Parkinson's Law

Subtitle:  Work expands so as to fill the time available for its completion

Just over a year ago, I wrote smugly about how I had gotten caught up on all of my tasks at work and about how wonderful it felt.  At the time, I fully intended to keep up with everything, always and forever, so as to keep the wonderful feeling going.

I think I may have lasted a month.

Inevitably, I got behind during a busy time at work, and then I never seemed to have enough time or motivation to get caught up again.  So for most of the past year, I've left work every day knowing that there were piles of charts and long to-do lists waiting for me the next morning.

For me, the worst part about never being caught up isn't the overwhelming feeling of always having too much to do:  it's the terrible lethargy that comes from doing the same thing over and over again without seeing any progress.  There is nothing quite as demotivating as signing off on a letter, only to be greeted by 50 other letters that need signing off.  For the past year, work has felt like a neverending slog through the same neverending tasks.  Day after day after day.

A few weeks ago, I had a brief but welcome break from the teaching and presenting and administrative duties that fill my non-clinical time.  And I thought to myself "Now!  Now is the time to get caught up again."  So I took the extra time I had and phoned every last patient and dictated every letter and signed off on every chart.  For the first time in way too long, I was caught up.

And I've stayed that way for the past three weeks.  And once again, it has felt amazing.  I feel a little burst of joy every time I open my letter queue and see the words "You have no new letters to sign off".  Or when I look at my empty inbox.  Or when I look at the folders in my desk, and there's absolutely nothing in them.

The second best part of being caught up is that I've regained the efficiency that I had lost.  When I have just a few tasks to do, I can plow through them quickly, knowing that I'm going to get the satisfaction of being done, once again.  And it's much easier to let go of my relentless perfectionism when I know that it's standing between me and being caught up on everything.

The absolute best part?  I get a bonus day off today because I'm done everything!  I was finishing up my tasks yesterday, and I realized that there wasn't anything that needed to be done today, so I didn't have to come in for my usual catch up day in the office.  No dreaded Thursday paperwork day.  I've taken my car in to get the winter tires removed (just a wee bit late), gotten a haircut for the first time in eight months, and now written a blog post.  Next is lunch and then reading for fun.

Life, for this moment at least, is good.

(If you are hating me and my smugness right now, please note two things:  1)  I start two weeks of call on Monday, which is going to destroy everything I just wrote about; and 2) When I say I'm "done everything", I am ignoring the paper I need to write and the CV I need to update and a number of other longer-term tasks that will forever be on my to-do list.  No matter how efficiently I work or how late I stay, there will always be something left to do.)

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:

• 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).

That list makes me feel vastly better than saying to myself "I have to work at this miserable job* for another 10 years before I will feel happy again" all the time.

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.

Movement - September Goal

Oh exercise, how I struggle with you.  With just a quick look through the blog, it's easy to find multiple posts in which I'm either committing to exercising more or lamenting the fact that I've failed at exercising more (see here, here, here, here, and here for just a few examples).  It's not a habit that comes easily to me.

The problem, for me, is that there are so many things that I would rather being doing than exercising.  Reading, blogging, cuddling with my cats and/or girlfriend, eating out, cooking at home, etc. etc.  There is no shortage of things that I want to do, and it is always difficult to say no to them in order to do something that doesn't really appeal to me.

But I know I need to.  For my stress level, for my health, for my happiness.  Everything is better when I get exercise.  So this month, I set myself the goal of exercising three times a week.  I didn't set any specific requirements for how long or what type of exercise or anything else, I simply had to move.  And I'm happy to report that I was almost perfect.  In the entire month, I only missed one workout, and that was due to the fact that I had such bad sciatic pain that I could barely walk.

In addition to working on the habit, I wanted to observe myself and figure out what helped me/hindered me when it came to exercise.  I want to better understand why I've failed in the past so that hopefully I can do better at making this a lifelong habit.  If nothing else, it will be much more interesting for the blog if I can set a monthly goal for myself that isn't exercising!  Here's what I learned over the past month:

Variety:  I've tried in the past to just run on the treadmill in my building three times per week, and it gets boring very quickly.  (Not to mention the bloody sciatic pain.  My borderline obese body was not designed for running.)  This time I've been trying to do more variety - walking outside, yoga classes, aerobics classes, elliptical - and it's definitely easier to stay motivated.

Planning:  I do much better if I sit down at the beginning of the week and plan out my exercise than if I just try to wing it.  Not surprisingly.  (I didn't promise that these would be profound observations, just observations.)

Changes in Schedule:  I have been aiming for a Tuesday/Thursday/Saturday exercise schedule, which is great when it works, but terrible if I happen to have an extra morning clinic or something else that interferes with my plans.  Going forward, I'm going to have to get better at dealing with the things that throw me off of my schedule.  (Case in point:  I have an 8 am lecture to attend tomorrow, combined with our local LGBTQ film festival in the evening, and I have no idea how to deal with it yet.)

Mood:  My mood has been vastly better over the past month than it has been in perhaps ever.  While I think the counseling and the improvements in my relationship have played a huge part, I certainly don't want to discount the role that exercise is probably playing.

So, for the first time in ever, let's call this month of exercising a success!

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As for October (quick comment before rushing off to Thanksgiving dinner #2), my goal is to not look at my net worth.  Not once.  I normally check it on a daily basis and think about it pretty obsessively, so going 31 days without looking at it is a big step for me.  But one that has been good so far, and one that I think is necessary for my happiness.

Happy Thanksgiving to everyone in Canada!  Hope you enjoy your turkey (or Aloo Gobi, which is how we're celebrating this year). 

Missing the Blog

I think about this blog frequently.  Post titles pop into my head while I'm showering.  Entire lines of text write themselves in my mind while I'm examining patients.  I am the type of person who is constantly trying to understand life, to fit it to a logical narrative, and this blog feels like an integral part of that process of understanding.  And yet, I don't make enough time for it.  Days or weeks go by without a post until I return, overwhelmed with things I want to write about, only to write a list of bullet points.

I've been working a lot lately on habits - finishing up my work efficiently, getting to the gym, staying connected with friends - and I think that blogging is going to be the next one I try to work one.  I'm finding that if I just leave things to chance that I never seem to get to them, but if I make a regular commitment of time, then I tend to get things done.  So hopefully if I make a plan for blogging I will start logging more than one or two posts per month.

Any suggestions on how frequently I should post?  If you're a blogger, how do you keep up a regular posting schedule?

Back to Work

I've taken a lot of vacation already this summer.  In May, it was Egypt/Greece/Jordan with my (now ex-) girlfriend.  In June, it was Chicago with my family.  This month, I spent a weekend in New York City for a wedding and then took a week off at home so that I could go to our local theatre festival, which is pretty much my favourite thing in the world.  Unfortunately, today was the last day of the festival, and tomorrow I go back to work.

There is actually a small part of me that is looking forward to going back.  Despite my Facebook posts to the contrary*, I mostly enjoy my job, and I am happy to have a bit more routine in my life again.  The past month and a half has felt very unsettled, and I'm hoping that being back at work will help me to feel more grounded.  More like myself again.

As I prepare to go back for a long stretch with no vacation in sight**, I have been thinking a lot about happiness - specifically, about things that I can do to be happier in both the short and the long term.  Find a new girlfriend seems to be the one that pops into my head most readily, but I'm well aware that I'm not yet in a place where I should start dating again, so I will just try my best to ignore that thought for at least a few more months.  Beyond that, there isn't one single thing that comes to mind; rather, there's a long list of small things that might help to make my life easier and better.  So...I'm back to trying to make some small habit changes. 

At the moment, there are three things that I'm trying to work on, which I will discuss very briefly, because it is suddenly late, and I have to set an alarm clock for the first time in 11 days.

Stop drinking pop: 

I know that I need to make healthier food choices, and I also know that sudden radical changes inevitably lead to failure, so I'm going to start small.  I gave up pop for the month of April, and I was really surprised by how little I missed it.  At the beginning of the month, I though about drinking it periodically, but the cravings for it always passed quickly, and by the end of the month I didn't even think about it.  I was actually a few days into May before I realized that I could start drinking pop again.  Which I wish I hadn't. 

Put my keys, wallet, and cell phone in the same place when I come home:

I am ashamed to admit that I spend a lot of time searching for my keys, wallet, and cell phone.  I frequently switch them between my purse, my work bag, and an assortment of backpacks that I use when I'm out at festivals or other events, and I can never seem to find them when I need them.  Not to mention the fact that my cell phone is rarely charged, which is inconvenient given that I recently gave up my land line.  A few days ago, I moved a storage unit into my front hallway and put a wicker basket on top of it, and I am trying very hard to put my things into it whenever I get home.  Except for the cell phone, which is getting attached to the charger.

Review my schedule on a weekly basis:

I'm pretty good about entering events into my calendar, but I'm not the best at subsequently looking at the calendar and remembering what I need to do.  So far I haven't missed any major appointments (in recent history, at least), but this leaves me with a bit of an unsettled feeling all the time.  My plan is to spend a bit of time every Sunday reviewing my schedule for the week (work and home) and to make a few work/personal goals for the week.  I will never come anywhere near sarah (SHU) in my organizational skills, but I am hoping to slowly improve them.

And that's it.  Three small habits that will not radically change my life but that will hopefully make things a bit better.  And once I've adopted these habits, there can always be more! 

*My Mom freaked out when I recently posted on Facebook that I preferred being at the theatre festival to being at work.  What would your patients think if they saw that?  Um...that I'm a normal human being who sometimes likes vacation more than being at work.

**Any ideas of fun things for single people to do on vacation?  The thought of booking a holiday without my (now ex-) girlfriend makes me want to vomit in my mouth a little, but I know that I will eventually need to go somewhere without her.  Or just work all the time.  Also an option.

March/April Goals - Eat Food

Once again, I'm late with reflecting on last month's goals and setting out this month's goals.  Perhaps my goal for this month should be to be on time with my next post about goals?

Anyway...for March, I made a very vague commitment to "recognize what I need and to meet those needs".  I was feeling in a bit of a slump at the time, and I couldn't quite figure out what would make me feel better, so my goal was essentially an attempt to identify anything that would make me feel better and do it.  After a few days of self reflection, I realized that one of my biggest sources of unhappiness was feeling like I was spending all of my time doing the tedious parts of my job (dictating, editing dictations, reviewing labs) without ever being finished with it.  In response to this, I made it my priority to get all the stuff done, and I did.  (As I wrote about here).

In getting caught up on my work, and even more so in trying to prevent the work from reaccumulating, I have come to realize that I was making the fatal mistake of letting my work expand to fill the time available to me.  I'm usually in clinic only about 50% of the time, leaving me with more than enough time for office work when I'm not on call, and I was allowing the tedious work to unnecessarily fill up all of my non-clinic time.  I would come in a bit late, have a nice long coffee break, check Facebook, and do all kinds of things to procrastinate getting the work done because there wasn't a real urgency to doing it.  When I had another project to work on, such as a presentation with a firm deadline, then I would get more efficient at the tedious work to make time for the other project, but otherwise I was dawdling.  And feeling trapped in paperwork hell.

Forcing myself to finish my tedious work on a daily basis (as much as possible) has made me much more efficient.  I come in on time, I minimize non-work activities, and I use even the random five- or ten-minute chunks of available time between events to be productive.  There is absolutely no way that I want to stay later than I need to because I've been scrolling through Facebook instead of signing off on dictations.  By making much better use of my time, I've finally freed up some of the big chunks of time that I need for bigger projects.  Which feels awesome.

So, March goal?  Let's call it a success.

April Goal - Eat Food:

A lot of my time with patients is spent counseling them on living a healthy lifestyle.  Many of them hope that I hold a magical secret to living better, but in reality, my advice to them is always pretty basic:  Get exercise (30 minutes per time, 3-5 times per week).  Eat more healthy food (fruits, vegetables, lower-fat dairy, lower-fat meat/meat alternatives, whole-grain products).  Eat less unhealthy food (pop, chips, fast food, processed food, sugar).  Simple in theory, frustratingly difficult in practice.

After spending my days giving (what I think is) fundamentally sound advice, I unfortunately often go home and sit on my couch eating precisely the things I tell my patients not to.  I love pop.  And chocolate.  And ice cream.  And eating out in almost any restaurant, including the greasiest of greasy spoons.  I am an extraordinary hypocrite, and I know it's something I need to work on. 

About a week ago, my girlfriend and I watched an excellent documentary featuring Michael Pollan, an author who has written books about the problems with the industrial food system and with our current approach to eating healthily.  The documentary focuses around Pollan's simple advice on how to eat:

As I was watching the documentary, I was struck by how simple the advice was, and by how horribly I fail to live up to it.  Even though I actually like real, unprocessed, healthy foods.  The main reason I eat so much bad food is laziness and accessibility, both of which I can change.  So...I'm making two commitments for the months that fall under the heading of "Eat Food". 

1)  No pop.  It's something I don't need, and it's one of the worst things I can possibly consume.  So for this month (if not longer), I'm done with it. 

2)  Take one fruit and one vegetable in my lunch every day.  It's a small start, but it is at least a start.  I bought an assortment of vegetables at the grocery store today, I've cut up a bunch of vegetables to take in my lunches, and I'm ready to be successful at this one.

Now I'm off to Red Lobster for dinner.  I wonder if they sell any real food....

Goals: Review of January/Plan for February

Well...

My main goal for January, if you remember, was to go to the gym three times per week.  I think the best phrase to describe my performance is epic fail.  In total, I think I made it five times.  And the fifth only happened because my girlfriend resisted my desperate pleas to stay in the warm bed this morning and dragged me to the gym. 

Part of the failure wasn't my fault.  Soon after recovering from my horrible Christmas cold, at approximately the time when my chapped nostrils were starting to heal and I was getting used to being able to breathe without choking on phlegm, I got another cold.  So for at least 3-4 days I didn't have the respiratory function to run on the treadmill.  The rest of the failure was clearly my fault.  Some of the excuses I used for skipping the gym included not getting enough sleep, feeling groggy from getting too much sleep, the bed is warm, and of course "I don't want to".

I don't know how to do better.  While my resolve is generally good when I'm thinking about going to the gym during the day, it is abysmal at 6:45 in the morning when the room is dark and I am buried under my favourite duvet.  I'm hopeful that my girlfriend will be a positive influence, as she has committed to working out regularly, and she's vastly better at sticking to habits than I am.  (She still wears her retainer at night.  Over a decade after her braces came off.  I think I might have done that for a month, if that.)  I know that it isn't enough to rely on my girlfriend's commitment, but maybe her encouragement will help me in the early stages of developing this habit.

Recycled February goal:  Go to the gym three days a week.

My other January goal was to find a counselor.  Success!  Thanks to a service for physicians, I've actually been able to get an appointment with a psychiatrist for an initial assessment next week.  I'm a bit nervous about it because 1) it's in the hospital where I work and 2) I know some of the psychiatrists who are on the treatment team.  I can't say I like the possibility that someone I know, or worse yet one of my colleagues, could find out about this.  But...I believe very strongly that we shouldn't stigmatize mental illness, particularly in medical professionals, and one of the ways of breaking down the stigma is to show that good, competent physicians can struggle with mental health issues.  So I'm just going to suck it up and do it.

Second February goal:  Don't chicken out and skip the assessment with the psychiatrist.

Because it's rather boring to just recycle old goals, I'm setting one new big goal for the month.  I wrote recently about how much I hate winter, and my hatred just seems to grow as the season continues with no sign of an end.  Despite my plans to embrace winter, I've been doing a spectacular job of staying home on my couch, which isn't doing anything to make me a happier person.  So, I've set myself a goal of making two social plans with friends or family for every week in February.  It doesn't matter what it is, as long as it requires me to change out of my sweatpants and spend time with another person.  And it can't just be my girlfriend or friends of my girlfriend, as I'm way too reliant on her for social interactions (a problem when introverts date extroverts, and something I've been meaning to blog about for a while).  It has to be someone whose primary connection is to me.

It's been kind of fun to brainstorm things that I can do over the next month.  While restaurants and movies will undoubtedly feature heavily in my plans, I'm also thinking about taking my nieces to a play, having friends over for games, and hosting a potluck.  And maybe even going skating with friends in an attempt to get over my hatred of this miserable season.

Any other creative ideas?

Third February goal:  Spend time with people I love.  At least twice a week.  The girlfriend doesn't count.

2016 - Looking Ahead

Much of medical training is about deferring happiness*.  Every study session, every 24-hour-plus call shift, is an exchange of the fun things I could be doing now for the benefits I hope to get in the future.  In my case, I invested 16 years into post-secondary education with the expectation that it would make me happier in the long run.

It occurred to me recently that I have finally left the stage of deferred happiness.  The studying and exams and overnight call are all behind me, and the time for enjoying life is here.  The unfortunate thing, however, is that I have spent so much of my life looking ahead and waiting that it's hard to adjust to being in the present and enjoying it for what it is.  Whenever I think about my life, it is reflexively with a forward-looking gaze, wondering what is over the next horizon and how soon I will get there.

Which is something that I want to change.  So my overarching goal for 2016 is to learn to be present.  To stop thinking about what comes next and instead focus on what is happening now.  To enjoy the life of a physician that I worked so hard and so long to create.  To be mindful of the multitude of blessings in my life.  To do this, I plan to set little goals for myself, along the lines of the "gradual, long-lasting change" that I talked about in December.  I'll probably set one or two goals every month, although sometimes I'll set weekly goals just to try something out for a short while.  All of the goals will be focused on making life better in the now, rather than banking happiness for the future.

For January, my main goal is a resurrected one:  get to the gym three days a week.  I had been doing well prior to catching the cold from hell, but I stopped entirely when I was sick and missed about two weeks.  This week I regained the ability to breathe through my nose, so I started going to the gym again, and I've made it all three days (go me!).  This may seem like a goal with a more long-term purpose (lose weight, get healthy, don't die of a stroke at 40), but I'm really doing it for the way that exercise makes me feel in the present.  It helps my anxiety, it helps with sleep, and it simply makes me a happier person than when I'm sitting on the couch eating cheese.

My minor goal for the month is to find a counselor.  My job weighs on me emotionally - I feel anxious about the possibility of screwing things up, and I am at times devastated by the bad health outcomes that my patients experience despite my best efforts.  Although I'm coping with all of this, I don't want my work life to be just about coping.  So I'm going to try to find a counselor with whom I can talk and debrief periodically.

We'll see how I do at the end of the month.

*SLukettG writes in her typically eloquent way about this in a post entitled "Marshmallows".  Definitely worth reading.

Habits - December

I spend a lot of time with my patients talking to them about healthy lifestyles.  I talk about good food choices and how much exercise they need and strategies for making positive changes in a world that is pretty much optimized to make people fat.  And then I go home and sit on my couch eating cheese.

I have the misfortune of being someone who both hates exercising and loves eating (I suspect I'm not alone in this), so my natural tendency is to get larger with every passing year.  Over the course of my nine years of medical training, I gained approximately 30 pounds - over 3 pounds per year!  While that doesn't sound too bad, if I keep up the same slow rate of weight gain until retirement, I will be approaching 300 pounds by the time I get there.  Assuming my heart and my liver and my knees don't give out before I make it to retirement.

The other, and perhaps more important part of the healthy lifestyle equation, is that I simply don't feel good when I spend my life on the couch eating cheese.  Well...I must admit...I feel great at the moment when I'm lying horizontally in my favourite pjs and shoveling gooey cheese into my mouth.  It's the moments afterwards when I feel sluggish and tired and anxious and unable to focus that are less pleasant. 

For years, it's been easy to justify my choices, because I've simply felt so overwhelmed by the stress of medical training.  There were many days in medical school and residency when I felt like it took everything I had just to make it to bedtime, so I allowed myself to do (and eat) whatever would help me get through the day.  Now that I'm an attending, though, things are different.  I have much more control over how much I work, even if I sometimes don't make good decisions with that control.  I do far less call than before, and none of it is in-hospital call.  I finally have the time and the energy to start making some of the good choices that I talk to my patients about all the time.

So...how do I do that?  I've written here many, many times about wanting to make changes in my life, yet so far few of them have stuck.  Most recently, there were my four categories of habits that I wanted to adopt as an attending, which were so unsuccessful that I didn't even get around to blogging about the last two categories.  As I've been thinking about how to make the changes that I want to make, I keep coming back to the piece of advice that I give to all of my patients:  make gradual, long-lasting change.  No complete transformations on January 1 that last for less than a week.  No four categories of habits to adopt when you're starting a new job and dealing with all of the stress and adjustment that doing so entails.  Gradual, long-lasting change.

For me, the obvious first step is getting back to the gym.  I have pretty much the best setup for working out that anyone could have, as there is a gym two floors below where I live that costs me nothing, has brand-new exercise equipment, and is rarely used by anyone else.  My goal is to go three times a week:  Tuesdays and Thursdays before work, as I have no morning clinics on those days, and Sundays while my girlfriend is at church.  I'm not setting any specific requirements for myself beyond 1) getting to the gym and 2) spending 30 minutes doing anything that counts as exercise.  If I choose, I can spend the 30 minutes walking very slowly on the treadmill.  I just have to move. 

I've done okay with this the past few weeks, although today was the first day that I made it to the gym on Sunday.  I'm hoping that by making exercise part of my routine, like cleaning the litter boxes or showering, that it'll just become something I do without thinking about it. 

Wish me luck!

Check In - Home and Hobbies

About a month ago, I wrote a post about my goals for "Home and Hobbies" and promised to check in after starting work to let everyone know how things are going.  Here's the update:

Have two knitting projects on the go at all times:

I've been using knitting as a way of relaxing in the evenings (when I'm not mindlessly surfing the internet), and I've made some good progress on my knitting projects.  I recently finished knitting a baby sweater for a friend, and I just need to sew the hood and sleeves for it to be completely finished.  Her son is now seven months old, so it's a good thing I opted for the 18-month size!  I'm also almost to the end of knitting my first sock, which has been a six-month-long exercise in frustration; I may never knit the second one.

Now that I've finished knitting the baby sweater, I've essentially only got one knitting project on the go, so I need to find something else to work on.  I'm thinking maybe something mindless, like a prayer shawl (maybe a Christmas gift for my Mom?), or something big, like a cozy sweater for myself.  Ravelry here I come!

Cook regularly with my girlfriend:

This one has been fairly successful.  We have a ton of produce from our CSA share (too much zucchini), so we've been doing a lot of cooking in an attempt to avoid wasting the beautiful organic vegetables.  I also finally got our BBQ cleaned off, so we've been eating a lot of charred meat.  I feel a bit like a caveman.

Read for pleasure every day:

This one got off to a very slow start due to exhaustion and my unfortunate technology addiction, but it's starting to pick up.  After starting a few books that didn't hold my interest, I finally found "Chasing the Scream", which is a fascinating book about how the prohibition of drugs has led to the worldwide drug war.  If you have even a passing interest in drug laws or racism or gang violence, you should read this book.

Now that I have a good book, I'm finding some time almost every day for reading.  Unfortunately, I'm approaching the end of this book, so I'm not sure what I'll read next.  Any "must-read" books that you'd suggest?

Keep up with my finances:

I've probably been doing too well with this.  I've continued to track my budget on my iPhone, and I've started tracking all of my billings in an Excel file so that I can confirm that I'm being paid properly for the work I do.  All of the monitoring has made me a bit obsessed with money, and I'm finding that I get unreasonably anxious whenever I spend money or drop below a budget surplus that I've arbitrarily decided is "enough".  I'm hoping that the anxiety will wane as I get a better sense of my income and as I make progress with paying off my debt.

Spend time daily and weekly on keeping the apartment clean and organized:

Remember when I said "This will be a challenge.  A huge challenge."?  I was correct in my assessment.  Cleaning and tidying have been the lowest priorities in my life lately, so the clutter and disorganization are starting to return.  It's been made even worse by the fact that my girlfriend has been going through her own work transition, leaving her with neither the energy nor the motivation to help out much.

We have been doing a few things right, thankfully.  We've been keeping up with the dishes and cleaning the kitchen semi-regularly, which means that there is usually space in the kitchen for cooking and eating.  I've also been doing laundry every Sunday morning, so my laundry pile is small and I always have clothing to wear.  I've also been filing my mail as soon as it comes in, which is keeping me more on top of bills and other important things than I usually am.  So all in all, not a total failure with this goal.

Any goals that you've been working on lately?  How are they going?

Evening Routines

OMDG posted today about her challenge with evenings, which got me reflecting on my own evening routine since starting back at work.  When I was on holidays, my plans for my work evenings were very ambitious - cook tasty dinners with my girlfriend, clean the kitchen, take care of housework/paperwork, exercise, and read stimulating and erudite books.  Shockingly, the reality has been somewhat less impressive.  Despite not actually working that hard yet (I'm only working about half-time at the moment), I've been coming home mentally exhausted every day, and I haven't been able to motivate myself to do most of the things I would like to.

Currently, my post-work schedule looks something like this:

1)  Arrive home and dump all possessions (lunch bag, purse, backpack, jacket) in the front hallway.  Ignore voice in the back of my head that tells me that I should be putting things in the spaces I created for them.

2)  Cook dinner with my girlfriend.  This varies from spending 2-3 hours making an elaborate dinner (we love cooking) to BBQing hot dogs and eating potato chips from the bag.

3)  Spend way too much time on the computer.  Facebook, blogs, news, repeat.  I haven't mastered the art of turning off the computer when there is nothing good left to look at, so this eats up a lot of time.  On a good day, I write a blog post of variable quality.

4)  Watch something on Netflix with my girlfriend.  Lately we've been watching Human Planet, which is actually a decent and not entirely mind-numbing show, so it could be worse.

5)  Look at the stack of library books on my coffee table.  Decide it isn't worth the effort.  Possibly watch another Netflix show, usually of lower quality than Human Planet.

6)  Feel progressively more exhausted.  Resist the urge to go to bed like a reasonable human being.  Repeat item #3.

7)  Realize it's past my bedtime.  Rush around trying to make a lunch, pack my work bag, feed the cats, and do anything else that needs to be done.  (Feeding the cats is the only thing I consistently accomplish before bed, and that's only because they meow at me.)

8)  Finally get to bed much later than I should.  Realize that eight hours of restful sleep has become an impossible dream.

9)  Lie awake staring at the ceiling, regretting all of the things I didn't do.

This is something I need to work on, because evenings make up a lot of the quality time I have for myself and my girlfriend outside of work.  Looking back on this time of my life, I don't want Facebook and Netflix and a cluttered apartment to be my most vivid memories.

How happy are you with your evening routine?

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.

Habits - Home and Hobbies

As I was reading Gretchen Rubin's book "Better Than Before", I kept thinking about habits that I've recently incorporated into my life, as well as habits that I'd like to adopt.  There are so many of them, most of which unfortunately fall into the latter category.  Over the next few days, I plan to write posts outlining the habits I'd like to have in four different broad categories:  home and hobbies, personal, work, and relationships.  (Not necessarily in that order or on four consecutive days.  I'll pick my topics as the mood hits me.)  Because going back to work is going to make habit change challenging, I plan to do a check in on my habits once I'm two weeks in (and finished my first stretch of call as an attending).

In deciding on the habits on which to focus, I'm trying to remember that the end goal isn't to adopt good habits - it's to be happy in both the short and long term.  If these habits aren't making me happier, then I can choose to drop them whenever I please.  (Isn't being an adult wonderful?)

So here we go with habits in the home and hobbies category.  The habits are roughly arranged from what I consider to be least important to most important.

Have two knitting projects on the go at all times: 

I started knitting sometime in the last year after being inspired by the many women (and some men!) at my girlfriend's church who knit.  Some of them knit during the services, and many more of them knit at social events, and I was always jealous when I watched them work.  Since I started knitting, I've knit three infinity scarves (one for myself and two for my nieces), as well as almost one sock and almost one baby sweater.

I love a lot of things about knitting - dreaming about projects and picking out nice yarn, watching a project slowly come together over weeks to months, and having something to distract me when I'm in a boring or awkward social situation.  I also like that it's slightly subversive to be a knitting physician.  Physicians are supposed to be constantly rushing and stressed and short on time, so I love the idea of doing something that is intentionally slow.

This is something that will undoubtedly wax and wane depending on how busy I am, but that's okay.  Knitting projects can sit idle for a long time and then be picked up when needed.  I'm choosing to have two projects going, as it's nice to have something that gives me a bit of a challenge (e.g. a baby sweater) as well as something that is purely mindless and relaxing (e.g. an infinity scarf).

Cook regularly with my girlfriend:

My girlfriend and I both have a huge love of cooking and of trying new foods/recipes, and it's one of the things that brought us together early in our relationship.  We've unfortunately fallen out of the habit of cooking together recently, as my girlfriend's job has required her to stay at work until after the supper hour.  I think our relationship has suffered as a result of us not cooking and eating together, and it's something I want to work on.  Thankfully, starting next month her days will be ending at 5 PM, so hopefully it won't be hard for us to get back into this habit.

Read for pleasure every day:

Have I mentioned recently how much I love books?  I love reading once I get into it, but I sometimes avoid it when I'm tired, because checking Facebook/surfing the internet/watching tv seems easier and more relaxing.  Which it isn't; reading is definitely more relaxing than any activity involving technology.  I want to maintain the habit I've developed this summer of always having a book going and of reading every day.

Keep up with my finances:

I was a bit of a financial disaster during my training.  Not only did I not budget, I also did terrible things like file my tax returns late (really, really late) and occasionally miss a credit card payment.  I've finally gotten on top of everything financial, including meeting with my financial adviser to figure out my get-out-of-debt-as-soon-as-humanly-possible strategy, and I want to keep it that way.  To do this, I plan to deal with financial things (bills, etc.) as soon as they come in, even if that means waiting a day or two to check the mail until I have time to deal with it.  I also plan to set aside time on Sunday mornings (while my girlfriend is at church) to quickly review my bank/investment statements and to do anything financial that didn't get done during the week.

Spend time daily and weekly on keeping the apartment clean and organized:

This will be a challenge.  A huge challenge.  I've done very well this summer at getting the apartment decluttered and organized, and I've managed to adopt the habit of doing annoying little tasks (like unpacking from our weekend camping/wedding adventure) as soon as they come up.  The apartment is so much tidier as a result, and it facilitates things like cooking and reading and other fun activities.  But doing tasks when they arise isn't my default setting, which means that this will be really hard to maintain once I go back to work.  And my girlfriend is much more tolerant of chaos than I am, which will make it hard to get her on board!

My first strategy for achieving this is to set aside dedicated times for cleaning and tidying.  On a daily basis, this will mean taking a few minutes when I first arrive home to hang up my jacket/purse and empty out my lunch container, as well as spending some time doing dishes before bed.  On a weekly basis, this will mean spending some time every Sunday morning doing laundry and tackling some of the items on my to-do list.

My second strategy is going to have to be talking to my girlfriend.  While I've been on holidays, I've assumed the majority of the household responsibilities, and it's gotten stuff done, but it won't be sustainable (or fair) once I go back to work.  As difficult as it may be to do, we need to come up with a way of dividing up the household tasks.  The big challenge for me will be accepting that we have different ideas of what needs to be done around the apartment; therefore, if I want things done better than she does, I may need to do a bit more of the work.

Hmmm....it seems like I have my work cut out for me.  And this is only day one of four!