I've been feeling quite resentful about having only three days of holidays for Christmas this year*. For the past two years, I've had a full week off, and I've loved having some time to sleep and read and recuperate, in addition to the time spent rushing around celebrating with family. I can't complain too much, though, as the short holiday was entirely my own doing. Back in July, when I was feeling crippled by my six-figure debt, I decided it would be best to maximize my income by taking as little time off as possible. (Big mistake)
Apparently, my body decided this week that it was finished with my busy work schedule that has far too often spilled over into the evenings and weekends. When I started my afternoon clinic yesterday afternoon, I noticed that my throat was a little sore, and my energy level was starting to wane. By the third patient, I was starting to feel like death. By the end of clinic, I wasn't certain that I would make it home. I spoke with my clerk before leaving for the day, who told me that I had seven new patients in today's morning clinic. I bravely said "I'll be there" as I left her office, but by the time I made it to my office I had started rigoring. Who was I kidding? I called her back and cancelled today's clinic.
After 17 hours in bed, three naproxens, and a good schluck of generic Nyquil, I'm starting to feel human again. My plan for the day is to spend most of it on the couch catching up on the Walking Dead. There will also be lots of juice, chicken noodle soup, and maybe some Kraft dinner. If I feel really ambitious, I'll make creme brulee for Christmas eve dessert. We shall see.
Wishing everyone who celebrates it a Merry Christmas! Hope you're feeling better than I am.
*For the people in healthcare and other fields who have to work through holiday, I am truly sorry. Been there, done that. I know that three days off is better than many people get.
Wednesday, December 23, 2015
Wednesday, December 16, 2015
Ripples
Monday night was a terrible, terrible night during which I tossed and turned in bed, thinking about the 2-hour presentation that I had to give later in the day and the curriculum that still hasn't been redeveloped and all of my sick patients who keep getting sicker. By the time the alarm went off at 6:45, I was a bit of a wreck. The evil voice in the back of my head kept telling me to skip the gym and go back to sleep, and it even managed to convince me to hit snooze and roll over.
But as I lay there trying to enjoy my nine minutes of reprieve, I realized that a little bit of extra sleep (if I could even get it) wasn't the right answer. It wouldn't be enough to make a difference in my energy level, and it would mean one more failure in my attempt to get back to exercising. So I got myself up, put on my workout clothes, and dragged my tired body through 30 minutes on the treadmill.
Afterwards, not surprisingly, I felt better. More awake, more energetic. Vastly less anxious. The feeling carried me through the day, up until the point where I started my presentation and all of my self consciousness and stage fright came back in one horrible moment of panic. But that eventually passed (after two hours of being stared at by everyone in the room who was still awake), and I felt okay for the remainder of the day. And then, last night, I actually slept through the entire night. Which, to someone with chronic insomnia, feels like a Christmas miracle.
Today, having slept, everything feels easier to handle. I have a schedule for getting the curriculum done by next week. I have plans for all of my sick patients. Life is better. Exercise is good.
I just need to remember this when I don't want to go for a run tomorrow morning...
But as I lay there trying to enjoy my nine minutes of reprieve, I realized that a little bit of extra sleep (if I could even get it) wasn't the right answer. It wouldn't be enough to make a difference in my energy level, and it would mean one more failure in my attempt to get back to exercising. So I got myself up, put on my workout clothes, and dragged my tired body through 30 minutes on the treadmill.
Afterwards, not surprisingly, I felt better. More awake, more energetic. Vastly less anxious. The feeling carried me through the day, up until the point where I started my presentation and all of my self consciousness and stage fright came back in one horrible moment of panic. But that eventually passed (after two hours of being stared at by everyone in the room who was still awake), and I felt okay for the remainder of the day. And then, last night, I actually slept through the entire night. Which, to someone with chronic insomnia, feels like a Christmas miracle.
Today, having slept, everything feels easier to handle. I have a schedule for getting the curriculum done by next week. I have plans for all of my sick patients. Life is better. Exercise is good.
I just need to remember this when I don't want to go for a run tomorrow morning...
Sunday, December 13, 2015
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!
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!
Sunday, December 6, 2015
The Most Wonderful Time of the Year
I find the Christmas season stressful. I'm a person who prefers being undercommited to being overcommited*, so I get easily overwhelmed by the addition of holiday parties and gift buying and dainty making to my schedule. (But not the dainty eating. I'm always game for dainty eating.) Last year was particularly challenging for me, as it was my first Christmas with my girlfriend, and we tried to fit in all of the gatherings and traditions that are important to both of us. It was too much, and it left both of us (mostly me) exhausted by the end.
This year, I thought I would cut back on my stress level by being on top of my game from the beginning. I would make all the dainties and buy all the gifts and stock the liquor cabinet early so that once the celebrating began, I would be ready to just enjoy myself. And I was doing okay, up until the point two weeks ago when I said "Why yes, I'd be happy to revamp the entire curriculum before January"**.
Wait...what? Who agreed to revamp an entire curriculum in six weeks? At Christmastime? It couldn't possibly have been me, because I am a rational human being who recognizes her limitations and doesn't take on utterly ridiculous and near impossible tasks.
Aren't I?
Apparently I'm not. Because I did take on that task at precisely the time when I most want to be scaling back and enjoying my life outside of work. And if I could find a way to go back in time and open my mouth and take those words back into it and swallow them whole so that they could never, ever escape my lips, I absolutely would. Because when I look ahead to the next 19 days, it isn't Christmas spirit that I see.
*What does it say about our society that overcommited is a legitimate word, while undercommited apparently isn't?
**Back in July, I also said "Why yes, I'd be happy to be on call the entire week after Christmas", not realizing that my girlfriend would have the time off of work. Bah humbug.
This year, I thought I would cut back on my stress level by being on top of my game from the beginning. I would make all the dainties and buy all the gifts and stock the liquor cabinet early so that once the celebrating began, I would be ready to just enjoy myself. And I was doing okay, up until the point two weeks ago when I said "Why yes, I'd be happy to revamp the entire curriculum before January"**.
Wait...what? Who agreed to revamp an entire curriculum in six weeks? At Christmastime? It couldn't possibly have been me, because I am a rational human being who recognizes her limitations and doesn't take on utterly ridiculous and near impossible tasks.
Aren't I?
Apparently I'm not. Because I did take on that task at precisely the time when I most want to be scaling back and enjoying my life outside of work. And if I could find a way to go back in time and open my mouth and take those words back into it and swallow them whole so that they could never, ever escape my lips, I absolutely would. Because when I look ahead to the next 19 days, it isn't Christmas spirit that I see.
*What does it say about our society that overcommited is a legitimate word, while undercommited apparently isn't?
**Back in July, I also said "Why yes, I'd be happy to be on call the entire week after Christmas", not realizing that my girlfriend would have the time off of work. Bah humbug.
Wednesday, November 18, 2015
Paris
For days I have been wanting to write here, to share my thoughts
about the conference I'm attending in San Francisco and to tell you
about the places we've visited and the food we've eaten during the gaps
between sessions. To talk about things that are light and fun and
pleasurable. But I've felt like I can't talk about lightness and
trivialities until I say something to acknowledge the recent attacks on
Paris.
But what can I possibly say?
This is the third attempt that I've made at writing a post, and every attempt has seemed too....earnest? Cheesy? Ignorant? In my attempt to write something meaningful, I've given myself an incurable case of writer's block. And now that it's late, and given that we have tickets to Alcatraz for early tomorrow morning, I'm going to say something quick to simply get it over with.
All that I'm going to say is the one thought that enters my head every time I hear about the attack on Paris and the resultant escalation of the war in Syria: we have to find a better way. As the (purportedly) most intelligent species on Earth, we need to acknowledge that our endless cycles of war are failing. We aren't making the world safer by constantly responding to violence with more violence; we're simply creating more enemies. And destroying the lives of more innocent people, both civilian and military.
We have to find a better way.
---
Because this post isn't nearly as good as I would like it to be, here are the thoughts of some other people that I think are worth sharing:
An American college professor's eight ways to defend against terror nonviolently.
SLukettG's thoughts about the need to recognize the tragedies occurring throughout the world, regardless of the skin colour of the people affected.
Feel free to share any other links that you think are interesting/relevant (as long as they aren't racist or xenophobic) in the comments. Or tell me your thoughts about all of the horrible things that are happening in our broken world.
But what can I possibly say?
This is the third attempt that I've made at writing a post, and every attempt has seemed too....earnest? Cheesy? Ignorant? In my attempt to write something meaningful, I've given myself an incurable case of writer's block. And now that it's late, and given that we have tickets to Alcatraz for early tomorrow morning, I'm going to say something quick to simply get it over with.
All that I'm going to say is the one thought that enters my head every time I hear about the attack on Paris and the resultant escalation of the war in Syria: we have to find a better way. As the (purportedly) most intelligent species on Earth, we need to acknowledge that our endless cycles of war are failing. We aren't making the world safer by constantly responding to violence with more violence; we're simply creating more enemies. And destroying the lives of more innocent people, both civilian and military.
We have to find a better way.
---
Because this post isn't nearly as good as I would like it to be, here are the thoughts of some other people that I think are worth sharing:
An American college professor's eight ways to defend against terror nonviolently.
SLukettG's thoughts about the need to recognize the tragedies occurring throughout the world, regardless of the skin colour of the people affected.
Feel free to share any other links that you think are interesting/relevant (as long as they aren't racist or xenophobic) in the comments. Or tell me your thoughts about all of the horrible things that are happening in our broken world.
Sunday, November 8, 2015
Status Update
I had no intention of being absent from the blog for as long as I was. Work got busy; life outside of work got busy; and somehow, in the midst of it, six weeks passed without a single blog post. Sorry!
A few weeks ago, I was finally starting to settle into the routine of being an attending. My anxiety about being responsible for all the people was becoming manageable; I was figuring out how to work with my large and diverse group of clerks and nurses and other support staff; and I no longer had moments when I would look around me hoping that there was, in fact, someone other than me who was in charge. It was refreshing after two months of nearly continuous panic. Then, two weeks ago, I started back on the inpatient service, and it all went to hell again.
In addition to my entirely manageable schedule of clinics and clinic prep time (so many labs to review, so many patients to call), I was once again dealing with new consults and follow ups and phone calls from remote communities with no access to anything and residents with their own needs and personalities. And it was nuts. I would find myself at the end of the day doing the terrifying dance of a three-year-old in need of a potty because I hadn't made it to the bathroom since I left for work in the morning. I kept cancelling plans with my girlfriend because the work never seemed to end. I was exhausted. And stressed! So stressed that I could think of nothing other than the seemingly endless needs of the patients under my care.
And then, Friday night, after 12 consecutive days of call, I finally got a reprieve. My girlfriend had forced me to take the weekend off of call because her birthday was Saturday, so I started my glorious 63-hour break from my pager. It took me the first 24 hours to stop frantically reaching for my belt and panicking that I'd forgotten my pager at home, but it has otherwise been lovely. We've had a birthday party with friends, gone to explore a new kitchen store*, eaten at a fancy restaurant, and bough $245 worth of booze**. I am now sitting on the couch in pjs with cats, which is pretty much my favourite way to spend a Sunday. My girlfriend is off at church, and when she returns we will have a second birthday party, complete with fancy cocktails and cheesy card games. Life is good.
As long as I don't think about the fact that I go back on call at 8 am tomorrow***.
*Funny story (to me at least): The kitchen store was selling a chef's knife that I have been coveting for years for 50% off, and we decided that it was too good a deal to pass on. The only problem was that my girlfriend had been planning to buy it for me for Christmas, which she obviously couldn't do with me standing right there. I offered to just buy it for myself, which she thought was a terrible idea, because I am a person who wants very few material things and is therefore impossible to shop for. (I'm also incredibly picky.) After hemming and hawing for a few minutes, I finally decided that she should just go ahead and buy it for me, but wanting to maintain the illusion of surprise, I loudly declared "I'm just going to walk over to the other side of the store, and I will pay no attention to whatever may or may not happen between you and that knife." The clerk thought we were nuts.
**I bought my girlfriend a cocktail recipe book for her birthday, and we decided that we needed "a few things" in order to make some of the more interesting cocktails. We probably shouldn't have gone to the liquor store late at night when we were both exhausted/lacking our usual self restraint, but the upside of the experience is that we are now well-equipped to make pretty much any cocktail that a person could want. Unless it requires cognac, because I still had enough self restraint to not spend $3 per ounce on the cheapest bottle of cognac. Hard liquor never goes bad, right?
***Thankfully for only three days. On Thursday, I head to San Francisco for a conference and a few days of vacation with my girlfriend. I was traveling in San Francisco when the girlfriend and I started chatting online, so I'm looking forward to showing her all of the places that I told her about when I was first wooing her.
A few weeks ago, I was finally starting to settle into the routine of being an attending. My anxiety about being responsible for all the people was becoming manageable; I was figuring out how to work with my large and diverse group of clerks and nurses and other support staff; and I no longer had moments when I would look around me hoping that there was, in fact, someone other than me who was in charge. It was refreshing after two months of nearly continuous panic. Then, two weeks ago, I started back on the inpatient service, and it all went to hell again.
In addition to my entirely manageable schedule of clinics and clinic prep time (so many labs to review, so many patients to call), I was once again dealing with new consults and follow ups and phone calls from remote communities with no access to anything and residents with their own needs and personalities. And it was nuts. I would find myself at the end of the day doing the terrifying dance of a three-year-old in need of a potty because I hadn't made it to the bathroom since I left for work in the morning. I kept cancelling plans with my girlfriend because the work never seemed to end. I was exhausted. And stressed! So stressed that I could think of nothing other than the seemingly endless needs of the patients under my care.
And then, Friday night, after 12 consecutive days of call, I finally got a reprieve. My girlfriend had forced me to take the weekend off of call because her birthday was Saturday, so I started my glorious 63-hour break from my pager. It took me the first 24 hours to stop frantically reaching for my belt and panicking that I'd forgotten my pager at home, but it has otherwise been lovely. We've had a birthday party with friends, gone to explore a new kitchen store*, eaten at a fancy restaurant, and bough $245 worth of booze**. I am now sitting on the couch in pjs with cats, which is pretty much my favourite way to spend a Sunday. My girlfriend is off at church, and when she returns we will have a second birthday party, complete with fancy cocktails and cheesy card games. Life is good.
As long as I don't think about the fact that I go back on call at 8 am tomorrow***.
*Funny story (to me at least): The kitchen store was selling a chef's knife that I have been coveting for years for 50% off, and we decided that it was too good a deal to pass on. The only problem was that my girlfriend had been planning to buy it for me for Christmas, which she obviously couldn't do with me standing right there. I offered to just buy it for myself, which she thought was a terrible idea, because I am a person who wants very few material things and is therefore impossible to shop for. (I'm also incredibly picky.) After hemming and hawing for a few minutes, I finally decided that she should just go ahead and buy it for me, but wanting to maintain the illusion of surprise, I loudly declared "I'm just going to walk over to the other side of the store, and I will pay no attention to whatever may or may not happen between you and that knife." The clerk thought we were nuts.
**I bought my girlfriend a cocktail recipe book for her birthday, and we decided that we needed "a few things" in order to make some of the more interesting cocktails. We probably shouldn't have gone to the liquor store late at night when we were both exhausted/lacking our usual self restraint, but the upside of the experience is that we are now well-equipped to make pretty much any cocktail that a person could want. Unless it requires cognac, because I still had enough self restraint to not spend $3 per ounce on the cheapest bottle of cognac. Hard liquor never goes bad, right?
***Thankfully for only three days. On Thursday, I head to San Francisco for a conference and a few days of vacation with my girlfriend. I was traveling in San Francisco when the girlfriend and I started chatting online, so I'm looking forward to showing her all of the places that I told her about when I was first wooing her.
Thursday, September 24, 2015
Responsibility
I just had a very long phone conversation with a friend trying to figure out what to do with a mutual patient. She is the patient's attending, and I the consultant, and we were stuck deciding between two similarly bad alternatives. Pick option A, and the patient might die. Pick option B, and the patient might still die.
We discussed whether there were other options for treatment (none that we could see). We debated the pros and cons of each option (essentially equal). We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen). In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.
And it feels terrible. It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision. There is no longer an attending who takes responsibility for everything. We are the attendings now. And at times it is completely and utterly terrifying.
We discussed whether there were other options for treatment (none that we could see). We debated the pros and cons of each option (essentially equal). We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen). In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.
And it feels terrible. It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision. There is no longer an attending who takes responsibility for everything. We are the attendings now. And at times it is completely and utterly terrifying.
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