2015 - Looking Back

The gifts have been opened, the horrible Christmas cold has been survived, and the girlfriend and I are spending the last few days of holidays maximizing our laziness.  Our wardrobes alternate between sleep clothes and sweatpants, meals consist of assorted cheeses and chocolates from the dwindling supply of leftovers, and our main activity is binge watching Netflix on our laptops (The Good Wife for her; The Walking Dead for me).  If I didn't have to carry the pager and periodically put on grown up clothes to go to the hospital, it would be perfect.

Although it seems cliche, I thought I'd take this opportunity to reflect on the year that has passed.  While some parts of it have been hard, I would say that it's overall been a good one.

Work:  Without question, this has been the biggest event of the year.  After 16 years of post-secondary training, I finally completed all of my studies in June.  And then I started as an attending in August!  By the time my fellowship ended, I was feeling very "done" with being a trainee and with having to do what other people tell me to.  Now as an attending, I sometimes wish that someone else would tell me what to do.  I struggle daily with the stress of making my own decisions and being responsible for the outcomes of my patients.  I worry that I don't know enough - that I'm not enough - to be a good doctor for them.  And it sucks.

On the upside, though, I'm slowly learning to be the type of doctor that I want to be.  I'm taking time with my patients to get to know them and to earn their trust.  I'm learning to work with very diverse staff members, the vast majority of whom I enjoy and make my life easier.  And I'm developing more of the clinical experience and judgment that make someone a really good doctor.  So some of it is really good.

Also, I managed to complete the monstrous curriculum redevelopment project with more than 24 hours to spare before the deadline.  And I think I did a pretty good job.  So yay for me.

Finances:  2015 has mostly been a year of budgeting.  For the first half of the year, I was very careful with my money in order to save for an out-of-town elective* and for seven weeks of vacation after fellowship.  While the tight budget was stressful at times, there were some unexpected benefits to having to find ways to be happy without spending money.  On my vacation, for example, I saved money by volunteering at our local music and theatre festivals, and I created a lot of positive memories from the volunteering itself.

Once I started working, I did a very smart thing and kept up with the budget (although with some loosening given that I don't have major expenses for which to save).  I also went to my trusted financial advisor and said "Here is all the extra money I will be making.  Save it for me."  By not inflating my lifestyle along with my income, I've been able to make even more financial headway than I had hoped.  I'm ending the year approximately $40,000-$45,000 better off than I started it, and I'm hoping to be back to a positive net worth within a year of starting work.  Only $42,000 to go**.

(Full disclosure:  I did completely lose my financial shit in November, and it took me the entire month of December to recover.  I'm not perfect.  It was a good life lesson, and one that I may write about here if I make the time for it.)

Romance:  2015 is the first full calendar year that the girlfriend and I have spent together.  For both of us, it was a year of transitioning from the initial "Yay!  I'm in love!  Everything is wonderful!" phase into the "Hmmmm....I'm actually dating a real, imperfect human being" phase.  Some of it has been challenging, and there have been more discussions about the appropriate loading of the dishwasher than I thought two people could have in one year, but most of it has been wonderful.

After spending almost 15 years of my adult life as a single person, it is simultaneously incredible and strange to be sharing my life with someone.  I love having someone to debrief with at the end of the day and to wake up with on weekends.  (On weekdays, waking up is horrible, and it is made worse by the fact that my girlfriend starts work much later than I do.)  I love always having a date for weddings, particularly one who is less excited about dressing up than I am.  I find it strange that someone else gets an opinion about the type of soap that I buy and whether the cats sleep with me in the bed.  I am sometimes an asshole about sharing the couch.  (The spot in the corner by the lamp is always mine.)  It is imperfect, but it is also lovely, and I think I'm going to keep her.

Relationships:  My seven-week-long vacation was a great opportunity to reconnect with people in my life.  I spent time with my Mom, my grandmother who lives outside of the city, my nieces, and multiple friends whose lives are even busier than my own.  It was a great reminder of how many good people I have in my life and of how important they are to me.

Then work started and...well...time with other people is always the first thing to go.  This is something to work on.

Hobbies:  2015 was the year of the library.  I always have a stack of library books waiting to be read, as well as a running list on the library website of books to order when I need more.  I seem to mostly be reading non-fiction, with an emphasis on medical memoirs and strategies for life improvement (e.g. Gretchen Rubin), but there has been some good fiction thrown in there.  I'm thankful that my girlfriend reintroduced me to the library, as it has led me to read many books that I never would have been willing to spend money on and therefore would not have otherwise read.

The real positive to reading more is that I have been watching far less television than I used to.  While I still haven't given up cable, and I probably won't unless Top Chef gets cancelled, I have probably cut my television watching time in half.  (Not counting the 16 episodes of The Walking Dead that I have watched in the past week.)

Travel:  Due to the budget, 2015 has involved much less travel than other years.  I spent a month away from home on elective in February, and at the end of the month the girlfriend and I had a few days in the Rocky Mountains for vacation.  We similarly had a few days of vacation in San Francisco following a conference in November.  But that was it.  Even my seven weeks of holidays were spent entirely in my home city, without even a trip to the country to photograph grain elevators.  While I'm happy to have saved the money, I am feeling a bit of wanderlust.

Health:  There is a smear of cheese on my sweatshirt.  This pretty much sums up my commitment to health this year.  Although I did take up biking in the summer!  That counts for something, right?

That's it!  How was your 2015?

*In the end, I was reimbursed all of my expenses for my out-of-town elective, which was a huge boost to my budget.  Yay!

**I still have approximately $165,000 of debt though.  Ugh.  It'll be close to a decade before that beast is slain.

Forced Holidays

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.

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...

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!

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.

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.

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.