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.
Showing posts with label Anxiety. Show all posts
Showing posts with label Anxiety. Show all posts
Thursday, October 31, 2019
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.
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.
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.
Wednesday, May 23, 2018
What It's Like to be Queer
Pride Week is coming up in my city, and as an early event, last week my medical school hosted a group of transgender individuals talking about their experiences and answering questions. Although it was a Friday afternoon and I was tired from being on call, I made an effort to attend, partly because I was interested in the session, and partly because as a queer person I feel a sense of responsibility to show up to all LGBTQ* events. The session was hosted in the same room as my first-year medical school class, and as I pulled open the familiar door, I felt something completely unexpected.
Fear.
Now, before I continue, I want to give some back story. I came out as a lesbian when I was 16, and as bisexual less than a year later, so I have been out to the people closest to me for decades. I brought my same-sex partner to a work dinner over four years ago, and I have been answering people's awkward questions about swingers resorts and polyamory at work ever since. But when I was in medical school, having just returned to my home city after seven years away, none of my classmates knew. Because I was still dating men at the time, everyone operated on the assumption that I was straight, and I did nothing to challenge them.
So my first thought, walking into my old classroom, was a reflexive "I hope no one sees me here and figures out that I'm queer." Which...hello. A little late now. I work at a small university, and pretty much everyone who knows me also knows that I'm queer.
But there it was, nonetheless. An almost instinctive desire to hide. To pretend to be just like everyone else.
And it came up again last night. The new girl and I went to a theatre show together, which was hosted by the company with which I volunteer, and my first thought was that I needed to hide the relationship from my fellow volunteers.
My fellow volunteers in a left-wing theatre company.
There aren't a lot of spaces in this world that are more queer-positive than a theatre show, and yet that automatic response was still there. Even though I live in a country where same-sex marriage has been legal for 13 years and where the Charter of Rights and Freedoms protects LGBTQ* individuals, I still feel anxious about being out everywhere I go.
If my patient finds out that I'm queer, will they want a different doctor?
If my doctor finds out that I'm queer, will she want a different patient?
Can I hold my partner's hand in this alleyway at night? In the elevator of my apartment building? In the grocery store?
I am so lucky and grateful to live in a time and place where my rights as a queer woman are protected.
And yet.
Fear.
Now, before I continue, I want to give some back story. I came out as a lesbian when I was 16, and as bisexual less than a year later, so I have been out to the people closest to me for decades. I brought my same-sex partner to a work dinner over four years ago, and I have been answering people's awkward questions about swingers resorts and polyamory at work ever since. But when I was in medical school, having just returned to my home city after seven years away, none of my classmates knew. Because I was still dating men at the time, everyone operated on the assumption that I was straight, and I did nothing to challenge them.
So my first thought, walking into my old classroom, was a reflexive "I hope no one sees me here and figures out that I'm queer." Which...hello. A little late now. I work at a small university, and pretty much everyone who knows me also knows that I'm queer.
But there it was, nonetheless. An almost instinctive desire to hide. To pretend to be just like everyone else.
And it came up again last night. The new girl and I went to a theatre show together, which was hosted by the company with which I volunteer, and my first thought was that I needed to hide the relationship from my fellow volunteers.
My fellow volunteers in a left-wing theatre company.
There aren't a lot of spaces in this world that are more queer-positive than a theatre show, and yet that automatic response was still there. Even though I live in a country where same-sex marriage has been legal for 13 years and where the Charter of Rights and Freedoms protects LGBTQ* individuals, I still feel anxious about being out everywhere I go.
If my patient finds out that I'm queer, will they want a different doctor?
If my doctor finds out that I'm queer, will she want a different patient?
Can I hold my partner's hand in this alleyway at night? In the elevator of my apartment building? In the grocery store?
I am so lucky and grateful to live in a time and place where my rights as a queer woman are protected.
And yet.
Monday, May 21, 2018
Anticipatory Grief
Years ago, a friend of mine who was eight months pregnant commented that she hadn't set up her nursery yet, as she knew that it would upset her if she were so unlucky as to have a late complication and lose her baby. Another friend, who was already a mother, gave her a piece of advice that has stuck with me to this day:
"If you lose your baby, you're going to be devastated whether you've set up the nursery or not. All that you're accomplishing by trying to protect yourself from grief is preventing yourself from feeling joy right now."
I have been thinking about this a lot over the past ten days. Ten days ago I met "the new girl", and in addition to blogging about her here, I've also been tweeting about her incessantly. About how much we have in common. About how easy it is to talk to her. About how I kind of wanted to marry her after she told me that she has a plan to retire at 55.
I recognize that this is ridiculous. We have known each other for only 10 days, and while there are many things that work, 10 days is way too soon to be making any sort of decisions about anything. It is not impossible to think that we could end up in a wonderful forty-year-long relationship, but we could also be sick of each other by the end of the month. We just don't know.
And honestly, I'm scared. I'm scared that I am going to fuck something up, or she is going to fuck something up, or that things are just not going to align in the right way, and this lovely feeling I'm feeling is going to end. So part of me thinks that I should stop tweeting and daydreaming and feeling all of the happy feels.
But then I remember the advice. And I just go with it.
"If you lose your baby, you're going to be devastated whether you've set up the nursery or not. All that you're accomplishing by trying to protect yourself from grief is preventing yourself from feeling joy right now."
I have been thinking about this a lot over the past ten days. Ten days ago I met "the new girl", and in addition to blogging about her here, I've also been tweeting about her incessantly. About how much we have in common. About how easy it is to talk to her. About how I kind of wanted to marry her after she told me that she has a plan to retire at 55.
I recognize that this is ridiculous. We have known each other for only 10 days, and while there are many things that work, 10 days is way too soon to be making any sort of decisions about anything. It is not impossible to think that we could end up in a wonderful forty-year-long relationship, but we could also be sick of each other by the end of the month. We just don't know.
And honestly, I'm scared. I'm scared that I am going to fuck something up, or she is going to fuck something up, or that things are just not going to align in the right way, and this lovely feeling I'm feeling is going to end. So part of me thinks that I should stop tweeting and daydreaming and feeling all of the happy feels.
But then I remember the advice. And I just go with it.
Thursday, May 17, 2018
Dating
Hey wow...yes...I have a blog.
It turns out that when you take three weeks off of work, no matter how good a job you do of getting caught up before you leave, there will be a shit tonne* of work waiting for you on your return. And if you're sick for three weeks before you leave and therefore don't get done everything you want?
You're doomed.
It has taken me a solid three weeks of hard work to get almost fully caught up, and I am now on call for two weeks, so I am falling further behind every day. So there (obviously) hasn't been a lot of blogging happening.
But there has been some dating. (Also a reason for the not blogging.)
Dating is one of my least favourite activities in the world. I have a few hangups about my appearance (thanks bad genetics and critical mother!), so putting photos out there for people to judge me by is not fun. (I'm sure I'm the only person who feels this way.) I also really don't like to meet new people. I do like when new people become old friends, but I do not like the anxiety of meeting someone new or the tedium of making small talk with someone I don't like.
So yeah. Introverts. Don't like dating. Who knew?
But then I met someone. Maybe not SOMEONE, someone. But someone interesting. Someone whom I have actually been seeing around my city for years, because my city is small and we both love the theatre. Someone who likes 90% of the same things as me. Someone whom I have now spent over 8 hours with and had virtually no moments of awkward silence with.
Someone.
And it has been pretty wonderful, in a lot of ways. Except for my anxious brain. My anxious brain does not like to just relax and let things happen. It wants answers to everything. Now.
Are we compatible enough? Will my mother like her**? Will I break her heart? Will she break mine? Will I stay with her too long and regret time lost, like I always do?
It is, frankly, ridiculous. I haven't known her long enough to be wondering any of these things. All of these questions, and the many others that distract me constantly, can be answered with time. There is no rush.
I can just date.
So I am trying to go against my nature and do just that. Trying to slow down and let things unfold how they will.
We shall see.
*The metric equivalent of a shit ton.
**Probably not. But that's just my mother.
It turns out that when you take three weeks off of work, no matter how good a job you do of getting caught up before you leave, there will be a shit tonne* of work waiting for you on your return. And if you're sick for three weeks before you leave and therefore don't get done everything you want?
You're doomed.
It has taken me a solid three weeks of hard work to get almost fully caught up, and I am now on call for two weeks, so I am falling further behind every day. So there (obviously) hasn't been a lot of blogging happening.
But there has been some dating. (Also a reason for the not blogging.)
Dating is one of my least favourite activities in the world. I have a few hangups about my appearance (thanks bad genetics and critical mother!), so putting photos out there for people to judge me by is not fun. (I'm sure I'm the only person who feels this way.) I also really don't like to meet new people. I do like when new people become old friends, but I do not like the anxiety of meeting someone new or the tedium of making small talk with someone I don't like.
So yeah. Introverts. Don't like dating. Who knew?
But then I met someone. Maybe not SOMEONE, someone. But someone interesting. Someone whom I have actually been seeing around my city for years, because my city is small and we both love the theatre. Someone who likes 90% of the same things as me. Someone whom I have now spent over 8 hours with and had virtually no moments of awkward silence with.
Someone.
And it has been pretty wonderful, in a lot of ways. Except for my anxious brain. My anxious brain does not like to just relax and let things happen. It wants answers to everything. Now.
Are we compatible enough? Will my mother like her**? Will I break her heart? Will she break mine? Will I stay with her too long and regret time lost, like I always do?
It is, frankly, ridiculous. I haven't known her long enough to be wondering any of these things. All of these questions, and the many others that distract me constantly, can be answered with time. There is no rush.
I can just date.
So I am trying to go against my nature and do just that. Trying to slow down and let things unfold how they will.
We shall see.
*The metric equivalent of a shit ton.
**Probably not. But that's just my mother.
Sunday, December 3, 2017
Set It And Forget It
I am really lucky to have had a Dad who was an insurance salesperson and later a financial advisor. From the time I was a kid, we had long talks about money and economics and saving for the future. I had a university savings account from the time I was five, and half of my $2 a week allowance got put into it. When I turned 18, my Dad gave me a $500 RRSP and a copy of The Wealthy Barber for my birthday, complete with the advice to always put 10% of my earnings directly into savings.
"Even when I'm a university student and I can barely afford to pay my tuition", I asked?
Yes. Even when I was a university student and I could barely afford to pay my tuition. Always.
Along with the recommendation to save at least 10% of my earnings, my Dad advised me to "set it and forget it". Pick a good investment vehicle (or vehicles), set up a monthly direct deposit, and then almost never look at it. Check it every 3-6 months to make sure the investment strategy is still sound, adjust as necessary, and then ignore it. Don't get caught up in the day to day fluctuations in the market, which cause people to make damaging emotional decisions, and just focus on long-term wealth building.
This strategy served me well. I followed his advice through my 20s, and by the time I started medical school at 29 I had a nice chunk of savings, which I kept for retirement instead of putting towards school. And I kept up the 10% rule through medical school and residency, so even though I became a wild spending machine, I was still building some savings. (Although not nearly as rapidly as I was building debt, sadly.) The best part of the "set it and forget it" advice was that I could do just that: forget it. I included savings in my budget, they came out automatically, and I could rest comfortable in the knowledge that I was preparing for the future.
All of that changed when I became an attending. As a fee-for-service physician, I was no longer earning a regular paycheque. The amount I took home fluctuated wildly depending on whether I was on call, how busy my clinics were, and whether I took vacation. This year, for example, there was a four-fold difference between my best and my worst paid months. I'm not complaining at all about how much I am paid - it's wonderful to earn enough to save over 2/3 of what I'm earning without having to adopt Frugalwoods-level frugality - but I have struggled a lot with the variability of my income.
In good months, when I am earning and savings lots, I feel great. In months when I'm not on call or I lose a lucrative Monday clinic to a long weekend, I feel anxious. What if I don't save as much as I normally do? What if this is the beginning of a decline in my income, and I'm not going to be in a position to retire in 5-7 years? What if I burn out and can't keep working until I FIRE?
I hate it. I hate that I'm earning way more than I need to live and yet I'm just as anxious about money as ever. I've tried not looking at my net worth, and it did help to reduce my anxiety, but I'm not very good at ignoring my net worth on an ongoing basis. I'm good enough at mental math that I can generally estimate my net worth even if I'm not looking at my spreadsheet.
I've been thinking a lot about this anxiety, and I realized that a lot of it stems from having set a very aggressive FIRE target for myself. Based on the amounts I've been saving to date, I could retire on a reduced budget in about 5 years and retire more comfortably in about 7 years. So January 1, 2025 has become my tentative FIRE date. But that FIRE date requires that things stay essentially the same. It doesn't allow me to buy a house, nor does it account for the very real possibility that physician payments may be cut, or at the very least will not increase at the rate of inflation. It's an anxiety-provoking FIRE date, rather than a liberating FIRE date.
So this weekend, I came up with a plan. I've figured out how much I would need to save to FIRE in 10 years, when I will be 50, and it is about 2/3 of what I've been saving to date. I'm going to take that amount and put 75% of it into investments and 25% of it towards repayment of my line of credit, thereby reducing my remaining time to pay off the LOC to another 4 years. (Initially it was supposed to take 10 years, but thanks to a lump-sum payment this year and increasing my repayment rate, I've cut that by almost half.) In the past year, I achieved this level of savings in all but two months (both big travel months), so it is a comfortable amount to set aside. And I know that it is enough, so hopefully I can relax more knowing that I am meeting good savings targets.
The funny thing is, it won't really change much on a practical level. I'm not going to go out and blow the 1/3 that I had previously been saving, as I am pretty happy with my current lifestyle. Any extra money will simply go into a high-interest savings account, where it will act as a bit of a cushion for the months when I'm spending more or earning less than usual. When it gets too big, I can either put it towards more investments or use it to pay down the debt more aggressively. I'm not really changing how much I'm spending and saving, but I'm hoping that a bit of financial hocus-pocus will allow me to stop thinking about it so much and just focus on enjoying life.
"Even when I'm a university student and I can barely afford to pay my tuition", I asked?
Yes. Even when I was a university student and I could barely afford to pay my tuition. Always.
Along with the recommendation to save at least 10% of my earnings, my Dad advised me to "set it and forget it". Pick a good investment vehicle (or vehicles), set up a monthly direct deposit, and then almost never look at it. Check it every 3-6 months to make sure the investment strategy is still sound, adjust as necessary, and then ignore it. Don't get caught up in the day to day fluctuations in the market, which cause people to make damaging emotional decisions, and just focus on long-term wealth building.
This strategy served me well. I followed his advice through my 20s, and by the time I started medical school at 29 I had a nice chunk of savings, which I kept for retirement instead of putting towards school. And I kept up the 10% rule through medical school and residency, so even though I became a wild spending machine, I was still building some savings. (Although not nearly as rapidly as I was building debt, sadly.) The best part of the "set it and forget it" advice was that I could do just that: forget it. I included savings in my budget, they came out automatically, and I could rest comfortable in the knowledge that I was preparing for the future.
All of that changed when I became an attending. As a fee-for-service physician, I was no longer earning a regular paycheque. The amount I took home fluctuated wildly depending on whether I was on call, how busy my clinics were, and whether I took vacation. This year, for example, there was a four-fold difference between my best and my worst paid months. I'm not complaining at all about how much I am paid - it's wonderful to earn enough to save over 2/3 of what I'm earning without having to adopt Frugalwoods-level frugality - but I have struggled a lot with the variability of my income.
In good months, when I am earning and savings lots, I feel great. In months when I'm not on call or I lose a lucrative Monday clinic to a long weekend, I feel anxious. What if I don't save as much as I normally do? What if this is the beginning of a decline in my income, and I'm not going to be in a position to retire in 5-7 years? What if I burn out and can't keep working until I FIRE?
I hate it. I hate that I'm earning way more than I need to live and yet I'm just as anxious about money as ever. I've tried not looking at my net worth, and it did help to reduce my anxiety, but I'm not very good at ignoring my net worth on an ongoing basis. I'm good enough at mental math that I can generally estimate my net worth even if I'm not looking at my spreadsheet.
I've been thinking a lot about this anxiety, and I realized that a lot of it stems from having set a very aggressive FIRE target for myself. Based on the amounts I've been saving to date, I could retire on a reduced budget in about 5 years and retire more comfortably in about 7 years. So January 1, 2025 has become my tentative FIRE date. But that FIRE date requires that things stay essentially the same. It doesn't allow me to buy a house, nor does it account for the very real possibility that physician payments may be cut, or at the very least will not increase at the rate of inflation. It's an anxiety-provoking FIRE date, rather than a liberating FIRE date.
So this weekend, I came up with a plan. I've figured out how much I would need to save to FIRE in 10 years, when I will be 50, and it is about 2/3 of what I've been saving to date. I'm going to take that amount and put 75% of it into investments and 25% of it towards repayment of my line of credit, thereby reducing my remaining time to pay off the LOC to another 4 years. (Initially it was supposed to take 10 years, but thanks to a lump-sum payment this year and increasing my repayment rate, I've cut that by almost half.) In the past year, I achieved this level of savings in all but two months (both big travel months), so it is a comfortable amount to set aside. And I know that it is enough, so hopefully I can relax more knowing that I am meeting good savings targets.
The funny thing is, it won't really change much on a practical level. I'm not going to go out and blow the 1/3 that I had previously been saving, as I am pretty happy with my current lifestyle. Any extra money will simply go into a high-interest savings account, where it will act as a bit of a cushion for the months when I'm spending more or earning less than usual. When it gets too big, I can either put it towards more investments or use it to pay down the debt more aggressively. I'm not really changing how much I'm spending and saving, but I'm hoping that a bit of financial hocus-pocus will allow me to stop thinking about it so much and just focus on enjoying life.
Thursday, August 17, 2017
Financial Personalities
I am very lucky to have a few super long-term friends, the longest-term of whom is my friend L. L and I met in kindergarten, and we have lived fairly parallel lives ever since (same elementary/junior high/high school, same university, same medical school, same residency site, and now working at the same hospital). Although our lives have been pretty similar, we are nonetheless very different people. Where L is outgoing, I'm a classic introvert. Where I am uptight and neurotic, she is laid-back and has a laissez-faire attitude. She chose to be an Emergency physician because she loves the fast pace and variety, while I chose to be an Internal Medicine sub-specialist so that I could spend lots of time thinking and pouring over medical minutiae. We're closer-than-sister friends, but very different in many respects.
As an introvert, I cling tightly to established relationships, so I make it a priority to maintain my friendship with L. Because we're both busy people, the easiest way for us to do this is to get together for dinner, which we try to do once a month. (This is one of the reasons my eating out budget is ridiculously high.) Earlier this week, we met at a local restaurant for cocktails, charcuterie, and a chance to catch up on everything that's happening in our lives. And one of the subjects that came up was money.
Having known her for 35 years, L is one of the few people with whom I can honestly talk about money. So I talked frankly about how I'mhorribly a little bit obsessive about saving money, about how closely I monitor my net worth, and about how much I would love to have enough to retire right now, even though I probably wouldn't. As I talked, I could see a bemused little smile form on her face.
"Oh my god, Solitary! You're a physician. Stop worrying about money so much! You have enough money. Just spend it!"
She then proceeded to tell me about her financial strategy, which is basically to meet with her financial advisor once a year to review her debt repayment strategy and investment strategy, after which she spends whatever money is left over. She doesn't really know her net worth, and she certainly doesn't know her daily net worth like I do. But with how little attention she pays to her money, she is vastly less stressed about finances than I am.
Now...I have no idea whether her financial strategy is a good one or not. She might be saving only a small percentage of her earnings, thus ensuring that she will need to work til 65 or beyond, in which case her approach isn't great. But she spends pretty reasonably for a high income earner, and she does recognize the importance of saving, so I suspect she's doing okay. And as I just said, she is vastly less stressed about finances than I am.
Which makes me wonder: Is a person's stress level about money inherent and inflexible, or can it be changed? If I start paying less attention to my finances, could they be less of a source of anxiety for me, or is this just part of my innately anxious personality? I had thought that building up a solid net worth would get rid of my financial worries altogether, but it has really only lessened them slightly. I'm now convinced that achieving Financial Independence is the key, but I'm not certain that even that will be enough. Maybe I'm just hard-wired to worry?
Are you anxious (reasonably or unreasonably so) about your finances? If so, how do you deal with it?
As an introvert, I cling tightly to established relationships, so I make it a priority to maintain my friendship with L. Because we're both busy people, the easiest way for us to do this is to get together for dinner, which we try to do once a month. (This is one of the reasons my eating out budget is ridiculously high.) Earlier this week, we met at a local restaurant for cocktails, charcuterie, and a chance to catch up on everything that's happening in our lives. And one of the subjects that came up was money.
Having known her for 35 years, L is one of the few people with whom I can honestly talk about money. So I talked frankly about how I'm
"Oh my god, Solitary! You're a physician. Stop worrying about money so much! You have enough money. Just spend it!"
She then proceeded to tell me about her financial strategy, which is basically to meet with her financial advisor once a year to review her debt repayment strategy and investment strategy, after which she spends whatever money is left over. She doesn't really know her net worth, and she certainly doesn't know her daily net worth like I do. But with how little attention she pays to her money, she is vastly less stressed about finances than I am.
Now...I have no idea whether her financial strategy is a good one or not. She might be saving only a small percentage of her earnings, thus ensuring that she will need to work til 65 or beyond, in which case her approach isn't great. But she spends pretty reasonably for a high income earner, and she does recognize the importance of saving, so I suspect she's doing okay. And as I just said, she is vastly less stressed about finances than I am.
Which makes me wonder: Is a person's stress level about money inherent and inflexible, or can it be changed? If I start paying less attention to my finances, could they be less of a source of anxiety for me, or is this just part of my innately anxious personality? I had thought that building up a solid net worth would get rid of my financial worries altogether, but it has really only lessened them slightly. I'm now convinced that achieving Financial Independence is the key, but I'm not certain that even that will be enough. Maybe I'm just hard-wired to worry?
Are you anxious (reasonably or unreasonably so) about your finances? If so, how do you deal with it?
Sunday, June 18, 2017
One Year in the Black
It has been just over one year since I reached a net worth of zero. After being in debt for almost ten years, it has been a welcome change to open the Excel file in which I track everything financial and see that my investments finally exceed the balance on my line of credit.
As a medical student and resident, I hadn't thought much about finances. I was surrounded by people who came from wealthy families, and it didn't take me long to adopt their spendy habits and to accumulate a lot of debt. I reassured myself that "everyone was doing it" and that the debt was okay, because it would be easily repayed once I became a physician and started getting paid in bags full of money. I rarely looked at the balance of my line of credit, and whenever I did it was just a quick glance, followed by a nervous chuckle at the ridiculousness of owing the bank such an enormous sum.
It wasn't until my last year of fellowship that I actually woke up to the reality of how much money I owed and started doing something about it. I went on a budget, and I actually started spending less than I was earning for the first time in eight years. I didn't save a lot of money in that year, as it was a major adjustment just to start living within my means, but at the very least I laid some groundwork for financial responsibility as an attending.
And then I finished training! And got an adult job! And suddenly there was a lot of extra money to put towards savings and debt repayment. Every day that I worked, I got a little bit closer to the longed for balance of zero. And yet, my anxiety about money actually got worse. When my line of credit was ridiculously big, I comforted myself by saying that I could declare bankruptcy if I ever lost my job*, because there was no way I could pay it back on anything other than a physician's salary. As it got smaller, and my investments bigger, I suddenly entered territory where I would be expected to pay back my loans, regardless of whether I could continue to work as a physician. And the idea of earning a non-physicians salary but still being $50,000 or $60,000 in debt was terrifying.
Thankfully, I have kept my job, and after ten months of working and saving I got myself back into the black. I expected that the anxiety about money would resolve instantaneously after achieving that milestone, but oddly enough I didn't take a lot of comfort in being a 39-year old with a net worth of zero. I still felt vulnerable to the possibility of becoming disabled** or burning out of my career and not having enough money to have good options. So I kept saving and repaying debt and watching my net worth get healthier and healthier.
In the past year, I've increased my net worth by enough that I could live at my current standard of living for about three years. While I hesitate to share actual numbers here, I will say that my net work growth breaks down roughly as follows: 10% from growth on investments; 10% line of credit repayment; 30% cash savings (for a down payment on our first home); and 50% long-term savings (RRSPs and a TFSA to minimize taxes).
My savings vary a lot from month to month, due to a fluctuating call schedule and taking time off work for vacations and conferences, but the overall trajectory of my net worth has been pleasantly positive. And finally...FINALLY...I am starting to relax a little. It is comforting to know that I could become disabled and live comfortably off my disability insurance payments. Or I could burn out from medicine and pursue a different career, and I would be absolutely fine. For the first time in a decade, I feel like I have some real security and real options. I'm still a long way from financial independence, but at least I'm sleeping more peacefully at night.
*I only had private student loans, so I think they would have been cancelled out by a bankruptcy. But don't quote me on that. And don't be an idiot like me and think that bankruptcy is a good financial strategy!
**Yes, I have disability insurance. As should every physician.
Saturday, April 1, 2017
Mistakes, I've Made A Few
When I started medical school, I believed wholeheartedly that physicians were perfect. I fully expected that, over the following 6-9 years of training, I would fill my brain with everything I needed to know about medicine and that I would learn how to use this information correctly, in every patient encounter, with 100% accuracy.
I'm not sure where I got this idea from. Certainly I recognized (probably too clearly) that I was a fallible human being, yet I somehow thought that medical training would beat the fallibility out of me. I envisioned the epic 28-hour-plus call shifts transforming me into someone perfect, someone who never wrote down the wrong drug dose and who never froze, uncertain of what to do, in the middle of a code blue.
It was a shock to me then, as I progressed through my training, to discover that my human imperfections didn't go away. I certainly learned to be much better - to double check my orders and to write list after list in an attempt to never miss anything - but the promise of perfection has remained elusive. Sometimes I slip up. Sometimes I forget to do something important, or I fail to take something into consideration when making a treatment plan, or I misjudge just how sick the patient in front of me is.
Imperfection feels horrible as a trainee, but it still feels bearable. As a trainee, right up until the last day of fellowship, there is always someone watching, someone double checking. Someone who ranks higher than you on the list of people responsible. Someone who retains the burden of final responsibility.
And then you graduate. And now you are the person in charge. And suddenly the weight of the work you do, the importance of every decision you make, seems ten times greater. Double checking becomes triple checking. Minutes of insomnia turn into hours. Precious time outside of work, which is finally not quite as rare as it was in training, is spoiled by endless questioning and self doubt.
Did I screw something up?
Is someone going to die because of something I did?
And the worst part of it is, almost no one talks about it. If you ever dare to talk to a colleague about your fears, they will minimize them, reassuring you that you're one of the good doctors. You're not one of the ones who makes mistakes.
Almost no one acknowledges that we all make mistakes. And that it isn't enough to learn how not to make mistakes or, more realistically, how to make fewer of them. What we really need to learn is how to cope with the fact that we are fallible humans, called upon to do superhuman work despite our inability to ever be superhuman.
I'm not sure where I got this idea from. Certainly I recognized (probably too clearly) that I was a fallible human being, yet I somehow thought that medical training would beat the fallibility out of me. I envisioned the epic 28-hour-plus call shifts transforming me into someone perfect, someone who never wrote down the wrong drug dose and who never froze, uncertain of what to do, in the middle of a code blue.
It was a shock to me then, as I progressed through my training, to discover that my human imperfections didn't go away. I certainly learned to be much better - to double check my orders and to write list after list in an attempt to never miss anything - but the promise of perfection has remained elusive. Sometimes I slip up. Sometimes I forget to do something important, or I fail to take something into consideration when making a treatment plan, or I misjudge just how sick the patient in front of me is.
Imperfection feels horrible as a trainee, but it still feels bearable. As a trainee, right up until the last day of fellowship, there is always someone watching, someone double checking. Someone who ranks higher than you on the list of people responsible. Someone who retains the burden of final responsibility.
And then you graduate. And now you are the person in charge. And suddenly the weight of the work you do, the importance of every decision you make, seems ten times greater. Double checking becomes triple checking. Minutes of insomnia turn into hours. Precious time outside of work, which is finally not quite as rare as it was in training, is spoiled by endless questioning and self doubt.
Did I screw something up?
Is someone going to die because of something I did?
And the worst part of it is, almost no one talks about it. If you ever dare to talk to a colleague about your fears, they will minimize them, reassuring you that you're one of the good doctors. You're not one of the ones who makes mistakes.
Almost no one acknowledges that we all make mistakes. And that it isn't enough to learn how not to make mistakes or, more realistically, how to make fewer of them. What we really need to learn is how to cope with the fact that we are fallible humans, called upon to do superhuman work despite our inability to ever be superhuman.
Thursday, November 24, 2016
Gathering my People
This has been a really, really rough week.
Really.
I didn't expect it at all. I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar. It was supposed to be a good week.
And then we had a department meeting.
There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty. And as an anxious person, uncertainty is not my friend. I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*. It's been miserable.
While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently. I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire. This isn't working.
Thankfully, today was a paperwork day, so I had lots of time to figure things out. And what I figured out was that I need a support system. People who have been through what I'm going through who can offer me some advice. Unfortunately, in Medicine this is a really, really hard thing to find. We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy.
Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending. When I realized this morning that I need more people, my brain went "Ah-ha!". That was who I needed. Except...she is an attending that I don't know personally. And I run into her about once every 3-6 months.
So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.
And she said yes.
And then I emailed another attending. Who also said yes.
Suddenly, after a week of feeling alone and scared, I don't feel so much of either.
*For the record, none of this is rationally necessary. Everything is going to be fine, one way or another. This is just anxiety.
Really.
I didn't expect it at all. I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar. It was supposed to be a good week.
And then we had a department meeting.
There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty. And as an anxious person, uncertainty is not my friend. I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*. It's been miserable.
While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently. I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire. This isn't working.
Thankfully, today was a paperwork day, so I had lots of time to figure things out. And what I figured out was that I need a support system. People who have been through what I'm going through who can offer me some advice. Unfortunately, in Medicine this is a really, really hard thing to find. We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy.
Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending. When I realized this morning that I need more people, my brain went "Ah-ha!". That was who I needed. Except...she is an attending that I don't know personally. And I run into her about once every 3-6 months.
So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.
And she said yes.
And then I emailed another attending. Who also said yes.
Suddenly, after a week of feeling alone and scared, I don't feel so much of either.
*For the record, none of this is rationally necessary. Everything is going to be fine, one way or another. This is just anxiety.
Sunday, October 23, 2016
Surviving Call
When I wrote my most recent blog post, I was feeling a little bit smug about how well my life was going. I was exercising, I was feeling calm, and my relationship was in pretty much the best state it has ever been. I was happy. I was about to start an 11-day stretch of 24-hour-a-day call, but I felt ready for it.
I've got this, I thought.
Except I didn't. It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level. I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves. (How dare they?) After weeks of respite, my mind was back to ramped-up panic mode.
And that's where it remained for most of my 11 days on call. I worried and obsessed over the decisions I was making. I felt stressed by the increasing pile of undictated charts piling up on my desk. I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough. As it often is, it was awful.
And of course, my life outside of work suffered. My relationship that had, until that point, been ticking along nicely, suddenly struggled. I was short-tempered. Everything she did seemed wrong and irritating. I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well. Also awful.
In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year. Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call. I want my life on call to still feel okay.
So I've been thinking a lot about the things that I can do to make call less awful. This is what I've come up with so far:
Undercommit: I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities. Evenings on my couch with a book and my cats are as essential to me as vitamins. This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life. Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.
The other downside to making plans when I'm on call is that I hate disappointing anyone. Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me. It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.
I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations. I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.
Keep moving: It always comes back to this. Exercise is good. I need to do it. Regularly. End of story.
Talk to M: I have a really good partner who is loving and supportive and a good listener. I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.
Let things go: The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole. I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book. And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!
I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch. I can eat a fried egg with toast or a frozen fish fillet and the world will not end. Pozole can wait for a week when I'm not on call. As can many other things. Call weeks should be about doing what is necessary, not what is perfect.
Recognize my irrationality: I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life. When I'm in the extremes of my anxiety, it can lead me to think really irrational things. Like that my relationship may not be a good one. Or I'm not cut out to be a doctor. Or I'm going to end up on the street if I don't hoard every penny I earn. Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.
Keep going to counseling: I am somewhat amazed at the difference that six counseling sessions made in my life. It probably saved my relationship with M. It certainly made work better. It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.
Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth. Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go. I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.
UTTERLY AND COMPLETELY STUPID. (I'm looking at you when I say that, Solitary.)
For now, call is done, and I am recovering on my couch with my computer/books and Callie. It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.
Hopefully my next time on call will be better.
I've got this, I thought.
Except I didn't. It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level. I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves. (How dare they?) After weeks of respite, my mind was back to ramped-up panic mode.
And that's where it remained for most of my 11 days on call. I worried and obsessed over the decisions I was making. I felt stressed by the increasing pile of undictated charts piling up on my desk. I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough. As it often is, it was awful.
And of course, my life outside of work suffered. My relationship that had, until that point, been ticking along nicely, suddenly struggled. I was short-tempered. Everything she did seemed wrong and irritating. I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well. Also awful.
In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year. Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call. I want my life on call to still feel okay.
So I've been thinking a lot about the things that I can do to make call less awful. This is what I've come up with so far:
Undercommit: I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities. Evenings on my couch with a book and my cats are as essential to me as vitamins. This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life. Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.
The other downside to making plans when I'm on call is that I hate disappointing anyone. Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me. It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.
I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations. I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.
Keep moving: It always comes back to this. Exercise is good. I need to do it. Regularly. End of story.
Talk to M: I have a really good partner who is loving and supportive and a good listener. I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.
Let things go: The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole. I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book. And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!
I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch. I can eat a fried egg with toast or a frozen fish fillet and the world will not end. Pozole can wait for a week when I'm not on call. As can many other things. Call weeks should be about doing what is necessary, not what is perfect.
Recognize my irrationality: I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life. When I'm in the extremes of my anxiety, it can lead me to think really irrational things. Like that my relationship may not be a good one. Or I'm not cut out to be a doctor. Or I'm going to end up on the street if I don't hoard every penny I earn. Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.
Keep going to counseling: I am somewhat amazed at the difference that six counseling sessions made in my life. It probably saved my relationship with M. It certainly made work better. It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.
Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth. Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go. I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.
UTTERLY AND COMPLETELY STUPID. (I'm looking at you when I say that, Solitary.)
For now, call is done, and I am recovering on my couch with my computer/books and Callie. It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.
Hopefully my next time on call will be better.
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