Tuesday, January 16, 2018

Life as a Highly Sensitive Physician - Part One

A little over a year ago, I stumbled across an article about highly sensitive people.  I had never heard the term before, but as I read the article, it resonated very strongly.

Feel more deeply?
Emotionally reactive?
Take longer to make decisions?
Detail oriented?
Cry more easily?

That's me!  After reading the article, I went on to do a self quiz, and the answer that came back was basically "You fit this profile so perfectly, why did you even need to take the quiz?"

So yeah.  I'm a highly sensitive person.  Meaning that I tend to respond very emotionally to things, that I am very sensitive to criticism, and that I can get overwhelmed easily.  These were all things that I knew before reading the article (and the subsequent articles/blogs/books on the subject that I have read), but the concept of a highly sensitive person was helpful to me for the way that it presented my individual traits as something bigger, some complete personality type that described me shockingly well.

It also helped me by explaining why some aspects of work were much harder for me than for other people.  All through medical training (and into my first years of practice), I would look at the high achievers around me and wonder how it was that they were able to accomplish so much more than I did.  How could they work a long day and then come home and raise a family and do research projects?  And without hating their lives? 

Identifying myself as an HSP has helped me to realize that things exhaust me more than they do other people.  I engage deeply with everything I do, and so I use up a lot of energy doing my work.  One challenging conversation can deplete a lot of my emotional reserves, so when I have a day with multiple tough patients, it isn't surprising that I have no energy for anything else in the evening.  I'm simply done.

This happened to me last week, when I had to tell a long-term patient that he was dying.  That interaction was difficult enough, but then it was followed by a number of really tough disclosures about personal trauma from other patients.  I did everything I could to be present for my patients and to help them get the resources they needed, but by the end of the day I had nothing left.  I spent my evening on my couch binge-watching Top Chef and eating leftovers from the fridge, physically and mentally unable to do anything else.

When I tell stories like this to some of my colleagues, they look at me like I'm crazy.  It's not that they're not empathetic or that they don't care about their patients*, it's just that they don't personalize things in the way that I do.  They can detach from their patients and move on quickly, whereas I struggle to not be too deeply affected by my patients' stories.

But it's something I'm working on.  I have zero desire to burn out early, so I'm constantly looking for ways to do my work well without giving so much of myself.

Which will be a subject for a future post, because for the moment it's time to read a book and recharge for work tomorrow.

*Well....for some of them it is.

Friday, January 12, 2018

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.

Sunday, January 7, 2018

How I Like to Travel

The first time I ever traveled overseas, I was 22 years old, and I had just graduated from university.  Using my parents' travel miles, I flew to Europe with my good friend N, whom I'd known since I was five.  We had six weeks, ridiculously heavy backpacks, Eurail passes, and very little money.  It was going to be amazing.

Except, it kind of wasn't.  I mean...there were moments that were amazing.  Like the first day in London, when I walked around the city with my mouth hanging open saying things like "OMG...Alfred Russel Wallace lived here*.  OMG...MAHATMA GANDHI LIVED HERE!!!"  Or the beautiful day we spent on a boat on Loch Ness, before I discovered how badly I had burned my legs because I had decided to "let them tan".   But there was also a lot of hard stuff.

The biggest problem was that N and I wanted to have completely different trips.  I had planned for the trip obsessively, reading Let's Go Europe from cover to cover and marking things as "Must-See" or "Would-Like-To-See-If-We-Have-Time".  I had practiced saying Hello/Goodbye/Please/Thank You/I desperately need a bathroom now in the languages of every country we would visit.  And I had dreamed of all the nerdy historical places we would visit:  Westminster Abbey, Edinburgh Castle, Notre Dame Cathedral, the Roman Forum. 

N had packed her party clothes.  Unbeknownst to me, this trip for her represented an opportunity to escape from her somewhat overprotective parents and just have fun.  She had almost no desire to buy the discount passes that let you see all the historical sites in a city, but every desire to meet people at hostels and go dancing.  So for six weeks, we cramped each other's style, arguing constantly about whether to spend our time in a museum or a bar.  By the time we flew home, we were barely talking to each other.

I realized on that trip that I have some pretty specific desires when I travel, and they aren't necessarily the desires of others.  Which is completely okay.  I in no way judge the crazy people who want to be social and spend times in crowded spaces.  I simply don't want to travel with them.

Over the years, I have been very fortunate to have lots of opportunities to travel.  And with each trip, I've gotten even better at knowing what I will or will not enjoy.  Which is particularly relevant to me right now, as I just bought tickets for a conference and vacation in France this Spring.  FRANCE!  If you follow me on Twitter, you will know that I have been posting there frequently about my excitement about learning to speak French and planning my trip.  And to build on that excitement, I've decided to post about some of the things that make a great trip for me.

Really Nerdy Activities:
I love nerdy things, and the more I embrace this fact, the happier I become.  When traveling, I have no interest at all in the popular shopping district, but I absolutely do want to see the collection of 18th century dioramas/the site where a famous scientist was born/Galileo's middle finger.

When traveling, I seek out the oddities.  I look on Atlas Obscura to find places to visit (Oradour-Sur-Glane is high on my list for France).  I allocate entire days to medical and natural history museums.  And I love every minute of it.

Traveling Alone:
Shockingly there are few people in this world who want to spend hours with me in a natural history museum photographing a dodo bird (A DODO BIRD!) from every angle.  When I travel with another person, it is inevitable that at some point the other person will become impatient and/or I will feel rushed.  Which is quite easily overcome by me simply traveling alone.

While traveling with someone else isn't entirely negative (eating in restaurants tends to be better with another person), I do tend to prefer traveling on my own.  I like having complete control over where I go and what I see.  I like being able to commit a day of travel and four hours on a bus to visiting the seaside town from which the French explorers departed for Canada.  And I like never being dragged out in the evening to socialize with people I don't know.

Flexible Schedule:
Whenever I travel, I tend to alternate between days of "OMG I'm so excitied!  I'm going to see three museums and take a walking tour and take hundreds of photos!" and days of "Cobblestone hurts my feet and I don't like the food here and I want to stay in bed and Internet".  This pattern repeats itself on every trip I go on, and if I ignore my need for downtime and try to push on with the sightseeing, I will inevitably become miserable.  I've learned to build flexibility and extra time into my schedule so that, when needed, I can spend a day on the couch with a block of cheese and a good book and recharge my traveling energy.

Small Cities and Towns:
When N and I went to Europe, we gave ourselves four full days in Rome, recognizing that there was a lot to see.  And for four days we rode on the crowded subways and got catcalled by Roman men and saw site after site of broken columns.  For me, I was overwhelmed by the number of people and by the sense that no matter how much we rushed, we would never see everything.  I learned from my visit to Rome that I prefer the small places to the big.  Small places may not have as many things to see, but I enjoy the sense of being able to see everything, even when I go at a leisurely pace.  And I love the oddities that turn up in small places, which would never attract tourists in a big city, like the preserved two-headed pig in the farming town where my grandparents lived.

Packing Light:
On my first trip, I bought the biggest backpack I could find, and I filled it with everything that would fit in it.  And then I packed a second smaller backpack as a day pack.  Even though I was only 22 years old, I felt like an old woman thanks to the constant back and shoulder pain from carrying my things around.  When I watched the movie Wild, I couldn't stop laughing in recognition at Cheryl Strayed's pack (although, for the record, I did not pack 12 condoms for my trip to Europe).

Every time I travel, my suitcase gets lighter.  I simply don't need much stuff, and I hate hauling a heavy bag into airport bathrooms and onto trains.  On my most recent trip, which was to Quebec City, I took only my camera bag and a carry-on suitcase, and it was still more stuff than I needed.  I will probably need to take a larger bag to France, as I need to bring work-appropriate clothes with me, but you can bet that it will be packed as lightly as possible.  (Leaving room to bring home wine.)

So this is how I travel.  A solitary introvert with a tiny bag and a big camera, visiting the nerdiest places I can find.  My idea of a fun vacation would probably be a nightmare to a more outgoing person, but it works perfectly for me.  Which I think is a good guiding principle for life:  do what works perfectly for you.

*You know you're a nerd when you not only know who Alfred Russel Wallace was but also still feel angry that he didn't get the recognition he deserved for the theory of evolution.

Saturday, December 30, 2017

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.

Saturday, December 23, 2017

What I Will Be Doing Instead of Writing a Play

Remember when Christmas was still a month away and I was freaking out because I thought I wouldn't have enough to do?  And then I decided that I was going to use some of my spare holiday time to write a play?


Yeah.  About that.  As the holidays approached, my list of things to do slowly grew.  At the current time, I am absolutely committed to the following activities:

Dinner and a movie with my new friend tonight*
Christmas Eve dinner with family tomorrow night
Christmas Eve sleepover with my Mom
Christmas Day dinner with more family
Counseling session with my performance coach on Thursday**
French lesson on Thursday
Dinner and a show with friends at the Art Gallery on Friday

And this is with minimal effort actually put into making plans.  I still have a list of multiple other friends with whom I'm hoping to make plans in the next ten days.  I have made so many plans that I actually managed to double book myself for Friday night, and for the third year in a row I will not be attending my residency group's annual party.  (Is it surprising that an introvert would pick an intimate evening with friends over a big party?  Zero surprising.)

Until about a week ago, I was still thinking about writing a play.  But the more I thought about it, the more it seemed like a burden that I would resent, rather than a fun activity to keep me busy over the holidays.  And then I had an insanely busy week on call, which has left me with a desk covered in unfinished work, and I thought "nope".  No.  No play this year.  Rest.

Over the next ten days, I'm just going to recharge and get my life back on track.  I'm going to empty the dishwasher that has been clean since Monday and refill it with the week's worth of dishes that are on the counter.  I'm going to replenish my freezer stores so that I won't go hungry the next time I'm on call.  And I'm going to do a little (lot) of work stuff so that I will not feel too horribly overwhelmed when I go back to work.

And I'm going to do fun stuff!  I saved season two of Stranger Things, so there will be some serious binge watching.  And books.  And drinking peppermint hot chocolate.  And drinking all of the wine I couldn't drink while I was on call.  And sleep.  Glorious, glorious sleep.

It may not be the same as Christmas with my ex's family, but I think it's going to be lovely all the same.

*I made a new friend this year!  As an introvert who treats friends like precious heirlooms and keeps them forever, this is exciting.

**I need to write a post about this, because this has been life-changing.

Sunday, December 17, 2017

Solitary Diner, Debt Slayer

When I was still in residency, my financial advisor recommended that I pay off my line of credit as slowly as possible so that I could maximize my investments.  From a numbers perspective, his advice made perfect sense:  I pay prime (currently 3.2%) on my LOC, and I can earn more than prime from investments, so investing wins.  When he made the recommendation, he followed it with the prescient caveat "Assuming that you aren't bothered by the debt".

"Why would I be bothered by the debt?", I wondered.  I had been in debt for almost a decade, and I was doing a great job of ignoring it, so why would it be any different when I was an attending?  I was a rational person who did not make financial decisions based on emotions.  This would be easy.

After finishing training, I initially stuck with the plan.  I took the one-year grace period before I had to start paying back my LOC, and I poured every extra penny I had into retirement savings.  Then when the repayments started, I paid the monthly minimum with the plan to pay it all off in the required ten years.  Everything was on auto-pilot, and everything was great.

Except...every time I logged into my banking account, I had to see the balance on my LOC.  And it was big.  And ugly.  And even though I had achieved a positive net worth, it didn't feel real, because I still had this horrible six-figure debt hanging over me. 

At the same time that I was not repaying my debt, I was saving cash in my savings account* for a future down payment on a home, meaning that I was basically throwing away interest on my LOC.  Which wasn't a big deal when the down payment was small, but got increasingly painful as the down payment grew.  I eventually moved the down payment into an online bank account to earn a bit of interest, but I was still losing money by not using that money to pay off the LOC.  And I hated it.

So...I started going against the plan.  When my ex and I separated earlier this year, I decided that I would defer buying a home for at least a year, and I took some of the down payment money and put it towards the LOC.  Then a few months later I put some more of the down payment money towards my LOC so that I could achieve this:

For about ten minutes, I was ecstatic about my debt being under six figures!  I would look at the balance and smile, realizing that I had cut my LOC by more than half from its highest level.

And then I got mad about the fact that I still owed $100,000 to the bank.

I have tried really hard to not hate my debt and to stick with the plan of maximizing my investments, but the reality is that I. Hate. My. Debt.  I hate paying almost as much towards my debt every month as I do for rent.  I hate that the debt represents bad financial decisions that I made during training.  I hate that my really lovely net worth feels meaningless to me when I still have this debt to repay.  And I hate that I am making big financial decisions like whether to buy a house based on the debt rather than based on what I most want to do.  (Although I would probably still not buy a house right now even if I didn't have the debt.)

So this week, I said fuck it.  I am paying off this debt.  I am taking every penny I had set aside for a down payment and putting it towards the debt, because realistically I am not going to buy a house until the debt is gone.  I have a big end of the year payment coming up, because the university retains part of my income to control for variability in billing, and that is also going towards the debt.  In the new year, I am going to continue with my regularly scheduled monthly investments, but everything else is going onto my LOC. 

Fuck logic**.  I am done with debt. 

*This is a terrible idea.  Do not do this.  Get an online savings account that will at least pay you some interest.

**I apologize to anyone whom I ever silently judged for using the debt snowball method, which always seemed like a ridiculous waste of interest.  I totally get it now!

Sunday, December 10, 2017

You Should Buy A Home

At least once a week, someone will ask me when I'm going to buy a home.  It started in residency, and it has increased in frequency with every year that I continue to "throw my money away" on rent.  In residency, it was easy to justify not buying a home, because I had over $200,000 in debt and I had no time for home maintenance.  People could understand those reasons.  But as soon as I became an attending, paid off a lot of my debt, and stopped doing 28 hour-plus call shifts, those reasons disappeared.  And suddenly, my renting instead of owning became some sort of personal affront to people who own their homes.

These zealous home owners seem to have made it their personal mission to get me to buy a home too.  They will send me listings in my favourite areas, along with messages about how perfect the living room would be for a games night or how much I would love the granite counter tops.  Any time an article is published that extols the virtues of home ownership, I can expect at least two or three of these people to send it to me.  And if I dare say anything even remotely critical of my apartment, I am immediately subjected to a tirade about how much better owning is and how ridiculous it is that I'm still renting.

But you know what?  I like renting.  For a lot of reasons.

I am not throwing away my money:  I have used various calculators to compare the cost of renting and owning in my situation, and based on the home I would likely buy, renting comes out a few hundred dollars a month ahead of owning.  So contrary to popular belief, I am actually saving money by renting.  People immediately respond by saying "Well...paying a mortgage is forced savings.  No one actually has the discipline to invest the money they save by renting."  To which I just laugh.

I like putting almost zero effort into my home:  This summer, while we were out for dinner with friends, I got a phone call that my kitchen sink had overflowed and was flooding the apartment below it.  My (now ex-) partner had to run home to shop vac up the mess, but otherwise the building took care of everything, including paying a plumber premium rates to come out on a Friday evening.  The cost to us was zero, and the time involved to deal with it was minimal.  As has been the case for anything else that has gone wrong with the apartment.  The only maintenance I'm responsible for is replacing the light bulbs!  There is no snow to shovel, no leaves to rake, no grass to mow.  And I love it.

I love my location:  The ex and I started looking at homes earlier this year, and when we talked about where we wanted to live, we both decided that we were already living in the perfect neighbourhood.  It generally takes me 15 minutes or less to drive to and from work, which gives me so much more free time than the crazy people who drive 45 minutes or more to the suburbs.  My apartment is in mature area with old houses and lots of trees, so it's a beautiful place to walk when the weather is nice.  I'm within walking distance of two major restaurant areas, so I can have a drink or two without worrying about driving home.  I can even walk to the library!  Because it's a very desirable and popular neighbourhood, the housing prices here are high.  So I'd be paying even more than a few hundred dollars a month extra to have a nice house or condo in the area where I'm already happily living*.

My apartment is nearly perfect:  In addition to location, there are a lot of things I love about my apartment.  I have huge balconies (plural) to sit on; there are two washing machines and two dryers just down the hall; there is an exercise room that I use on occasion; there's an indoor hot tub; and I have heated indoor parking.  The size of my apartment is pretty perfect for a single person with minimalist tendencies.  My building is also filled with dogs who love to visit, which means I get the pleasure of enjoying other people's dogs without ever having to pick up their poop. 

I hate the idea of taking on more debt:  Although all the other reasons are valid, this is probably at the heart of why I am not looking to buy a home right now.  I still have a six-figure debt, and on my current repayment schedule I'm four years away from paying it off.  The idea of adding a six-figure mortgage to that makes me want to vomit.  "But it's good debt," people say.  Gaaaaahhhhh.  No.  It's still debt.  It's still money that I would owe to someone else, which would limit my choices and almost guarantee that I would have to stay at my current job until the debt is gone.

I may buy a home someday.  Once the debt is gone and I've saved a bigger nest egg for retirement, I can see myself being interested in buying a place.  Something with a bigger kitchen and more space to entertain and hardwood floors, because carpets are gross when you have cats.  But at the current moment, renting works for me.

Which ties into one of the most important (and cliché) things I've learned about personal finances:  it's personal.  Everyone has their own unique circumstances, preferences, and neuroses, so there is no one perfect formula for life happiness and financial success.  Lots of people want to buy a home, and it makes sense to them, so great!  Buy a home.

Just stop telling me that I should too.

*I looked at an apartment condo a few buildings down from where I'm living, and the condo was over half a million dollars with condo fees that were only slightly less than my rent.  It was a really nice condo, but OMG talk about throwing money away.