running and home-cooked food and time with the people I love, not another item on my to-do list.
No.
It sounds straightforward, but it goes against the very essence of medical culture. Physicians pride themselves on being able to work a 28-hour shift and then go climb a mountain on their post-call day. Medicine is the North American worship of busyness and achievement taken to the extreme. Saying no means being inadequate and not measuring up to the standard.
And Medicine doesn't always listen to no. A few weeks ago, I was emailed a request to help someone out with a presentation. My stomach sunk when I read the email, because it was something that I really didn't want to do, even if I had had an abundance of time in which to do it. So I sat on the email for weeks, debating the merits of saying yes versus no, until I finally got up the guts to sent a polite email declining the request.
The response? Within seconds, a return email that basically said "Can you do part of the work for me?".
No!
I'm still completely flabbergasted by the response. Why is my attempt to protect my happiness and my time not respected? Why am I expected to say yes to every request that comes into my inbox?
Learning to say no isn't going to be easy. It's going to mean letting go of the need for other people to tell me how wonderful I am and what a good job I'm doing. It's going to mean letting go of the belief that if I were just better, just like every other physician, that I would be able to say yes to everything. It's going to mean ignoring the blogs of the overachievers, who have a medical practice and children and exercise daily and cook healthy food, and setting my own standards for achievement. Because ultimately no one cares about my happiness as much as I do. And no one else in Medicine is looking out for my well-being as much as I am.
Sunday, November 20, 2016
How Am I Doing So Far?
This week was my first week of call since I wrote my post about how to not hate call so much. (I've been on call for 21 of the past 42 days. Too much call.) As the week approached, I tried very hard to say no to anything but the most essential of activities. I deferred dinner with a friend until next week. I said no to doing anything with my Mom. I was ruthless with turning people down.
And then the week arrived.
Monday night a group of medical school friends whom I only see a few times a year were getting together for dinner, and I couldn't say no.
Tuesday night my girlfriend's parents invited us over for a birthday dinner.
Wednesday night a friend was visiting from Egypt and wanted to meet for dinner.
Thursday night we decided to go see a new house that had just come onto the market.
Friday night was trivia night at my girlfriend's church. And I love trivia.
Over the weekend, we have seen three more houses, gone out for breakfast twice, gone for an impromptu coffee with my Mom and brother, watched my niece in a volleyball tournament, shopped at two craft markets, seen Romeo Dallaire speak, and gone for another birthday dinner with my girlfriend's friends*.
I apparently am incapable of just saying no to anything. If it sound remotely interesting, and especially if it involves food, I am there. Regardless of how tired or extroverted out I may happen to be. Regardless of how much I need to just be quiet and still after the stress of a call week. Regardless of what I say in my blog posts.
And yet...somehow this week worked for me. I gave myself the option of saying no to things, but when it came time to exercise that option, I never wanted to. I got to do a lot of fun and interesting things with people whom I love over the course of the week, and it felt pretty good. I'm not quite sure why it was okay this time when it wasn't the last time I was on call, but somehow it was. Maybe it was knowing that I could say no to things without guilt? Maybe it was only being on call for one week and knowing that I would have a long stretch of recovery afterwards?
I haven't the foggiest clue, but I'm very glad it did. And I'm hoping that it will continue to do so when the next stretch of call comes around.
And then the week arrived.
Monday night a group of medical school friends whom I only see a few times a year were getting together for dinner, and I couldn't say no.
Tuesday night my girlfriend's parents invited us over for a birthday dinner.
Wednesday night a friend was visiting from Egypt and wanted to meet for dinner.
Thursday night we decided to go see a new house that had just come onto the market.
Friday night was trivia night at my girlfriend's church. And I love trivia.
Over the weekend, we have seen three more houses, gone out for breakfast twice, gone for an impromptu coffee with my Mom and brother, watched my niece in a volleyball tournament, shopped at two craft markets, seen Romeo Dallaire speak, and gone for another birthday dinner with my girlfriend's friends*.
I apparently am incapable of just saying no to anything. If it sound remotely interesting, and especially if it involves food, I am there. Regardless of how tired or extroverted out I may happen to be. Regardless of how much I need to just be quiet and still after the stress of a call week. Regardless of what I say in my blog posts.
And yet...somehow this week worked for me. I gave myself the option of saying no to things, but when it came time to exercise that option, I never wanted to. I got to do a lot of fun and interesting things with people whom I love over the course of the week, and it felt pretty good. I'm not quite sure why it was okay this time when it wasn't the last time I was on call, but somehow it was. Maybe it was knowing that I could say no to things without guilt? Maybe it was only being on call for one week and knowing that I would have a long stretch of recovery afterwards?
I haven't the foggiest clue, but I'm very glad it did. And I'm hoping that it will continue to do so when the next stretch of call comes around.
Sunday, October 23, 2016
Surviving Call
When I wrote my most recent blog post, I was feeling a little bit smug about how well my life was going. I was exercising, I was feeling calm, and my relationship was in pretty much the best state it has ever been. I was happy. I was about to start an 11-day stretch of 24-hour-a-day call, but I felt ready for it.
I've got this, I thought.
Except I didn't. It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level. I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves. (How dare they?) After weeks of respite, my mind was back to ramped-up panic mode.
And that's where it remained for most of my 11 days on call. I worried and obsessed over the decisions I was making. I felt stressed by the increasing pile of undictated charts piling up on my desk. I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough. As it often is, it was awful.
And of course, my life outside of work suffered. My relationship that had, until that point, been ticking along nicely, suddenly struggled. I was short-tempered. Everything she did seemed wrong and irritating. I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well. Also awful.
In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year. Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call. I want my life on call to still feel okay.
So I've been thinking a lot about the things that I can do to make call less awful. This is what I've come up with so far:
Undercommit: I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities. Evenings on my couch with a book and my cats are as essential to me as vitamins. This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life. Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.
The other downside to making plans when I'm on call is that I hate disappointing anyone. Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me. It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.
I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations. I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.
Keep moving: It always comes back to this. Exercise is good. I need to do it. Regularly. End of story.
Talk to M: I have a really good partner who is loving and supportive and a good listener. I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.
Let things go: The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole. I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book. And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!
I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch. I can eat a fried egg with toast or a frozen fish fillet and the world will not end. Pozole can wait for a week when I'm not on call. As can many other things. Call weeks should be about doing what is necessary, not what is perfect.
Recognize my irrationality: I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life. When I'm in the extremes of my anxiety, it can lead me to think really irrational things. Like that my relationship may not be a good one. Or I'm not cut out to be a doctor. Or I'm going to end up on the street if I don't hoard every penny I earn. Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.
Keep going to counseling: I am somewhat amazed at the difference that six counseling sessions made in my life. It probably saved my relationship with M. It certainly made work better. It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.
Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth. Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go. I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.
UTTERLY AND COMPLETELY STUPID. (I'm looking at you when I say that, Solitary.)
For now, call is done, and I am recovering on my couch with my computer/books and Callie. It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.
Hopefully my next time on call will be better.
I've got this, I thought.
Except I didn't. It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level. I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves. (How dare they?) After weeks of respite, my mind was back to ramped-up panic mode.
And that's where it remained for most of my 11 days on call. I worried and obsessed over the decisions I was making. I felt stressed by the increasing pile of undictated charts piling up on my desk. I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough. As it often is, it was awful.
And of course, my life outside of work suffered. My relationship that had, until that point, been ticking along nicely, suddenly struggled. I was short-tempered. Everything she did seemed wrong and irritating. I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well. Also awful.
In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year. Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call. I want my life on call to still feel okay.
So I've been thinking a lot about the things that I can do to make call less awful. This is what I've come up with so far:
Undercommit: I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities. Evenings on my couch with a book and my cats are as essential to me as vitamins. This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life. Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.
The other downside to making plans when I'm on call is that I hate disappointing anyone. Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me. It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.
I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations. I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.
Keep moving: It always comes back to this. Exercise is good. I need to do it. Regularly. End of story.
Talk to M: I have a really good partner who is loving and supportive and a good listener. I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.
Let things go: The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole. I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book. And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!
I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch. I can eat a fried egg with toast or a frozen fish fillet and the world will not end. Pozole can wait for a week when I'm not on call. As can many other things. Call weeks should be about doing what is necessary, not what is perfect.
Recognize my irrationality: I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life. When I'm in the extremes of my anxiety, it can lead me to think really irrational things. Like that my relationship may not be a good one. Or I'm not cut out to be a doctor. Or I'm going to end up on the street if I don't hoard every penny I earn. Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.
Keep going to counseling: I am somewhat amazed at the difference that six counseling sessions made in my life. It probably saved my relationship with M. It certainly made work better. It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.
Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth. Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go. I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.
UTTERLY AND COMPLETELY STUPID. (I'm looking at you when I say that, Solitary.)
For now, call is done, and I am recovering on my couch with my computer/books and Callie. It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.
Hopefully my next time on call will be better.
Sunday, August 7, 2016
The End of Budgeting?
My budget is currently sitting at $294.13 in the red. A year ago, when I was just starting to work and I was trying to dig myself out of nine years of medical school debt, this would've caused me to panic. Or more realistically, I never would've gone $294.13 into the red. I would've eaten rice and beans and said no to get togethers with friends to keep myself from ever going over budget.
Now, I barely notice. When I hit a positive net worth, my stress level about money dropped, and I have gradually gotten less and less worried about money as my savings have climbed. Slowly, I've reintroduced things into my life that I've forgone over the past two years: fancy drinks in restaurants, expensive cheeses, clothing of any sort. And it feels really nice.
I'm not entirely sure what to do about budgeting at this stage. Even with being over budget, I'm saving over 2/3 of my earnings, so I am more than meeting my financial goals. I don't really have to budget anymore; and yet, there is part of me that doesn't want to abandon budgeting altogether. Part of it is for the reasons I outlined in a long ago post about why I continue to be relatively frugal. But it's more than that.
I think a huge part of me worries that I'll go back to my terribly consumeristic ways if I stop budgeting. Before I started budgeting two years ago, I had developed an almost instinctual habit of buying whatever I wanted. Whether I was shopping for clothes or eating in a nice restaurant or ordering books online, I would simply buy whatever appealed to me in the moment with the knowledge that it was going on my line of credit and I wouldn't have to pay for it until I was an attending*. I would take whatever boredom or loneliness or exhaustion I was feeling and try to spend it away. Always unsuccessfully.
Starting to budget made me much more mindful of my spending. It made me realize that I often wasn't looking for a new thing when I went shopping, but rather for some feeling that I was missing. A lot of the time, the best thing I could do when I felt like buying something at random was to just go have a nap, as I've been chronically tired since my first day of medical school in 2006. It also made me focus on non material ways of being happier, rather than on buying a new pair of happy socks. (Although I really love happy socks. And am now searching their website thinking about placing an order. Well done, me. You've clearly learned your lesson.)
I guess what I'm looking for is some way to be intentional with my spending while not feeling constantly constrained by my budget. I want to take advantage of the fact that I'm earning ridiculous amounts of money for a single woman with no dependents, without thinking that I can somehow buy happiness. Balance. The endless search for balance.
Any ideas?
*Thank you very much, past me. You are an asshole.
---
To update you on my habits from a few weeks ago, I've been doing surprisingly well with them. I have completely resisted the cans of Coke in my fridge, and I've passed on pop multiple times in restaurants. I am allowing myself to have pop in mixed drinks (something I decided to do in the beginning but didn't mention in my previous post because I was lazy), but in total it's been about one can of pop since I started. I almost always put my things where they belong when I get home, which has made leaving in the morning much more efficient and peaceful. I've also started putting my keys/wallet/phone in specific spots in my bag (my bag has about 8 different spots, so searching for something can be frustrating), and that has also been a huge improvement. Finally, I have planned out my weekly schedule every Sunday night, and it has given me a bit more awareness of the week and a big more structure. It also saved me from missing dinner with a good friend this week (I thought it was on Thursday, but it's actually on Tuesday), so that is also a win.
Well done, me.
Now, I barely notice. When I hit a positive net worth, my stress level about money dropped, and I have gradually gotten less and less worried about money as my savings have climbed. Slowly, I've reintroduced things into my life that I've forgone over the past two years: fancy drinks in restaurants, expensive cheeses, clothing of any sort. And it feels really nice.
I'm not entirely sure what to do about budgeting at this stage. Even with being over budget, I'm saving over 2/3 of my earnings, so I am more than meeting my financial goals. I don't really have to budget anymore; and yet, there is part of me that doesn't want to abandon budgeting altogether. Part of it is for the reasons I outlined in a long ago post about why I continue to be relatively frugal. But it's more than that.
I think a huge part of me worries that I'll go back to my terribly consumeristic ways if I stop budgeting. Before I started budgeting two years ago, I had developed an almost instinctual habit of buying whatever I wanted. Whether I was shopping for clothes or eating in a nice restaurant or ordering books online, I would simply buy whatever appealed to me in the moment with the knowledge that it was going on my line of credit and I wouldn't have to pay for it until I was an attending*. I would take whatever boredom or loneliness or exhaustion I was feeling and try to spend it away. Always unsuccessfully.
Starting to budget made me much more mindful of my spending. It made me realize that I often wasn't looking for a new thing when I went shopping, but rather for some feeling that I was missing. A lot of the time, the best thing I could do when I felt like buying something at random was to just go have a nap, as I've been chronically tired since my first day of medical school in 2006. It also made me focus on non material ways of being happier, rather than on buying a new pair of happy socks. (Although I really love happy socks. And am now searching their website thinking about placing an order. Well done, me. You've clearly learned your lesson.)
I guess what I'm looking for is some way to be intentional with my spending while not feeling constantly constrained by my budget. I want to take advantage of the fact that I'm earning ridiculous amounts of money for a single woman with no dependents, without thinking that I can somehow buy happiness. Balance. The endless search for balance.
Any ideas?
*Thank you very much, past me. You are an asshole.
---
To update you on my habits from a few weeks ago, I've been doing surprisingly well with them. I have completely resisted the cans of Coke in my fridge, and I've passed on pop multiple times in restaurants. I am allowing myself to have pop in mixed drinks (something I decided to do in the beginning but didn't mention in my previous post because I was lazy), but in total it's been about one can of pop since I started. I almost always put my things where they belong when I get home, which has made leaving in the morning much more efficient and peaceful. I've also started putting my keys/wallet/phone in specific spots in my bag (my bag has about 8 different spots, so searching for something can be frustrating), and that has also been a huge improvement. Finally, I have planned out my weekly schedule every Sunday night, and it has given me a bit more awareness of the week and a big more structure. It also saved me from missing dinner with a good friend this week (I thought it was on Thursday, but it's actually on Tuesday), so that is also a win.
Well done, me.
Sunday, May 8, 2016
Cairo
It took three flights, almost 24 hours, and a small meltdown in the Frankfurt airport, but my girlfriend and I are now comfortably settled in an apartment in the Heliopolis neighbourhood of Cairo. The two days since we arrived have been devoted to seeing as many people as possible (my girlfriend lived in Cairo for three years and, being an extrovert unlike me, left behind a long list of people who love and miss her), adjusting to the seven hour time difference, and challenging the defences of our gastrointestinal tracts with street foods. Shawarma...mmmm...
As we were waiting in the airport in our home city, we ran into our accountant, who was waiting to fly to his vacation home in Phoenix. The girlfriend and I were already in vacation mode, eating hot dogs and deciding which of the many ebooks we had downloaded to read first, while the accountant was surrounded by his computer and cell phone and stacks of papers. When he saw us, he quickly picked up his phone to call the Canada Revenue Agency about an issue with my tax return, and after speaking with someone, he called over to me to let me know that he had resolved the issue. His voice was eager, like a child seeking praise. "Look at me! I'm on vacation but I'm still working for you! Aren't I great?"
And then he chatted with us about where we were going and how long we were going to be away. When I told him that we were traveling for three weeks, and that I had left all of my work at the hospital, a momentary flash of disgust passed over his face. He recovered quickly, but he still made it clear that he didn't approve of my prolonged absence. "Three weeks? No doctor goes away for three weeks! That's crazy!"
Which it shouldn't be. When I am at work, I work very hard, often giving up lunches to finish paperwork and coming in early so that I can fit in another urgent patient. So why on Earth should I have to apologize to my accountant about wanting to take some time away for myself? Why does medicine (and North American society as a whole) fetishize work so much that people are viewed as weak or as failures if they choose to do anything other than work?
I refuse to apologize for not wanting to give my entire life to medicine. The further I get into my career, the more I realize I'm going to have to fight the dominant culture of medicine in order to take time for myself, but I'm prepared to do that. Life outside of medicine is too sweet to squander it all simply to meet other people's expectations of me.
As we were waiting in the airport in our home city, we ran into our accountant, who was waiting to fly to his vacation home in Phoenix. The girlfriend and I were already in vacation mode, eating hot dogs and deciding which of the many ebooks we had downloaded to read first, while the accountant was surrounded by his computer and cell phone and stacks of papers. When he saw us, he quickly picked up his phone to call the Canada Revenue Agency about an issue with my tax return, and after speaking with someone, he called over to me to let me know that he had resolved the issue. His voice was eager, like a child seeking praise. "Look at me! I'm on vacation but I'm still working for you! Aren't I great?"
And then he chatted with us about where we were going and how long we were going to be away. When I told him that we were traveling for three weeks, and that I had left all of my work at the hospital, a momentary flash of disgust passed over his face. He recovered quickly, but he still made it clear that he didn't approve of my prolonged absence. "Three weeks? No doctor goes away for three weeks! That's crazy!"
Which it shouldn't be. When I am at work, I work very hard, often giving up lunches to finish paperwork and coming in early so that I can fit in another urgent patient. So why on Earth should I have to apologize to my accountant about wanting to take some time away for myself? Why does medicine (and North American society as a whole) fetishize work so much that people are viewed as weak or as failures if they choose to do anything other than work?
I refuse to apologize for not wanting to give my entire life to medicine. The further I get into my career, the more I realize I'm going to have to fight the dominant culture of medicine in order to take time for myself, but I'm prepared to do that. Life outside of medicine is too sweet to squander it all simply to meet other people's expectations of me.
Tuesday, April 5, 2016
Happiness Over Money
Years ago, soon after I had started medical school, a friend of mine who is a physician came in from out of town for a visit. During his stay, I inundated him with questions about medicine and work life balance and time off for physicians. When the subject of vacation came up, I was quite surprised to hear that he could take almost as much time off as he wanted to, but he didn't. It was, he said, too hard to give up the money.
At the time, I didn't understand. I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.
Fast forward eight or nine years, and I understand completely. When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work. Every day off is a calculation:
One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.
It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy. Except that I do. And it isn't.
So I'm learning to value my time more than my income. It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance. And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival. A week! It took me hours to commit to the decision, but now that I've made it, it feels right. It feels entirely right for me to make time for something that I love that gives me joy.
After all, why else am I here?
At the time, I didn't understand. I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.
Fast forward eight or nine years, and I understand completely. When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work. Every day off is a calculation:
One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.
It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy. Except that I do. And it isn't.
So I'm learning to value my time more than my income. It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance. And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival. A week! It took me hours to commit to the decision, but now that I've made it, it feels right. It feels entirely right for me to make time for something that I love that gives me joy.
After all, why else am I here?
Tuesday, March 22, 2016
Sunday, March 13, 2016
Goals - Looking Back at February and Ahead to (What's Left of) March
This post is a little late. I've been scrambling a bit to catch up on everything that didn't get done while I was in Montreal, and I've been feeling a lot of end-of-winter blahs, so the blog has been a bit neglected.
I set three goals for myself for February: Work out three days a week; go see the psychiatrist, and go out with friends/family twice a week. How did it go, you ask?
Recycled February goal: Go to the gym three days a week.
Nope. Didn't happen. I went a few times at the beginning of the month, and then sleeping in seemed more appealing than exercise (as it always does), and I stopped. I think I've hit the dreaded point where I no longer believe that I can be successful at this goal, so I'm not even making an effort. I'm not sure what it's going to take for me to get exercising again, but I do genuinely want to find a way to make this a regular part of my life. I commented to my girlfriend yesterday that I'm happier and more relaxed when I exercise, and she looked at me as if I'd just said that the sky is blue and responded "Um. Yes."
Second February goal: Don't chicken out and skip the assessment with the psychiatrist.
With this, I was fully successful. Not only did I go to the initial assessment, but I also went to three follow up appointments to convince him that there wasn't something seriously wrong with me and that I just wanted some help learning better coping skills. (Aside: I have never been asked about drinking, drug use, and suicidal thoughts as many times as I was in those four sessions with the psychiatrist. Apparently physicians only seek help when things are terribly wrong, and I'm a bit of an anomaly for wanting some preventative mental health care.) Having passed the psychiatrist's test, I'm now awaiting the availability of a psychologist who will do some cognitive-behavioural therapy with me.
At some point, I will write a whole post about my experiences with this and about physician mental health in general, but today is not that day. For the thoughts of another soon-to-be physician on this subject, check out Kay's blog Premed Post-Mom.
Third February goal: Spend time with people I love. At least twice a week. The girlfriend doesn't count.
Yes! I did this*! Apparently if I set fun goals for myself, like go out for dinner with my favourite people, I can achieve them. Over the course of February, I did the following:
This goal was a good one for me, as it reminded me that, as much as I love my girlfriend and her people, I get something unique from spending time with my people. My family and my long-term friends know me and love me in a way that my girlfriend's people don't, and that connection and understanding are central to my happiness. As an introvert, I am more than able to meet my need for time spent with other people through my girlfriend and her extroverted social life, but it is still important for me to maintain my own social contacts.
The main downside to this goal was that it completely wiped me out. In addition to the activities that I did with my people, I also spent a lot of time with the girlfriend and her people, and it was simply more than this fragile introvert could handle. By the end of the month, all I wanted was time in my pjs on the couch with my cats. Which is pretty much how I've spent all my free time in March so far. Also...all of the eating out was expensive. My eating out budget is usually ridiculously high, but in February it was about 50% beyond what it usually is.
March's really vague, non-SMART goal:
For a while I was thinking of not setting a goal for March, as I'm mostly just feeling tired and in need of a break, but then I came up with something that I think I can do even in my tired state, which is kind of, but not really, a goal.
In March, I want to make more of an effort to recognize what I need and to meet those needs.
(See? Vague.)
For essentially all of my medical training, I didn't think much about what I wanted or needed. There was always a long list of things that I absolutely had to do, so I just focused on getting them done, regardless of how happy or unhappy I was doing them. Thankfully, things are different now, and I have much more flexibility to do the things that are important and life-giving to me. Or, on a smaller scale, to simply do the things that make me calmer and happier from moment to moment.
While I could've tried to make this a defined goal, I've intentionally left it nebulous because the things that I need vary from day to day. Some days I need to retreat from the world and be with my cats, while other days I need to socialize and connect with the people I love. Some days I need to be stingy with my budget and save for the future, while other days I need to be self-indulgent and enjoy the results of my hard work. Some days I need to work less so that I can get enough rest and relaxation, while other days I need to work more so that I can get shit done and stop stressing about it. Different days, different needs.
I'll let you know how it turns out.
*Technically I only did seven things instead of the eight that would be required to have gone out exactly twice per week, but I'm still counting this as a success. In part because I achieved the spirit of the goal, and in part because one of my friends bailed on dinner plans at the last minute, so I can blame her for falling slightly short of eight.
I set three goals for myself for February: Work out three days a week; go see the psychiatrist, and go out with friends/family twice a week. How did it go, you ask?
Recycled February goal: Go to the gym three days a week.
Nope. Didn't happen. I went a few times at the beginning of the month, and then sleeping in seemed more appealing than exercise (as it always does), and I stopped. I think I've hit the dreaded point where I no longer believe that I can be successful at this goal, so I'm not even making an effort. I'm not sure what it's going to take for me to get exercising again, but I do genuinely want to find a way to make this a regular part of my life. I commented to my girlfriend yesterday that I'm happier and more relaxed when I exercise, and she looked at me as if I'd just said that the sky is blue and responded "Um. Yes."
Second February goal: Don't chicken out and skip the assessment with the psychiatrist.
With this, I was fully successful. Not only did I go to the initial assessment, but I also went to three follow up appointments to convince him that there wasn't something seriously wrong with me and that I just wanted some help learning better coping skills. (Aside: I have never been asked about drinking, drug use, and suicidal thoughts as many times as I was in those four sessions with the psychiatrist. Apparently physicians only seek help when things are terribly wrong, and I'm a bit of an anomaly for wanting some preventative mental health care.) Having passed the psychiatrist's test, I'm now awaiting the availability of a psychologist who will do some cognitive-behavioural therapy with me.
At some point, I will write a whole post about my experiences with this and about physician mental health in general, but today is not that day. For the thoughts of another soon-to-be physician on this subject, check out Kay's blog Premed Post-Mom.
Third February goal: Spend time with people I love. At least twice a week. The girlfriend doesn't count.
Yes! I did this*! Apparently if I set fun goals for myself, like go out for dinner with my favourite people, I can achieve them. Over the course of February, I did the following:
- Took my nieces to see a play about Harriet Tubman
- Organized a gathering of medical friends to try out a local restaurant promotion
- Drove to the country to visit my bff from medical school
- Went to my Mom's house for dinner and to help her move furniture
- Went to dinner and the theatre with my Mom
- Met up with a friend from grad school in Montreal
- Breakfast at a shitty new restaurant with my Mom
This goal was a good one for me, as it reminded me that, as much as I love my girlfriend and her people, I get something unique from spending time with my people. My family and my long-term friends know me and love me in a way that my girlfriend's people don't, and that connection and understanding are central to my happiness. As an introvert, I am more than able to meet my need for time spent with other people through my girlfriend and her extroverted social life, but it is still important for me to maintain my own social contacts.
The main downside to this goal was that it completely wiped me out. In addition to the activities that I did with my people, I also spent a lot of time with the girlfriend and her people, and it was simply more than this fragile introvert could handle. By the end of the month, all I wanted was time in my pjs on the couch with my cats. Which is pretty much how I've spent all my free time in March so far. Also...all of the eating out was expensive. My eating out budget is usually ridiculously high, but in February it was about 50% beyond what it usually is.
March's really vague, non-SMART goal:
For a while I was thinking of not setting a goal for March, as I'm mostly just feeling tired and in need of a break, but then I came up with something that I think I can do even in my tired state, which is kind of, but not really, a goal.
In March, I want to make more of an effort to recognize what I need and to meet those needs.
(See? Vague.)
For essentially all of my medical training, I didn't think much about what I wanted or needed. There was always a long list of things that I absolutely had to do, so I just focused on getting them done, regardless of how happy or unhappy I was doing them. Thankfully, things are different now, and I have much more flexibility to do the things that are important and life-giving to me. Or, on a smaller scale, to simply do the things that make me calmer and happier from moment to moment.
While I could've tried to make this a defined goal, I've intentionally left it nebulous because the things that I need vary from day to day. Some days I need to retreat from the world and be with my cats, while other days I need to socialize and connect with the people I love. Some days I need to be stingy with my budget and save for the future, while other days I need to be self-indulgent and enjoy the results of my hard work. Some days I need to work less so that I can get enough rest and relaxation, while other days I need to work more so that I can get shit done and stop stressing about it. Different days, different needs.
I'll let you know how it turns out.
*Technically I only did seven things instead of the eight that would be required to have gone out exactly twice per week, but I'm still counting this as a success. In part because I achieved the spirit of the goal, and in part because one of my friends bailed on dinner plans at the last minute, so I can blame her for falling slightly short of eight.
Thursday, February 25, 2016
Montreal
I'm sitting in a hotel room in Montreal, awaiting dinner with a friend (in 1 hour) and the start of a conference (tomorrow morning), and I am struggling to write one of the blog posts that has been floating around in my brain for the past few weeks. I want to write about how it feels to be six months into my work as an attending, about my struggles to start up a research program, or about my recent two-year anniversary, but all my brain and body want to do is rest. In the past two weeks, I've taken on three extra clinics and an extra weekend of call, and while my net worth is very happy about the additional work, the rest of me is not. I'm exhausted.
This past weekend, my girlfriend and I had a long discussion about careers and life goals and what is important to us. Both of us want to do work that is meaningful and that hopefully makes the world a slightly less miserable place, but we also want to have full lives outside of our work. We want to sleep in on weekends and cook good homemade food and read books and knit*. And maybe even do productive things like exercise and clean our messy apartment. If we run out of fun things to do, that is.
At the moment, it feels like what I want to do is always in conflict with what I need to do (work). I wish at times (always) that I could go back a decade and live more frugally so that I would have actual money now, instead of debt, and would feel like I could take more time to myself. I keep hoping that hitting the zero net worth mark will bring about a major change in how I feel and how I approach work. I'm hoping that it will make me feel okay with saying no to the extra clinic time and the extra weekends of call. Because while I like my job, I love my life outside of it more.
*Well, I want to knit. Specifically this, in a gorgeous grey yarn that is ridiculously expensive but will be worth it because it will undoubtedly take me at least six months to knit the scarf, thus keeping the cost per hour of knitting very, very low.
This past weekend, my girlfriend and I had a long discussion about careers and life goals and what is important to us. Both of us want to do work that is meaningful and that hopefully makes the world a slightly less miserable place, but we also want to have full lives outside of our work. We want to sleep in on weekends and cook good homemade food and read books and knit*. And maybe even do productive things like exercise and clean our messy apartment. If we run out of fun things to do, that is.
At the moment, it feels like what I want to do is always in conflict with what I need to do (work). I wish at times (always) that I could go back a decade and live more frugally so that I would have actual money now, instead of debt, and would feel like I could take more time to myself. I keep hoping that hitting the zero net worth mark will bring about a major change in how I feel and how I approach work. I'm hoping that it will make me feel okay with saying no to the extra clinic time and the extra weekends of call. Because while I like my job, I love my life outside of it more.
*Well, I want to knit. Specifically this, in a gorgeous grey yarn that is ridiculously expensive but will be worth it because it will undoubtedly take me at least six months to knit the scarf, thus keeping the cost per hour of knitting very, very low.
Monday, September 7, 2015
The Weekly Hiss and Purr - September 7 Edition
I knew from the beginning that I was unlikely to write a "Hiss and Purr" post every week, but I was hoping to do it a bit more frequently than monthly. By comparison, slukettg at This Liminal Space has been writing her "Weekly Hiss and Purr" literally every week and has lapped me in a very short time. (If you haven't read her recent post about substance abuse and privilege, you should do that now. It's way better written and more important than anything I'm going to come up with today.) I'm going to try to write these posts more often, as they're a relatively easy way to get some of my thoughts out and to keep up with the habit of blogging. I don't, however, promise weekly.
The Hiss - Insomnia:
Insomnia has been a lifelong enemy of mine, and for some reason it has decided to be particularly bad lately. Most nights I wake up in the middle of the night to go to the bathroom, and then I lie in bed afterwards for anywhere from one to three hours, completely awake. On bad nights, the timing of falling back asleep corresponds to the timing of the cats crawling into bed, and then there is no additional sleep for me. The interrupted sleep has left me profoundly tired - on Friday night, I started whining about needing to go to bed at 9 PM, which is very unusual for a night owl like me.
The strange thing is, I don't know why the insomnia is so bad. Usually I suffer from insomnia when I'm under stress or unhappy about something, but I don't feel like either of those things are the case right now. Yes, there is some stress associated with starting work as a real doctor, but it feels very mild compared to what I'd feared. And I'm not unhappy! I'm enjoying work even more than I had expected; the girlfriend and I have been doing lots of fun things in our spare time; and I'm getting better about avoiding the trap of staying up too late at night. I just don't get it!
I've been exercising again recently (more about that later in the week), and I'm hoping that will help turn things around. Because I'm tired of staring at the ceiling when I should be asleep!
The Purr - Long Weekends:
There is something so unbelievably luxurious about having three days off in a row. I love having one day for fun things and one day for necessary things and then yet another day for whatever I choose to do. This has been a particularly good long weekend, as we haven't had any weddings to go to (I am so done with weddings). I've finished my book (more about Chasing the Scream in a future post), finished knitting my first sock (and started my second), introduced my girlfriend to Treme in honour of the 10-year anniversary of Hurricane Katrina, played board games, tried four different hamburgers for Burger Week, and eaten an amazing celebratory dinner at my favourite tapas restaurant. And it's not over yet!
At the moment, I'm still in pj's, and I'm keeping my girlfriend company while she makes zucchini loaf. We have an oldies station playing in the background, and we're chatting about everything from the tragedy of the Syrian refuge crisis to the awkwardness of junior high. It's everything I need in life.
The Hiss - Insomnia:
Insomnia has been a lifelong enemy of mine, and for some reason it has decided to be particularly bad lately. Most nights I wake up in the middle of the night to go to the bathroom, and then I lie in bed afterwards for anywhere from one to three hours, completely awake. On bad nights, the timing of falling back asleep corresponds to the timing of the cats crawling into bed, and then there is no additional sleep for me. The interrupted sleep has left me profoundly tired - on Friday night, I started whining about needing to go to bed at 9 PM, which is very unusual for a night owl like me.
The strange thing is, I don't know why the insomnia is so bad. Usually I suffer from insomnia when I'm under stress or unhappy about something, but I don't feel like either of those things are the case right now. Yes, there is some stress associated with starting work as a real doctor, but it feels very mild compared to what I'd feared. And I'm not unhappy! I'm enjoying work even more than I had expected; the girlfriend and I have been doing lots of fun things in our spare time; and I'm getting better about avoiding the trap of staying up too late at night. I just don't get it!
I've been exercising again recently (more about that later in the week), and I'm hoping that will help turn things around. Because I'm tired of staring at the ceiling when I should be asleep!
The Purr - Long Weekends:
There is something so unbelievably luxurious about having three days off in a row. I love having one day for fun things and one day for necessary things and then yet another day for whatever I choose to do. This has been a particularly good long weekend, as we haven't had any weddings to go to (I am so done with weddings). I've finished my book (more about Chasing the Scream in a future post), finished knitting my first sock (and started my second), introduced my girlfriend to Treme in honour of the 10-year anniversary of Hurricane Katrina, played board games, tried four different hamburgers for Burger Week, and eaten an amazing celebratory dinner at my favourite tapas restaurant. And it's not over yet!
At the moment, I'm still in pj's, and I'm keeping my girlfriend company while she makes zucchini loaf. We have an oldies station playing in the background, and we're chatting about everything from the tragedy of the Syrian refuge crisis to the awkwardness of junior high. It's everything I need in life.
Friday, August 21, 2015
Doing the Unthinkable
Yesterday afternoon I left work at 1 PM.
This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours. What made it amazing is that I had absolutely nothing to go to. I was simply done my work for the day*.
As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day. The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?" It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home: if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.
As an attending, on the other hand, I set my own schedule (within certain limits). I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all). The freedom is awesome! And while I have no intention of abusing this freedom, I do intend to make the most of it. Before starting work, I decided that I will no longer stay at work just to make an appearance. If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital.
I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM. But on the days when I can go home in the early afternoon, I fully intend to do it. And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.
*Of course, as soon as I left the hospital I got paged to go back, but such is life.
**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry. My chosen career is awesome.
This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours. What made it amazing is that I had absolutely nothing to go to. I was simply done my work for the day*.
As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day. The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?" It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home: if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.
As an attending, on the other hand, I set my own schedule (within certain limits). I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all). The freedom is awesome! And while I have no intention of abusing this freedom, I do intend to make the most of it. Before starting work, I decided that I will no longer stay at work just to make an appearance. If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital.
I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM. But on the days when I can go home in the early afternoon, I fully intend to do it. And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.
*Of course, as soon as I left the hospital I got paged to go back, but such is life.
**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry. My chosen career is awesome.
Sunday, August 16, 2015
Habits - Work
It's the evening before I return to work, and my feelings are alternating between excited and distraught and absolutely terrified. It definitely feels like time to go back (there is almost nothing left on my to-do list), but at the same time I'm dreading the first day. I start with a busy clinic and I'm on home call for the first 12 days, so it won't be an easy return. But I can do this.
Right?
I'm hoping that, if I start off on the right foot, I can set myself up for long-term success. With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning. For those of you who work in medicine, is there anything else you'd add? Any advice? (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)
Record Billing Information as it Happens:
This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid. While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do. The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.
Finish my Dictations Every Day:
So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations. Which means so much unnecessary stress! When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending. It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.
Devote Time and Energy to Teaching:
Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time. As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return. Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service. I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today. The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).
Read for at Least Three Hours per Week:
Medicine changes. Every day, I get emails from journals about all of the articles that I should be reading. In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.
Research:
This is worthy of a post all its own. I don't even know what to say here. I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research. Soooo.....we'll just have to see where this one ends up. I had hoped to have this figured out by the end of my vacation, but not so much.
Put Patient Care Above Other Considerations:
This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room. Their outcomes are more important than how much I bill or what time I leave work at the end of the day. While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.
Right?
I'm hoping that, if I start off on the right foot, I can set myself up for long-term success. With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning. For those of you who work in medicine, is there anything else you'd add? Any advice? (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)
Record Billing Information as it Happens:
This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid. While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do. The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.
Finish my Dictations Every Day:
So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations. Which means so much unnecessary stress! When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending. It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.
Devote Time and Energy to Teaching:
Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time. As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return. Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service. I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today. The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).
Read for at Least Three Hours per Week:
Medicine changes. Every day, I get emails from journals about all of the articles that I should be reading. In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.
Research:
This is worthy of a post all its own. I don't even know what to say here. I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research. Soooo.....we'll just have to see where this one ends up. I had hoped to have this figured out by the end of my vacation, but not so much.
Put Patient Care Above Other Considerations:
This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room. Their outcomes are more important than how much I bill or what time I leave work at the end of the day. While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.
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