Friday, November 8, 2019

How to Rest

As a resident, I had almost no time off.  I worked as much as 100 hours in some weeks, often in 24-hour-plus stretches, so I was basically always either at work or collapsed half dead on my couch.  I didn't have to think about the concept of work-life balance, because there wasn't any.  I worked, and I did what I could to survive the five years relatively unscathed*.

And then it ended.  And I was an attending!  With a better schedule!  And money!  And completely no idea of how to take care of myself in a long-term, I want to be happy and not die of a heart attack kind of way.

I knew that having a life outside of work was a priority for me, but because it had been so long since I had had one, I had no idea how to make that happen.  I also faced the new challenge of always having work to do.  Labs to review, patients to call, prescriptions to renew, presentations to prepare - I live in a giant game of medical Whack-A-Mole.  For the longest time, I tried to get everything done before I would "allow" myself to rest, which meant that I was always trying to work and never actually resting.

Except....I was wasting a shit tonne of time.  Like most people, I have a limited amount of mental and physical energy every day (spoons!), and once I use it up, I can pretend to be working, but I'm really not.  I'm checking Twitter.  Or Instagram.  Or Facebook.  Or going to Starbucks for another tea.  It feels like work time, and I resent it, but I'm accomplishing very little.

Earlier this year, when work seemed to occupy every waking and sleeping moment of my life, I was finally forced to acknowledge that I can only accomplish a finite amount of things.  And this amount is never as much as I want it to be.  Yet I was working myself beyond a sustainable limit, and for what?  Desire for more money that I didn't need?  A sense of obligation?  Conditioning from the medical system to never rest?  I was failing miserably at having a good life for really no reason at all.

I am incredibly lucky to have flexibility in my job and to earn much more than I need to, which as I've mentioned over and over again has allowed me to back off from work and regain some much needed time.  But just as importantly, recognizing my limits has given me permission to rest.  To designate evenings and weekends and long stretches of holidays as "not working" time, rather than "working but not actually accomplishing anything because I keep Tweeting about marshmallow peanut butter squares" time.

Which makes all the difference.  Because distracting myself on the Internet while I'm supposed to be working isn't restful.  Sleep is.  Yoga is.  Meditation is**.

Not doing is restful.

Next week I'm on call again, and I have a long list of things I would like to get done before I go back on call.  Some of which I will get done tomorrow morning, but once my designated work time is over, I'm going to stop.  I'm going to go to the theatre with my mom, and then I'm going to eat and drink more than is doctor recommended.  On Sunday I'm taking myself to a Nordic spa, and I can guarantee that I will spend the whole day moving from heated bed to hot tub to wet sauna to dry.  Because I will need all my spoons next week, and trying to work all weekend is not going to give any of them back.

*By the end, I had raging anxiety, was socially isolated, and had lost all self-care habits.  "Unscathed" is defined very loosely here.

** When my f-ing monkey brain isn't wandering all over the place, which it always is, so I take this back, meditation is not restful, dammit.

Thursday, October 31, 2019

The Return of Happiness

Years ago, when I was early in residency training, I wrote a post on the first version of this blog called "Fundamentally Happy"*.  In it, I talked about how, despite the many challenges of residency, at my core I was happy.  Satisfied with where I was in life and with where I was going.

Earlier this year, I lost that feeling.  Not just for a moment, but for months on end.  I felt like I was working constantly and as if life was a perpetual slog through overbooked clinics and piles of paperwork.  In the beginning, I was having trouble staying caught up for more than the briefest of moments, and eventually I lost the ability to ever catch up.  I was slowly drowning.

It has taken a lot to come back.   I have drawn on every resource available to me to get through this, and I have been so lucky to have been met by nothing but support everywhere I went.  Support from friends, colleagues (remember the one who took three weeks of summer call for me?), and even my department head.  I am so thankful to have had a good experience, because I know that many physicians who burn out don't.

Life is different now.  My clinics are capped, so even on days when everyone shows up, I usually run (at least close to) on time.  I don't run over too often, and some days I finish early.  I still get behind on paperwork sometimes, but it's usually because I've taken something extra on (like travelling to a remote community to share my knowledge with a group of rural physicians) and not because the work load is too much.  And when I get behind, I can catch up again.

I can finally breathe again.  Not the shallow, panicked, desperate breaths that I was breathing for months.  Deep, calm, happy breaths.

Things are so much better.

*I think.  My memory is crappy.

Monday, September 2, 2019

Practice, Part One

I wrote a while back about how online dating got me into meditation.  While I only went on one date with the yoga-loving woman mentioned in the post, we have established a fairly close friendship over the past year, and after listening to her talk about her love of yoga, I decided it was something I should also do.

I had done yoga before, but only in a once- or twice-a-week, go-months-without-practicing kind of way.  Thanks in part to my friend's inspiration, as well as another friend directing me to a fabulous studio, I have now become someone with a regular practice.  I look forward to classes more than almost anything else I do, and I am sad that I don't yet have the stamina to go to a class every day - although I set a personal record of 19 classes in August, so I'm getting there.

In all my posts so far about burnout, I haven't yet written much about the role that yoga played, but ironically, I think it was a big part of why I burnt out when I did.  Before I started doing yoga, I was living with blinders on, getting through each day by focusing on the work and ignoring how miserable it was making me.  In yoga, I spend an hour or more each class inside my own head, and it's really hard to ignore how you're feeling when it's just you and your thoughts*.  Being present with my own emotions forced me to acknowledge them and, eventually, to do something about them.

Yoga also, in a very tangible and physical way, forced me to confront the fact that I am limited.  Doctors aren't supposed to be - we're taught from the beginning of medical school that we should be able to do any amount of work under any conditions without ever making a mistake.  And while I knew intellectually that this was utter nonsense, on an emotional level, this concept of what a physician should be was harder to let go of.  In yoga, my limitations are right there and are impossible to ignore.  If I go to a hard class one day, my muscles will be sore the next day and I won't be able to do the same poses.  I am limited and imperfect.  And I need rest.

Now, on what is hopefully the other side of burnout, yoga is a big part of how I'm rebuilding.  It's exercise and stress relief and a place that always feels safe.  On harder days at work, I take comfort in knowing that I can end my day on my mat, with a bit of calm and a bit of peace.  It's my happy place, and I'm incredibly grateful to have found it.


*and an instructor made of nothing but bone and muscle who can bend their body in super-human ways

Monday, August 5, 2019

How FIRE led me to Burnout

For a physician, I think and talk and write a lot about taking time off.  Two years ago, I committed to taking vacation every three months, and I have done a pretty good job of sticking to that ever since (I even took an extra vacation this year!).  I talk to trainees all the time about taking time away from work in order to maintain their mental health and have some joy in their lives.  So, until recently, I really thought I had the right mindset with respect to so-called work-life balance.

Except...underlying everything has been the idea of FIRE.  Work my ass off for a few years, save as much as possible, and then run away to a life of complete freedom and constant joy.  The dream!  While I still allowed myself vacations, the desire to have enough money to retire as soon as possible led me to make other bad decisions that were perhaps worse than never taking time off.  Sure, I'll add more patients to my already overbooked clinic.  Sure, I'll take on some lucrative contract work that I don't have time for.  Sure, I can do an extra Friday afternoon clinic even though I'm barely clawing my way to the end of the week as it is.  I convinced myself that I was being a good doctor by seeing more patients, but if I'm being honest, the real driver was the extra money that could go directly into my retirement savings.

And so, as I've already written about, I crashed in a somewhat spectacular way.

I'm actually kind of thankful for the crash (or, at least I think I will be when I look back on it someday), because it has forced me to reevaluate my decisions.  And two big things have come out of my months of self reflection.  First, continuing to work at as a physician is the best option for me, at least in the present.  I have contemplated taking a significant chunk of time off or quitting to pursue another career altogether, but when I look at it in the most practical of ways, doing so doesn't make any financial sense.  I could go part-time as a physician and earn more than I would doing most other jobs.  In the years it would take me to study to do something else, I could work full-time as a physician and save up most of what I need to retire.  My current reality is that I need to work to pay bills and save for the future, and medicine is by far the most efficient way of doing that.  As an added bonus, I also often like my job, at least when things aren't as overwhelming as they have been recently.

Second, and probably the more important, is that I need to stop making my decisions from a place of fear.  While part of my motivation for achieving financial independence has been a desire to not work, most of it has been a desire to not need to work.  To know that, whatever illness or mental health crisis or government overhaul of the healthcare system may hit, I am going to be okay.  Because as a single person with no one else to rely on, I worry a lot about my financial future, even when there's zero necessity to do so.  And that is a really unpleasant and unhealthy approach to money.

Thankfully, things at work are starting to get better.  I have only one slightly overbooked clinic left, and my clinics are going to continue to get lighter over the next few months until I achieve a point of actually being slightly underbooked.  I'm at the point where I can usually get my work done within the 45 hour a week maximum I've set for myself.  I'm scheduled to start six days of call tomorrow, and I'm not having panic attacks or suffering from intractable insomnia.

There are moments when I'm actually enjoying my work and remembering why I became a physician in the first place.

So I am going to keep practicing at letting go of all the things that have been driving me to burnout.  Letting go of my obsessive tracking of my net worth.  Letting go of the countdown to retirement.  Letting go of the belief that the future is going to be so much better than the present, and the desire to burn through time in order to get there.

I'm going to try, as much as I can, to live in the now.  To enjoy what I have, to be grateful for all the good, and to simply breathe.

Saturday, June 15, 2019

When the Body Says No, Really

When I wrote this post three months ago, I thought everything was going to be okay. I had turned down a few things that were stressing me out, and I'd shuffled around a few patients so that I was only overbooked for the next two months instead of the next four, and I thought it was going to be enough.

Except it wasn't.

The stress kept getting worse.  I went from feeling anxious most of the time to feeling anxious all of the time.  I was constantly aware of all of the work I still had to do, and no matter how many extra hours I logged, the amount kept getting bigger.  I would push myself hard for days to get sort of caught up, but then a single busy call shift or clinic that ran over would undo it all.  I eventually stopped trying to get caught up, resigning myself to being perpetually behind and overwhelmed.

And then I started fantasizing about leaving.  Not random, fleeting thoughts of "I wish I could spend this beautiful day outside instead of in the hospital", but whole days of thinking "If I liquidate all my assets and live on a mustachian budget, how long can I go before I'd have to work again?"

I might have been able to hold things together if I'd actually stuck to my plan to say no to everything, but I didn't.  An offer came for me to present at a national meeting, and it felt like turning it down would have a hugely negative impact on my career.  So even though I was at my limit, and doing so would mean days of preparation and travel and time changes, I said yes.

The presentation went fine, but I was so tired afterwards that I could barely force myself to leave my hotel room.  I tried to go to conference sessions, but the speakers' words turned to static in my brain, so I wandered Montreal aimlessly when I should've been at the conference.  I bought books and sushi, and I spent almost an entire day devouring them both while hiding in my hotel bed.  I didn't want to be a doctor anymore. 

It was a week later that I crashed completely.  The weekend after the conference was Pride, and I decided to do all the Pride things all weekend, which is not a recipe for introvert happiness.  By the time I dragged my beer-soaked Blundstones home at 10 PM on Sunday night, I was a wreck.  And I couldn't sleep.  At 2 am, wide-eyed and jittery, I made my way to the computer and emailed the nurses to say I was cancelling a clinic.

11 years of clinical training and practice, and until then I had never missed a day of work for anything other than the direst of medical situations.

It was (at least, I hope it was) the wakeup call I needed.  It was my moment of realizing that slowing things down a bit in a few more months wasn't enough - I was in trouble now.  I could maybe muddle my way through six weeks of clinics until my next vacation, but there was no way I could do that and do two weeks of inpatient call.  I could not keep pushing myself.

The two weeks since that moment have involved a lot of soul searching and a lot of conversations with people who have thankfully been incredibly supportive of me.  The biggest thing - the thing that saved me and for which I will be ever grateful - is one of my colleagues took three weeks of my summer call.

Three weeks.
Of call.
In the summer.

I hope that someday in the very distant future I will be in a position to do someone such a huge favour, because if he hadn't done that, I'd be on stress leave right now.  Taking those weeks of call from me has given me a way forward, a bridge to a time when I can actually scale my workload back enough to make it tenable in the long-term.

He quite literally saved me.

There is so much more to say, but as I write that line and let the truth of it sink in, I can't think very far past it.

I am so glad that every time I'm in darkness, someone brings me a light.

Sunday, March 24, 2019

Why Saying No is Hard

In retrospect, I'm a little surprised that it took me as long as it did to start protecting my time.  I've known from the very beginning of my training that, in order for my career to be sustainable, I need to have some time to recharge.  And I've done very well at protecting my time when it comes to vacations.  I've taken all of my allowed vacation days, and I've refused to do any work or studying when on vacation.  But when it comes to the day to day, I've let myself take on far more work than I can handle permanently without being miserable.  So why?

I spent nine years in medical training (4 years medical school, 3 years residency, and 2 years fellowship), and seven years in undergraduate/graduate school before that.  As a trainee, I got very limited choice about things.  My courses were mostly decided for me, someone else set my schedule, and saying no to things was almost never an option.  So I just sucked it up.  For years.  I suppressed my desire to sleep and eat healthy food and have strong relationships as much as I possibly could, and I survived in a sugar- and caffeine-fueled haze because I had to.

And then, I came out on the other side, and it took a while to occur to me that I was in charge for once.  Since starting my job, I've somewhat reflexively said yes to things, because that's simply what I've always done.  But I actually don't have to do that.  For once, I get to make the decisions. 

Denial (It'll Get Better Soon):
Whenever I look at my schedule, I think "Once <insert current thing that is taking up too much of my time> is over, I'll get a chance to catch up".  Except I never do.  Current thing gets replaced by next thing, and my schedule stays busy and overwhelming.  It has been like this for almost four years, and yet it is only now that I'm really waking up to the fact that my schedule will always be overwhelming unless I deliberately take steps to slow down.

I really have absolutely zero to complain about when it comes to my money.  I am paid very well, and since I started working in 2015, I've paid off my six-figure student line of credit and accumulated almost 1/3 of what I need to retire.  I am doing great, and I know there are a lot of people who would be very happy to swap financial situations with me.  I recognize how fortunate I am financially, and I am incredibly grateful for that.

And yet...I still worry.  What will happen if I become disabled*?  If my province radically cuts healthcare funding and my job changes or disappears?  If I burn out and am no longer able to work?

The worry drives me to accumulate.  To build up my cash savings and my investments as protection against all of the uncertainty of life.  Working less means earning less, and while it would still be more than enough, it feels scary to someone who is as security-focused as I am.

Other people do more than me.  They see more patients, do (waaaay) more research, and have more administrative responsibilities.  Lots of them have spouses and/or children, so they have a whole second set of duties to take care of when they go home.  And when I look at these people, I wonder "Why am I complaining about my much emptier schedule?  Why can't I do as much as they do without complaining so much?"

It is hard to accept that I simply can't.  Whether it's because of my anxiety, or being an introvert, or my perfectionism, or some combination of that fabulous trifecta, I simply cannot do as much as other people do.  And more importantly, I don't want to.  I want to not panic if I have to add an extra patient to a clinic because of an emergency.  I want to sleep through the night without experiencing anxiety-induced insomnia.  I want to have unstructured time at home to just breathe and exist, without having to constantly run through my to-do list in my head.

I want to be happy, at least most of the time.

What makes it hard for you to say no?

*I have some, but not enough, disability insurance right now.  This is one of those "important but not urgent" things that I've been putting off for too long.

Wednesday, March 20, 2019

When the Body Says No

Overwork crept up on my slowly.

Work has always felt busy to me, but over the past six months, the intensity has been increasing.  An extra patient or two added to each clinic.  A new computer system that is supposed to, but doesn't, make things easier.  An extra trainee to supervise each week.  Nothing particularly time-consuming on its own, but the cumulative effect has been a few extra hours of work every week.

At the same time, life outside of work has become busier.  I've invested a lot of energy into meeting people, and my social circle has expanded.  And on New Year's Day, I met my new girlfriend!  And I've started doing yoga.  And while all of these things are good (some of them really good), they all take time.

I started to notice the effects of being too busy right before my Christmas break.  At the end of yoga class, lying in shavasana (aka "corpse pose"), I'd often fall asleep.  On a particularly bad day, I'd cry.  I thought that I just needed a good break, but I felt just as tired and overwhelmed after my 10-day break as I had before.  The same thing was true when I returned from a recent week of vacation in Mexico.

The lowest point came the first week back from Mexico.  I was in the middle of my usual Thursday paperwork day when I started having an anxiety attack.  I couldn't focus on anything I was supposed to do, and all I could think about was how I could never possibly get done everything I needed to do.  I ended up having to leave early, because I was just desperately spinning my wheels while accomplishing absolutely nothing.

That night, I took a long and serious look at what had gotten me to that place.  (Also a long and serious look at my bank balance.  If it had been high enough for FIRE, that might have been the moment for me.  But alas, it's not even close.)  And I realized that I haven't done anything to protect my time and energy, even though I know that I am someone who gets (relatively) easily overwhelmed.

So my new phrase is "fuck no".  (The "fuck" part said inside my head, because of the aforementioned lack of enough money to retire.)  I have put an absolute moratorium on saying yes to anything else, and I've been getting rid of any commitment that I can possibly get rid of.  I've put a firm cap on my clinics, and when people say "Can't you just squeeze in one more patient?", the answer is "Noooooo".

Better to pare back now, when I'm not totally burnt out, than to be forced to do it when I am.

(I have so much more to say about this, but I'm exhausted.  Hopefully soon!)