Four Days into 2020 - Getting My Ass Handed to Me By Call

When I wrote my post about resolutions for 2020, I was very intentional in talking about "experimenting".  I knew that I wasn't going to be able to change everything the moment the clock struck midnight (I am not a magician), so I wanted to give myself permission to do things gradually and to falter along the way.

Well. 

This was a good thing.

I went back to work on Thursday, and I am starting the year with four days on call.  And what a call it has been.  I've had multiple really sick people spread all over the province, and my pager has been going off seemingly constantly.  Whereas I thought I'd be staying late to keep up with paperwork, I've had to stay late just to get the bare minimum done.

It's honestly a little demoralizing.  I'm only three days into the work year, and I already have new letters that need to be dictated and old letters that need to be edited.  And I've had one night of insomnia, followed by a sleep deprivation-induced migraine.  (Awesome combo)

But...it's a process.  And I know that call is the hardest part of my job, particularly when it's busy call.  So I'm breathing.  And focusing on what I can learn from this experience, rather than on all the things that don't seem to be working.

When I reflect on the past few days, the biggest thing that I'm reminded of is how much I dislike the uncertainty of call.  This isn't really shocking, as I'm a person who hates surprises and likes to have everything planned.  Carrying around a tiny piece of plastic that can scream at me and derail my day without warning is really not my favourite thing.

Fortunately, there are things that I can do to make this easier to cope with.  The biggest one, and one that I've been leaning towards but not quite willing to commit to until now, is not making plans with other people while I'm on call.  In theory, the best thing about home call is the fact that I can continue to live a normal life while I'm call, but in reality, everything is made worse by the pager hanging over me.  I hate planning to meet someone and then having to cancel (or getting called away in the middle of doing something).  It happened on Thursday night when I was planning to meet a BFF for my favourite yoga class, and then it happened again on Friday night when I was supposed to go to a party for people from my residency.  And it sucked.

Not to say that I will never make plans (I would still try to make it to the Friday night party, for example, as the date was fixed), but that I'm going to try to keep my call days as flexible as possible.  Some of this is more mental than anything - trying to not get attached to any idea of how the day will look, but rather take things as they come*.  If the day is busy and I have to work until late, I'm mentally prepared for that.  If it's not and I have time for non-work things, then it's a bonus and I can use the opportunity to go to yoga or wash dishes or sit on the couch with the cats playing Stone Age online with The 76K Project.  (Mostly the latter).

I'm trying to approach my current weekend this way, and so far it seems to be helping (?).  When I got up this morning, instead of trying to map out the weekend, I made myself a list of things from highest to lowest priority.  Providing good patient care was #1, with prepping for my upcoming lectures (which I technically should've had done by yesterday) #2.  While I was responding to pages this morning, I spent a few hours getting the lectures done, thus getting the most important (as well as the most stress-inducing) task out of the way.  And then the pager was kind to me, and I was able to go to an hour of the worst suffering I would ever willingly subject myself to yoga.  I've also managed to get a few other important items knocked off my to-do list, and if I ever stop playing online games I will even do my dishes.

The change in approach and mindset has already made me a little less emotionally reactive when the pager has gone off.  It has still been annoying, and I'm not looking forward to starting my day at the hospital tomorrow, but it's better.  Will it help in the long term?  I guess I'll see...

*I feel like call gives me some sense of what it would be like to be a parent.  Everything is going well, then *BAM*, one kid spills a 2 L of milk on the floor and the other is running around naked drawing on themself with permanent marker.

2020 - Progress, Not Perfection

It has been a few years since I made a New Year's resolution.  In 2017, I resolved to say no to more things, which obviously wasn't enough given the burnout I hit in 2019.  In 2018, I seem to have been in a bit of a dark place in which I thought resolving to do anything was futile, because I wouldn't be able to stick to it anyway.

The past two years have shown me that, under the right circumstances, I can actually make pretty big changes in my life.  In that time, I've greatly expanded and strengthened my social circle, to the point where I couldn't see everyone I wanted to during my two weeks of holidays.  I've started a (somewhat) daily meditation practice and gone to a meditation retreat.  I've been really consistent with yoga, going to 45 classes in the first half of the year and 83 in the second half*.  I've adopted an intuitive eating practice, which has led me to a much healthier relationship with food (and overall healthier eating habits) than I've had in my life.  And I've cut back on my work responsibilities to the point where I am only slightly dreading returning to it tomorrow.

When I look back at the changes I've made, the keys for me have been twofold:  motivation and gradual progress.  I haven't made changes out of a sense that it's what I should do, but rather because I can see how the changes will make me happier and otherwise enhance my life.  The goals I set for myself are personal and are aligned with my values, not things that other people think are important.  I've also started slowly with things (It took me over a decade to develop a regular yoga practice!) and allowed myself to learn from the process of change, rather than thinking that I'll be perfect at a new thing the moment I start it.  As Done By 40 said in a comment on my last post, "Progress, not perfection".

Looking ahead to 2020, my hope is to have a relatively uneventful year.  2019 was a year of tremendous growth and change, but it was also a hard one.  I kind of want to catch my breath**.  I want to continue with my mindfulness practice, and I'm aiming for a regular practice of four yoga classes per week and meditating every day.  I want to keep building on the friendships I have.  My financial situation is really good (No debt!  Lots of investments!), and I mostly just want to keep working and hoarding money for the future.  Overall, I don't anticipate any radical changes in 2020***.

But....in 2020, I would like to work on keeping up with everything.  I feel like I'm perpetually behind - on housework, on work work - and I find it draining.  I hate having clutter in my home and 100 dictations to sign off on in my inbox.  I hate feeling like I'm perpetually catching up, only to have new work pile on top of me the moment I finally get through the old work.  And it's not like I'm saving time by procrastinating on things - I have the same amount of work to do, regardless of whether I do it right away or put it off for weeks.

Which...is really everyone's problem, right?  While the specific tasks may differ, I think we all have an endless to-do list that is never done to our satisfaction.  So, while I'm setting this as a goal, I am also trying to be realistic.  And to extend a lot of grace and compassion to myself.  Because no matter how hard I work, I am never going to get to the bottom of the list.  And I need to make peace with that.

As far as how to do this...I'm going to experiment.  Try something for a while, see how it goes, then keep it or reject it.  I'm not expecting that I will get to the end of the list by midnight tonight and then always keep up with it, forever and ever.  I know it will be a process, and so I'm trying to give myself the time and space (and lots of grace!) to work with the process.  For the moment, I am going to try three things that I think may help:

1)  Going to later yoga classes:  Some of my favourite yoga classes are at 5:30 PM, which unfortunately means leaving work at 4:30 and therefore losing out on a lot of potential work time.  I'm going to try sticking to a regular weekly schedule, with a 7 PM class as my earliest, so that I get an extra hour or so at work at the end of many days.

2)  Coming to work earlier:  My work days start between 8 and 9:30 am (sometimes 10 if I really let myself sleep in) depending on whether or not I have a morning clinic.  I'm going to try to get to work for 8 am consistently so that I'm getting some extra work time first thing in the morning.  As an added bonus, I'm hopeful that the more regular wake up/go to work schedule will be good for my insomnia.

I recognize that I'm proposing to both start later and finish later, which has the potential to simply be too much work.  But I'm hoping that this will allow me to get most, if not all, of my work done during the week, thus giving me weekends completely off to recharge.  I'll see how it goes...

3)  Just doing the shit now:  I'm human.  I procrastinate.  Sometimes epically.  Yesterday I logged onto a conference website, thinking it was the last day for early bird registration, and when I discovered that I still had two weeks, I logged off.  I did very quickly log back on and register for the conference (also booked my Airbnb like a superstar), but my initial impulse was to procrastinate for another two weeks.  I've already started trying to break myself of this habit, as I know it is a huge contributor to the piles of things to do that build up.  So I'm trying to just respond to the email, just put my dishes in the dishwasher, just put away the laundry that I've already folded (instead of it sitting on my dresser until the basket is empty), and just add the item to my grocery list (instead of cursing myself when I get home from the store without it).  Just.  Do.  The.  Shit.

Who knows if this will work.  I like some of the 5:30 yoga classes, so I might cave and go to them.  My bed is very comfortable, so I may sleep in.  Doing the shit gets tedious.  But I'm going to give it a try and see where it takes me.

Any suggestions as I try to get more on top of things in my life?

*At least.  I only track yoga classes for my main studio; I think I did another 10 or so at other studios over the year.

**I feel like I'm tempting the universe by typing this.

***Seriously, I feel like I'm baiting the universe with this post.

Self Care

When medical schools interview prospective students, the question "How do you deal with stress?", or some variant, inevitably comes up.  Having been an interviewer on a few occasions, I know that every interviewee with at least basic interviewing skills will come up with some combination of the following:

Exercise
Rest
Adequate breaks
Healthy eating
Meditation
Yoga
Time with friends and family
Etc.

When I said those things in my medical school interviews, just like everyone else, I was very earnest.  I legitimately thought I would find the time and energy for all of them in my medical training.

(Insert sound of my laughter here.)

Medical training was the hardest and most life-altering thing I have ever done.  Not so much the first two years - those were almost entirely classroom based, and I had long ago mastered the art of sitting in lectures and writing exams - but definitely everything that came after.  The moment I set foot on a ward for the first time, I transformed into a human-shaped bundle of stress and anxiety, constantly terrified that I was going to be responsible for letting someone die.  And unlike with many of my classmates, that feeling didn't go away for a very long time.

My strategy for dealing with this terror was to pretty much never stop working.  I would come in earlier than everyone else, work through lunch, and stay late.  I convinced myself that double, triple, quadruple checking everything would make me perfect and prevent me from ever making a mistake.  (Spoiler alert:  It doesn't.)  Any time I thought about putting in less than 100% of my maximum effort at work, I would remind myself of what was at stake:  People will die if you screw up.

Not surprisingly, my perpetual state of panic and overwork wasn't very conducive to taking care of myself.  I essentially stopped exercising on day one of my clinical rotations.  I gave up cooking for myself and ordered food so often that the receptionists at the delivery services recognized my voice.  And I started spending all the money I wanted, whenever I wanted, because "I deserved it". 

Yoga?  Did my stomach doing nervous back flips count?
Healthy eating?  If I bought my Coke and Nacho Cheese Doritos from the vending machine on the Cardiology ward, did that make them healthy?

I don't know how long I would have continued being so completely and utterly negligent of myself had it not been for a few key events.  The first was a crisis at work, which woke me up to the fact that I might not ever graduate and earn a doctor's salary.  (Spoiler alert:  I did!  And I paid off my student loans yesterday!!!)  Suddenly it no longer felt okay to spend more money than I was earning, so I discovered the great Mr. Money Mustache, started a budget, and got my financial life back in order.  The second was some upheaval at work, during which I reached out to some of the other attendings, and which ultimately led to me being connected to a wonderful performance coach.  While I have only seen him twice, I credit him with enabling me to let go of my self-destructive perfectionism and to forgive myself for being human.

The third thing wasn't a specific event, but rather years of working with people with lifestyle-related illnesses.  I spend a lot of my time at work counseling people about the negative effects of poor diet and lack of exercise, as well as treating them when their bodies break down after years of misuse.  Somewhere around the thousandth time that I said "Pop is basically poison", the message started to sink into my brain.  I'm not immune to the things that affect my patients.  I also need to care for myself.

So slowly (sometimes oh so painfully slowly) I have started to change the bad habits that I learned in medical school.  I've almost completely abandoned sugar-sweetened beverages.  I've started mostly eating brown rice* and brown pasta.  I cook a lot of my meals from scratch, and I try to pack them full of veggies and other healthy things.  I'm even exercising again and (amazingly) kind of enjoying it.

And so many other things, like getting enough sleep and meditating and taking enough vacations and quitting Twitter.  All of the things that I said I would do in my medical school interview 13 years ago, I am finally getting around to.  And it feels really, really good.

*This is huge for me, because I love white rice with a fiery passion and can happily eat two large bowls of it, smothered in butter and salt, in one sitting.

She Will Be Okay

The first four weeks of my most recent relationship passed in a strange and magical sort of delirium.  Perhaps I have always felt this way at the beginning of a relationship and had simply forgotten, but it seemed more intense and all-consuming than any relationship I'd ever been in.  When we weren't together, we texted constantly, and when not texting, I still thought about her all the time.  It was utterly distracting in the most wonderful of ways.

And then, something shifted.

I can't pinpoint the moment or the reason, but suddenly my interest waned.  I waited longer to respond to texts, and I wanted to see her less often.  It became easier to say goodnight at the end of a date.  Without any real warning, I was done.

So Saturday evening, I broke up with her.

It was a horribly difficult thing for me to do, because I hate hurting people.  In the past, I have stayed in relationships way too long (weeks to months to years too long) out of a desire to not hurt the other person.  While we had only been together seven weeks, we had made plans months into the future, and I felt like an ass for being the one to say that those things weren't going to happen.

I spent most of Saturday agonizing over breaking up with her, even though I had no real doubt that it was the right thing to do.  I contemplated waiting, "giving it a bit more time", because I was dreading the moment of the breakup.  I texted all my close friends, trying their patience with hours of rapid cycling between "I'm going to break up with her tonight" and "I'm going to wait a little longer".  I was unbearable.

And then I saw a Facebook post from an ex of mine from years ago.  She had fallen apart when I broke up with her, crying and sending me angry texts for weeks.  The Facebook post was a picture of her, 20 weeks pregnant, with her wife.  It is completely cliché to say this, but the only way to describe her expression is "glowing".

And then it was easy.  Because while breakups are messy and hurtful and absolutely zero fun, people do survive them.  And hopefully there are better things waiting for all of us on the other side.

Anticipatory Grief

Years ago, a friend of mine who was eight months pregnant commented that she hadn't set up her nursery yet, as she knew that it would upset her if she were so unlucky as to have a late complication and lose her baby.  Another friend, who was already a mother, gave her a piece of advice that has stuck with me to this day:

"If you lose your baby, you're going to be devastated whether you've set up the nursery or not.  All that you're accomplishing by trying to protect yourself from grief is preventing yourself from feeling joy right now."

I have been thinking about this a lot over the past ten days.  Ten days ago I met "the new girl", and in addition to blogging about her here, I've also been tweeting about her incessantly.  About how much we have in common.  About how easy it is to talk to her.  About how I kind of wanted to marry her after she told me that she has a plan to retire at 55.

I recognize that this is ridiculous.  We have known each other for only 10 days, and while there are many things that work, 10 days is way too soon to be making any sort of decisions about anything.  It is not impossible to think that we could end up in a wonderful forty-year-long relationship, but we could also be sick of each other by the end of the month.  We just don't know.

And honestly, I'm scared.  I'm scared that I am going to fuck something up, or she is going to fuck something up, or that things are just not going to align in the right way, and this lovely feeling I'm feeling is going to end.  So part of me thinks that I should stop tweeting and daydreaming and feeling all of the happy feels.

But then I remember the advice.  And I just go with it.

Taking a Risk

In my first year of medical school, an opportunity came up to work on the development of an inner-city student health clinic.  I got excited just reading the job description; I loved the idea of getting early exposure in a clinical setting, and the clinic was well-aligned with my desire to improve healthcare for marginalized individuals.  The job opportunity was exactly what I wanted to be doing during my first summer of medical school.

I didn't apply.

I had no experience working with marginalized populations, so I thought there was no possible way I would ever be chosen for the job.  I didn't even give them the opportunity to reject me, I just self-selected out.  I completely ignored the fact that I had been writing and editing grants professionally for four years, which would have been a huge asset in a position that involved a lot of fundraising.

My best friend got the position.

She had even less relevant experience than I did, but she wanted the position and had the guts to apply for it, so she got it.  And she was excellent at it, because it turns out you don't need to fit perfectly with a position to be good at it.  You bring in your existing skills, and you learn and you stretch yourself, and you gain the ability to do something different.

Her getting the position actually worked out well for me, because she didn't want to work full-time in the summer, and she asked me to job share!  (Funnily enough, there wasn't a huge demand for the poorly paying job, so they were willing to be very accommodating.)  I ended up liking it as much as I had hoped, and I stayed on to volunteer during the school year and to work for the clinic again the following summer.  

Fast forward to the present.  I have been looking for ways to meet new people and broaden my activities, and in my search I came across a feminist theatre group that is looking for new members for its board of directors.  I luuuuurve the theatre, and I am an unapologetic feminist, so the ad filled me with the same excitement I had felt reading that job description as a baby medical student years ago.  Followed immediately after by that same sense of inadequacy.

Why would a theatre company want me?  What do I know about theatre, beyond attending 39 fringe festival plays this summer*?

It was exactly the same as with the summer job years ago.  So I sat on it.  Didn't apply.  Ignored the fact that the opportunity sounded fun and exciting and exactly like something I would want to do.

But then, I asked a friend about it.  Poured out my heart and my doubt and my little tiny bit of hope to her, and she said "The worst that could happen is they say no."

As simple as that.  She stated it matter-of-factly and then immediately resumed stuffing her face with deep fried veggie balls at the vegan restaurant where we were eating.  My neurotic self wanted to counter with one hundred reasons why they might say no and why being rejected would be the worst thing that ever happened to anyone, but really?  If they said no, I would get over it.

So this morning I wrote a letter.  And as soon as my friend edits it and gives me feedback, I am sending it off.

The worst that could happen is they say no.

*Too many.  I think 25-30 in 12 days is my sweet spot.

Weekend Progress

Remember how my living room looked on Friday?

This is how it looks at the end of the weekend:

The after photo doesn't quite do it justice, as everything that is currently on the table is waiting for someone to pick it up and take it away.  There will be a lot of empty space once it's finally done.  Including space for games nights!

A few more before and afters:

The desk:

The bookshelf:

The light in the photos is terrible, but you get the idea.  I have gotten rid of a lot of clutter.  So far I think I've done a reasonable job of not getting rid of important things, with two notable exceptions.  First, I gave away some chargers that I thought were old and not in use anymore, but which turned out to be for my bike lights.  So I'll need to get a new charger before bike season next year*.  And second, I gave away a tea set to one of my friends, and a few hours later, she texted me to say "You didn't look in the teapot before you gave it to me, did you?"

Turns out I had stashed $130 in cash in it at some point in the past.  (Years and years ago, perhaps?)  I'm really glad I gave that one to a friend instead of putting it in the lobby of my building.

Anyone else decluttering right now?  How is it going?

*Also a new bike, as I had previously been using the ex-girlfriend's bike.  Sigh.

My Exciting Friday Evening

Although I have enjoyed the resultant comments and conversations, I have had enough writing about controversial things for one week.  It is the beginning of the long weekend, and I am going to stop thinking and writing about "big things" for a while.

So that I can move on to this:

This is my living room.  At some point in the not too distant past, it was reasonably well organized and uncluttered.  And then.

Stuff.

Stuff happened.  Christmas* and the Women's March and music festivals and camping and all kinds of other things that we never quite cleaned up from.  Where once we used to eat meals and entertain, now I just store things.

A few weeks ago, I was thinking about the things I want to do in my post-breakup life, and one of the things that kept coming up was games night.  I don't love games quite as much as Creampuff and Katr, but I do love games for their combination of competition and buffer against awkward social interactions.  Playing a game is a great thing for an introvert such as myself who sometimes gets overwhelmed by the need to maintain a conversation the whole time someone is in my home. 

The only problem is, there is no game playing happening in the living room shown above.  People and games just don't fit into it.  The initial solution I had to this problem was to buy a house, which in retrospect is a slightly extreme solution to the "my living room is a pigsty" dilemma.  Thankfully, the second solution I came up with was to actually organize my living room.

Which I have been doing for the past few weeks.  Before tonight, I had:

1)  Organized my memory box, two boxes of children's toys, and one box of Christmas ornaments;
2)  Gotten rid of three bags of books, one of my two Cabbage Patch Kids, and multiple bags of Christmas things;
3)  Recycled the Women's March posters; and 
4)  Decided to get rid of the desk.

And then tonight, because I am one of the cool kids who spends my Friday nights going minimalist, I:

1)  Organized another box of Christmas ornaments;
2)  Went through every single item on the tall bookshelf;
3)  Put all my (now organized) boxes away in the storage space;
4)  Started a pile of things to sell or give to the thrift store; and
5)  Got rid of the proofs for my med school grad photos, every single note I took during residency, my ridiculously uncomfortable chair that has never quite worked, printable labels that I bought for medical school applications (in 2005!), and my Christmas tree.

There is space!  Everything to the left of and behind the table is now put away, gotten rid of, or on its way to being gotten rid of.  And the rest of it will be tackled this weekend.  I am ready to use my space again.

*Yes, I am blaming a holiday that happened almost a year ago for the state of my living room, because until earlier this evening the tree was still on the living room floor.

Post Mortem

I keep opening this post, typing a few sentences, deleting them, and closing the post again without publishing anything.  I alternate between wanting to write a few lines to get it over with and wanting to pour everything in my heart out, consequences be damned.  I suspect in the end I'll do something in between, although it's hard to know, because whereas I usually have some idea of what a post will look like before I write it, this time I'm improvising.

I've heard it said that life keeps giving you the same lesson, over and over again, until you learn it.  For me, the lesson that I seem to be unable to learn is to let a relationship go the first time it ends.  In every long-term relationship I've ever been in, after the relationship has fallen apart, I've always gone back to see if the pieces could be reassembled.  Instead of just dealing with the loss and moving on from it, I've let myself be stuck in the process of the relationship ending, asking over and over again, "Can I make this work?"

The answer, of course, is no.  With rare exception, a relationship that has truly ended - in a furniture-moved-out, shared-possessions-divided-up kind of way - can't be made to work.  And that is the long and the short of what happened with M and I.  Our relationship ended over a year ago when I called it quits, but thanks to optimism and poor judgement and the ability of good memories to block out the bad ones, I invested a whole other year into making absolutely certain that it was over.

It hasn't all been bad.  In the past year, we've eaten chicken wings at trivia night and picked strawberries at the U-pick and camped under multiple starry skies.  We traveled to Europe in the Spring, eating currywurst in Berlin and waffles in Brussels.  There has been a lot of struggle and a lot of unhappiness, but there has also been life, in all of its beautiful imperfection.  And while I wish we hadn't been so unhappy, I don't wish away our last year together.

ZebraNRP at Mothers in Medicine wrote a beautiful post recently about the end of her marriage, and I have gone back to it multiple times over the past few months, while I've been witnessing the last days of my own relationship.  I love her idea that something isn't a failure just because it ends.  I also love the poem that someone included in one of the comments, and it seems like a fitting way to end this post.

          Failing and Flying
          Jack Gilbert, 1925 - 2012

          Everyone forgets that Icarus also flew.
          It’s the same when love comes to an end,
          or the marriage fails and people say
          they knew it was a mistake, that everybody
          said it would never work. That she was
          old enough to know better. But anything
          worth doing is worth doing badly.
          Like being there by that summer ocean
          on the other side of the island while
          love was fading out of her, the stars
          burning so extravagantly those nights that
          anyone could tell you they would never last.
          Every morning she was asleep in my bed
          like a visitation, the gentleness in her
          like antelope standing in the dawn mist.
          Each afternoon I watched her coming back
          through the hot stony field after swimming,
          the sea light behind her and the huge sky
          on the other side of that. Listened to her
          while we ate lunch. How can they say
          the marriage failed? Like the people who
          came back from Provence (when it was Provence)
          and said it was pretty but the food was greasy.
          I believe Icarus was not failing as he fell,
          but just coming to the end of his triumph.

Radio Silence

After a brief period of activity, I've been quiet here for the past few weeks.  It isn't because I've had nothing to write about.  I've actually had too much to write about, but I simply couldn't, and so I've been silent.

M and I have separated.

Again.

I will likely write more about this in the future, as I enjoy oversharing personal information on the internet, but that's all I'm going to write for now.

Enjoy some David Gray!

Mistakes, I've Made A Few

When I started medical school, I believed wholeheartedly that physicians were perfect.  I fully expected that, over the following 6-9 years of training, I would fill my brain with everything I needed to know about medicine and that I would learn how to use this information correctly, in every patient encounter, with 100% accuracy.

I'm not sure where I got this idea from.  Certainly I recognized (probably too clearly) that I was a fallible human being, yet I somehow thought that medical training would beat the fallibility out of me.  I envisioned the epic 28-hour-plus call shifts transforming me into someone perfect, someone who never wrote down the wrong drug dose and who never froze, uncertain of what to do, in the middle of a code blue.

It was a shock to me then, as I progressed through my training, to discover that my human imperfections didn't go away.  I certainly learned to be much better - to double check my orders and to write list after list in an attempt to never miss anything - but the promise of perfection has remained elusive.  Sometimes I slip up.  Sometimes I forget to do something important, or I fail to take something into consideration when making a treatment plan, or I misjudge just how sick the patient in front of me is.

Imperfection feels horrible as a trainee, but it still feels bearable.  As a trainee, right up until the last day of fellowship, there is always someone watching, someone double checking.  Someone who ranks higher than you on the list of people responsible.  Someone who retains the burden of final responsibility.

And then you graduate.  And now you are the person in charge.  And suddenly the weight of the work you do, the importance of every decision you make, seems ten times greater.  Double checking becomes triple checking.  Minutes of insomnia turn into hours.  Precious time outside of work, which is finally not quite as rare as it was in training, is spoiled by endless questioning and self doubt.

Did I screw something up?

Is someone going to die because of something I did?

And the worst part of it is, almost no one talks about it.  If you ever dare to talk to a colleague about your fears, they will minimize them, reassuring you that you're one of the good doctors.  You're not one of the ones who makes mistakes.

Almost no one acknowledges that we all make mistakes.  And that it isn't enough to learn how not to make mistakes or, more realistically, how to make fewer of them. What we really need to learn is how to cope with the fact that we are fallible humans, called upon to do superhuman work despite our inability to ever be superhuman.

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.

Gathering my People

This has been a really, really rough week.

Really.

I didn't expect it at all.  I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar.  It was supposed to be a good week.

And then we had a department meeting.

There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty.  And as an anxious person, uncertainty is not my friend.  I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*.  It's been miserable.

While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently.  I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire.  This isn't working.

Thankfully, today was a paperwork day, so I had lots of time to figure things out.  And what I figured out was that I need a support system.  People who have been through what I'm going through who can offer me some advice.  Unfortunately, in Medicine this is a really, really hard thing to find.  We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy. 

Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending.  When I realized this morning that I need more people, my brain went "Ah-ha!".  That was who I needed.  Except...she is an attending that I don't know personally.  And I run into her about once every 3-6 months. 

So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.

And she said yes.

And then I emailed another attending.  Who also said yes. 

Suddenly, after a week of feeling alone and scared, I don't feel so much of either.

*For the record, none of this is rationally necessary.  Everything is going to be fine, one way or another.  This is just anxiety.

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.

So Many Things

You know how something happens and you think "I should blog about this", but then you don't have make the time to do it, and then something else happens that you want to blog about, but you can't because you still have to blog about the first thing, and then it happens over and over again until you have ten things you want to write about and you haven't blogged in almost a month?

Yeah.  That. 

So...because I can't decide which of the major life events I want to leave out of my blog post, and because no one wants to read a brief autobiography disguised as a blog post, here is the last month of my life in bullet points:

1. I got back together with my (no longer) ex-girlfriend.  After the breakup, I don't think I went more than four or five days without seeing M*, and I definitely didn't go that long without talking to her.  I missed her.  We started out doing the "we're spending all our time together but not dating" thing over a month ago, and we declared ourselves dating again a few weeks ago, and so far it seems to be going well.  We're doing our best not to repeat some of the mistakes we've made in the past, and it definitely makes for a healthier relationship.  We shall see where this goes...
2. My grandmother died.  My grandmother was 94, slightly senile, and diabetic, and yet I was convinced that she would live forever.  A few weeks ago, I got the call that she had had a heart attack and been made palliative, so I headed out to her small community as prepared as one ever is to say goodbye.  When I arrived at the hospital, she was asleep in her bed, but she quickly roused and demanded to be taken home.  By the time we got her back to the PCH, she was back to her usual feisty self, showing no signs of what had happened.  Unfortunately, a week later she fell and broke her hip (for the third time), and that was the beginning of a very rapid end.  My grandmother was the most resilient of the resilient Depression era farm women, and so it's still amazing to me that she's gone.  I still have moments when I feel guilty for not visiting her, so I don't think it's quite sunk in yet.
3. I decided what to do with my budget.  The comments on my previous blog post were fascinating to me!  It's interesting how everyone has their own unique way of being financially responsible, many of which are different from my own.  In the end, I realized that my current method of budgeting is actually working pretty well for me, except for the fact that the amount of money I was allowing myself didn't fit with the amount of income I was bringing in.  So, I threw $500 at the budget to get myself out of the black, and I increased the regular amount in my budget by 1/3.  Since the change, I have bought Threadless t-shirts and Happy Socks, taken a thankfully not sick cat for a very expensive vet visit, and booked a luxurious spa day for the long weekend.  So I'm over budget again.  But enjoying spending some of my hard earned money instead of just hoarding it in the event of future catastrophe.
4. I started counselling.  I wrote before about how I had seen a psychiatrist through a service at work, but what I've never written about was how abysmal the whole experience was.  I went in looking for some coping strategies and maybe some cognitive behavioural therapy for anxiety, but what I got was someone who wanted to put me on medication and explore all of the supposedly traumatic events from my childhood (um, no thanks).  It was a terrible match.  I put off looking for someone else until M and I got back together, and then I decided that I needed someone external to help me navigate the waters of rekindling an old relationship.  I've met with the counsellor once, and it seems like a better fit so far, so I'm hoping that something good will come out of it.
5. I started exercising again.  It has become abundantly obvious to me that everything is better when I exercise.  Not in a future oriented "I won't have a heart attack when I'm 50" kind of way, but in an "I'm less of a psycho hose beast when I exercise" kind of way.  Exercise is definitely good for my stress, my energy level, my sleep, and my all round happiness.  My goal for September, in fact, is to restart the habit of exercising three times a week.  It will likely consist of me running on the treadmill on Tuesday and Thursday mornings, as I have no clinics those mornings, and then doing something else on Saturdays or Sundays.  I may alternatively do an exercise class at work on Thursday afternoons, as there's one that starts after my work day ends.  This week I'm planning to go to yoga on Saturday morning, as my sciatic pain has flared up from the running**, but I may be more creative in the future.
6. I signed up for a meditation class.  This terrifies me.  I've been reading books about how wonderful meditation is (like 10% Happier and Full Catastrophe Living), and I'm fully convinced that it can make me a happier and more productive person, but I absolutely hate the idea of having to actually do it.  Sitting with nothing but my thoughts?  Breathing exercises?  Walking meditations?  All of that sounds terrible.  And yet, starting October 5 I will be doing it every Wednesday evening.  

And that is my life.  How is everyone else doing?

*I'm giving her an initial, because it's far too tedious to keep typing "the girlfriend" or "the ex-girlfriend" depending on my current relationship status.  Also my hands are sore from typing chart notes.

**When did I turn 80?

Zero

Two major events happened last week.

First, I finally hit the zero point on my net worth.  After two years of budgeting and frugal(ish) living, I finally dug myself out of the hole that medical training and lots of careless spending created.  I feel a little bit lighter and a little bit less stressed, but it hasn't been quite as momentous an achievement as I had hoped.  Now that I am officially worthless (ha ha), I want to actually start accumulating some money.  An emergency fund!  A down payment on a home!  Apparently I'm incapable of being satisfied with where I am in life.

Second...I broke up with my girlfriend of two years.

It's hard to know what to say about this, because there are so many things at play in a breakup, and they never quite fit together into a coherent story.  It's inevitably messy.  I can say that it was my decision, that I had a sense it was coming for a while, that I'm doing okay.  That it is very strange to watch carloads of her things disappear from my small apartment and to see my old life emerging from underneath them.  That the worst thing in the world is hurting someone you love.  There is so much more.

For now, one of the many songs that I'm listening to, over and over again.

Notes Towards a Poem That Can Never Be Written

"The facts of this world seen clearly

are seen through tears;

why tell me then

there is something wrong with my eyes?

To see clearly and without flinching,

without turning away,

this is agony, the eyes taped open

two inches from the sun." - Margaret Atwood

Part of my girlfriend's job involves resettling Syrian refugees.  After experiencing almost unspeakable horrors in their home country, these people have now traveled halfway across the world to a foreign city searching for something better.  Which they don't always find.  The cold and the grey of a Canadian winter, even as it begins to melt into spring, isn't always inviting.  The residents of my city too aren't always welcoming towards more people who will need government support (more taxes on the already overtaxed) to establish themselves.  The low-income housing into which people are placed doesn't always match with the image of an affluent Canadian city.  Life here can be hard.

And so they talk.  They talk about many of the sad things from their pasts and about the disappointment that they don't leave the sadness behind when they physically leave their country.  They talk to my girlfriend, and she listens because she's a good person and can feel these people's need to unburden themselves, if only a little.  With each story, each heartbreaking story, some of the weight of their experience transfers from them to her.  Their loads lighten, hers becomes heavier.

And I see it in her.  I see it in how she laughs a little bit less and seems a little bit more distracted when we talk.  I see it when I awaken in the night, and she is already awake, her mind unable to rest.  And I know what it is like, to bear witness to the suffering of others, and to feel powerless.

And I wonder, how do we - the doctors, the nurses, the social workers, the myriad of helpers - stay intact?  How do we witness these things and not be destroyed by them?  How do we keep coming back, day after day, offering what little we have to offer, when all we see is the neverending need?

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.

Friday Night

For the past few weeks, I have been taking on an extra half day clinic per week to address the seemingly never-ending list of people who need to be seen.  While I actually kind of enjoy the extra clinical work, I don't enjoy having more paperwork to do and less time in which to do it.  By the beginning of yesterday, my desk was piled high with charts to dictate and phone messages to return and labs to review.  I have no clinics on Thursdays, so I spent the entire day in my office slowly crossing things off my to-do list.

It still wasn't enough. 

After clinic today, I ate lunch while dictating charts, and then I left the hospital to go to the other clinic where I work once a week.  And did more paperwork there.

I'm still not done.

I'm really hoping that, with experience, I will get faster at dealing with paperwork, because it is currently taking up almost all of my non-clinical time.  Time that I should be spending developing a research program (*ha*) or preparing presentations or teaching.  Fun things.  Non paperwork things.  It also exhausts me in a way that no other aspect of my work does, because I need to focus carefully on what I'm doing despite how tedious and dull it is. 

Thankfully, it's Friday, and for the next two days I can forget about the 45 dictations* that are sitting in my inbox waiting to be signed off on.  Tomorrow the girlfriend and I are heading to an independent cinema in our pjs to watch Saturday morning cartoons and eat sugary cereal.  Then on Sunday, I'm doing social activity #2** for the week and taking my nieces to a play about Harriet Tubman.  After I go for a run in keeping with my goal to work out three times a week.  And there will be sleep.  Lots and lots of glorious sleep.

I need this weekend.

*Literally.  Shit.

**Social activity #1 was dinner with my mom and my brother for part of a week-long promotion in which restaurants serve three-course meals at a discount.  The conversation was good, but the food was really underwhelming (including inadequately cleaned shrimp *shudder*).

The Most Wonderful Time of the Year

I find the Christmas season stressful.  I'm a person who prefers being undercommited to being overcommited*, so I get easily overwhelmed by the addition of holiday parties and gift buying and dainty making to my schedule.  (But not the dainty eating.  I'm always game for dainty eating.)  Last year was particularly challenging for me, as it was my first Christmas with my girlfriend, and we tried to fit in all of the gatherings and traditions that are important to both of us.  It was too much, and it left both of us (mostly me) exhausted by the end.

This year, I thought I would cut back on my stress level by being on top of my game from the beginning.  I would make all the dainties and buy all the gifts and stock the liquor cabinet early so that once the celebrating began, I would be ready to just enjoy myself.  And I was doing okay, up until the point two weeks ago when I said "Why yes, I'd be happy to revamp the entire curriculum before January"**.

Wait...what?  Who agreed to revamp an entire curriculum in six weeks?  At Christmastime?  It couldn't possibly have been me, because I am a rational human being who recognizes her limitations and doesn't take on utterly ridiculous and near impossible tasks.

Aren't I?

Apparently I'm not.  Because I did take on that task at precisely the time when I most want to be scaling back and enjoying my life outside of work.  And if I could find a way to go back in time and open my mouth and take those words back into it and swallow them whole so that they could never, ever escape my lips, I absolutely would.  Because when I look ahead to the next 19 days, it isn't Christmas spirit that I see. 

*What does it say about our society that overcommited is a legitimate word, while undercommited apparently isn't?

**Back in July, I also said "Why yes, I'd be happy to be on call the entire week after Christmas", not realizing that my girlfriend would have the time off of work.  Bah humbug.