Monday, July 13, 2020

Four Months

I think this is officially the longest I've gone without posting here.

March and April were surreal months.  The day that the WHO declared COVID a pandemic, I went to work like normal, rounded with my trainees, and went to yoga.  The following day, my city started going into lock down.  My clinics were shut down, and except in the most extreme of cases I could only do patient visits over the phone.  Schools and non-essential businesses closed.  My world shrunk down to my apartment, my cats, and my computer.

I wish I could say that I handled things better than I did.  I would like to tell you about the books I read, the fabulous sourdough I baked, and the superfit body I gained through turning my bedroom into a home gym.  But I can't.  What I can tell you about is cheese.  Because for a solid month and a half, my main activity was eating ridiculous amounts of cheese.

I had a lot of time off of work in April, because I was supposed to be in the UK at a conference and on vacation, and instead I spent most of that time on my couch eating.  Partly it was my way of resting after a really busy start to the year, but mostly it was my way of grappling with (or trying to avoid grappling with) the complete upheaval of everything I had previously considered to be stable.  I struggle with uncertainty at the best of times, and I really didn't know how to cope with *waves hands at everything*.  So I avoided, and I numbed as best as I could.

I almost started this next paragraph with "We were really lucky", but I won't, because what has happened in my province and in my country hasn't been a matter of luck:  it's been leadership.  Both federally and provincially, the government has acknowledged the seriousness of COVID and taken steps to protect its citizens.  And as a result, we've been really fortunate to mostly contain COVID.  Even though we're slowly reopening across the country, our numbers have fallen to just over 200 cases a day - for the whole country.

Four months after the start of lock down, life is starting to go somewhat back to normal.  I'm eating less cheese.  And things that were tenuous and uncertain are slowly settling, albeit not as much as they were pre-COVID.  I am so, so grateful to live in the country that I do.

For all of my American friends, I am so, so sorry.

Sunday, March 15, 2020

Stay Home

I know that I am mortal.

Anyone who goes through medical training, if they pay any attention whatsoever, is forced to confront this fact.  For me, there is one particular moment from my residency training that brought this home to me.  A woman very close to my age had come into the hospital feeling unwell, and a series of CT scans had shown that she was dying.  The scan report described numbers and dimensions of multiple tumours, and at the end the Radiologist had left a horrifying impression statement:  "Riddled with cancer".  I was the one left to deliver the news to her, and as I read the scan report and thought about what I was going to say, her two children ran past the computer I was working on, laughing as they turned the hospital ward into an impromptu field for tag.

I know that I am mortal, and yet, I don't really KNOW that I am mortal.

A week ago, I was watching the New York Times Coronavirus map, as the outbreak spread closer and closer to the United Kingdom, worried that my conference in April would be cancelled.

Then I accepted that my conference would be cancelled, and worried that if I went to the UK for vacation, I would be quarantined on my return.

Then I worried about going to the States.

Then about going to the Rockies.

It was only about Thursday, as I watched the numbers go up and previously yellow countries turn to red on the map, that the seriousness of this started to hit me.

My first real worry was that I would be called on to provide inpatient care.  I've worked almost entirely outpatient care for the past seven years, and I've never worked inpatient care except under direct supervision, so the idea of managing a heart attack or having to put a breathing tube into someone in respiratory failure fills me with terror.  I will do my best to step up and do whatever I am called upon to do, but I certainly do not want to.

And then, in the last 24 hours, as I've had a quiet day of social distancing at home with the cats, I've had time to reflect on what this really means.  I'm just as vulnerable to this infection as anyone else.  Probably even more, given that I will still be going into the hospital and seeing patients, albeit in a very limited capacity for the foreseeable future.  And my friends.


One of my good friends is a paramedic.

The mother of my godson is an ER doc.

Another good friend is an anaesthesiologist.

Another friend a surgeon.

Many others family physicians.

Many, many others internist who have taught me and with whom I trained.

And fucking idiots are going to the bars for St. Patrick's Day.  Getting their nails done.  Taking advantage of discounted fares to go on holidays.  I understand the denial, because I was there a week ago.  But I am filled with fear at the thought that the people I love, my community, are vulnerable because other people don't want to have their freedom restricted in any way.

I keep saying the same thing over and over again:  Please, for the love of everything, stay home.

Friday, January 31, 2020

One Month In - How Am I Doing?

You may recall that I set some pretty ambitious (for me) goals at the beginning of the year.  So how is it going one month in?

The Good:
"meditating every day"  I have done this!  I was pretty well established with my weekday morning practice, so my main challenge here was finding a way to meditate on the weekends.  Initially, I thought that I would meditate first thing in the morning like I do on weekdays, but this literally never happened.  Turns out, I really enjoy sleeping in and getting a lazy slow start to weekend days, and there is no part of me that wants to start the day on a meditation cushion.  So I have been doing it before I go to bed on weekends, and it has gone perfectly so far.

"I mostly just want to keep working and hoarding money for the future" I had nine days of very busy call this month, so I have done a lot of hoarding of money.  It's lovely for the net worth, but I would honestly like to do a little less earning and a little more resting.

"I want to keep building on the friendships I have."  I've also been doing this!  Even though it's been a busy month, I've made time to go with friends to see our local queer choir, to visit my godson and his family, to go for dinner with my brother, and to go out for dinner and a play with my mom and her partner.  (I think there has been more?  It's a bit of a blur.)  For an introvert who has been busy with work, it has been about the maximum amount I can expect of myself.

The Not As Good:
"I would like to work on keeping up with everything."  This has been very mixed.  One of my proposed ways of achieving this was "just doing the shit now", and I have definitely incorporated this approach into my life, to good effect.  I am constantly trying to spend a few extra minutes to do all the nagging little tasks as they come up, and as a result I'm getting a lot more done without it feeling overwhelming or like a giant burden.  And I'm worrying less about missing things.  Perfect example - I got an application for reimbursement of a work expense, which isn't due until April.  My initial instinct was to put it in my to do pile (I had three months to do it, after all), but instead I took the five minutes required to fill it out, put it in the return envelope, and put it in the mailbox.  And now it's done, and I don't have to worry about missing the deadline for getting money back.

The biggest challenge has simply been that work has been really busy.  In addition to nine busy (and really emotionally exhausting) days of call, I had a week of teaching, and I've taken on a new volunteer position with a national organization (You know.  Because that helps with burnout.)  I've worked at least part of one weekend day every week since the beginning of the year, and still things are slowly starting to build up.  It's frustrating.

And as for my "go to work earlier and stay later" approach?


When I was writing my original post, I had the (utterly ridiculous, I don't know where it came from) idea in my head that I sometimes go to work late or leave early because I'm lazy.  This past month has reminded me that it's actually because I'm tired.  I have a limited number of productive work hours in me every day, and once they are finished, there is no value in me sitting in front of a computer trying to work.  I need a mental break.  So those days when I leave early are usually because I'm mentally shutting down and ready for the day to be over.  And the days when I arrive late are usually because I've been suffering from insomnia and have allowed myself an extra hour to catch up on some sleep.

This has been an important reminder to not be too hard on myself and to extend myself a bit of grace.  I am human, and I can only do so much.  It's also a really important reminder to set boundaries and to not apologize for doing so.  At the moment, I'm having to set some boundaries on fun things in my personal life, but I'm hoping as the year goes on and my call schedule settles down a bit that the boundaries will be more towards work.  I've also firmly decided that I'm going to give up a volunteer commitment at the end of the year (I reeeeealy should've given it up at the beginning of the year, but I got talked into agreeing to another year), which will free up one precious evening every month.

The Total Nope:
"I'm aiming for a regular practice of four yoga classes per week"  At best so far I've made it to three classes in one week.  Things have just been busy, and in some cases (call) I've had to skip yoga, and in other cases (social life) I've chosen to skip yoga.  Part of me is sad, because I really do love it and am seeing a lot of progress, but I'm also making peace with it.  I have a really full life, in mostly good ways, so it's okay that I'm not being absolutely perfect at everything.

So that's the one-month check in.  As for February?  I have three more weeks off call (yay!), during which I'm fully intending to get caught up on everything work related (plausible if I do some work on weekends), after which I have one week on, one off, and one on.  Ugh.  I'm intending to keep up with the daily meditations, as I do think they help keep me present and calm, even though my brain feels squirrely while I'm doing them.  I'm going to try to do three yoga classes a week, as I think it's more realistic than four right now.  And, perhaps mostly importantly, I'm going to keep learning from the process and being kind to myself.  I'm actually doing pretty well at things that are hard, and I deserve to be proud of myself for that.

Saturday, January 4, 2020

Four Days into 2020 - Getting My Ass Handed to Me By Call

When I wrote my post about resolutions for 2020, I was very intentional in talking about "experimenting".  I knew that I wasn't going to be able to change everything the moment the clock struck midnight (I am not a magician), so I wanted to give myself permission to do things gradually and to falter along the way.


This was a good thing.

I went back to work on Thursday, and I am starting the year with four days on call.  And what a call it has been.  I've had multiple really sick people spread all over the province, and my pager has been going off seemingly constantly.  Whereas I thought I'd be staying late to keep up with paperwork, I've had to stay late just to get the bare minimum done.

It's honestly a little demoralizing.  I'm only three days into the work year, and I already have new letters that need to be dictated and old letters that need to be edited.  And I've had one night of insomnia, followed by a sleep deprivation-induced migraine.  (Awesome combo)'s a process.  And I know that call is the hardest part of my job, particularly when it's busy call.  So I'm breathing.  And focusing on what I can learn from this experience, rather than on all the things that don't seem to be working.

When I reflect on the past few days, the biggest thing that I'm reminded of is how much I dislike the uncertainty of call.  This isn't really shocking, as I'm a person who hates surprises and likes to have everything planned.  Carrying around a tiny piece of plastic that can scream at me and derail my day without warning is really not my favourite thing.

Fortunately, there are things that I can do to make this easier to cope with.  The biggest one, and one that I've been leaning towards but not quite willing to commit to until now, is not making plans with other people while I'm on call.  In theory, the best thing about home call is the fact that I can continue to live a normal life while I'm call, but in reality, everything is made worse by the pager hanging over me.  I hate planning to meet someone and then having to cancel (or getting called away in the middle of doing something).  It happened on Thursday night when I was planning to meet a BFF for my favourite yoga class, and then it happened again on Friday night when I was supposed to go to a party for people from my residency.  And it sucked.

Not to say that I will never make plans (I would still try to make it to the Friday night party, for example, as the date was fixed), but that I'm going to try to keep my call days as flexible as possible.  Some of this is more mental than anything - trying to not get attached to any idea of how the day will look, but rather take things as they come*.  If the day is busy and I have to work until late, I'm mentally prepared for that.  If it's not and I have time for non-work things, then it's a bonus and I can use the opportunity to go to yoga or wash dishes or sit on the couch with the cats playing Stone Age online with The 76K Project.  (Mostly the latter).

I'm trying to approach my current weekend this way, and so far it seems to be helping (?).  When I got up this morning, instead of trying to map out the weekend, I made myself a list of things from highest to lowest priority.  Providing good patient care was #1, with prepping for my upcoming lectures (which I technically should've had done by yesterday) #2.  While I was responding to pages this morning, I spent a few hours getting the lectures done, thus getting the most important (as well as the most stress-inducing) task out of the way.  And then the pager was kind to me, and I was able to go to an hour of the worst suffering I would ever willingly subject myself to yoga.  I've also managed to get a few other important items knocked off my to-do list, and if I ever stop playing online games I will even do my dishes.

The change in approach and mindset has already made me a little less emotionally reactive when the pager has gone off.  It has still been annoying, and I'm not looking forward to starting my day at the hospital tomorrow, but it's better.  Will it help in the long term?  I guess I'll see...

*I feel like call gives me some sense of what it would be like to be a parent.  Everything is going well, then *BAM*, one kid spills a 2 L of milk on the floor and the other is running around naked drawing on themself with permanent marker.

Wednesday, January 1, 2020

2020 - Progress, Not Perfection

It has been a few years since I made a New Year's resolution.  In 2017, I resolved to say no to more things, which obviously wasn't enough given the burnout I hit in 2019.  In 2018, I seem to have been in a bit of a dark place in which I thought resolving to do anything was futile, because I wouldn't be able to stick to it anyway.

The past two years have shown me that, under the right circumstances, I can actually make pretty big changes in my life.  In that time, I've greatly expanded and strengthened my social circle, to the point where I couldn't see everyone I wanted to during my two weeks of holidays.  I've started a (somewhat) daily meditation practice and gone to a meditation retreat.  I've been really consistent with yoga, going to 45 classes in the first half of the year and 83 in the second half*.  I've adopted an intuitive eating practice, which has led me to a much healthier relationship with food (and overall healthier eating habits) than I've had in my life.  And I've cut back on my work responsibilities to the point where I am only slightly dreading returning to it tomorrow.

When I look back at the changes I've made, the keys for me have been twofold:  motivation and gradual progress.  I haven't made changes out of a sense that it's what I should do, but rather because I can see how the changes will make me happier and otherwise enhance my life.  The goals I set for myself are personal and are aligned with my values, not things that other people think are important.  I've also started slowly with things (It took me over a decade to develop a regular yoga practice!) and allowed myself to learn from the process of change, rather than thinking that I'll be perfect at a new thing the moment I start it.  As Done By 40 said in a comment on my last post, "Progress, not perfection".

Looking ahead to 2020, my hope is to have a relatively uneventful year.  2019 was a year of tremendous growth and change, but it was also a hard one.  I kind of want to catch my breath**.  I want to continue with my mindfulness practice, and I'm aiming for a regular practice of four yoga classes per week and meditating every day.  I want to keep building on the friendships I have.  My financial situation is really good (No debt!  Lots of investments!), and I mostly just want to keep working and hoarding money for the future.  Overall, I don't anticipate any radical changes in 2020***. 2020, I would like to work on keeping up with everything.  I feel like I'm perpetually behind - on housework, on work work - and I find it draining.  I hate having clutter in my home and 100 dictations to sign off on in my inbox.  I hate feeling like I'm perpetually catching up, only to have new work pile on top of me the moment I finally get through the old work.  And it's not like I'm saving time by procrastinating on things - I have the same amount of work to do, regardless of whether I do it right away or put it off for weeks. really everyone's problem, right?  While the specific tasks may differ, I think we all have an endless to-do list that is never done to our satisfaction.  So, while I'm setting this as a goal, I am also trying to be realistic.  And to extend a lot of grace and compassion to myself.  Because no matter how hard I work, I am never going to get to the bottom of the list.  And I need to make peace with that.

As far as how to do this...I'm going to experiment.  Try something for a while, see how it goes, then keep it or reject it.  I'm not expecting that I will get to the end of the list by midnight tonight and then always keep up with it, forever and ever.  I know it will be a process, and so I'm trying to give myself the time and space (and lots of grace!) to work with the process.  For the moment, I am going to try three things that I think may help:

1)  Going to later yoga classes:  Some of my favourite yoga classes are at 5:30 PM, which unfortunately means leaving work at 4:30 and therefore losing out on a lot of potential work time.  I'm going to try sticking to a regular weekly schedule, with a 7 PM class as my earliest, so that I get an extra hour or so at work at the end of many days.

2)  Coming to work earlier:  My work days start between 8 and 9:30 am (sometimes 10 if I really let myself sleep in) depending on whether or not I have a morning clinic.  I'm going to try to get to work for 8 am consistently so that I'm getting some extra work time first thing in the morning.  As an added bonus, I'm hopeful that the more regular wake up/go to work schedule will be good for my insomnia.

I recognize that I'm proposing to both start later and finish later, which has the potential to simply be too much work.  But I'm hoping that this will allow me to get most, if not all, of my work done during the week, thus giving me weekends completely off to recharge.  I'll see how it goes...

3)  Just doing the shit now:  I'm human.  I procrastinate.  Sometimes epically.  Yesterday I logged onto a conference website, thinking it was the last day for early bird registration, and when I discovered that I still had two weeks, I logged off.  I did very quickly log back on and register for the conference (also booked my Airbnb like a superstar), but my initial impulse was to procrastinate for another two weeks.  I've already started trying to break myself of this habit, as I know it is a huge contributor to the piles of things to do that build up.  So I'm trying to just respond to the email, just put my dishes in the dishwasher, just put away the laundry that I've already folded (instead of it sitting on my dresser until the basket is empty), and just add the item to my grocery list (instead of cursing myself when I get home from the store without it).  Just.  Do.  The.  Shit.

Who knows if this will work.  I like some of the 5:30 yoga classes, so I might cave and go to them.  My bed is very comfortable, so I may sleep in.  Doing the shit gets tedious.  But I'm going to give it a try and see where it takes me.

Any suggestions as I try to get more on top of things in my life?

*At least.  I only track yoga classes for my main studio; I think I did another 10 or so at other studios over the year.

**I feel like I'm tempting the universe by typing this.

***Seriously, I feel like I'm baiting the universe with this post.

Friday, December 27, 2019

2019 - The Year of Breaking Open

I'm not big into dates, but for some reason I love the start of the new year.  Even though there's nothing magical about the transition from December 31 to January 1, it always gets me reflecting on the previous year and thinking ahead to the next.  When I re-read my New Year's post from this year, I had to laugh at my intention for 2019:

"And what for 2019?  Mostly, I want to keep going on the path that I'm already on.  I want to remain in the present moment, enjoying it when I can and learning from it when I can't."

Learning from it when I can't describes so much of the past year.  I existed in a state of near-constant stress for months, and then I basically fell apart when the chronic stress became too much.  For weeks, I wasn't certain if I would choose to (or even be able to) stay at work.  It was horrible.

Probably the wisest thing I did, and something that was only possible because of my mindfulness practice, was stay present in the tough moments.  My mantra through that time, which I would sometimes recite multiple times in a day, was "Be patient.  Be present."  I somehow knew that, if I could just show up for those moments, that I would learn something important from them.

And I have learned an incredible amount over the past year.  I've learned that I am limited in how much I can do well (as is everyone), and more importantly, I've learned that I have the support of my institution to set limits on my work.  I don't have to overbook all of my clinics.  I don't have to work through weekends most of the time.  I don't have to say yes to every administrative task that comes my way.  I can (and absolutely must) say no.

I've also learned that I am very hard working, even though I don't always feel that way when I compare myself to the overachievers who seem to be everywhere in medicine.  I regularly go beyond what I need to for my patients, and I show up for them even on the days when I would rather pull the covers over my head.  I'm committed to the work that I do, and I put in the effort needed to be a really good doctor.

Overall, as hard as a lot of the past year has been, I'm really proud of myself for getting through it.  And for not quitting my job!  Because it's generally a pretty good one, and I do a pretty good job at it, if I may say so myself.

Saturday, December 14, 2019

How I Almost Moved Into a House But Didn't

A few weeks ago, I opened up Facebook while eating breakfast and saw an ad for the perfect house.  Only a few minutes from where I currently live and still in a neighbourhood that I love, the house was the ideal balance between "old enough to be charming" and "new enough to not have knob and tube wiring*".  And it was for rent, which is probably the only way I'm ever going to get into a house, as I'm utterly terrified of buying something.

It took me only a few minutes to email the person renting it, and I stopped by to see it on my way home from work that evening.  When I walked in, the house was toasty warm and beautifully decorated for Christmas, and my heart said a very loud yes.  This is my home.  I want to live here.

For the next four days, I lived and breathed that house.  I posted about it on Twitter and Facebook, I dreamed of all the things I could do in it (Butterfly garden!  Bat house!  Little Free Library!), and I started rescheduling my upcoming vacation to include packing up my apartment and moving into a house.  I was 100% mentally there.

And then...I went back.  I went to see it again with my Mom and to work out the practical details, and the reality of the house started to sink it.  Houses come with lawns to be mowed and driveways to be shoveled and windows (so many beautiful windows) to be washed.  And the $400 more per month in rent was only the beginning of the increased costs - I would have to add electricity and water and gas and a home alarm system and alllll the things I would want to buy with double the space that I currently have.  Yes, I could host games nights in a stylish historic living room warmed by a gas fireplace, but I would also have to get up early on snow days to dig my car out of the detached and unheated garage.

I went home that night, and I thought and thought and thought, trying to figure out what to do.  It wasn't a question of whether I could afford it - I save a high percentage of my income, so there is money in my budget to move into a much nicer home than where I'm living right now.  The question was, why did I want to move into a house?

The answer, for me, was social.  I wanted to host games nights for friends and have my aunt over for coffee and drop in informally on the friend who lives around the corner.  All really good things.  But...none of them dependent on being in a house.  Sure, my one-bedroom apartment is limited in its ability to host big gatherings, but I'm an introvert who actually doesn't really like being around large groups of people.  Two to six people is about ideal for me, and my dining room table can comfortably seat six.  The size of my apartment isn't really what limits me socially - it's time and energy, both of which I'd have less of in a house.

The financial side of it, even though I could afford it, was also a big issue.  The added costs would be approximately equal to one month a year of income - that's huge!  When I looked at it that way, and asked myself "Would I rather have that house or an extra month of vacation every year?", vacation won without a moment of hesitation**.

So....I still live in the apartment where I've lived for nine years.  And...I'm good with that.  Work is a 6-minute drive when there's no traffic (and under 30 in even the worst of rush hour traffic).  I can easily walk to fabulous restaurants and coffee shops.  And I have time and money and energy to do the thing that's most important to me:  connect.

*Technically renovated to not have knob and tube wiring...but still new enough to not be a nightmare of old home disasters.

**Not that I'm going to take an extra month of vacation, as my vacation time is already pretty ridiculously amazing, and I do need to earn money.