Self Care

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

Exercise
Rest
Adequate breaks
Healthy eating
Meditation
Yoga
Time with friends and family
Etc.

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

(Insert sound of my laughter here.)

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

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

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

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

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

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

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

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

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

Movement - September Goal

Oh exercise, how I struggle with you.  With just a quick look through the blog, it's easy to find multiple posts in which I'm either committing to exercising more or lamenting the fact that I've failed at exercising more (see here, here, here, here, and here for just a few examples).  It's not a habit that comes easily to me.

The problem, for me, is that there are so many things that I would rather being doing than exercising.  Reading, blogging, cuddling with my cats and/or girlfriend, eating out, cooking at home, etc. etc.  There is no shortage of things that I want to do, and it is always difficult to say no to them in order to do something that doesn't really appeal to me.

But I know I need to.  For my stress level, for my health, for my happiness.  Everything is better when I get exercise.  So this month, I set myself the goal of exercising three times a week.  I didn't set any specific requirements for how long or what type of exercise or anything else, I simply had to move.  And I'm happy to report that I was almost perfect.  In the entire month, I only missed one workout, and that was due to the fact that I had such bad sciatic pain that I could barely walk.

In addition to working on the habit, I wanted to observe myself and figure out what helped me/hindered me when it came to exercise.  I want to better understand why I've failed in the past so that hopefully I can do better at making this a lifelong habit.  If nothing else, it will be much more interesting for the blog if I can set a monthly goal for myself that isn't exercising!  Here's what I learned over the past month:

Variety:  I've tried in the past to just run on the treadmill in my building three times per week, and it gets boring very quickly.  (Not to mention the bloody sciatic pain.  My borderline obese body was not designed for running.)  This time I've been trying to do more variety - walking outside, yoga classes, aerobics classes, elliptical - and it's definitely easier to stay motivated.

Planning:  I do much better if I sit down at the beginning of the week and plan out my exercise than if I just try to wing it.  Not surprisingly.  (I didn't promise that these would be profound observations, just observations.)

Changes in Schedule:  I have been aiming for a Tuesday/Thursday/Saturday exercise schedule, which is great when it works, but terrible if I happen to have an extra morning clinic or something else that interferes with my plans.  Going forward, I'm going to have to get better at dealing with the things that throw me off of my schedule.  (Case in point:  I have an 8 am lecture to attend tomorrow, combined with our local LGBTQ film festival in the evening, and I have no idea how to deal with it yet.)

Mood:  My mood has been vastly better over the past month than it has been in perhaps ever.  While I think the counseling and the improvements in my relationship have played a huge part, I certainly don't want to discount the role that exercise is probably playing.

So, for the first time in ever, let's call this month of exercising a success!

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As for October (quick comment before rushing off to Thanksgiving dinner #2), my goal is to not look at my net worth.  Not once.  I normally check it on a daily basis and think about it pretty obsessively, so going 31 days without looking at it is a big step for me.  But one that has been good so far, and one that I think is necessary for my happiness.

Happy Thanksgiving to everyone in Canada!  Hope you enjoy your turkey (or Aloo Gobi, which is how we're celebrating this year). 

So Many Things

You know how something happens and you think "I should blog about this", but then you don't have make the time to do it, and then something else happens that you want to blog about, but you can't because you still have to blog about the first thing, and then it happens over and over again until you have ten things you want to write about and you haven't blogged in almost a month?

Yeah.  That. 

So...because I can't decide which of the major life events I want to leave out of my blog post, and because no one wants to read a brief autobiography disguised as a blog post, here is the last month of my life in bullet points:

1. I got back together with my (no longer) ex-girlfriend.  After the breakup, I don't think I went more than four or five days without seeing M*, and I definitely didn't go that long without talking to her.  I missed her.  We started out doing the "we're spending all our time together but not dating" thing over a month ago, and we declared ourselves dating again a few weeks ago, and so far it seems to be going well.  We're doing our best not to repeat some of the mistakes we've made in the past, and it definitely makes for a healthier relationship.  We shall see where this goes...
2. My grandmother died.  My grandmother was 94, slightly senile, and diabetic, and yet I was convinced that she would live forever.  A few weeks ago, I got the call that she had had a heart attack and been made palliative, so I headed out to her small community as prepared as one ever is to say goodbye.  When I arrived at the hospital, she was asleep in her bed, but she quickly roused and demanded to be taken home.  By the time we got her back to the PCH, she was back to her usual feisty self, showing no signs of what had happened.  Unfortunately, a week later she fell and broke her hip (for the third time), and that was the beginning of a very rapid end.  My grandmother was the most resilient of the resilient Depression era farm women, and so it's still amazing to me that she's gone.  I still have moments when I feel guilty for not visiting her, so I don't think it's quite sunk in yet.
3. I decided what to do with my budget.  The comments on my previous blog post were fascinating to me!  It's interesting how everyone has their own unique way of being financially responsible, many of which are different from my own.  In the end, I realized that my current method of budgeting is actually working pretty well for me, except for the fact that the amount of money I was allowing myself didn't fit with the amount of income I was bringing in.  So, I threw $500 at the budget to get myself out of the black, and I increased the regular amount in my budget by 1/3.  Since the change, I have bought Threadless t-shirts and Happy Socks, taken a thankfully not sick cat for a very expensive vet visit, and booked a luxurious spa day for the long weekend.  So I'm over budget again.  But enjoying spending some of my hard earned money instead of just hoarding it in the event of future catastrophe.
4. I started counselling.  I wrote before about how I had seen a psychiatrist through a service at work, but what I've never written about was how abysmal the whole experience was.  I went in looking for some coping strategies and maybe some cognitive behavioural therapy for anxiety, but what I got was someone who wanted to put me on medication and explore all of the supposedly traumatic events from my childhood (um, no thanks).  It was a terrible match.  I put off looking for someone else until M and I got back together, and then I decided that I needed someone external to help me navigate the waters of rekindling an old relationship.  I've met with the counsellor once, and it seems like a better fit so far, so I'm hoping that something good will come out of it.
5. I started exercising again.  It has become abundantly obvious to me that everything is better when I exercise.  Not in a future oriented "I won't have a heart attack when I'm 50" kind of way, but in an "I'm less of a psycho hose beast when I exercise" kind of way.  Exercise is definitely good for my stress, my energy level, my sleep, and my all round happiness.  My goal for September, in fact, is to restart the habit of exercising three times a week.  It will likely consist of me running on the treadmill on Tuesday and Thursday mornings, as I have no clinics those mornings, and then doing something else on Saturdays or Sundays.  I may alternatively do an exercise class at work on Thursday afternoons, as there's one that starts after my work day ends.  This week I'm planning to go to yoga on Saturday morning, as my sciatic pain has flared up from the running**, but I may be more creative in the future.
6. I signed up for a meditation class.  This terrifies me.  I've been reading books about how wonderful meditation is (like 10% Happier and Full Catastrophe Living), and I'm fully convinced that it can make me a happier and more productive person, but I absolutely hate the idea of having to actually do it.  Sitting with nothing but my thoughts?  Breathing exercises?  Walking meditations?  All of that sounds terrible.  And yet, starting October 5 I will be doing it every Wednesday evening.  

And that is my life.  How is everyone else doing?

*I'm giving her an initial, because it's far too tedious to keep typing "the girlfriend" or "the ex-girlfriend" depending on my current relationship status.  Also my hands are sore from typing chart notes.

**When did I turn 80?

In the Gloaming

Given the recent end of my long-term relationship, you probably won't be too surprised to hear that my emotional state has been a bit volatile as of late.  One moment I'm feeling excited by the freedom and possibility that being single brings; the next moment I'm overwhelmed by sadness at everything that has been lost.  While I have still managed to do all of the things that I need to, getting through the days hasn't always felt great.

Tonight though, things were momentarily really good.  I had to bring my bike home from my ex-girlfriend's parents' house, where I had stored it over the winter, and I just happened to do so right at dusk.  The temperature was warm enough to be comfortable but cool enough that I didn't break a sweat; the air was still; and the clear sky transformed from pale blue to pink to indigo as I rode the bike home.  My out of shape muscles enjoyed being challenged, and my constantly busy mind reveled in being able to shift down a few gears.  It was as close to perfect as life ever gets.

I have gotten through the past few weeks by constantly reminding myself that things will get better.  Tonight though, if only for a brief moment, things already were.

2016 - Looking Ahead

Much of medical training is about deferring happiness*.  Every study session, every 24-hour-plus call shift, is an exchange of the fun things I could be doing now for the benefits I hope to get in the future.  In my case, I invested 16 years into post-secondary education with the expectation that it would make me happier in the long run.

It occurred to me recently that I have finally left the stage of deferred happiness.  The studying and exams and overnight call are all behind me, and the time for enjoying life is here.  The unfortunate thing, however, is that I have spent so much of my life looking ahead and waiting that it's hard to adjust to being in the present and enjoying it for what it is.  Whenever I think about my life, it is reflexively with a forward-looking gaze, wondering what is over the next horizon and how soon I will get there.

Which is something that I want to change.  So my overarching goal for 2016 is to learn to be present.  To stop thinking about what comes next and instead focus on what is happening now.  To enjoy the life of a physician that I worked so hard and so long to create.  To be mindful of the multitude of blessings in my life.  To do this, I plan to set little goals for myself, along the lines of the "gradual, long-lasting change" that I talked about in December.  I'll probably set one or two goals every month, although sometimes I'll set weekly goals just to try something out for a short while.  All of the goals will be focused on making life better in the now, rather than banking happiness for the future.

For January, my main goal is a resurrected one:  get to the gym three days a week.  I had been doing well prior to catching the cold from hell, but I stopped entirely when I was sick and missed about two weeks.  This week I regained the ability to breathe through my nose, so I started going to the gym again, and I've made it all three days (go me!).  This may seem like a goal with a more long-term purpose (lose weight, get healthy, don't die of a stroke at 40), but I'm really doing it for the way that exercise makes me feel in the present.  It helps my anxiety, it helps with sleep, and it simply makes me a happier person than when I'm sitting on the couch eating cheese.

My minor goal for the month is to find a counselor.  My job weighs on me emotionally - I feel anxious about the possibility of screwing things up, and I am at times devastated by the bad health outcomes that my patients experience despite my best efforts.  Although I'm coping with all of this, I don't want my work life to be just about coping.  So I'm going to try to find a counselor with whom I can talk and debrief periodically.

We'll see how I do at the end of the month.

*SLukettG writes in her typically eloquent way about this in a post entitled "Marshmallows".  Definitely worth reading.

Ripples

Monday night was a terrible, terrible night during which I tossed and turned in bed, thinking about the 2-hour presentation that I had to give later in the day and the curriculum that still hasn't been redeveloped and all of my sick patients who keep getting sicker.  By the time the alarm went off at 6:45, I was a bit of a wreck.  The evil voice in the back of my head kept telling me to skip the gym and go back to sleep, and it even managed to convince me to hit snooze and roll over.

But as I lay there trying to enjoy my nine minutes of reprieve, I realized that a little bit of extra sleep (if I could even get it) wasn't the right answer.  It wouldn't be enough to make a difference in my energy level, and it would mean one more failure in my attempt to get back to exercising.  So I got myself up, put on my workout clothes, and dragged my tired body through 30 minutes on the treadmill.

Afterwards, not surprisingly, I felt better.  More awake, more energetic.  Vastly less anxious.  The feeling carried me through the day, up until the point where I started my presentation and all of my self consciousness and stage fright came back in one horrible moment of panic.  But that eventually passed (after two hours of being stared at by everyone in the room who was still awake), and I felt okay for the remainder of the day.  And then, last night, I actually slept through the entire night.  Which, to someone with chronic insomnia, feels like a Christmas miracle.

Today, having slept, everything feels easier to handle.  I have a schedule for getting the curriculum done by next week.  I have plans for all of my sick patients.  Life is better.  Exercise is good.

I just need to remember this when I don't want to go for a run tomorrow morning...

Habits - December

I spend a lot of time with my patients talking to them about healthy lifestyles.  I talk about good food choices and how much exercise they need and strategies for making positive changes in a world that is pretty much optimized to make people fat.  And then I go home and sit on my couch eating cheese.

I have the misfortune of being someone who both hates exercising and loves eating (I suspect I'm not alone in this), so my natural tendency is to get larger with every passing year.  Over the course of my nine years of medical training, I gained approximately 30 pounds - over 3 pounds per year!  While that doesn't sound too bad, if I keep up the same slow rate of weight gain until retirement, I will be approaching 300 pounds by the time I get there.  Assuming my heart and my liver and my knees don't give out before I make it to retirement.

The other, and perhaps more important part of the healthy lifestyle equation, is that I simply don't feel good when I spend my life on the couch eating cheese.  Well...I must admit...I feel great at the moment when I'm lying horizontally in my favourite pjs and shoveling gooey cheese into my mouth.  It's the moments afterwards when I feel sluggish and tired and anxious and unable to focus that are less pleasant. 

For years, it's been easy to justify my choices, because I've simply felt so overwhelmed by the stress of medical training.  There were many days in medical school and residency when I felt like it took everything I had just to make it to bedtime, so I allowed myself to do (and eat) whatever would help me get through the day.  Now that I'm an attending, though, things are different.  I have much more control over how much I work, even if I sometimes don't make good decisions with that control.  I do far less call than before, and none of it is in-hospital call.  I finally have the time and the energy to start making some of the good choices that I talk to my patients about all the time.

So...how do I do that?  I've written here many, many times about wanting to make changes in my life, yet so far few of them have stuck.  Most recently, there were my four categories of habits that I wanted to adopt as an attending, which were so unsuccessful that I didn't even get around to blogging about the last two categories.  As I've been thinking about how to make the changes that I want to make, I keep coming back to the piece of advice that I give to all of my patients:  make gradual, long-lasting change.  No complete transformations on January 1 that last for less than a week.  No four categories of habits to adopt when you're starting a new job and dealing with all of the stress and adjustment that doing so entails.  Gradual, long-lasting change.

For me, the obvious first step is getting back to the gym.  I have pretty much the best setup for working out that anyone could have, as there is a gym two floors below where I live that costs me nothing, has brand-new exercise equipment, and is rarely used by anyone else.  My goal is to go three times a week:  Tuesdays and Thursdays before work, as I have no morning clinics on those days, and Sundays while my girlfriend is at church.  I'm not setting any specific requirements for myself beyond 1) getting to the gym and 2) spending 30 minutes doing anything that counts as exercise.  If I choose, I can spend the 30 minutes walking very slowly on the treadmill.  I just have to move. 

I've done okay with this the past few weeks, although today was the first day that I made it to the gym on Sunday.  I'm hoping that by making exercise part of my routine, like cleaning the litter boxes or showering, that it'll just become something I do without thinking about it. 

Wish me luck!