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.

2019 - The Year of Breaking Open

I'm not big into dates, but for some reason I love the start of the new year.  Even though there's nothing magical about the transition from December 31 to January 1, it always gets me reflecting on the previous year and thinking ahead to the next.  When I re-read my New Year's post from this year, I had to laugh at my intention for 2019:

"And what for 2019?  Mostly, I want to keep going on the path that I'm already on.  I want to remain in the present moment, enjoying it when I can and learning from it when I can't."

Learning from it when I can't describes so much of the past year.  I existed in a state of near-constant stress for months, and then I basically fell apart when the chronic stress became too much.  For weeks, I wasn't certain if I would choose to (or even be able to) stay at work.  It was horrible.

Probably the wisest thing I did, and something that was only possible because of my mindfulness practice, was stay present in the tough moments.  My mantra through that time, which I would sometimes recite multiple times in a day, was "Be patient.  Be present."  I somehow knew that, if I could just show up for those moments, that I would learn something important from them.

And I have learned an incredible amount over the past year.  I've learned that I am limited in how much I can do well (as is everyone), and more importantly, I've learned that I have the support of my institution to set limits on my work.  I don't have to overbook all of my clinics.  I don't have to work through weekends most of the time.  I don't have to say yes to every administrative task that comes my way.  I can (and absolutely must) say no.

I've also learned that I am very hard working, even though I don't always feel that way when I compare myself to the overachievers who seem to be everywhere in medicine.  I regularly go beyond what I need to for my patients, and I show up for them even on the days when I would rather pull the covers over my head.  I'm committed to the work that I do, and I put in the effort needed to be a really good doctor.

Overall, as hard as a lot of the past year has been, I'm really proud of myself for getting through it.  And for not quitting my job!  Because it's generally a pretty good one, and I do a pretty good job at it, if I may say so myself.

How FIRE led me to Burnout

For a physician, I think and talk and write a lot about taking time off.  Two years ago, I committed to taking vacation every three months, and I have done a pretty good job of sticking to that ever since (I even took an extra vacation this year!).  I talk to trainees all the time about taking time away from work in order to maintain their mental health and have some joy in their lives.  So, until recently, I really thought I had the right mindset with respect to so-called work-life balance.

Except...underlying everything has been the idea of FIRE.  Work my ass off for a few years, save as much as possible, and then run away to a life of complete freedom and constant joy.  The dream!  While I still allowed myself vacations, the desire to have enough money to retire as soon as possible led me to make other bad decisions that were perhaps worse than never taking time off.  Sure, I'll add more patients to my already overbooked clinic.  Sure, I'll take on some lucrative contract work that I don't have time for.  Sure, I can do an extra Friday afternoon clinic even though I'm barely clawing my way to the end of the week as it is.  I convinced myself that I was being a good doctor by seeing more patients, but if I'm being honest, the real driver was the extra money that could go directly into my retirement savings.

And so, as I've already written about, I crashed in a somewhat spectacular way.

I'm actually kind of thankful for the crash (or, at least I think I will be when I look back on it someday), because it has forced me to reevaluate my decisions.  And two big things have come out of my months of self reflection.  First, continuing to work at as a physician is the best option for me, at least in the present.  I have contemplated taking a significant chunk of time off or quitting to pursue another career altogether, but when I look at it in the most practical of ways, doing so doesn't make any financial sense.  I could go part-time as a physician and earn more than I would doing most other jobs.  In the years it would take me to study to do something else, I could work full-time as a physician and save up most of what I need to retire.  My current reality is that I need to work to pay bills and save for the future, and medicine is by far the most efficient way of doing that.  As an added bonus, I also often like my job, at least when things aren't as overwhelming as they have been recently.

Second, and probably the more important, is that I need to stop making my decisions from a place of fear.  While part of my motivation for achieving financial independence has been a desire to not work, most of it has been a desire to not need to work.  To know that, whatever illness or mental health crisis or government overhaul of the healthcare system may hit, I am going to be okay.  Because as a single person with no one else to rely on, I worry a lot about my financial future, even when there's zero necessity to do so.  And that is a really unpleasant and unhealthy approach to money.

Thankfully, things at work are starting to get better.  I have only one slightly overbooked clinic left, and my clinics are going to continue to get lighter over the next few months until I achieve a point of actually being slightly underbooked.  I'm at the point where I can usually get my work done within the 45 hour a week maximum I've set for myself.  I'm scheduled to start six days of call tomorrow, and I'm not having panic attacks or suffering from intractable insomnia.

There are moments when I'm actually enjoying my work and remembering why I became a physician in the first place.

So I am going to keep practicing at letting go of all the things that have been driving me to burnout.  Letting go of my obsessive tracking of my net worth.  Letting go of the countdown to retirement.  Letting go of the belief that the future is going to be so much better than the present, and the desire to burn through time in order to get there.

I'm going to try, as much as I can, to live in the now.  To enjoy what I have, to be grateful for all the good, and to simply breathe.

Usted Esta Aqui

M and I just came back from a lovely week in Cuba.  It had been seven months since my last true vacation (a week off at home for our local theatre festival in July), and I was starting to crack a bit under the strain of constantly having to be on for other people.  A week of sun and books and more alcohol than is recommended was somewhat desperately needed.

The setup was perfect for relaxing.  We were in an all-inclusive resort, so the most strenuous thing required of us was walking from our table to the buffet to refill our overflowing plates.  And yet, despite being on vacation, I found it hard to turn off the constant chatter in my brain.  When eating, I would be thinking about the books that were waiting to be read; when reading, I'd be wondering what was going to be served at our next meal.   When on the beach, I'd be wondering if I would've been happier spending the day in Havana; when in Havana, I would dream about the beach. 

My distractible brain, my ever present companion at home, had followed me to paradise*.

I am so accustomed to my constant thoughts about what else I should be doing and what needs to be done next that it took me days to recognize how ridiculous they were in paradise.  My moment of clarity happened on the beach, when M was snorkeling in the shallow water and I was walking beside her.  I had just come out of the water myself, and I was feeling a bit chilled, and all I could think about was wanting the walk to be over so that I would be back at my beach chair and wrapped in a warm towel.

And then I paused.  And I thought "Why on Earth am I wishing this time away?"  Wanting to be back at the beach chair wasn't going to make the distance any shorter or make M swim any faster.  All it was going to do was rob a perfectly good moment of any potential for happiness.  So I stopped, and instead of feeling my usual impatience, I took a look around me.  At the people and the palm trees and the mountains all glowing in the warmth of the late day sun.  And I realized that I was literally in the middle of a postcard.

A postcard that I had almost missed, because all I know how to do anymore is rush from what I am doing to whatever it is that comes next.

*I recognize that I am very privileged to view Cuba as "paradise", as that isn't the experience for many of its citizens.   

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?

The Way Things Should Be

Like a number of my favourite bloggers (see here and here), I recently read Leo Babauta's post about how to not be frustrated all the time.  In the post, he argues that frustration arises from our desire for things to be different from how they are.

"It’s from not wanting things to be a certain way. Not wanting other people to behave a certain way. Not wanting ourselves to be a certain way."

 Yup.  Welcome to my life.  After reading the post, I started paying attention to how much mental energy I expend wishing that things were different, and I was shocked by the fact that there is pretty much a never ending stream of thought going through my head that judges everything in my life as inadequate.  For example:

When waking up in the morning: "I wish it wasn't Tuesday and that I didn't have to get up and go for a run, because I'm tired and want to stay in bed under the warm covers and running sucks and I'm out of shape and I'm never going to get in shape anyway."

When walking to clinic:  "I wish I didn't have so many patients booked because I'm sure some of them are going to be really challenging and then I'm going to feel rushed, and feeling rushed makes me stressed, and I hate being stressed, and if I were a better doctor I would never feel stressed."

When dictating:  " I hate dictating, it's so boring and it takes so much time, and I don't have enough time for fun things or for more important work because I'm always spending time dictating, and if I were a better doctor I wouldn't take so long to do my dictations."

When leaving work:  "It's nice that work is over, but the evenings are never long enough, and I have to do things that aren't fun like cook supper and wash dishes and that always ruins the little bit of time I have when I'm not working."

And on and on and on.  The funny thing is, before paying attention to my thoughts, I would have described myself as a positive person.   I'm generally pretty happy, and I'm usually able to find the positive side of a situation, so I was shocked to realize just how much negative crap goes through my head on a daily basis.

Once I was conscious of my thought patterns, I realized how incredibly draining all of the negative crap is.  So I'm trying to change it.  I'm trying to follow Babauta's advice to become aware of my frustration and to let go of my expectation that things will always go my way.

"You want things to go your way, want people to behave the way you want them to. But you don’t and can’t control the universe. You aren’t entitled to getting everything your way."

Now, when I start down the horrible negative thought death spiral, I try to catch myself and be aware of it.  And then I try simply to not engage in all of the negative thinking (sometimes easier said than done).  I acknowledge that I would rather be on my couch drinking an Old Fashioned than sitting in my office doing my 12th dictation of the day, but that isn't my reality.  Or that I wish my girlfriend wouldn't look like she's on a terrifying roller coaster ride every time I drive, but that is my reality.  And I am better off accepting these things (as much as I can) than I am constantly raging against them.

The amazing thing to me is that it's actually helping.  I don't dread dictations and paperwork nearly as much as I used to, and I'm more efficient at them because I'm not wasting time feeling like the most hard done by person on the face of the Earth.  I'm not freaking out when I take longer than planned with a patient, because I know that there is some cushion in my schedule, and life will go on even if my clinic runs overtime.  Things feel surprisingly easier, despite making what seems like a very minor change in my thinking.

Since that Babauta post, I've encountered the same ideas in a few different places.  (It's almost like the universe is trying to tell me something.)  I went to a workshop about physician burnout on Friday, and there was a session on mindfulness meditation that explored the same concepts.  I recently finished a really good book called 10% Happier, which is about a tv anchorman's experiences with mindfulness meditation.  The more I encounter the idea, the more I think I might benefit from spending more time exploring the concept of mindfulness.

Which will unfortunately have to wait, because on Thursday I hop on a plane for three weeks in Egypt, Greece, and Jordan.  While this sounds wonderful (vacation!), I'm honestly a bit terrified, because there are going to be some major challenges.  Such as 24 hours of travel, jet lag, staying in an apartment that is 100 stairs from the main floor (no elevator), highs of 44 C*, crowds, noise, and two out of three weeks spent with my girlfriend's family.  Oh, and the fact that most of the places we're traveling to hate the gays, so we'll have to pretend that we're roommates.  My goal for the trip (Let's call this my May goal, shall we?) is to be mindful of all the things about travel that frustrate me and to do my best to let go of them.

Or, at the very least, to not have a screaming match with my girlfriend in front of the pyramids.

*I think the hottest I've ever experienced was about 35 C, and I felt like I was going to die.