I'm not big into dates, but for some reason I love the start of the new year. Even though there's nothing magical about the transition from December 31 to January 1, it always gets me reflecting on the previous year and thinking ahead to the next. When I re-read my New Year's post from this year, I had to laugh at my intention for 2019:
"And what for 2019? Mostly, I want to keep going on the path that I'm
already on. I want to remain in the present moment, enjoying it when I
can and learning from it when I can't."
Learning from it when I can't describes so much of the past year. I existed in a state of near-constant stress for months, and then I basically fell apart when the chronic stress became too much. For weeks, I wasn't certain if I would choose to (or even be able to) stay at work. It was horrible.
Probably the wisest thing I did, and something that was only possible because of my mindfulness practice, was stay present in the tough moments. My mantra through that time, which I would sometimes recite multiple times in a day, was "Be patient. Be present." I somehow knew that, if I could just show up for those moments, that I would learn something important from them.
And I have learned an incredible amount over the past year. I've learned that I am limited in how much I can do well (as is everyone), and more importantly, I've learned that I have the support of my institution to set limits on my work. I don't have to overbook all of my clinics. I don't have to work through weekends most of the time. I don't have to say yes to every administrative task that comes my way. I can (and absolutely must) say no.
I've also learned that I am very hard working, even though I don't always feel that way when I compare myself to the overachievers who seem to be everywhere in medicine. I regularly go beyond what I need to for my patients, and I show up for them even on the days when I would rather pull the covers over my head. I'm committed to the work that I do, and I put in the effort needed to be a really good doctor.
Overall, as hard as a lot of the past year has been, I'm really proud of myself for getting through it. And for not quitting my job! Because it's generally a pretty good one, and I do a pretty good job at it, if I may say so myself.
Showing posts with label Stress. Show all posts
Showing posts with label Stress. Show all posts
Friday, December 27, 2019
Friday, November 8, 2019
How to Rest
As a resident, I had almost no time off. I worked as much as 100 hours in some weeks, often in 24-hour-plus stretches, so I was basically always either at work or collapsed half dead on my couch. I didn't have to think about the concept of work-life balance, because there wasn't any. I worked, and I did what I could to survive the five years relatively unscathed*.
And then it ended. And I was an attending! With a better schedule! And money! And completely no idea of how to take care of myself in a long-term, I want to be happy and not die of a heart attack kind of way.
I knew that having a life outside of work was a priority for me, but because it had been so long since I had had one, I had no idea how to make that happen. I also faced the new challenge of always having work to do. Labs to review, patients to call, prescriptions to renew, presentations to prepare - I live in a giant game of medical Whack-A-Mole. For the longest time, I tried to get everything done before I would "allow" myself to rest, which meant that I was always trying to work and never actually resting.
Except....I was wasting a shit tonne of time. Like most people, I have a limited amount of mental and physical energy every day (spoons!), and once I use it up, I can pretend to be working, but I'm really not. I'm checking Twitter. Or Instagram. Or Facebook. Or going to Starbucks for another tea. It feels like work time, and I resent it, but I'm accomplishing very little.
Earlier this year, when work seemed to occupy every waking and sleeping moment of my life, I was finally forced to acknowledge that I can only accomplish a finite amount of things. And this amount is never as much as I want it to be. Yet I was working myself beyond a sustainable limit, and for what? Desire for more money that I didn't need? A sense of obligation? Conditioning from the medical system to never rest? I was failing miserably at having a good life for really no reason at all.
I am incredibly lucky to have flexibility in my job and to earn much more than I need to, which as I've mentioned over and over again has allowed me to back off from work and regain some much needed time. But just as importantly, recognizing my limits has given me permission to rest. To designate evenings and weekends and long stretches of holidays as "not working" time, rather than "working but not actually accomplishing anything because I keep Tweeting about marshmallow peanut butter squares" time.
Which makes all the difference. Because distracting myself on the Internet while I'm supposed to be working isn't restful. Sleep is. Yoga is. Meditation is**.
Not doing is restful.
Next week I'm on call again, and I have a long list of things I would like to get done before I go back on call. Some of which I will get done tomorrow morning, but once my designated work time is over, I'm going to stop. I'm going to go to the theatre with my mom, and then I'm going to eat and drink more than is doctor recommended. On Sunday I'm taking myself to a Nordic spa, and I can guarantee that I will spend the whole day moving from heated bed to hot tub to wet sauna to dry. Because I will need all my spoons next week, and trying to work all weekend is not going to give any of them back.
*By the end, I had raging anxiety, was socially isolated, and had lost all self-care habits. "Unscathed" is defined very loosely here.
** When my f-ing monkey brain isn't wandering all over the place, which it always is, so I take this back, meditation is not restful, dammit.
And then it ended. And I was an attending! With a better schedule! And money! And completely no idea of how to take care of myself in a long-term, I want to be happy and not die of a heart attack kind of way.
I knew that having a life outside of work was a priority for me, but because it had been so long since I had had one, I had no idea how to make that happen. I also faced the new challenge of always having work to do. Labs to review, patients to call, prescriptions to renew, presentations to prepare - I live in a giant game of medical Whack-A-Mole. For the longest time, I tried to get everything done before I would "allow" myself to rest, which meant that I was always trying to work and never actually resting.
Except....I was wasting a shit tonne of time. Like most people, I have a limited amount of mental and physical energy every day (spoons!), and once I use it up, I can pretend to be working, but I'm really not. I'm checking Twitter. Or Instagram. Or Facebook. Or going to Starbucks for another tea. It feels like work time, and I resent it, but I'm accomplishing very little.
Earlier this year, when work seemed to occupy every waking and sleeping moment of my life, I was finally forced to acknowledge that I can only accomplish a finite amount of things. And this amount is never as much as I want it to be. Yet I was working myself beyond a sustainable limit, and for what? Desire for more money that I didn't need? A sense of obligation? Conditioning from the medical system to never rest? I was failing miserably at having a good life for really no reason at all.
I am incredibly lucky to have flexibility in my job and to earn much more than I need to, which as I've mentioned over and over again has allowed me to back off from work and regain some much needed time. But just as importantly, recognizing my limits has given me permission to rest. To designate evenings and weekends and long stretches of holidays as "not working" time, rather than "working but not actually accomplishing anything because I keep Tweeting about marshmallow peanut butter squares" time.
Which makes all the difference. Because distracting myself on the Internet while I'm supposed to be working isn't restful. Sleep is. Yoga is. Meditation is**.
Not doing is restful.
Next week I'm on call again, and I have a long list of things I would like to get done before I go back on call. Some of which I will get done tomorrow morning, but once my designated work time is over, I'm going to stop. I'm going to go to the theatre with my mom, and then I'm going to eat and drink more than is doctor recommended. On Sunday I'm taking myself to a Nordic spa, and I can guarantee that I will spend the whole day moving from heated bed to hot tub to wet sauna to dry. Because I will need all my spoons next week, and trying to work all weekend is not going to give any of them back.
*By the end, I had raging anxiety, was socially isolated, and had lost all self-care habits. "Unscathed" is defined very loosely here.
** When my f-ing monkey brain isn't wandering all over the place, which it always is, so I take this back, meditation is not restful, dammit.
Wednesday, March 20, 2019
When the Body Says No
Overwork crept up on my slowly.
Work has always felt busy to me, but over the past six months, the intensity has been increasing. An extra patient or two added to each clinic. A new computer system that is supposed to, but doesn't, make things easier. An extra trainee to supervise each week. Nothing particularly time-consuming on its own, but the cumulative effect has been a few extra hours of work every week.
At the same time, life outside of work has become busier. I've invested a lot of energy into meeting people, and my social circle has expanded. And on New Year's Day, I met my new girlfriend! And I've started doing yoga. And while all of these things are good (some of them really good), they all take time.
I started to notice the effects of being too busy right before my Christmas break. At the end of yoga class, lying in shavasana (aka "corpse pose"), I'd often fall asleep. On a particularly bad day, I'd cry. I thought that I just needed a good break, but I felt just as tired and overwhelmed after my 10-day break as I had before. The same thing was true when I returned from a recent week of vacation in Mexico.
The lowest point came the first week back from Mexico. I was in the middle of my usual Thursday paperwork day when I started having an anxiety attack. I couldn't focus on anything I was supposed to do, and all I could think about was how I could never possibly get done everything I needed to do. I ended up having to leave early, because I was just desperately spinning my wheels while accomplishing absolutely nothing.
That night, I took a long and serious look at what had gotten me to that place. (Also a long and serious look at my bank balance. If it had been high enough for FIRE, that might have been the moment for me. But alas, it's not even close.) And I realized that I haven't done anything to protect my time and energy, even though I know that I am someone who gets (relatively) easily overwhelmed.
So my new phrase is "fuck no". (The "fuck" part said inside my head, because of the aforementioned lack of enough money to retire.) I have put an absolute moratorium on saying yes to anything else, and I've been getting rid of any commitment that I can possibly get rid of. I've put a firm cap on my clinics, and when people say "Can't you just squeeze in one more patient?", the answer is "Noooooo".
Better to pare back now, when I'm not totally burnt out, than to be forced to do it when I am.
(I have so much more to say about this, but I'm exhausted. Hopefully soon!)
Work has always felt busy to me, but over the past six months, the intensity has been increasing. An extra patient or two added to each clinic. A new computer system that is supposed to, but doesn't, make things easier. An extra trainee to supervise each week. Nothing particularly time-consuming on its own, but the cumulative effect has been a few extra hours of work every week.
At the same time, life outside of work has become busier. I've invested a lot of energy into meeting people, and my social circle has expanded. And on New Year's Day, I met my new girlfriend! And I've started doing yoga. And while all of these things are good (some of them really good), they all take time.
I started to notice the effects of being too busy right before my Christmas break. At the end of yoga class, lying in shavasana (aka "corpse pose"), I'd often fall asleep. On a particularly bad day, I'd cry. I thought that I just needed a good break, but I felt just as tired and overwhelmed after my 10-day break as I had before. The same thing was true when I returned from a recent week of vacation in Mexico.
The lowest point came the first week back from Mexico. I was in the middle of my usual Thursday paperwork day when I started having an anxiety attack. I couldn't focus on anything I was supposed to do, and all I could think about was how I could never possibly get done everything I needed to do. I ended up having to leave early, because I was just desperately spinning my wheels while accomplishing absolutely nothing.
That night, I took a long and serious look at what had gotten me to that place. (Also a long and serious look at my bank balance. If it had been high enough for FIRE, that might have been the moment for me. But alas, it's not even close.) And I realized that I haven't done anything to protect my time and energy, even though I know that I am someone who gets (relatively) easily overwhelmed.
So my new phrase is "fuck no". (The "fuck" part said inside my head, because of the aforementioned lack of enough money to retire.) I have put an absolute moratorium on saying yes to anything else, and I've been getting rid of any commitment that I can possibly get rid of. I've put a firm cap on my clinics, and when people say "Can't you just squeeze in one more patient?", the answer is "Noooooo".
Better to pare back now, when I'm not totally burnt out, than to be forced to do it when I am.
(I have so much more to say about this, but I'm exhausted. Hopefully soon!)
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, May 1, 2016
The Way Things Should Be
Like a number of my favourite bloggers (see here and here), I recently read Leo Babauta's post about how to not be frustrated all the time. In the post, he argues that frustration arises from our desire for things to be different from how they are.
"It’s from not wanting things to be a certain way. Not wanting other
people to behave a certain way. Not wanting ourselves to be a certain
way."
Yup. Welcome to my life. After reading the post, I started paying attention to how much mental energy I expend wishing that things were different, and I was shocked by the fact that there is pretty much a never ending stream of thought going through my head that judges everything in my life as inadequate. For example:
When waking up in the morning: "I wish it wasn't Tuesday and that I didn't have to get up and go for a run, because I'm tired and want to stay in bed under the warm covers and running sucks and I'm out of shape and I'm never going to get in shape anyway."
When walking to clinic: "I wish I didn't have so many patients booked because I'm sure some of them are going to be really challenging and then I'm going to feel rushed, and feeling rushed makes me stressed, and I hate being stressed, and if I were a better doctor I would never feel stressed."
When dictating: " I hate dictating, it's so boring and it takes so much time, and I don't have enough time for fun things or for more important work because I'm always spending time dictating, and if I were a better doctor I wouldn't take so long to do my dictations."
When leaving work: "It's nice that work is over, but the evenings are never long enough, and I have to do things that aren't fun like cook supper and wash dishes and that always ruins the little bit of time I have when I'm not working."
And on and on and on. The funny thing is, before paying attention to my thoughts, I would have described myself as a positive person. I'm generally pretty happy, and I'm usually able to find the positive side of a situation, so I was shocked to realize just how much negative crap goes through my head on a daily basis.
Once I was conscious of my thought patterns, I realized how incredibly draining all of the negative crap is. So I'm trying to change it. I'm trying to follow Babauta's advice to become aware of my frustration and to let go of my expectation that things will always go my way.
"You want things to go your way, want people to behave the way you want
them to. But you don’t and can’t control the universe. You aren’t
entitled to getting everything your way."
Now, when I start down the horrible negative thought death spiral, I try to catch myself and be aware of it. And then I try simply to not engage in all of the negative thinking (sometimes easier said than done). I acknowledge that I would rather be on my couch drinking an Old Fashioned than sitting in my office doing my 12th dictation of the day, but that isn't my reality. Or that I wish my girlfriend wouldn't look like she's on a terrifying roller coaster ride every time I drive, but that is my reality. And I am better off accepting these things (as much as I can) than I am constantly raging against them.
The amazing thing to me is that it's actually helping. I don't dread dictations and paperwork nearly as much as I used to, and I'm more efficient at them because I'm not wasting time feeling like the most hard done by person on the face of the Earth. I'm not freaking out when I take longer than planned with a patient, because I know that there is some cushion in my schedule, and life will go on even if my clinic runs overtime. Things feel surprisingly easier, despite making what seems like a very minor change in my thinking.
Since that Babauta post, I've encountered the same ideas in a few different places. (It's almost like the universe is trying to tell me something.) I went to a workshop about physician burnout on Friday, and there was a session on mindfulness meditation that explored the same concepts. I recently finished a really good book called 10% Happier, which is about a tv anchorman's experiences with mindfulness meditation. The more I encounter the idea, the more I think I might benefit from spending more time exploring the concept of mindfulness.
Which will unfortunately have to wait, because on Thursday I hop on a plane for three weeks in Egypt, Greece, and Jordan. While this sounds wonderful (vacation!), I'm honestly a bit terrified, because there are going to be some major challenges. Such as 24 hours of travel, jet lag, staying in an apartment that is 100 stairs from the main floor (no elevator), highs of 44 C*, crowds, noise, and two out of three weeks spent with my girlfriend's family. Oh, and the fact that most of the places we're traveling to hate the gays, so we'll have to pretend that we're roommates. My goal for the trip (Let's call this my May goal, shall we?) is to be mindful of all the things about travel that frustrate me and to do my best to let go of them.
Or, at the very least, to not have a screaming match with my girlfriend in front of the pyramids.
*I think the hottest I've ever experienced was about 35 C, and I felt like I was going to die.
Wednesday, March 30, 2016
Exhaling
For weeks (months? years?) I've been feeling overwhelmed by work. My desk has been covered with charts and lab results, my dictation inbox has been overflowing with letters to edit, and I've been weeks behind on my to do list. No matter how much effort I put in, it seemed like I was never doing any better than keeping the piles from growing larger. And I hated it.
About two weeks ago, I had finally had enough of all of the things that loomed over me, so I made it my goal to get caught up on everything. Everything. Whenever I had a spare minute, I tackled the things that needed to be done. I went into work early and stayed late. I worked through lunch. I logged on from home when I had extra time in the evenings or on weekends. I worked my butt off, and I got shit done. And now? I'm caught up. There are zero charts on my desk and zero dictations to sign off on.
All done.
It feels amazing. I no longer want to scream at my administrative assistant* when she brings a pile of lab results into my office. I have actual time to do the big picture things, like read journal articles and prepare presentations and (maybe someday) finish the article on my fellowship research. By getting caught up, it is now possible to keep up with the things that come in every day and to stay caught up.
Best. Feeling. Ever.
The only problem? I'm so used to existing in a state of chaos and panic that I don't know how to function with the stress gone. With nothing screaming at me to pay attention to it, it's hard to pay attention to anything. How is a procrastinator to function once they stop procrastinating?
*I have never done this, because I'm not a jerkface. Any physician who yells at people in his or her workplace (or anyone else, for that matter) is a jerkface.
About two weeks ago, I had finally had enough of all of the things that loomed over me, so I made it my goal to get caught up on everything. Everything. Whenever I had a spare minute, I tackled the things that needed to be done. I went into work early and stayed late. I worked through lunch. I logged on from home when I had extra time in the evenings or on weekends. I worked my butt off, and I got shit done. And now? I'm caught up. There are zero charts on my desk and zero dictations to sign off on.
All done.
It feels amazing. I no longer want to scream at my administrative assistant* when she brings a pile of lab results into my office. I have actual time to do the big picture things, like read journal articles and prepare presentations and (maybe someday) finish the article on my fellowship research. By getting caught up, it is now possible to keep up with the things that come in every day and to stay caught up.
Best. Feeling. Ever.
The only problem? I'm so used to existing in a state of chaos and panic that I don't know how to function with the stress gone. With nothing screaming at me to pay attention to it, it's hard to pay attention to anything. How is a procrastinator to function once they stop procrastinating?
*I have never done this, because I'm not a jerkface. Any physician who yells at people in his or her workplace (or anyone else, for that matter) is a jerkface.
Saturday, February 13, 2016
Student Debt Identity
When I was in San Francisco two years ago, immediately before I met my girlfriend in person for the first time, I visited a small bookstore in the city's gay district (The Castro). It was the kind of cozy, inviting bookstore that encouraged leisurely browsing, which is exactly what I did for my last few hours in the city. I checked out the staff favourites; I discretely flipped through LGBTQ books that would make Dan Savage blush; and I somehow resisted the enormous selection of magnets and mugs and bookmarks that I'm usually suckered into buying. In the end, despite finding a large collection of books that wanted to come home with me, I managed to leave with only one: Tiny Beautiful Things, by Cheryl Strayed.
If you have never read this book, you should go out and do so immediately. And don't take it out from the library (although I love libraries): buy it so that you can read it over and over and over again. The book is a collection of articles from the "Dear Sugar" online advice column that Strayed used to write, and it is easily the best advice column I've ever read. She addresses every topic from romance (of course) to friendship to finances to body image to life's purpose, and she does so in a way that is wise and frank and kind and simply amazing. I loved the book so much that I finished it on the red-eye from San Francisco (instead of resting up for my date when I got home), and I have read it cover to cover two additional times. When I picked it up to start writing this blog post, I had a hard time not reading it a fourth time.
Anyway...this is not supposed to be a post about the genius of Cheryl Strayed but rather a post inspired by one of her responses as "Dear Sugar". In one of the letters she received, a young woman wrote about her desire to go to graduate school and her frustration about having to incur additional student debt to do so because her parents didn't have the means to put her through school. In one line that stuck with me, the woman stated "[M]ore often than not, I am defined by my 'student loan identity'." Strayed's response surprised me a bit. She seemed to diminish the woman's concerns about debt, and she encouraged her to strongly consider graduate school despite the cost. In addressing the woman's concerns about the psychological aspect of debt, she said "I don't even known what a student loan identity is. Do you? What is a student loan identity?"
As I sit here, months away from having a positive net worth for the first time in almost a decade, and another decade away from having my debts payed off, I know exactly what a student loan identity is. A student loan identity is waking up every morning and thinking about how much you still owe. It's feeling like every dollar you earn is already accounted for and that none of it is actually yours. It's saying yes to extra clinics and extra weekends of call because you're bloody tired of being in the red. It's feeling like every decision you make has to be based on the financial implications, rather than on what you most want to do in your heart. No matter what my rational brain tells me about the wisdom of my decision to go to medical school or the long-term financial security that I will enjoy, my lizard brain keeps fixating on my student loan and the long road between me and debt repayment.
I wish I could be more Zen about my debt and just accept that it's there and will be for a long time, but I can't seem to get past the sensation of OH MY GOD, MY HAIR IS ON FIRE! I can't seem to stop questioning every purchase, wondering if I can somehow live without $20 a bag cat litter and train my cats to use the toilet. (The answer to that question is a resounding no.) I can't seem to say no to any opportunity to make extra money, no matter how tired or stressed I may be making myself.
More than anything, I just want to be back in the black.
If you have never read this book, you should go out and do so immediately. And don't take it out from the library (although I love libraries): buy it so that you can read it over and over and over again. The book is a collection of articles from the "Dear Sugar" online advice column that Strayed used to write, and it is easily the best advice column I've ever read. She addresses every topic from romance (of course) to friendship to finances to body image to life's purpose, and she does so in a way that is wise and frank and kind and simply amazing. I loved the book so much that I finished it on the red-eye from San Francisco (instead of resting up for my date when I got home), and I have read it cover to cover two additional times. When I picked it up to start writing this blog post, I had a hard time not reading it a fourth time.
Anyway...this is not supposed to be a post about the genius of Cheryl Strayed but rather a post inspired by one of her responses as "Dear Sugar". In one of the letters she received, a young woman wrote about her desire to go to graduate school and her frustration about having to incur additional student debt to do so because her parents didn't have the means to put her through school. In one line that stuck with me, the woman stated "[M]ore often than not, I am defined by my 'student loan identity'." Strayed's response surprised me a bit. She seemed to diminish the woman's concerns about debt, and she encouraged her to strongly consider graduate school despite the cost. In addressing the woman's concerns about the psychological aspect of debt, she said "I don't even known what a student loan identity is. Do you? What is a student loan identity?"
As I sit here, months away from having a positive net worth for the first time in almost a decade, and another decade away from having my debts payed off, I know exactly what a student loan identity is. A student loan identity is waking up every morning and thinking about how much you still owe. It's feeling like every dollar you earn is already accounted for and that none of it is actually yours. It's saying yes to extra clinics and extra weekends of call because you're bloody tired of being in the red. It's feeling like every decision you make has to be based on the financial implications, rather than on what you most want to do in your heart. No matter what my rational brain tells me about the wisdom of my decision to go to medical school or the long-term financial security that I will enjoy, my lizard brain keeps fixating on my student loan and the long road between me and debt repayment.
I wish I could be more Zen about my debt and just accept that it's there and will be for a long time, but I can't seem to get past the sensation of OH MY GOD, MY HAIR IS ON FIRE! I can't seem to stop questioning every purchase, wondering if I can somehow live without $20 a bag cat litter and train my cats to use the toilet. (The answer to that question is a resounding no.) I can't seem to say no to any opportunity to make extra money, no matter how tired or stressed I may be making myself.
More than anything, I just want to be back in the black.
Wednesday, December 16, 2015
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...
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...
Sunday, December 6, 2015
The Most Wonderful Time of the Year
I find the Christmas season stressful. I'm a person who prefers being undercommited to being overcommited*, so I get easily overwhelmed by the addition of holiday parties and gift buying and dainty making to my schedule. (But not the dainty eating. I'm always game for dainty eating.) Last year was particularly challenging for me, as it was my first Christmas with my girlfriend, and we tried to fit in all of the gatherings and traditions that are important to both of us. It was too much, and it left both of us (mostly me) exhausted by the end.
This year, I thought I would cut back on my stress level by being on top of my game from the beginning. I would make all the dainties and buy all the gifts and stock the liquor cabinet early so that once the celebrating began, I would be ready to just enjoy myself. And I was doing okay, up until the point two weeks ago when I said "Why yes, I'd be happy to revamp the entire curriculum before January"**.
Wait...what? Who agreed to revamp an entire curriculum in six weeks? At Christmastime? It couldn't possibly have been me, because I am a rational human being who recognizes her limitations and doesn't take on utterly ridiculous and near impossible tasks.
Aren't I?
Apparently I'm not. Because I did take on that task at precisely the time when I most want to be scaling back and enjoying my life outside of work. And if I could find a way to go back in time and open my mouth and take those words back into it and swallow them whole so that they could never, ever escape my lips, I absolutely would. Because when I look ahead to the next 19 days, it isn't Christmas spirit that I see.
*What does it say about our society that overcommited is a legitimate word, while undercommited apparently isn't?
**Back in July, I also said "Why yes, I'd be happy to be on call the entire week after Christmas", not realizing that my girlfriend would have the time off of work. Bah humbug.
This year, I thought I would cut back on my stress level by being on top of my game from the beginning. I would make all the dainties and buy all the gifts and stock the liquor cabinet early so that once the celebrating began, I would be ready to just enjoy myself. And I was doing okay, up until the point two weeks ago when I said "Why yes, I'd be happy to revamp the entire curriculum before January"**.
Wait...what? Who agreed to revamp an entire curriculum in six weeks? At Christmastime? It couldn't possibly have been me, because I am a rational human being who recognizes her limitations and doesn't take on utterly ridiculous and near impossible tasks.
Aren't I?
Apparently I'm not. Because I did take on that task at precisely the time when I most want to be scaling back and enjoying my life outside of work. And if I could find a way to go back in time and open my mouth and take those words back into it and swallow them whole so that they could never, ever escape my lips, I absolutely would. Because when I look ahead to the next 19 days, it isn't Christmas spirit that I see.
*What does it say about our society that overcommited is a legitimate word, while undercommited apparently isn't?
**Back in July, I also said "Why yes, I'd be happy to be on call the entire week after Christmas", not realizing that my girlfriend would have the time off of work. Bah humbug.
Sunday, November 8, 2015
Status Update
I had no intention of being absent from the blog for as long as I was. Work got busy; life outside of work got busy; and somehow, in the midst of it, six weeks passed without a single blog post. Sorry!
A few weeks ago, I was finally starting to settle into the routine of being an attending. My anxiety about being responsible for all the people was becoming manageable; I was figuring out how to work with my large and diverse group of clerks and nurses and other support staff; and I no longer had moments when I would look around me hoping that there was, in fact, someone other than me who was in charge. It was refreshing after two months of nearly continuous panic. Then, two weeks ago, I started back on the inpatient service, and it all went to hell again.
In addition to my entirely manageable schedule of clinics and clinic prep time (so many labs to review, so many patients to call), I was once again dealing with new consults and follow ups and phone calls from remote communities with no access to anything and residents with their own needs and personalities. And it was nuts. I would find myself at the end of the day doing the terrifying dance of a three-year-old in need of a potty because I hadn't made it to the bathroom since I left for work in the morning. I kept cancelling plans with my girlfriend because the work never seemed to end. I was exhausted. And stressed! So stressed that I could think of nothing other than the seemingly endless needs of the patients under my care.
And then, Friday night, after 12 consecutive days of call, I finally got a reprieve. My girlfriend had forced me to take the weekend off of call because her birthday was Saturday, so I started my glorious 63-hour break from my pager. It took me the first 24 hours to stop frantically reaching for my belt and panicking that I'd forgotten my pager at home, but it has otherwise been lovely. We've had a birthday party with friends, gone to explore a new kitchen store*, eaten at a fancy restaurant, and bough $245 worth of booze**. I am now sitting on the couch in pjs with cats, which is pretty much my favourite way to spend a Sunday. My girlfriend is off at church, and when she returns we will have a second birthday party, complete with fancy cocktails and cheesy card games. Life is good.
As long as I don't think about the fact that I go back on call at 8 am tomorrow***.
*Funny story (to me at least): The kitchen store was selling a chef's knife that I have been coveting for years for 50% off, and we decided that it was too good a deal to pass on. The only problem was that my girlfriend had been planning to buy it for me for Christmas, which she obviously couldn't do with me standing right there. I offered to just buy it for myself, which she thought was a terrible idea, because I am a person who wants very few material things and is therefore impossible to shop for. (I'm also incredibly picky.) After hemming and hawing for a few minutes, I finally decided that she should just go ahead and buy it for me, but wanting to maintain the illusion of surprise, I loudly declared "I'm just going to walk over to the other side of the store, and I will pay no attention to whatever may or may not happen between you and that knife." The clerk thought we were nuts.
**I bought my girlfriend a cocktail recipe book for her birthday, and we decided that we needed "a few things" in order to make some of the more interesting cocktails. We probably shouldn't have gone to the liquor store late at night when we were both exhausted/lacking our usual self restraint, but the upside of the experience is that we are now well-equipped to make pretty much any cocktail that a person could want. Unless it requires cognac, because I still had enough self restraint to not spend $3 per ounce on the cheapest bottle of cognac. Hard liquor never goes bad, right?
***Thankfully for only three days. On Thursday, I head to San Francisco for a conference and a few days of vacation with my girlfriend. I was traveling in San Francisco when the girlfriend and I started chatting online, so I'm looking forward to showing her all of the places that I told her about when I was first wooing her.
A few weeks ago, I was finally starting to settle into the routine of being an attending. My anxiety about being responsible for all the people was becoming manageable; I was figuring out how to work with my large and diverse group of clerks and nurses and other support staff; and I no longer had moments when I would look around me hoping that there was, in fact, someone other than me who was in charge. It was refreshing after two months of nearly continuous panic. Then, two weeks ago, I started back on the inpatient service, and it all went to hell again.
In addition to my entirely manageable schedule of clinics and clinic prep time (so many labs to review, so many patients to call), I was once again dealing with new consults and follow ups and phone calls from remote communities with no access to anything and residents with their own needs and personalities. And it was nuts. I would find myself at the end of the day doing the terrifying dance of a three-year-old in need of a potty because I hadn't made it to the bathroom since I left for work in the morning. I kept cancelling plans with my girlfriend because the work never seemed to end. I was exhausted. And stressed! So stressed that I could think of nothing other than the seemingly endless needs of the patients under my care.
And then, Friday night, after 12 consecutive days of call, I finally got a reprieve. My girlfriend had forced me to take the weekend off of call because her birthday was Saturday, so I started my glorious 63-hour break from my pager. It took me the first 24 hours to stop frantically reaching for my belt and panicking that I'd forgotten my pager at home, but it has otherwise been lovely. We've had a birthday party with friends, gone to explore a new kitchen store*, eaten at a fancy restaurant, and bough $245 worth of booze**. I am now sitting on the couch in pjs with cats, which is pretty much my favourite way to spend a Sunday. My girlfriend is off at church, and when she returns we will have a second birthday party, complete with fancy cocktails and cheesy card games. Life is good.
As long as I don't think about the fact that I go back on call at 8 am tomorrow***.
*Funny story (to me at least): The kitchen store was selling a chef's knife that I have been coveting for years for 50% off, and we decided that it was too good a deal to pass on. The only problem was that my girlfriend had been planning to buy it for me for Christmas, which she obviously couldn't do with me standing right there. I offered to just buy it for myself, which she thought was a terrible idea, because I am a person who wants very few material things and is therefore impossible to shop for. (I'm also incredibly picky.) After hemming and hawing for a few minutes, I finally decided that she should just go ahead and buy it for me, but wanting to maintain the illusion of surprise, I loudly declared "I'm just going to walk over to the other side of the store, and I will pay no attention to whatever may or may not happen between you and that knife." The clerk thought we were nuts.
**I bought my girlfriend a cocktail recipe book for her birthday, and we decided that we needed "a few things" in order to make some of the more interesting cocktails. We probably shouldn't have gone to the liquor store late at night when we were both exhausted/lacking our usual self restraint, but the upside of the experience is that we are now well-equipped to make pretty much any cocktail that a person could want. Unless it requires cognac, because I still had enough self restraint to not spend $3 per ounce on the cheapest bottle of cognac. Hard liquor never goes bad, right?
***Thankfully for only three days. On Thursday, I head to San Francisco for a conference and a few days of vacation with my girlfriend. I was traveling in San Francisco when the girlfriend and I started chatting online, so I'm looking forward to showing her all of the places that I told her about when I was first wooing her.
Thursday, September 24, 2015
Responsibility
I just had a very long phone conversation with a friend trying to figure out what to do with a mutual patient. She is the patient's attending, and I the consultant, and we were stuck deciding between two similarly bad alternatives. Pick option A, and the patient might die. Pick option B, and the patient might still die.
We discussed whether there were other options for treatment (none that we could see). We debated the pros and cons of each option (essentially equal). We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen). In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.
And it feels terrible. It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision. There is no longer an attending who takes responsibility for everything. We are the attendings now. And at times it is completely and utterly terrifying.
We discussed whether there were other options for treatment (none that we could see). We debated the pros and cons of each option (essentially equal). We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen). In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.
And it feels terrible. It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision. There is no longer an attending who takes responsibility for everything. We are the attendings now. And at times it is completely and utterly terrifying.
Sunday, September 13, 2015
Money Stress
I spend far too much time thinking about money.
At work, I keep track of every one of my patient encounters, ostensibly to ensure that I'm correctly billing for my work, but in reality as a way of monitoring exactly how much I'm earning. When spending money, I record every transaction in my iPhone budget and then check to see how much money is left. At home, I check my bank account, my monthly budget, and my net worth statement over and over and over again.
It's becoming unhealthy.
On the surface, it seems like the motivation behind this is good - I want to live below my means so that I can be back to a positive net worth by the end of 2016. Looking deeper, however, it's clear that there are other, less positive, driving forces. The main one is fear. I'm afraid that something will happen to me before I'm able to repay my debt and I won't be able to support myself. I'm afraid that I won't have enough money for retirement. I'm afraid that I'll always have to watch my spending and will never be able to stop thinking about my budget.
There's also shame. From the time I was a child, I was a person who saved money. I saved for my first camera; I saved for university; I saved for my first car. Prior to starting medical school, my only debt ever had been a small line of credit from my undergraduate degree, which was paid off within a few months of starting graduate school and getting a regular paycheque. The monstrosity that is my medical school debt (over $210,000 at its worst) looms over me like a reminder of my past sins. I hate that it's there, and I hate that I'm responsible for how out of control it got by the end.
So. How do I stop obsessing about money? The first step is clearly to acknowledge that I am okay. I'm employed. I'm earning a good income. I'm taking steps to save for retirement and repay my debt. As long as I earn the amount that has been very conservatively estimated for my income*, which I have been from the very beginning, then I can keep my current budget and be out of the red by the end of next year. I also have a girlfriend with a stable job who would do everything possible to make sure I was okay (we were okay) if something happened. I am okay.
The second step is to stop thinking about it so bloody much. While I need to have some awareness of my finances, I don't need to know the precise details on a minute by minute basis. To this end, I'm restricting how much I can look at my financial information. Once a day, I can access my spreadsheet of income to enter my billings for the day. I can look at my iPhone budget only when I'm entering a purchase. And I can only look at my monthly budget and net worth statement once per week on Sunday mornings when I'm doing paperwork. No more checking my net worth every few hours to make sure it's still okay.
I'm hoping that stepping back from my finances will make me happier. My goal, ultimately, is to put my finances on autopilot so that I can focus on the much more interesting business of living this wonderful life that I am blessed to have.
*I'm working fee-for-service, so my income is entirely determined by how much I work. Which doesn't help with my anxiety.
At work, I keep track of every one of my patient encounters, ostensibly to ensure that I'm correctly billing for my work, but in reality as a way of monitoring exactly how much I'm earning. When spending money, I record every transaction in my iPhone budget and then check to see how much money is left. At home, I check my bank account, my monthly budget, and my net worth statement over and over and over again.
It's becoming unhealthy.
On the surface, it seems like the motivation behind this is good - I want to live below my means so that I can be back to a positive net worth by the end of 2016. Looking deeper, however, it's clear that there are other, less positive, driving forces. The main one is fear. I'm afraid that something will happen to me before I'm able to repay my debt and I won't be able to support myself. I'm afraid that I won't have enough money for retirement. I'm afraid that I'll always have to watch my spending and will never be able to stop thinking about my budget.
There's also shame. From the time I was a child, I was a person who saved money. I saved for my first camera; I saved for university; I saved for my first car. Prior to starting medical school, my only debt ever had been a small line of credit from my undergraduate degree, which was paid off within a few months of starting graduate school and getting a regular paycheque. The monstrosity that is my medical school debt (over $210,000 at its worst) looms over me like a reminder of my past sins. I hate that it's there, and I hate that I'm responsible for how out of control it got by the end.
So. How do I stop obsessing about money? The first step is clearly to acknowledge that I am okay. I'm employed. I'm earning a good income. I'm taking steps to save for retirement and repay my debt. As long as I earn the amount that has been very conservatively estimated for my income*, which I have been from the very beginning, then I can keep my current budget and be out of the red by the end of next year. I also have a girlfriend with a stable job who would do everything possible to make sure I was okay (we were okay) if something happened. I am okay.
The second step is to stop thinking about it so bloody much. While I need to have some awareness of my finances, I don't need to know the precise details on a minute by minute basis. To this end, I'm restricting how much I can look at my financial information. Once a day, I can access my spreadsheet of income to enter my billings for the day. I can look at my iPhone budget only when I'm entering a purchase. And I can only look at my monthly budget and net worth statement once per week on Sunday mornings when I'm doing paperwork. No more checking my net worth every few hours to make sure it's still okay.
I'm hoping that stepping back from my finances will make me happier. My goal, ultimately, is to put my finances on autopilot so that I can focus on the much more interesting business of living this wonderful life that I am blessed to have.
*I'm working fee-for-service, so my income is entirely determined by how much I work. Which doesn't help with my anxiety.
Monday, August 17, 2015
That Wasn't Horrible
When I was planning my schedule a few months ago, I thought that I would "start off easy" by being on the consult service for the first two weeks and only doing one or two half-day clinics per week. I spent months (and months and months) on the consult service as a fellow, so being on service as an attending shouldn't be all that different from what I was doing before, and it guarantees me a minimum income to help with the bills that have piled up after seven weeks of vacation.
The only problem with my plan? I scheduled my first clinic for the morning of my very first day. At the inner city clinic where I've only worked twice and therefore am unfamiliar with pretty much everything (like the bloody EPR). The clinic with the very complicated patients who actually require time.
In the end, my two-and-a-half-hour-long clinic took four hours, followed by a full hour of charting and paperwork. Amazingly, I stayed calm throughout it and didn't once cry or freak out. And it was actually (dare I admit it) a tiny bit of fun. My nurse is absolutely amazing with both me and my patients, and she was the main reason why I didn't go insane when my clinic ran horribly over. It also helped that there was nothing pressing on the consult service, so it was okay that I showed up at the other hospital at 3 PM.
Maybe this attending gig will be bearable after all.
The only problem with my plan? I scheduled my first clinic for the morning of my very first day. At the inner city clinic where I've only worked twice and therefore am unfamiliar with pretty much everything (like the bloody EPR). The clinic with the very complicated patients who actually require time.
In the end, my two-and-a-half-hour-long clinic took four hours, followed by a full hour of charting and paperwork. Amazingly, I stayed calm throughout it and didn't once cry or freak out. And it was actually (dare I admit it) a tiny bit of fun. My nurse is absolutely amazing with both me and my patients, and she was the main reason why I didn't go insane when my clinic ran horribly over. It also helped that there was nothing pressing on the consult service, so it was okay that I showed up at the other hospital at 3 PM.
Maybe this attending gig will be bearable after all.
Sunday, August 16, 2015
Habits - Work
It's the evening before I return to work, and my feelings are alternating between excited and distraught and absolutely terrified. It definitely feels like time to go back (there is almost nothing left on my to-do list), but at the same time I'm dreading the first day. I start with a busy clinic and I'm on home call for the first 12 days, so it won't be an easy return. But I can do this.
Right?
I'm hoping that, if I start off on the right foot, I can set myself up for long-term success. With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning. For those of you who work in medicine, is there anything else you'd add? Any advice? (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)
Record Billing Information as it Happens:
This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid. While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do. The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.
Finish my Dictations Every Day:
So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations. Which means so much unnecessary stress! When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending. It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.
Devote Time and Energy to Teaching:
Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time. As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return. Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service. I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today. The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).
Read for at Least Three Hours per Week:
Medicine changes. Every day, I get emails from journals about all of the articles that I should be reading. In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.
Research:
This is worthy of a post all its own. I don't even know what to say here. I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research. Soooo.....we'll just have to see where this one ends up. I had hoped to have this figured out by the end of my vacation, but not so much.
Put Patient Care Above Other Considerations:
This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room. Their outcomes are more important than how much I bill or what time I leave work at the end of the day. While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.
Right?
I'm hoping that, if I start off on the right foot, I can set myself up for long-term success. With that in mind, here are a few of the work habits that I hope to cultivate from the very beginning. For those of you who work in medicine, is there anything else you'd add? Any advice? (Or just reassurance that I will not in fact spontaneously combust during my first clinic tomorrow?)
Record Billing Information as it Happens:
This seems like a rather greedy thing to be thinking/talking about, but the reality is that I'll be paid fee-for-service, so if I don't bill for things, I don't get paid. While I have no intention of exaggerating my billings (I spent three minutes talking to the patient...so that counts as 30 minutes of counselling), I do want to get paid fairly for the work I do. The best way of achieving that is to document things as I go along so that I don't miss patient encounters or forget about things like phone calls and letters and family meetings.
Finish my Dictations Every Day:
So many of the other attendings (can I really say other?) have offices filled with charts and are constantly lamenting how far behind they are with dictations. Which means so much unnecessary stress! When I've been on clinic rotations in the past, I've been successful at keeping up with my dictations on a daily basis, and I plan to do the same as an attending. It just takes discipline, as well as remembering how much longer it takes to dictate on a patient I saw two weeks ago than on a patient I saw earlier in the day.
Devote Time and Energy to Teaching:
Most of my work will be in a teaching hospital, meaning that I'll have medical students and residents and fellows working with me most of the time. As a recent trainee, I know how frustrating it is to work hard and do all of the scut work without getting some teaching in return. Even though I find teaching challenging and sometimes stressful, I plan to make it a priority to do some of it every day that I have a learner on my service. I also plan to take on some of the teaching opportunities (small group sessions, lectures, etc.) that are always understaffed as a way of giving back to the medical school that got me to where I am today. The bonus of teaching is that it's a great way of keeping up my own skills (and getting some Continuing Medical Education credits so that I can keep my license).
Read for at Least Three Hours per Week:
Medicine changes. Every day, I get emails from journals about all of the articles that I should be reading. In order to keep up with at least part of the giant fire hose of medical knowledge, I plan to set aside three, one-hour reading sessions every week.
Research:
This is worthy of a post all its own. I don't even know what to say here. I have a few research projects that I'm interested in pursuing, but I have no funding, time, or salary to support research. Soooo.....we'll just have to see where this one ends up. I had hoped to have this figured out by the end of my vacation, but not so much.
Put Patient Care Above Other Considerations:
This is more a work philosophy than a habit, but I think it's important to always remember that my patients are real people, with hopes and fears and people who love them and lives outside of my clinic room. Their outcomes are more important than how much I bill or what time I leave work at the end of the day. While I do want to earn a good living (pay off debt!) and have a life outside of medicine, those goals can never be at the expense of providing good patient care.
Thursday, August 13, 2015
In Need of Sleep
The past few nights I've found myself lying awake for hours on end, stressing about money and my return to work and anything else I could think about. Despite the resultant fatigue, today I drove to the country to visit one of my closest friends from medical school. While we ate cafe food and she nursed her wee babe, I poured out my anxieties and fears for hours. She, a master listener, absorbed everything I said. After I had exhausted my deep pool of insecurities, she said simply "It will all be okay". And because she is always right, I knew it would be.
Now, back in the city, I feel lighter than I have in weeks. My mind is slowing and my limbs are growing heavy, and it is time to give in to sleep. I'm hoping it will be a good one.
Now, back in the city, I feel lighter than I have in weeks. My mind is slowing and my limbs are growing heavy, and it is time to give in to sleep. I'm hoping it will be a good one.
Sunday, August 9, 2015
The Last Week
As of tomorrow morning, I will have only one week until I go back to work. It seems like I've been gone forever; I've managed to relax and get stressed out again and return (slowly) back to a relaxed state one more time. I'm sure more stress is coming, particularly if my license doesn't come through in the next day or two.
Part of me wants to stay on vacation - to enjoy structuring my days as I please (minus weddings) and to sleep in as late as I choose. But most of me is getting impatient to move on with the next stage of life. Fingers crossed I'm ready.
Part of me wants to stay on vacation - to enjoy structuring my days as I please (minus weddings) and to sleep in as late as I choose. But most of me is getting impatient to move on with the next stage of life. Fingers crossed I'm ready.
Friday, August 7, 2015
The Weekly Hiss and Purr - August 7 Edition
Oh this week. This week has been one full of angst, coming from a variety of sources. Even though I'm still on vacation (yay), I feel like I could list a dozen or so hisses without much effort. Bah.
Angst is soooo overrated. Take a nap, Mom.
The (Biggest) Hiss - Anxiety:
One of the best things about this vacation has been how relaxed I've been. Until recently, I was waking up feeling refreshed and looking forward to all the great things the day had in store. I even looked relaxed - my skin was tanned (as much as my Northern European ancestry permits), my hair was longer and curlier than it had been in years (the word "mullet" comes to mind), and my clothing choices were comfortable, if not bordering on vagabond.
And then, a week ago, I decided to get my hair cut so that I would look slightly put together for the wedding I attended last Saturday. And it was as if everything changed. Going back to my "work hairstyle" seemed to signal that it was time to go back to work, or at the very least to start stressing out about it. Since then, I've been experiencing increasing bouts of panic as I come to terms with the fact that I will be the one in charge starting August 17.
It doesn't help that there are still major issues up in the air...like my license. Everything is happening at a snail's pace because it's summer, and despite doing things in what I thought was lots of time, I am still waiting on a number of important documents that are required for me to work. And I have only five business days left until my first day of work. Aaaaaah.
(Please be patient while I go and vomit.)
The Purr - Reading:
The biggest thing I need right now to keep myself sane is distraction from thinking about work (and from hitting refresh on my email program to see if anything is happening with my license). Enter reading! As I previously blogged about, I just finished reading Gretchen Rubin's book "Better Than Before". I also have her book "Happier at Home" sitting in my to-read pile, but for a change of pace, I've decided to start with Barbara Kingsolver's book "Animal, Vegetable, Miracle". This book tells about her family's journey of moving across the country and trying to eat locally for a year. I'm only one chapter in, but I'm loving her writing style and her exploration of all the issues (environmental, economic, health) related to what we choose to eat.
There are so many more things that I want to read! I have a giant stack of books from the library on my coffee table, plus a list on Goodreads and another list in my iPhone. I need more hours in the day!
What are you reading this week?
Wednesday, August 5, 2015
Patience and Forgiveness
Because nothing says vacation like dealing with your finances, I spent most of my morning today figuring out a strategy for getting myself to a positive net worth*. Ever since I started budgeting, I've been haunted by the negative on my balance sheet and desperate to get back into the black.
The good news about my strategy session is that I figured out that I can be back to a positive net worth in just 16 months, thanks to having lots of room to invest in an RRSP (Registered Retirement Savings Plan, the Canadian equivalent of a 401(k)). The bad news is, it's going to take me 16 months. Which literally feels like forever.
It's hard at times to forgive myself for the financial mistakes that I've made in the past. There is absolutely no way that I could have made it to this point debt-free, but I know that my burden of debt could have been much less if I'd been more careful with my spending. And it's even harder to be patient, to refrain from adding more call shifts and more patients to each clinic just to bring my bank balance up.
I have to remind myself, on pretty much a daily basis, that it took me eight years to get to this point. 16 months is entirely doable for getting rid of it. I just need to breathe.
*My goal is to increase my assets beyond the level of my debt, rather than to pay off the debt itself, because interest rates are currently so low.
The good news about my strategy session is that I figured out that I can be back to a positive net worth in just 16 months, thanks to having lots of room to invest in an RRSP (Registered Retirement Savings Plan, the Canadian equivalent of a 401(k)). The bad news is, it's going to take me 16 months. Which literally feels like forever.
It's hard at times to forgive myself for the financial mistakes that I've made in the past. There is absolutely no way that I could have made it to this point debt-free, but I know that my burden of debt could have been much less if I'd been more careful with my spending. And it's even harder to be patient, to refrain from adding more call shifts and more patients to each clinic just to bring my bank balance up.
I have to remind myself, on pretty much a daily basis, that it took me eight years to get to this point. 16 months is entirely doable for getting rid of it. I just need to breathe.
*My goal is to increase my assets beyond the level of my debt, rather than to pay off the debt itself, because interest rates are currently so low.
Sunday, May 3, 2015
Budget
Before I started medical school, I was a pretty financially responsible person. Since the age of 18, I had invested a minimum of 10% of my income in long-term savings, even when I was an undergraduate student living off of scholarships and low-paying summer jobs, or a graduate student earning a stipend that was too small to permit "extras" like clothing or bus fare to the grocery store. My only travel was home for Christmas and maybe my birthday, paid for with my Dad's Aeroplan Miles from his job. I didn't even own a car until I was 28, when I had saved enough money from a contract job to pay cash for my mom's 10-year-old beige Chevy Malibu.
(It was basically an ugly boat with wheels. I called her Mabel.)
The polite way of describing the person I used to be would be "frugal", although it would not be inaccurate to say "cheap". But it served me well; when I started medical school, I had over $60,000 squirreled away towards school costs and my eventual retirement.
And then medical school started. And suddenly, I was no longer friends with graduate students who brought peanut butter sandwiches for lunch and had pot lucks on weekends because no one could afford to eat in a restaurant. Instead, I was going to school with people who had grown up in rich families and who thought nothing of dropping $200 on a night out or of flying to South Africa for safari over Spring Break. I was also surrounded by the mentality that debt didn't matter, because someday we would all be making so much money that our $200,000 (or more) lines of credit would just disappear without effort.
So I changed. Slowly at first, but with increasing speed as I got more and more comfortable with debt, I let go of my frugal habits and started to spend like the people around me. I stopped bringing lunches to school and started spending $10 a day on terrible cafeteria food. I went to Cuba (my first international trip since finishing my undergraduate degree in 1999) for Spring Break. When my beloved Malibu got totaled by an idiot who was texting while driving in the rain at night, I got a shiny new Toyota and started making lease payments. And the debt piled up.
I barely paid attention to my debt until September 2014, when something terrible happened at work. As I was trying to put the pieces of my professional life back together, I thought a lot about what would happen if I couldn't practice in medicine, and I realized that I had so much debt that I would probably never be able to pay it back. And it terrified me. Night after night, I would lie awake in bed, thinking about the imposing six figures of doom on my line of credit statement, wondering if I should start buying lottery tickets, because I couldn't think of any other way to get it under control. Eventually, the stress got so bad for me that I did the unthinkable; I put myself on a budget.
I had thought about sticking to a budget prior to the terrible work event, but I never seemed to have the motivation to give up on all the fancy dinners and concerts and exotic vacations that had somehow become my life over the previous eight years. After the terrible work event, visions of myself moving back in with my mother because I couldn't make rent and loan payments simultaneously became that motivation. And it worked. For the past nine months, I've stuck to a budget, and I'm now $12,000 ahead of where I was at the start of this whole experience.
And my stress level? So much better, knowing that I'm finally chipping away at the imposing six figures of doom. And that I likely won't ever again have to share space with my Mom.
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