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

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

Well. 

This was a good thing.

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

It's honestly a little demoralizing.  I'm only three days into the work year, and I already have new letters that need to be dictated and old letters that need to be edited.  And I've had one night of insomnia, followed by a sleep deprivation-induced migraine.  (Awesome combo)

But...it's a process.  And I know that call is the hardest part of my job, particularly when it's busy call.  So I'm breathing.  And focusing on what I can learn from this experience, rather than on all the things that don't seem to be working.

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

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

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

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

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

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

Trading Money for Happiness

Like any good HSP, I don't like to be too busy.  Long to-do lists and piles of unfinished work make me anxious.  Extended periods on call break me a little mentally.  I'm not entirely sure how I survived residency, in retrospect.

As an attending, my happiness is affected a lot by the call schedule.  When the 2018 call schedule came out last year, I was initially ecstatic:  no less than a month between blocks of call*, all of my requested days off, and Christmas off for the second year in a row.  I was a tiny bit disappointed to see that I was working a lot of the long weekends, but that was a small sacrifice for what was otherwise pretty much the best call schedule I could ask for.

And then a revision came out.  And suddenly I was doing two extra weeks of call, with only a two-week break before I had to do my next stretch of call.  And the second stretch of call was immediately before my trip to France, meaning that I would be going into vacation tired and inevitably behind at work.

I was not happy.  I angrily** emailed the person in charge of making the call schedule to try to get it changed, but she had clearly had enough of dealing with demanding physicians, and she told me that I would have to find someone to switch with myself.  She was done.

So I studied the call schedule, looking for someone with whom I could switch one of my dreaded call periods.  There were a few options that would make things better, but all of them had at least one drawback:  during my beloved theatre festival, right before a major presentation, too close to another call period.  No matter how I switched them, the two extra weeks were going to make some stretch of my year miserable.

And then it occurred to me that I could just get rid of them.  Call is as lucrative as it is unpleasant, and there are other physicians who value money more than I do.  A few quick emails, and two weeks of call were gone.

The moment I got the email confirming that someone else was taking my call, I felt light.  I hadn't even realized how stressed I was feeling about my schedule until suddenly it was reasonable again.  I felt the tiniest bit of regret about the money I would lose out on, because I still have a line of credit to pay off and retirement savings to build, but it was tiny.  So tiny.

Having just come off a two-week stretch of call, I am currently even happier than I was initially about my decision to give up the extra weeks.  Even though I like the inpatient work that I do, I have spent the past two weeks counting down the days (and sometimes hours) until I would be able to turn off my pager.  I have hated the constant anxiety that comes from not knowing when I would get paged or what new challenge I would have to deal with next.  I need my downtime to be happy and healthy, and two weeks with none of it is hard.

This is what financial freedom means to me.  The ability to say "This is not worth the money" and walk away from something that makes me miserable.  Two weeks with no call is sweeter than any big house or fancy car will ever be.

*We do 1-2 weeks of call at a time for a total of about 10 weeks per year.

**Not really.  I am not an angry person.  At worst I am slightly passive-aggressive, and even then I'm mostly passive.

What I Will Be Doing Instead of Writing a Play

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

Hahahahaha.

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

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

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

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

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

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

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

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

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

How To Be Less Stabby While On Call

As a resident, I couldn't wait for the day that I would be an attending and would get to do fewer call shifts.  In my last two years of residency, I did 130 days of call per year, while as an attending I do about 70 days per year.  I anticipated that my attending schedule would feel positively luxurious by comparison, but of course, as with many things in life, that hasn't been the case.  Somehow doing less call makes me less accustomed to it and even more resentful of it when I'm in the midst of it.

Generally, I spend my weeks on call in a self-indulgent funk.  I whine about how busy I am and how long the days are; I neglect anything that isn't work-related (thank all that is holy for housekeepers); and I live off of all the foods that I tell my patients to never eat.  I'm about as miserable and self-pitying as an adult can acceptably be.  Possibly more so.

This call period, however, things seem to have shifted, if only the slightest bit.  I hate my life a little less than normal.  My smiles for patients and co-workers are a little more sincere.  I spread a little less misery everywhere I go.

Being caught up on everything at the start of the call period has probably been the biggest contributor to my slightly less horrible than usual mood.  My state of being on top of things lasted for all of one day after I started call, but at the very least I've only had to scramble to keep up with the additional work of call*, rather than struggling not to drown under call work and leftover work from the weeks before.  There is comfort in knowing that, at the absolute worst, I'm no more than two weeks behind on things.

The slight reduction in overwhelm at work has carried over into not feeling like I want to die when I get home, which in turn has led to me actually doing productive things in the evening.  Where normally I would binge watch Gilmore Girls with a peanut butter chocolate Drumstick** in my hand, I've actually gone for walks to enjoy the beautiful Spring weather.  I've done dishes.  I've paid bills.  I'm actually adulting!

Maybe forty will be the year that I actually grow up?

*Unsuccessfully, of course.

**Immediately after writing this I ate a peanut butter chocolate Drumstick.  Because I'm only human.  I would've turned on Gilmore Girls, but the girlfriend isn't home, and I think watching our show without her is probably grounds for divorce.

How Am I Doing So Far?

This week was my first week of call since I wrote my post about how to not hate call so much.  (I've been on call for 21 of the past 42 days.  Too much call.)  As the week approached, I tried very hard to say no to anything but the most essential of activities.  I deferred dinner with a friend until next week.  I said no to doing anything with my Mom.  I was ruthless with turning people down.

And then the week arrived.

Monday night a group of medical school friends whom I only see a few times a year were getting together for dinner, and I couldn't say no.

Tuesday night my girlfriend's parents invited us over for a birthday dinner.

Wednesday night a friend was visiting from Egypt and wanted to meet for dinner.

Thursday night we decided to go see a new house that had just come onto the market.

Friday night was trivia night at my girlfriend's church.  And I love trivia.

Over the weekend, we have seen three more houses, gone out for breakfast twice, gone for an impromptu coffee with my Mom and brother, watched my niece in a volleyball tournament, shopped at two craft markets, seen Romeo Dallaire speak, and gone for another birthday dinner with my girlfriend's friends*.

I apparently am incapable of just saying no to anything.  If it sound remotely interesting, and especially if it involves food, I am there.  Regardless of how tired or extroverted out I may happen to be.  Regardless of how much I need to just be quiet and still after the stress of a call week.  Regardless of what I say in my blog posts.

And yet...somehow this week worked for me.  I gave myself the option of saying no to things, but when it came time to exercise that option, I never wanted to.  I got to do a lot of fun and interesting things with people whom I love over the course of the week, and it felt pretty good.  I'm not quite sure why it was okay this time when it wasn't the last time I was on call, but somehow it was.  Maybe it was knowing that I could say no to things without guilt?  Maybe it was only being on call for one week and knowing that I would have a long stretch of recovery afterwards?

I haven't the foggiest clue, but I'm very glad it did.  And I'm hoping that it will continue to do so when the next stretch of call comes around.

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.

It Only Took Two Days

As a resident, it used to drive me nuts when I would try to page my attending and he or she wouldn't respond to my page.  It was particularly annoying when it was the middle of the night and all I wanted to do was review a case quickly so that I could get to my call room and possibly be horizontal for a few minutes.  Whenever it happened to me, I would vow that I would never, ever fail to answer my pager as an attending.

Guess which attending woke up this morning to discover that she'd slept right through a middle of the night page?

Moments When I Love My Job

It has been an absolutely perfect weekend here, which of course means that I have been on home call and working on a presentation that I have to give on Wednesday.  (Grumble, grumble)  To make sure that I didn't completely miss out on the beautiful weather, I made plans to take a break from work this morning to meet my Mom for breakfast and a walk through the largest park in my city.  Unfortunately, while I was showering in preparation for my outing, my pager went off.

"Hi, this is (Surgery Resident who is surprisingly cheerful despite working at least twice as hard as a Hepatology Fellow).  We just admitted (Very Medically Complicated Liver Patient), who is going for emergency surgery today.  We need you to come see him."

(Grumble, grumble)

After phoning my Mom and telling her to delay our plans, my empty belly and I drove to the hospital, staring glumly out the windows at all of the happy people frolicking in the sunny, 25 C weather.  Arriving at the hospital, I went into my best doctor mode, pretending that there was nowhere in the world that I would rather be on a beautiful day than inside a dimly lit hospital ward that smelled of harsh disinfectant mixed with bodily fluids.

When I walked into the patient's room, prepared to re-introduce myself with my standard line of "You may not remember me, but I'm Doctor Solitary Diner", I was met unexpectedly by the most enthusiastic of greetings.

"Solitary!  So good to see you!"

What followed was part medical interview, part in-depth discussion about our respective plans for an upcoming music festival.  Despite not having seen the patient in a number of months, he remembered that I was planning to attend the same music festival as him, and he was eager to confirm that I'd purchased my advance tickets.  (I'm actually volunteering at the festival, so it's free!)

It seems like such a small thing, but this brief interaction was a major bright spot in an otherwise tiring weekend.  It was so nice to feel like I'm not just another random face in a patient's medical team, but that I'm seen as a real human being with my own interests outside of medicine.  And it was important for me to be reminded that the patients for whom I care are distinct people with lives outside of the hospital, not just a collection of lab reports and physical exam findings.  This is why I do what I do.

Not bad for an early Sunday morning page.