Saturday, August 11, 2018

Self Care

When medical schools interview prospective students, the question "How do you deal with stress?", or some variant, inevitably comes up.  Having been an interviewer on a few occasions, I know that every interviewee with at least basic interviewing skills will come up with some combination of the following:

Adequate breaks
Healthy eating
Time with friends and family

When I said those things in my medical school interviews, just like everyone else, I was very earnest.  I legitimately thought I would find the time and energy for all of them in my medical training.

(Insert sound of my laughter here.)

Medical training was the hardest and most life-altering thing I have ever done.  Not so much the first two years - those were almost entirely classroom based, and I had long ago mastered the art of sitting in lectures and writing exams - but definitely everything that came after.  The moment I set foot on a ward for the first time, I transformed into a human-shaped bundle of stress and anxiety, constantly terrified that I was going to be responsible for letting someone die.  And unlike with many of my classmates, that feeling didn't go away for a very long time.

My strategy for dealing with this terror was to pretty much never stop working.  I would come in earlier than everyone else, work through lunch, and stay late.  I convinced myself that double, triple, quadruple checking everything would make me perfect and prevent me from ever making a mistake.  (Spoiler alert:  It doesn't.)  Any time I thought about putting in less than 100% of my maximum effort at work, I would remind myself of what was at stake:  People will die if you screw up.

Not surprisingly, my perpetual state of panic and overwork wasn't very conducive to taking care of myself.  I essentially stopped exercising on day one of my clinical rotations.  I gave up cooking for myself and ordered food so often that the receptionists at the delivery services recognized my voice.  And I started spending all the money I wanted, whenever I wanted, because "I deserved it". 

Yoga?  Did my stomach doing nervous back flips count?
Healthy eating?  If I bought my Coke and Nacho Cheese Doritos from the vending machine on the Cardiology ward, did that make them healthy?

I don't know how long I would have continued being so completely and utterly negligent of myself had it not been for a few key events.  The first was a crisis at work, which woke me up to the fact that I might not ever graduate and earn a doctor's salary.  (Spoiler alert:  I did!  And I paid off my student loans yesterday!!!)  Suddenly it no longer felt okay to spend more money than I was earning, so I discovered the great Mr. Money Mustache, started a budget, and got my financial life back in order.  The second was some upheaval at work, during which I reached out to some of the other attendings, and which ultimately led to me being connected to a wonderful performance coach.  While I have only seen him twice, I credit him with enabling me to let go of my self-destructive perfectionism and to forgive myself for being human.

The third thing wasn't a specific event, but rather years of working with people with lifestyle-related illnesses.  I spend a lot of my time at work counseling people about the negative effects of poor diet and lack of exercise, as well as treating them when their bodies break down after years of misuse.  Somewhere around the thousandth time that I said "Pop is basically poison", the message started to sink into my brain.  I'm not immune to the things that affect my patients.  I also need to care for myself.

So slowly (sometimes oh so painfully slowly) I have started to change the bad habits that I learned in medical school.  I've almost completely abandoned sugar-sweetened beverages.  I've started mostly eating brown rice* and brown pasta.  I cook a lot of my meals from scratch, and I try to pack them full of veggies and other healthy things.  I'm even exercising again and (amazingly) kind of enjoying it.

And so many other things, like getting enough sleep and meditating and taking enough vacations and quitting Twitter.  All of the things that I said I would do in my medical school interview 13 years ago, I am finally getting around to.  And it feels really, really good.

*This is huge for me, because I love white rice with a fiery passion and can happily eat two large bowls of it, smothered in butter and salt, in one sitting.


  1. Yeah, I find it laughable (in a jaded, cynical kind of way) that medicine is so destructive of the health of the people who practice it.

    I'm currently in registrar time (similar to residency) in a surgical discipline in South Africa and the message is very clear.
    Want time to sleep? You're lazy
    Adequate breaks? This one is very lazy
    Healthy meals? You want food breaks too?! So lazy
    Meditation? Sitting and doing nothing? The laziest
    Hobbies? You should be reading when you're not actually at work

    This is honestly the most destructive, toxic work culture, and if you complain you are told that you chose to do it, you asked for it.

    That said, ignoring the messages from on high and trying to actually do these things does help. It's hard to dredge up the energy for exercise but when I do I feel so much better.

    Meditation is harder when one is sleep deprived though :-) naps tend to supervene

    1. I'm not sure I could have meditated during residency. I was either wired or asleep through most of those years.

      I think the culture is slowly changing and that people are slowly recognizing that doctors are humans who need time off, but it is a very hard culture to change.

  2. I'm so glad you were able to pay off that debt! And that you've taken more control of stressors in your life. Being good to yourself is a worthwhile investment. We need doctors to survive, and thriving is the preferred option.

    1. Yay for the debt being gone! It's totally because I'm lucky enough to be in a high-paying profession and wise enough to keep spending like a resident. I hope I can keep up the momentum of making good financial decisions...although I've already started dreaming about buying a car!

  3. An attending I talked to about two years ago told me that it would be a “red flag” to her if a resident had time to exercise, indicative of them not studying or working hard enough. Sometimes it’s best not to talk to anybody at work about anything you’re really doing, otherwise your superiors may assume the worst. Such a shame we do this to each other.

    1. Does she really think that taking 30 minutes a few times a week to exercise, which probably helps the resident sleep better and be more productive, is really going to make a difference in how much someone learns? I took one day a week off throughout medical school, and I did better academically than a lot of my classmates, likely because I was rested and efficient with the time I did spend working. I hate this toxic culture!

    2. Oh I agree. Today a faculty member caught me at the climbing gym with my family. Part of me worries he’ll spread rumors that I wasn’t working hard enough this weekend because I wasn’t home working on my research. That’s probably paranoia on my part though. You know what I do now to take care of myself? I exercise, sleep 8 hours a night whenever possible, and read books for pleasure (and blog when I’m not on the job market). You have to do what you need to do to take care of yourself. It makes me more productive and happier in the long run.

  4. yes, yes, yes to authentic self care! I feel like this is a trap for anyone in a helping profession; I teach and have a hard time letting go of work. My students dying are rarely the stakes, but I am teaching the next generation and all that.

    I've been working to put up some boundaries and find time for myself. Also hard with two little ones at home. Thankfully, my toddler LOVES to go out in the jogging stroller with me, so I've been walking/running this summer.

    I'm glad you are finding some things that work for you.

    1. I think it's an endless struggle. It's a lot easier now than it has ever been, because I've mostly settled into a pattern at work and I am single and childless, but I know that even this equilibrium will shift.

  5. May I recommend Joshua McFadden's cookbook, Six Seasons? I get a produce box every week and ended up wasting food (UGH) until I went through his book and marked recipes/ideas. Most are fairly quick, some are involved, but they're delicious and so healthy :)

    The lifestyle is part of the reason why I decided to spend another year in grad school. Sure, I work a million hours and hate most things, but, I CHOOSE my hours, and most of hate is self-directed :)

    1. Just ordered it from my library! Thanks for the suggestion.

  6. Nice casual slipping in of "paid off my med school loans" CONGRATS how exciting!

    And self care has taken me a while to really work towards too. I used to live off Lean Cuisines and energy drinks and over the last decade started realizing how crappy it made me feel (and look because my acne feeds off that crap).

    Wishing you lots more self care time in the future!

    1. Thanks! At some point I will write a blog post about paying off the loans, but it honestly hasn't completely sunk in yet. I also feel a bit like I'm cheating, because paying off the loans wasn't all that terrible on a physician's salary. The accomplishment feels like nothing in comparison to what many people are doing to repay loans.

      I wish the healthier lifestyle would help my acne! I stopped OCPs a year ago, and the acne has come back so badly that I've gone back on them. It just makes me too miserable to not be on the pill.

  7. Congratulations for paying off your student loan!! Funnily enough I only learnt about these self care techniques during medical school and especially in the last two years. I was looking for everything and anything that would help me out. But without proper planning, I'd often be too tired or unmotivated.

    1. Thanks! It's actually not that hard as a single person earning a physician's salary. Especially when you're cheap.

      I'm glad you were able to learn some self care in medical school. I basically just brute forced my way through it and was miserable most of the time.