Habits - Work

It's the evening before I return to work, and my feelings are alternating between excited and distraught and absolutely terrified.  It definitely feels like time to go back (there is almost nothing left on my to-do list), but at the same time I'm dreading the first day.  I start with a busy clinic and I'm on home call for the first 12 days, so it won't be an easy return.  But I can do this.

Right?

I'm hoping that, if I start off on the right foot, I can set myself up for long-term success.  With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning.  For those of you who work in medicine, is there anything else you'd add?  Any advice?  (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)

Record Billing Information as it Happens:

This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid.  While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do.  The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.

Finish my Dictations Every Day:

So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations.  Which means so much unnecessary stress!  When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending.  It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.

Devote Time and Energy to Teaching:

Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time.  As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return.  Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service.  I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today.  The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).

Read for at Least Three Hours per Week:

Medicine changes.  Every day, I get emails from journals about all of the articles that I should be reading.  In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.

Research: 

This is worthy of a post all its own.  I don't even know what to say here.  I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research.  Soooo.....we'll just have to see where this one ends up.  I had hoped to have this figured out by the end of my vacation, but not so much.

Put Patient Care Above Other Considerations:

This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room.  Their outcomes are more important than how much I bill or what time I leave work at the end of the day.  While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.

Ooops

On day 19/21 (yesterday), I somehow forgot to write a blog post.  I spent my day finishing off Barbara Kingsolver's "Animal, Vegetable, Miracle", after which I rushed to get takeout shawarma and pick up my girlfriend from work in time to go to an outdoor movie in a local park.  Amidst all the fun, I forgot entirely about blogging.

Now that the 21 days of consecutive blogging are almost finished, I'm forced to address the question of "What next?".  On the upside, over the past few weeks I've felt much more engaged with the blog, and I've found myself drafting posts in my head while doing dishes and other tedious activities.  I've also written a few posts that I've been happy with, including parts one and two of my thoughts on money, as well as my post about so-called road bump opiates.  On the downside, it's been difficult some days to find the time to blog, and I've often found myself crawling out of bed after 11 PM to whip off a quick (and often uninspired) post.  Some of my worst posts ever have resulted from this forced writing.

I may keep up with the daily blogging for a while just to see where it goes, or I may revert to blogging less frequently.  While the ideal blogging frequency is probably less than daily, I worry that if I lose the regular habit I may stop doing it at all.  Which would be a loss for me - I love the record of my thoughts and activities, the feedback from commenters (even if I don't always find the time to respond), and the sense that I'm perhaps sharing something that will be useful to the next generation of medical students/residents. 

I guess we'll see.  If you're a blogger, how do you balance regular blogging with all the other things going on in your life?  For everyone - what would you like to see from this blog as I start life as an attending?

In Need of Sleep

The past few nights I've found myself lying awake for hours on end, stressing about money and my return to work and anything else I could think about.  Despite the resultant fatigue, today I drove to the country to visit one of my closest friends from medical school.  While we ate cafe food and she nursed her wee babe, I poured out my anxieties and fears for hours.  She, a master listener, absorbed everything I said.  After I had exhausted my deep pool of insecurities, she said simply "It will all be okay".  And because she is always right, I knew it would be.

Now, back in the city, I feel lighter than I have in weeks.  My mind is slowing and my limbs are growing heavy, and it is time to give in to sleep.  I'm hoping it will be a good one.

Summer Bounty

Thanks for all of the suggestions on what to do with our abundance of CSA vegetables.  Tonight we had a CSA feast - grilled zucchini and pattypan squash, roasted beets with balsamic reduction, steamed baby carrots, and a cucumber-yogurt salad (thanks for the idea NOLA!).  The vegetables were so varied and flavourful that the barbequed sirloin steak seemed like an afterthought.

Washing down the meal was a bottle of Valpolicella Ripasso that I had brought back in my suitcase from a trip to Italy in 2013.  The bottle had long been stored at the back of our liquor cabinet, waiting for a special occasion to be opened, and I worried that I might have left it too long.  Thankfully the cork came out effortlessly, and the wine inside was smooth and mellow.

It's amazing to me how good local food can be, whether it's purchased in your home community or smuggled home from a special trip.  With such foods, why on earth would anyone buy flavourless food from Walmart* that has been shipped from hundreds (or thousands) of miles away?

*I hate Walmart, but that's a post for another day.

Day Off Fun

When I started planning my vacation, I imagined an abundance of time with my girlfriend.  We would sleep in late, cook elaborate breakfasts, ride our bikes through our local parks, and head off on adventures in the city and across the province.

I did not imagine weddings.  And multiple family gatherings.  And all kinds of things that involved people other than just the girlfriend and me.  In the end, we've had much less time to spend together than expected.  Until today!  There was no wedding to attend, all of the family has flown back to their home cities, and my girlfriend had a mid-week day off.  Bliss!

We started the day with a very large breakfast at an old-school diner.  The diner is only a few blocks from where I'll be working starting next week, and it's right in the heart of the inner city.  A lot of people avoid this part of my city because it's associated with gang activity and drug use, and they worry that it isn't safe.  While these are definite issues in the neighbourhood, in reality most of the members of the community are good people who are just trying to build their lives under sometimes difficult conditions.

And there's great food available at low prices.  (If you're not familiar with the deep fried pockets of goodness on the right, they're perogies, which are a staple in diners in my city.)

After breakfast, we headed across the street to a Thrift Store to search out some bargains.  My girlfriend found an assortment of $0.50 CDs, including the Sound of Music and a few classical CDs, while I scored big on knitting needles - six pairs for only $0.25 each! 

(Please do not put any needles in here)

While a big part of my motivation for going to thrift stores is to save money, it goes beyond that.  In our wasteful society, I think it's important to look for ways of reusing things and reducing how much we send to the landfills.  It's also a great way to support charities such as Mennonite Central Committee, which focuses on relief and peace-building efforts across the world.  And there's something really satisfying about making a great find (like six pairs of knitting needles for $1.50).

(End of soapbox)

After the thrift store, we went to almost every bike shop in the city to look for a bike for my girlfriend.  She's been using a second-hand bike from her brother for almost ten years, and it's probably well past the time when she should have bought one for herself.  She's looking at a cruiser bike, and I think she's finally settled on the one she wants to buy.  (At least I hope so, because I think I might ram a kickstand through my eye if I have to look at another bike.)

After the bike shopping, we headed to a local farm to pick up our Community Supported Agriculture share.  (I could wax poetic about CSAs for days, but I think the thrift store paragraph was probably enough sappiness for one blog post.)  The people with whom we've been splitting our weekly share are away for the next few weeks, so we have an even greater abundance of produce than usual.  I have no idea how we're going to eat ten cucumbers, five zucchinis, and four bags of kale in the next week.  Any suggestions?

And that was our day.  My girlfriend got a last minute invitation to a free play, so she's off watching that while I read and blog and try to fit copious amounts of produce into our tiny apartment fridge.

Life is good. 

Habits - Home and Hobbies

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

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

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

Have two knitting projects on the go at all times: 

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

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

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

Cook regularly with my girlfriend:

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

Read for pleasure every day:

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

Keep up with my finances:

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

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

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

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

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

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

The Last Week

As of tomorrow morning, I will have only one week until I go back to work.  It seems like I've been gone forever; I've managed to relax and get stressed out again and return (slowly) back to a relaxed state one more time.  I'm sure more stress is coming, particularly if my license doesn't come through in the next day or two.

Part of me wants to stay on vacation - to enjoy structuring my days as I please (minus weddings) and to sleep in as late as I choose.  But most of me is getting impatient to move on with the next stage of life.  Fingers crossed I'm ready.