Goals - Looking Back at February and Ahead to (What's Left of) March

This post is a little late.  I've been scrambling a bit to catch up on everything that didn't get done while I was in Montreal, and I've been feeling a lot of end-of-winter blahs, so the blog has been a bit neglected.

I set three goals for myself for February:  Work out three days a week; go see the psychiatrist, and go out with friends/family twice a week.  How did it go, you ask?

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

Nope.  Didn't happen.  I went a few times at the beginning of the month, and then sleeping in seemed more appealing than exercise (as it always does), and I stopped.  I think I've hit the dreaded point where I no longer believe that I can be successful at this goal, so I'm not even making an effort.  I'm not sure what it's going to take for me to get exercising again, but I do genuinely want to find a way to make this a regular part of my life.  I commented to my girlfriend yesterday that I'm happier and more relaxed when I exercise, and she looked at me as if I'd just said that the sky is blue and responded "Um.  Yes."

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

With this, I was fully successful.  Not only did I go to the initial assessment, but I also went to three follow up appointments to convince him that there wasn't something seriously wrong with me and that I just wanted some help learning better coping skills.  (Aside:  I have never been asked about drinking, drug use, and suicidal thoughts as many times as I was in those four sessions with the psychiatrist.  Apparently physicians only seek help when things are terribly wrong, and I'm a bit of an anomaly for wanting some preventative mental health care.)  Having passed the psychiatrist's test, I'm now awaiting the availability of a psychologist who will do some cognitive-behavioural therapy with me.

At some point, I will write a whole post about my experiences with this and about physician mental health in general, but today is not that day.  For the thoughts of another soon-to-be physician on this subject, check out Kay's blog Premed Post-Mom.

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

Yes!  I did this*!  Apparently if I set fun goals for myself, like go out for dinner with my favourite people, I can achieve them.  Over the course of February, I did the following:

• Took my nieces to see a play about Harriet Tubman
• Organized a gathering of medical friends to try out a local restaurant promotion
• Drove to the country to visit my bff from medical school
• Went to my Mom's house for dinner and to help her move furniture
• Went to dinner and the theatre with my Mom
• Met up with a friend from grad school in Montreal 
• Breakfast at a shitty new restaurant with my Mom 

This goal was a good one for me, as it reminded me that, as much as I love my girlfriend and her people, I get something unique from spending time with my people.  My family and my long-term friends know me and love me in a way that my girlfriend's people don't, and that connection and understanding are central to my happiness.  As an introvert, I am more than able to meet my need for time spent with other people through my girlfriend and her extroverted social life, but it is still important for me to maintain my own social contacts.

The main downside to this goal was that it completely wiped me out.  In addition to the activities that I did with my people, I also spent a lot of time with the girlfriend and her people, and it was simply more than this fragile introvert could handle.  By the end of the month, all I wanted was time in my pjs on the couch with my cats.  Which is pretty much how I've spent all my free time in March so far.  Also...all of the eating out was expensive.  My eating out budget is usually ridiculously high, but in February it was about 50% beyond what it usually is.

March's really vague, non-SMART goal:

For a while I was thinking of not setting a goal for March, as I'm mostly just feeling tired and in need of a break, but then I came up with something that I think I can do even in my tired state, which is kind of, but not really, a goal.

In March, I want to make more of an effort to recognize what I need and to meet those needs.

(See?  Vague.)

For essentially all of my medical training, I didn't think much about what I wanted or needed.  There was always a long list of things that I absolutely had to do, so I just focused on getting them done, regardless of how happy or unhappy I was doing them.  Thankfully, things are different now, and I have much more flexibility to do the things that are important and life-giving to me.  Or, on a smaller scale, to simply do the things that make me calmer and happier from moment to moment.

While I could've tried to make this a defined goal, I've intentionally left it nebulous because the things that I need vary from day to day.  Some days I need to retreat from the world and be with my cats, while other days I need to socialize and connect with the people I love.  Some days I need to be stingy with my budget and save for the future, while other days I need to be self-indulgent and enjoy the results of my hard work.  Some days I need to work less so that I can get enough rest and relaxation, while other days I need to work more so that I can get shit done and stop stressing about it.  Different days, different needs.

I'll let you know how it turns out.

*Technically I only did seven things instead of the eight that would be required to have gone out exactly twice per week, but I'm still counting this as a success.  In part because I achieved the spirit of the goal, and in part because one of my friends bailed on dinner plans at the last minute, so I can blame her for falling slightly short of eight.

Friday Night Purrs (No Hiss)

Oh, what a crabby person I've been this week.  I've allowed myself to be upset about the fact that I was on call and that my office is inaccessible due to a toilet that overflowed one floor above the power room*.  I could write another whiny post about all of the bad, but I'm getting really tired of hearing myself complain, so instead I'm going to talk about the good things (big and small) in my life at the moment.

Purrs:

1)  The girlfriend and I made an extra-large batch of tuna noodle casserole last night, so we got to come home to tasty comfort food that required zero effort.  And it isn't takeout sushi, so it's frugal to boot.

2)  The girlfriend convinced me to not watch Top Chef last night, so I get to enjoy my favourite show on Friday night.  Go Marjorie!

(I was going to insert a picture of Marjorie here, but I realized that I would most likely end up spoiling the episode for myself, so no visuals.)

3)  It is warm and sunny, and I can hear the sound of cars driving through melting snow through our open balcony door.

4)  New books from the library!  My reading goal for the year is to start** all of the books on the Canada Reads longlist, and I have three of them sitting on my coffee table.

5)  As I type this, my girlfriend is making homemade pizza dough for a dinner party on Sunday.  She is an incredible baker, and her pizza is better than most of what you can get in a restaurant. 

6)  Hagen Daas.

7)  Thanks to being on call, I've earned enough to cover all my expenses for the month, so every penny I earn for the rest of the month can go to debt repayment.

8)  If I use very generous calculations and include the value of my car, I'm almost at a net worth of zero.  For the first time in about nine years.

9)  I am only one week behind on paperwork.  After leaving a giant stack of paperwork behind to go to a conference, this is major progress.  Starting work early and leaving late pays off.

10)  Saturday morning brunch date.

What are your purrs for the week?

*Good design there, architect.

**I recently forced myself to finish reading a book that I absolutely hated, because I thought it was "good for me".  All that it really accomplished was that I stopped reading for a few weeks, because I couldn't stand the book.  I've now decided that if I am really not enjoying a book that I don't have to finish it. 

How to Conference Better

I'm on my fourth (and thankfully last) day of my conference in Montreal, and I am way past ready to go home. The talks that excited me on day one are now barely interesting enough to keep me awake, and my stomach is unhappy from too many unhealthy meals out. I have 25 minutes until my next (and last) talk, so I thought I'd share a few of my thoughts on how to optimize a conference experience.  While they may not be interesting to anyone reading this, at the very least they might help me do better next time.

So...my advice:

1) Be selective:  Attention spans (especially mine) are limited.  Not even the calmest and least ADD person can be engaged for over 8 hours a day of lectures and poster sessions.  Pick only the sessions that are most interesting and useful, and use the remaining time to nap or exercise or explore a new city (if it isn't fricking cold, like it is here now).

2)  Consider going for only part of the conference:  As a lifelong keener, it's hard for me to not participate in something from the opening until the bitter end.  And as someone who is trying to live somewhat frugally, it feels like I'm only getting my money's worth if I stay for the entire conference.  But the reality is that the best talks are rarely on the first or last day.  In the end, I will have gone to only about two hours of talks on each of the first and last days, because there simply isn't that much of interest to me.  I could've saved two nights away from home (and two nights of hotel/food costs) if I'd come only for the most useful days. (Not to mention the fact that I could've avoided cancelling three half days of clinic.)

3)  Don't go to every conference:  Again, this is difficult for me, because I want to stay knowledgeable and current, and conferences are generally a good way of doing that. But, being in a small field, the research doesn't change all that much in the 3-4 months between conferences.  I think I'd actually be better off skipping some of the conferences and just dedicating a day to reading all the articles that are piling up in my "To Read" folder.

If you attend conferences, what other advice would you give?

Gender

Since I read Cheryl Sandberg's book Lean In last summer, I have been hyper-aware of the ways in which men and women in medicine behave differently.  I've noticed how men speak up more during lectures and stay at the microphone even after they've been told that the question period is over.  I've seen how male residents give orders to nurses while female residents make requests.  I've witnessed the self doubt of smart and talented female medical students contrasted with the cockiness of some not as smart and talented male medical students*.  It saddens and frustrates me to see, time and time again, women reflexively and unconsciously making themselves smaller because they've internalized the message that they are somehow lesser.  (And men making themselves bigger because they believe that they're greater.)

This morning I went to an educational session in which these gendered behaviour patterns were on full display.  The session was led by one male physician and one female physician, both of whom are well-respected in their fields and have similarly impressive CVs.  Although they were supposed to be equal co-chairs, the man completely dominated the session.  He read not only his introductory slides, but also hers.  He answered all of the questions without even acknowledging that his co-chair might have an opinion that she wanted to add.  The few times that she managed to start answering the question before him, he interrupted her to finish the answer.  And then, partway through the session, he deviated from the planned presentation and, without asking permission from his co-chair, started showing his own set of slides on his area of research.

I was livid!  I couldn't believe how blatantly disrespectful he was to his colleague.  And the worst thing for me was, I suspect I was the only person in the room who noticed.  We're so accustomed to this pattern of male dominance and female submission that we don't even bat an eye at it.  Even though the voice of another smart and talented woman was completely silenced in the process.

I'm still livid.

*In case it needs to be stated, I don't think that female medical students are inherently smarter and/or more talented than male students.  I've simply observed that women in medicine tend to underestimate their abilities, while many men do the opposite.

Montreal

I'm sitting in a hotel room in Montreal, awaiting dinner with a friend (in 1 hour) and the start of a conference (tomorrow morning), and I am struggling to write one of the blog posts that has been floating around in my brain for the past few weeks.  I want to write about how it feels to be six months into my work as an attending, about my struggles to start up a research program, or about my recent two-year anniversary, but all my brain and body want to do is rest.  In the past two weeks, I've taken on three extra clinics and an extra weekend of call, and while my net worth is very happy about the additional work, the rest of me is not.  I'm exhausted.

This past weekend, my girlfriend and I had a long discussion about careers and life goals and what is important to us.  Both of us want to do work that is meaningful and that hopefully makes the world a slightly less miserable place, but we also want to have full lives outside of our work.  We want to sleep in on weekends and cook good homemade food and read books and knit*.  And maybe even do productive things like exercise and clean our messy apartment.  If we run out of fun things to do, that is.

At the moment, it feels like what I want to do is always in conflict with what I need to do (work).  I wish at times (always) that I could go back a decade and live more frugally so that I would have actual money now, instead of debt, and would feel like I could take more time to myself.  I keep hoping that hitting the zero net worth mark will bring about a major change in how I feel and how I approach work.  I'm hoping that it will make me feel okay with saying no to the extra clinic time and the extra weekends of call.  Because while I like my job, I love my life outside of it more.

*Well, I want to knit.  Specifically this, in a gorgeous grey yarn that is ridiculously expensive but will be worth it because it will undoubtedly take me at least six months to knit the scarf, thus keeping the cost per hour of knitting very, very low.

Student Debt Identity

When I was in San Francisco two years ago, immediately before I met my girlfriend in person for the first time, I visited a small bookstore in the city's gay district (The Castro).  It was the kind of cozy, inviting bookstore that encouraged leisurely browsing, which is exactly what I did for my last few hours in the city.  I checked out the staff favourites; I discretely flipped through LGBTQ books that would make Dan Savage blush; and I somehow resisted the enormous selection of magnets and mugs and bookmarks that I'm usually suckered into buying.  In the end, despite finding a large collection of books that wanted to come home with me, I managed to leave with only one:  Tiny Beautiful Things, by Cheryl Strayed. 

If you have never read this book, you should go out and do so immediately.  And don't take it out from the library (although I love libraries):  buy it so that you can read it over and over and over again.  The book is a collection of articles from the "Dear Sugar" online advice column that Strayed used to write, and it is easily the best advice column I've ever read.  She addresses every topic from romance (of course) to friendship to finances to body image to life's purpose, and she does so in a way that is wise and frank and kind and simply amazing.  I loved the book so much that I finished it on the red-eye from San Francisco (instead of resting up for my date when I got home), and I have read it cover to cover two additional times.  When I picked it up to start writing this blog post, I had a hard time not reading it a fourth time.

Anyway...this is not supposed to be a post about the genius of Cheryl Strayed but rather a post inspired by one of her responses as "Dear Sugar".  In one of the letters she received, a young woman wrote about her desire to go to graduate school and her frustration about having to incur additional student debt to do so because her parents didn't have the means to put her through school.  In one line that stuck with me, the woman stated "[M]ore often than not, I am defined by my 'student loan identity'."  Strayed's response surprised me a bit.  She seemed to diminish the woman's concerns about debt, and she encouraged her to strongly consider graduate school despite the cost.  In addressing the woman's concerns about the psychological aspect of debt, she said "I don't even known what a student loan identity is.  Do you?  What is a student loan identity?"

As I sit here, months away from having a positive net worth for the first time in almost a decade, and another decade away from having my debts payed off, I know exactly what a student loan identity is.  A student loan identity is waking up every morning and thinking about how much you still owe.  It's feeling like every dollar you earn is already accounted for and that none of it is actually yours.  It's saying yes to extra clinics and extra weekends of call because you're bloody tired of being in the red.  It's feeling like every decision you make has to be based on the financial implications, rather than on what you most want to do in your heart.  No matter what my rational brain tells me about the wisdom of my decision to go to medical school or the long-term financial security that I will enjoy, my lizard brain keeps fixating on my student loan and the long road between me and debt repayment.

I wish I could be more Zen about my debt and just accept that it's there and will be for a long time, but I can't seem to get past the sensation of OH MY GOD, MY HAIR IS ON FIRE!  I can't seem to stop questioning every purchase, wondering if I can somehow live without $20 a bag cat litter and train my cats to use the toilet.  (The answer to that question is a resounding no.)  I can't seem to say no to any opportunity to make extra money, no matter how tired or stressed I may be making myself.

More than anything, I just want to be back in the black.

Friday Night

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

It still wasn't enough. 

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

I'm still not done.

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

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

I need this weekend.

*Literally.  Shit.

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