One Month In - How Am I Doing?

You may recall that I set some pretty ambitious (for me) goals at the beginning of the year.  So how is it going one month in?

The Good:
"meditating every day"  I have done this!  I was pretty well established with my weekday morning practice, so my main challenge here was finding a way to meditate on the weekends.  Initially, I thought that I would meditate first thing in the morning like I do on weekdays, but this literally never happened.  Turns out, I really enjoy sleeping in and getting a lazy slow start to weekend days, and there is no part of me that wants to start the day on a meditation cushion.  So I have been doing it before I go to bed on weekends, and it has gone perfectly so far.

"I mostly just want to keep working and hoarding money for the future" I had nine days of very busy call this month, so I have done a lot of hoarding of money.  It's lovely for the net worth, but I would honestly like to do a little less earning and a little more resting.

"I want to keep building on the friendships I have."  I've also been doing this!  Even though it's been a busy month, I've made time to go with friends to see our local queer choir, to visit my godson and his family, to go for dinner with my brother, and to go out for dinner and a play with my mom and her partner.  (I think there has been more?  It's a bit of a blur.)  For an introvert who has been busy with work, it has been about the maximum amount I can expect of myself.

The Not As Good:
"I would like to work on keeping up with everything."  This has been very mixed.  One of my proposed ways of achieving this was "just doing the shit now", and I have definitely incorporated this approach into my life, to good effect.  I am constantly trying to spend a few extra minutes to do all the nagging little tasks as they come up, and as a result I'm getting a lot more done without it feeling overwhelming or like a giant burden.  And I'm worrying less about missing things.  Perfect example - I got an application for reimbursement of a work expense, which isn't due until April.  My initial instinct was to put it in my to do pile (I had three months to do it, after all), but instead I took the five minutes required to fill it out, put it in the return envelope, and put it in the mailbox.  And now it's done, and I don't have to worry about missing the deadline for getting money back.

The biggest challenge has simply been that work has been really busy.  In addition to nine busy (and really emotionally exhausting) days of call, I had a week of teaching, and I've taken on a new volunteer position with a national organization (You know.  Because that helps with burnout.)  I've worked at least part of one weekend day every week since the beginning of the year, and still things are slowly starting to build up.  It's frustrating.

And as for my "go to work earlier and stay later" approach?

Ha.
Ha.
Ha.

When I was writing my original post, I had the (utterly ridiculous, I don't know where it came from) idea in my head that I sometimes go to work late or leave early because I'm lazy.  This past month has reminded me that it's actually because I'm tired.  I have a limited number of productive work hours in me every day, and once they are finished, there is no value in me sitting in front of a computer trying to work.  I need a mental break.  So those days when I leave early are usually because I'm mentally shutting down and ready for the day to be over.  And the days when I arrive late are usually because I've been suffering from insomnia and have allowed myself an extra hour to catch up on some sleep.

This has been an important reminder to not be too hard on myself and to extend myself a bit of grace.  I am human, and I can only do so much.  It's also a really important reminder to set boundaries and to not apologize for doing so.  At the moment, I'm having to set some boundaries on fun things in my personal life, but I'm hoping as the year goes on and my call schedule settles down a bit that the boundaries will be more towards work.  I've also firmly decided that I'm going to give up a volunteer commitment at the end of the year (I reeeeealy should've given it up at the beginning of the year, but I got talked into agreeing to another year), which will free up one precious evening every month.

The Total Nope:
"I'm aiming for a regular practice of four yoga classes per week"  At best so far I've made it to three classes in one week.  Things have just been busy, and in some cases (call) I've had to skip yoga, and in other cases (social life) I've chosen to skip yoga.  Part of me is sad, because I really do love it and am seeing a lot of progress, but I'm also making peace with it.  I have a really full life, in mostly good ways, so it's okay that I'm not being absolutely perfect at everything.

So that's the one-month check in.  As for February?  I have three more weeks off call (yay!), during which I'm fully intending to get caught up on everything work related (plausible if I do some work on weekends), after which I have one week on, one off, and one on.  Ugh.  I'm intending to keep up with the daily meditations, as I do think they help keep me present and calm, even though my brain feels squirrely while I'm doing them.  I'm going to try to do three yoga classes a week, as I think it's more realistic than four right now.  And, perhaps mostly importantly, I'm going to keep learning from the process and being kind to myself.  I'm actually doing pretty well at things that are hard, and I deserve to be proud of myself for that.

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.

Words

In March of last year, about 5 months after my major breakup, I decided that I was ready to start dating again.  I had gotten past my initial euphoria at leaving a bad relationship, allowed myself to grieve the good parts, and reached the point where I felt okay with being single.  I was ready.

As I was getting back into dating, I distinctly remember thinking about how good a mental space I was in.  I felt like I had worked through a lot of my old demons (anxiety, self doubt) and kind of figured things out.  I understood shit.  I can even remember, in one particularly arrogant moment, thinking that I had learned most of the big things in life and really didn't have that much more to learn.

(Cue deep laughter from the universe.)

In my last post of an unsuccessful NaBloPoMo, I wrote somewhat glibly about starting to meditate, completely diminishing the magnitude of the impact it has had on me.  On one level, it has done what I expected it to:  made me appreciate the present moment more, helped lower anxiety, and improved my always inconsistent sleep.  What I completely didn't expect was the deeper changes it has brought about*.

Through meditation, I am learning to see everything more clearly.  I am getting more comfortable with difficult things and learning to sit with them so that I can understand them better.  Habits, thought patterns, relationships.  The last half of this year feels like a veritable explosion of self understanding and personal change.  Far more has happened than I can possibly capture in a single New Year's post.

It became popular a few years ago to choose a word for the year as a way of setting an intention, and while I didn't do it at the beginning of 2018, in retrospect, my word for the year was clearly growth.

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. 

2019 is going to be all about mindfulness.

*This whole post feels so hokey, and if I'd read someone else's version of it a year ago, I'm sure I would have rolled my eyes and accused the writer of having drunk the magical kombucha. 

Do I Need to Make Resolutions?

Since the end of 2017, I've been thinking a lot about writing a resolutions post.  I've been reading everyone else's posts, in which they talk about their goals of saving X dollars or losing Y pounds, and I've been thinking I should do that too.  But as I read these posts and think about writing my own, I find myself paralyzed by the fact that I have no idea what to resolve.

My challenge with resolutions is twofold.  First, I am not a person to make a resolution for the sake of doing so.  If I commit to doing something, it has to be because I believe that doing so is going to make me happier or is somehow going to make me a better person/make the world a better place.  Second, I am really, really bad at keeping resolutions.  Like my recurrent resolution to exercise.  A look at my last post about exercise shows that it starts with a paragraph bemoaning my failures:

"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."

I worry that committing to anything, especially exercise, will inevitably lead to me writing a follow up post in a month or two talking about how miserably I've failed at my commitment.  Which makes me ask the question, why do I feel like I need to write a resolution post?

While part of this feeling is just the feeling that I should be doing what everyone else is doing, I think another part of it is a desire to create some sort of...shape in my life.  I feel like I'm in a phase in life in which I go to work, pay off debt, save for retirement, learn a few more words of French, and keep repeating ad nauseam.  I'm 7-10 years away from hitting FIRE, and I will likely keep working even when I reach FIRE, so this is not going to be a short phase.  There is an incredible monotony to this stage, and I wonder if I could somehow break up the monotony with a resolution.  2018 will be the year that I become a true minimalist/ban all shopping/run a marathon...something other than just the year in which I keep going to work every day and slowly trudge forward with life.

Hmmm.  This post is turning out much darker than I had expected.  Maybe because I'm alone on a Friday night and it's -26C outside and I drank a glass of Malbec before I started writing?  Maybe because I got word that a longtime patient of mine died yesterday, and I can't quite believe that he's gone, so the sadness that I haven't yet allowed myself to feel is coming out in other ways?

There is part of me that is longing desperately for a solution to this.  To be able to say that I am going to do X in 2018 and everything is going to be perfect.  But maybe life doesn't work that way.  Maybe it's harder than we all like to pretend it is, and we can't solve everything with a resolutions post.

2017 - The Year in Review

I love the end of the year.  Partly that's because I have time off (10 days this year!), and partly because I love to reflect back on the year that was. 

2017 has been a pretty major year in my life.  I started it in a long-term relationship with plans to buy a home and eventually get married, and I ended it single with cats.  But in a very good way.  I can't remember a recent time in my life when I felt as happy or as deeply satisfied with life as I do at the end of 2017.

Here's a brief recap of the major events of 2017:

The Breakup:  M and I went through a breakup in 2016 but very quickly reconciled.  In retrospect, reconciling was a really unwise thing to do, as we were even less happy in round two of our relationship than we had been in round one.  We loved each other a lot, but we couldn't actually live happily together, which is somewhat essential for a committed romantic relationship.  For me, I started seriously considering breaking up again about a year ago, and from December 2016 until September 2017 breaking up was rarely far from my mind.  It was a really unhappy way of living.

And then, it was over.  After months of thinking and agonizing and building up to the moment, I finally ended it, and I felt like I could breathe again.  All of the emotional energy I had been investing in a relationship that wasn't working was suddenly available for more interesting and life-giving things.  Like joining Twitter.

I have not regretted the breakup for a single moment.  It has been an adjustment, of course, but everything about it feels right.  People comment regularly that I look happy and that they are glad to have "old me" back, and it is true that I am happier than I have been in a long time.  I have time to spend with my friends, instead of my social life being mostly dictated by M*.  My apartment is tidy and back to the semi-minimalist state that I love.  My cats have regained their rightful place next to me on the couch.  All is as it should be.

Work:  At the beginning of 2017, work wasn't going well.  I was feeling so overwhelmed by it that I declared 2017 "The Year of Saying No" and resolved to turn down as much extra work as I possibly could.  I knew at the time that I couldn't sustain my level of work unhappiness in the long-term, so I committed to doing whatever I could to improve my job.

Over the past year, I have made some major changes.  One of the most important ones has been going to a performance coach, whom I shall call B**, and whom I promise to write about in more detail in a dedicated post.  B is trained as a clinical psychologist and used to work with high-performance athletes, and over the years he has transitioned to working with high-performance professionals such as physicians.  He and I have worked on improving my thought patterns using a sort of cognitive behavioural therapy "light", which has been hugely helpful for dealing with my anxiety around work.  He's also given me some very practical advice about things that I can do on a daily basis to enjoy work more.

I have also committed to taking vacation every three months.  I cannot overemphasize how life changing this has been.  Vacation time is the only time that I can completely let go of the stress of work, and it is essential to recharging my easily depleted batteries.  It also gives me time to stock up at Costco and to replenish my freezer food stores.  And when I return from vacation, I no longer feel the dread of knowing that the next one is a long way away.  At most, it's another three months.

Lastly, I have been saying no.  When I was stressed about having to give a Grand Rounds presentation, I said no to a week of call so that I would have time to work on it.  When I got my 2018 call schedule and saw that I was scheduled for two more weeks than usual, I found other people to take those two weeks.  When I was asked by the trainees to develop two new teaching modules during a very busy work time, I agreed to do one but not both.  I am valuing my time and my mental health more than I ever have, and I am protecting both of them by setting my own limits for what I'm willing to do.

Finances:  When M and I were still together, we were planning to buy a home, as our one bedroom apartment was too crowded for the two of us.  For over a year, I saved all of the money that I didn't spend or invest for a down payment.  After the breakup, I underwent a major change of heart, realizing that I wasn't going to be comfortable taking on a mortgage until my debt was gone.  Since then, debt repayment has been my financial priority.  You can see the change in my line of credit here:

Until September 2017, my debt was gradually trending downwards thanks to my minimum monthly payments.  But in both September and December, I put large chunks of my down payment towards the debt.  What was once over $200,000 of debt is now $64,000.  And I anticipate that I will be able to get rid of it all before the end of 2018.

So those are the big parts of 2017.  There is much more than I had thought about saying, but this post is already long, and if I were reading it I would have started skimming it a long time ago.  So I will save my other thoughts for future blog posts.

I'm looking forward to sharing more in 2018.

*Not to falsely imply that she was controlling in any way, as she wasn't.  She is simply an extrovert with much higher social needs than introverted me, so I never had energy for social activities beyond the ones that she arranged.

**I am very creative with names on the blog.  You're welcome.

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.