When anticipating a vacation, I am always completely delusional about what it will be like. I imagine myself with no time constraints, able to endlessly blog and sleep and explore, without ever having to choose between different activities. The reality, of course, is not that. There is always more to do than there is time, and vacations eventually end, thus tonight is my last night in Paris and I haven't blogged in two weeks. I assure anyone who hasn't been following me on Twitter that yes, I have been having a fabulous time, and yes, I have been eating ridiculous numbers of pastries.
This has been a really, really good trip. There have been moments when I have felt lonely, and more than once I have seriously considered going to a cat cafe for some feline attention, but overall it has been good to travel alone. The introvert in me had been craving silence, long stretches of time without having to answer to anyone, and the past three weeks have been exactly that. My mind has been able to wander wherever it wants, and I have had time to think and think and think about all the big questions in my life. It has been good.
And of course, I have seen things! So, so many things. On my last day in Caen, I took a tour of the Canadian D-Day beaches, and then I went to Dijon, where I slept a lot and drank wine on the couch and did a bit of wandering through the historic city. In Paris I have been all over the place: the Eiffel Tower, Notre Dame, Shakespeare and Co, the Musée d'Orsay, the Natural History Museum, Sacre-Coeur, Montmartre, the Curie Museum, and the Army Museum. It has been delightfully nerdy, in both a scientific and a historical way, which suits me perfectly.
I haven't done as well with my French as I had hopped. I struggle a lot with verbal comprehension, and the accents are different from the ones that I am used to, so I have said "Désolé, je ne comprends pas" and "Pouvez-vous repétér ça, s'il vous plaît?" more times than I can count. (Actually, I have mostly just contorted my face painfully and made awkward sounds, which is the introvert's way of saying "I don't understand".) But I have learned new words, thanks to reading every street sign and countless museum displays, and my ability to understand written French is getting better quickly.
(Yesterday's word of the day was "ruche", as in hive, which I learned from this beehive at the Natural History Museum. Yup...I am a nerd.*)
There have been moments on the trip when I have considered giving up on learning French, as it is frustrating to see how far I still have to go before I will be functionally fluent. But then, I wander into a bookstore and walk out with The Handmaid's Tail in French (La servante écarlate), and I think that the learning will continue. I dream of living in Europe for at least a year in retirement, and if I continue to plug at it for the next 7+ years, I can hopefully be functional by then.
(Also, there is a cute lesbian in my conversational French group. Not that that's a reason to learn a language...)
So...that is my trip in a very small nutshell. I will try to post some more pictures, although I dread the volume of work that awaits my return to work, so I make no promises. There is part of me that is resentful of the fact that I need to go back to work, but mostly right now I am incredibly grateful to have been able to do this. I know how fortunate I am that this is my life.
*When I was a kid, my Dad used to play a silly game in which he would ask what letter a word started with, and when I would reply "B" he would scream "A bee! Bzzzzzzzzz!" and pretend that his hand was a buzzing bee. Since studying French, whenever I try to remember the word for bee, I will scream "Une abeille! Bzzzzzzzzzz!". Thankfully I have learned to scream this in my head when I am in public.
This trip continues to whirl by. As mentioned in my previous post, I had terrible internet access in Caen, so I basically gave up on posting to my blog or even Facebook for the entire time I was there (I did manage to post a few photos of the tasty food to Twitter). I am now in Dijon, and I have internet access again, so I will make more of an effort to post. But there is so much to do, it's hard to tear myself away from the doing!
Caen was not an intentional destination for me. While searching through places to visit in France, I fell in love with the tiny seaside town of Honfleur, and decided to use Caen as a home base for visiting Honfleur, which is accessible only by a very long bus ride*. When I arrived in Caen, I actually wondered if there would be enough for me to do there. And yes, there was more than enough. I needn't have worried.
Caen's main draw is as a site for World War II history. Almost 80% of the city was destroyed by Allied bombings around the time of D-Day, so it contains a lot of buildings that were rebuilt after the war, as well as many that still show major signs of damage.
(A photo of the church down the street from my apartment (Église Saint-Jean) following the bombing.)
(Although most of the church has been rebuilt, this tower still shows evidence of the damage.)
(Another church in Caen that was so badly damaged that they didn't even try to rebuild it.)
It was surreal to see partial remains of churches and to walk through the Abbaye-aux-Hommes (Men's Abbey), which is the burial site of William the Conquerer ("Guillaume le Conquérant") and also a place where the citizens of Caen took refuge during weeks of bombings.
For me, the best but also most difficult part of the visit was going to the Memorial de Caen, which is an amazing WWII museum. It covers the history of Europe post-WWI, the rise of fascism**, the German military campaigns, the concentration camps, and the eventual liberation of Europe starting with D-Day and the Battle of Normandy. It was amongst the best museums I've ever visited.
Reading about the concentration camps, seeing the photos and records of what people did to other people, breaks me a bit every time.
But when I see what physicians did? That's when I ugly cry in the corner.
*In the end, I didn't even go to Honfleur, as I decided that I didn't want to spend 5 hours on a bus when I could instead use the time to see more of Caen. Je ne regrette rien.
**The parallels between the rise of fascism and what's happening in the US right now are terrifying.
I thought that the jet lag was bad for the first two days, but really it wasn't. I had lots of adrenaline and a desire to see everything in Lyon, which kept me excited in spite of the overwhelming urge to fall asleep in the middle of the afternoon.
My jet lag really kicked in during my five-hour train ride from Lyon to Caen today. Oh my goodness, it felt like I was post-overnight call for the first time in five years. No amount of reading or internetting or listening to good music could keep me from dozing off and leaning precariously into the middle aisle of the train. (Over and over. I think my neck is going to be sore from snapping backwards every time I dozed off.)
I almost didn't make it to Caen. I left myself lots of time to get to my first train*, but I hadn't realized that the receipt I had printed out was not an actual ticket, so at the last minute I was scrambling to download an e-ticket on my phone. And then I had an hour to switch trains in Paris, which would have been fine except that I had to take the metro between stations, which got me to the second station less than 30 minutes before my train. And then I couldn't download my next e-ticket. So I stood in a very long ticket line, watching the time until my train departed disappear and panicking, until I got so nervous that I asked the person in front of me if I could cut ahead**. Unfortunately, seemingly everyone was trying to get on the same train, so no, I couldn't cut ahead of anyone. Thankfully, about 5 minutes before the train, my phone suddenly cooperated, and I was able to access my ticket. If it hadn't, I might still be in Paris trying to get a later train out.
But anyway....after a lot of head bobbing and drooling on my fleece, I arrived in Caen, where pretty much everything is closed for Easter Monday. I really didn't want to eat more cheese and bread for supper***, so I was quite happy to discover an open Vietnamese restaurant around the corner from my B and B. Not what I was expecting to have for supper on my third day in France, but it was surprisingly tasty.
So that was my day....I didn't blog about yesterday, as I got home from supper very late, but here are some photos to hopefully make up for it.
The meeting place for my morning walking tour (walking tour #2 and pain au chocolat #2):
One of the two open-air markets we saw on the tour:
A view of the Basilique Notre-Dame de Fourvière, as well as part of the city:
The Hotel de Ville (City Hall) on the walking tour, complete with participants in the race that was run roughly along the route of our walking tour.
After the walking tour, I visited some Roman ruins. But no photos of them for you, as my B and B has no internet (how is this a thing?), and my phone internet can only handle uploading so many photos.
After the ruins, I took a long walk up the hill to the Basilica. A view from the outside:
(The views from the inside are also being held captive on my computer.)
I ended my day at the Museum of the Resistance and Deportation. A photo of WWII refugees from Paris, who had been relocated to Lyon:
Hmmm....maybe I'm actually tired because I'm trying to do so much every day? I'm sure I'll do better tomorrow. During my one day in Caen. Cause there isn't much to do here...
*I also had lots of time to eat anglais abricots, a pastry that I might like better than
pain au chocolat...I'll let you know after a few more comparisons.
**This is unusual for me, as I don't generally like talking to strangers, and I find it extra hard to do in French.
***Yes, I have already reached the point of my trip at which I'm whining about having to eat the same thing two meals in a row. I blame the jet lag.
The first time I ever traveled overseas, I was 22 years old, and I had just graduated from university. Using my parents' travel miles, I flew to Europe with my good friend N, whom I'd known since I was five. We had six weeks, ridiculously heavy backpacks, Eurail passes, and very little money. It was going to be amazing.
Except, it kind of wasn't. I mean...there were moments that were amazing. Like the first day in London, when I walked around the city with my mouth hanging open saying things like "OMG...Alfred Russel Wallace lived here*. OMG...MAHATMA GANDHI LIVED HERE!!!" Or the beautiful day we spent on a boat on Loch Ness, before I discovered how badly I had burned my legs because I had decided to "let them tan". But there was also a lot of hard stuff.
The biggest problem was that N and I wanted to have completely different trips. I had planned for the trip obsessively, reading Let's Go Europe from cover to cover and marking things as "Must-See" or "Would-Like-To-See-If-We-Have-Time". I had practiced saying Hello/Goodbye/Please/Thank You/I desperately need a bathroom now in the languages of every country we would visit. And I had dreamed of all the nerdy historical places we would visit: Westminster Abbey, Edinburgh Castle, Notre Dame Cathedral, the Roman Forum.
N had packed her party clothes. Unbeknownst to me, this trip for her represented an opportunity to escape from her somewhat overprotective parents and just have fun. She had almost no desire to buy the discount passes that let you see all the historical sites in a city, but every desire to meet people at hostels and go dancing. So for six weeks, we cramped each other's style, arguing constantly about whether to spend our time in a museum or a bar. By the time we flew home, we were barely talking to each other.
I realized on that trip that I have some pretty specific desires when I travel, and they aren't necessarily the desires of others. Which is completely okay. I in no way judge the crazy people who want to be social and spend times in crowded spaces. I simply don't want to travel with them.
Over the years, I have been very fortunate to have lots of opportunities to travel. And with each trip, I've gotten even better at knowing what I will or will not enjoy. Which is particularly relevant to me right now, as I just bought tickets for a conference and vacation in France this Spring. FRANCE! If you follow me on Twitter, you will know that I have been posting there frequently about my excitement about learning to speak French and planning my trip. And to build on that excitement, I've decided to post about some of the things that make a great trip for me.
Really Nerdy Activities:
I love nerdy things, and the more I embrace this fact, the happier I become. When traveling, I have no interest at all in the popular shopping district, but I absolutely do want to see the collection of 18th century dioramas/the site where a famous scientist was born/Galileo's middle finger.
When traveling, I seek out the oddities. I look on Atlas Obscura to find places to visit (Oradour-Sur-Glane is high on my list for France). I allocate entire days to medical and natural history museums. And I love every minute of it.
Traveling Alone:
Shockingly there are few people in this world who want to spend hours with me in a natural history museum photographing a dodo bird (A DODO BIRD!) from every angle. When I travel with another person, it is inevitable that at some point the other person will become impatient and/or I will feel rushed. Which is quite easily overcome by me simply traveling alone.
While traveling with someone else isn't entirely negative (eating in restaurants tends to be better with another person), I do tend to prefer traveling on my own. I like having complete control over where I go and what I see. I like being able to commit a day of travel and four hours on a bus to visiting the seaside town from which the French explorers departed for Canada. And I like never being dragged out in the evening to socialize with people I don't know.
Flexible Schedule:
Whenever I travel, I tend to alternate between days of "OMG I'm so excitied! I'm going to see three museums and take a walking tour and take hundreds of photos!" and days of "Cobblestone hurts my feet and I don't like the food here and I want to stay in bed and Internet". This pattern repeats itself on every trip I go on, and if I ignore my need for downtime and try to push on with the sightseeing, I will inevitably become miserable. I've learned to build flexibility and extra time into my schedule so that, when needed, I can spend a day on the couch with a block of cheese and a good book and recharge my traveling energy.
Small Cities and Towns:
When N and I went to Europe, we gave ourselves four full days in Rome, recognizing that there was a lot to see. And for four days we rode on the crowded subways and got catcalled by Roman men and saw site after site of broken columns. For me, I was overwhelmed by the number of people and by the sense that no matter how much we rushed, we would never see everything. I learned from my visit to Rome that I prefer the small places to the big. Small places may not have as many things to see, but I enjoy the sense of being able to see everything, even when I go at a leisurely pace. And I love the oddities that turn up in small places, which would never attract tourists in a big city, like the preserved two-headed pig in the farming town where my grandparents lived.
Packing Light:
On my first trip, I bought the biggest backpack I could find, and I filled it with everything that would fit in it. And then I packed a second smaller backpack as a day pack. Even though I was only 22 years old, I felt like an old woman thanks to the constant back and shoulder pain from carrying my things around. When I watched the movie Wild, I couldn't stop laughing in recognition at Cheryl Strayed's pack (although, for the record, I did not pack 12 condoms for my trip to Europe).
Every time I travel, my suitcase gets lighter. I simply don't need much stuff, and I hate hauling a heavy bag into airport bathrooms and onto trains. On my most recent trip, which was to Quebec City, I took only my camera bag and a carry-on suitcase, and it was still more stuff than I needed. I will probably need to take a larger bag to France, as I need to bring work-appropriate clothes with me, but you can bet that it will be packed as lightly as possible. (Leaving room to bring home wine.)
So this is how I travel. A solitary introvert with a tiny bag and a big camera, visiting the nerdiest places I can find. My idea of a fun vacation would probably be a nightmare to a more outgoing person, but it works perfectly for me. Which I think is a good guiding principle for life: do what works perfectly for you.
*You know you're a nerd when you not only know who Alfred Russel Wallace was but also still feel angry that he didn't get the recognition he deserved for the theory of evolution.
Remember when Christmas was still a month away and I was freaking out because I thought I wouldn't have enough to do? And then I decided that I was going to use some of my spare holiday time to write a play?
Hahahahaha.
Yeah. About that. As the holidays approached, my list of things to do slowly grew. At the current time, I am absolutely committed to the following activities:
Dinner and a movie with my new friend tonight*
Christmas Eve dinner with family tomorrow night
Christmas Eve sleepover with my Mom
Christmas Day dinner with more family
Counseling session with my performance coach on Thursday**
French lesson on Thursday
Dinner and a show with friends at the Art Gallery on Friday
And this is with minimal effort actually put into making plans. I still have a list of multiple other friends with whom I'm hoping to make plans in the next ten days. I have made so many plans that I actually managed to double book myself for Friday night, and for the third year in a row I will not be attending my residency group's annual party. (Is it surprising that an introvert would pick an intimate evening with friends over a big party? Zero surprising.)
Until about a week ago, I was still thinking about writing a play. But the more I thought about it, the more it seemed like a burden that I would resent, rather than a fun activity to keep me busy over the holidays. And then I had an insanely busy week on call, which has left me with a desk covered in unfinished work, and I thought "nope". No. No play this year. Rest.
Over the next ten days, I'm just going to recharge and get my life back on track. I'm going to empty the dishwasher that has been clean since Monday and refill it with the week's worth of dishes that are on the counter. I'm going to replenish my freezer stores so that I won't go hungry the next time I'm on call. And I'm going to do a little (lot) of work stuff so that I will not feel too horribly overwhelmed when I go back to work.
And I'm going to do fun stuff! I saved season two of Stranger Things, so there will be some serious binge watching. And books. And drinking peppermint hot chocolate. And drinking all of the wine I couldn't drink while I was on call. And sleep. Glorious, glorious sleep.
It may not be the same as Christmas with my ex's family, but I think it's going to be lovely all the same.
*I made a new friend this year! As an introvert who treats friends like precious heirlooms and keeps them forever, this is exciting.
**I need to write a post about this, because this has been life-changing.
I must admit, there have been times in my life when I have looked at people who speak English as an additional language and thought that I would do better if I were in their shoes. I've imagined myself living in another country and easily learning the language by immersing myself fully in it - talking to other people, reading newspapers, watching television, listening to music. And most importantly, completely avoiding any sort of communication in English.
Sometimes I am an asshole.
I've been in Quebec City for three days now, and for the first time I am beginning to really appreciate how difficult it is to learn another language. Sure, I've traveled outside of Canada before, and I've amused myself by learning to say "hello" and "goodbye" and "I would like a reservation for two people" in other languages, but this is the first time I've ever tried to become fluent in another language. And despite having a reasonable baseline knowledge of French, I am finding it a huge struggle. I hate that it takes me five times as long to read a sign in French than in English, and that even then I am only able to get the gist of what it says. I feel horrified every time I ask a question in my well-rehearsed but halting French and then cannot understand the response.
My French classes are fully immersive, meaning that we can get in trouble for speaking in English anywhere on campus, and suddenly I feel cut off from the world. During conversational practice today, I had no idea what my classmate was saying, and I felt panicked at being unable to understand her or to make myself understood. The environment is very supportive, and my teacher did his best to not make me feel like an idiot, but it still feels terribly uncomfortable.
When I returned from my five hours of class at the end of the day, all I wanted was to speak and read in English. I opened my computer and was immediately relieved by how easy it was to read blogs and Facebook in my own language. The comfort of familiarity!
So yes. Sometimes I am an asshole. And I apologize to any non-native English speaker whom I have ever passed judgement on.
Given that I took a week of vacation to go to a theatre festival, you won't be surprised to learn that I am a huge fan of theatre. My love of theatre started at the age of 12, when I played the role of Weasel in "The Trial of the Big Bad Wolf"*, and it has grown over the following 28 years thanks to an impressive local theatre scene. I have seasons tickets to the main theatre in my city, I can easily be convinced to see pretty much any play, and the annual theatre festival is my own personal Christmas. Love it!
I also view theatre as something that's pretty important. As a teenager, it took me a long time to understand and accept the fact that I am bisexual, and theatre made the entire process easier. The plays that I went to often featured characters who were grappling with their sexuality, and when I watched them, I felt seen. I may not have been able to tell my parents or even talk to my friends** about what was going on in my life, but I could go to the theatre and see myself reflected in the characters on stage.
Which is why I think it's important for a lot of stories to be told in the theatre, not just those of straight, white, cis-gendered, middle-class, heterosexual people. But when I go to my theatre festival - my beloved, take-a-week-off, favourite-time-of-the-year theatre festival - those are the stories that are getting told. And those are the people telling the stories. Of the 25 plays I've seen to date, with over 50 actors in total, there have been only four non-white actors. Four! The population of my city is over 30% non-white, and yet virtually every actor at the festival is white. And virtually every story is about white people.
I find this really sad, particularly because I view the theatre community as one of the most diverse and accepting groups of people anywhere. If theatre isn't a space that welcomes and encourages the participation of everyone, then what space is?
**Of course, my friends aren't idiots, and it didn't take too many times of me asking "Hey! Wanna see this random lesbian play with me?" for them to figure it out.
Back in February, I was at one of the lowest points emotionally that I've been at in a long time. I was burnt out from work, but in a very different way from the burnout I had experienced in residency. In residency, difficult times were made easier by the knowledge that I was only days to weeks away from a new rotation; as an attending, I could take no such comfort from the knowledge that I would be doing the same work for years to decades.
So I took a vacation. In late January, M and I decided last minute to book a trip to Cuba, and it was a bit of a lifesaver. For the first time in months, I had a prolonged break from the incessant stress of work. I stopped waking in the middle of the night to ruminate about patient care decisions. I stopped calculating how many more days I would have to work until I would be financially independent. I started laughing again. For the ten days that I was away from work, I felt like myself again.
And when I went back, everything felt easier. Not always easy, and certainly not free from stress, but at the very least far more manageable than it had before the vacation. The whole experience made it clear to me that, while some physicians can go for years without a vacation, I am not one of those physicians. To be happy, and to be of much use to my patients, I need to take breaks.
So I've decided to aim for at least one week off every three months. By three months my neck is starting to stiffen and my sleep is getting more interrupted, and time away from the office feels really, really good. I could work longer without a vacation, but I don't want to.
As someone who is interested in financial independence/retire early, or FIRE, it's tempting at times to want to reach financial independence as early as possible. I sometimes think about taking extra call weekends and not taking time off and never eating out again so that I can squirrel away every possible penny for retirement. But the reality is that I'm at least seven years away from achieving financial independence, and probably ten years away from feeling comfortable enough to retire, which is a long time to be unhappy. I don't want to white knuckle my way to retirement; I want to be happy in the process. Heck, I would love it if I were so happy in the process that when I reach the point of being able to retire I won't want to.
So I will take vacations. And sleep through the night. And laugh. And be happy in my pursuit of FIRE.
(At the moment, I'm happily taking a week off of work to participate in our local theatre festival. And I am loving my life.)
M and I just came back from a lovely week in Cuba. It had been seven months since my last true vacation (a week off at home for our local theatre festival in July), and I was starting to crack a bit under the strain of constantly having to be on for other people. A week of sun and books and more alcohol than is recommended was somewhat desperately needed.
The setup was perfect for relaxing. We were in an all-inclusive resort, so the most strenuous thing required of us was walking from our table to the buffet to refill our overflowing plates. And yet, despite being on vacation, I found it hard to turn off the constant chatter in my brain. When eating, I would be thinking about the books that were waiting to be read; when reading, I'd be wondering what was going to be served at our next meal. When on the beach, I'd be wondering if I would've been happier spending the day in Havana; when in Havana, I would dream about the beach.
My distractible brain, my ever present companion at home, had followed me to paradise*.
I am so accustomed to my constant thoughts about what else I should be doing and what needs to be done next that it took me days to recognize how ridiculous they were in paradise. My moment of clarity happened on the beach, when M was snorkeling in the shallow water and I was walking beside her. I had just come out of the water myself, and I was feeling a bit chilled, and all I could think about was wanting the walk to be over so that I would be back at my beach chair and wrapped in a warm towel.
And then I paused. And I thought "Why on Earth am I wishing this time away?" Wanting to be back at the beach chair wasn't going to make the distance any shorter or make M swim any faster. All it was going to do was rob a perfectly good moment of any potential for happiness. So I stopped, and instead of feeling my usual impatience, I took a look around me. At the people and the palm trees and the mountains all glowing in the warmth of the late day sun. And I realized that I was literally in the middle of a postcard.
A postcard that I had almost missed, because all I know how to do anymore is rush from what I am doing to whatever it is that comes next.
*I recognize that I am very privileged to view Cuba as "paradise", as that isn't the experience for many of its citizens.
When I went to Chicago for the first time in 2012, I had just finished my first month as a senior resident in a Medical-Surgical Intensive Care Unit. That rotation was one of the most difficult months of my entire training. My medical knowledge and patient management skills were challenged beyond anything I had ever experienced, and I lived in constant fear that my ignorance and/or incompetence was going to kill someone. With only three residents in the unit, we were forced to take call every third night*, such that I was making difficult patient care decisions through a haze of severe sleep deprivation.
And then there were the patients.
Because the unit was home to the sickest patients in the hospital, death was a constant presence. The worst night of my training happened in that unit: over the course of a 15-hour overnight period, I admitted or ran a code on eight patients, not a single one of whom survived to the morning**. At 8 am, one of my co-residents walked into the unit, looked at the near-empty patient list, and nonchalantly commented "Oh, looks like you had a quiet night". In another situation her comment would've made me bawl, but I was too emotionally drained to do anything more than put my head on the desk and moan. It was a hard month.
My ICU rotation was followed by two weeks of vacation, which I had initially planned to spend relaxing at home and visiting with friends and family. But as I dragged myself through the too-long days of ICU, subsisting on digestive biscuits and ice cream cups that were intended for patients, I knew that I needed something better to look forward to in order to make it to the end of the rotation. So, a few days before I was finished with ICU, while lying nearly immobile on my couch in a post-call stupor, I booked an impromptu trip to Chicago. Leaving at 6 am on the first day of my vacation.
It was an amazing trip. Chicago was a beautiful city filled with interesting places to visit and a seemingly unending list of great places to eat. The weather was perfect. I lucked out and got a great hotel room on the 22nd floor that looked directly towards the Chicago River and the Wrigley Building. And for one week I didn't have to take orders or give orders or feel people's pulses slip away as I held my hand over their femoral arteries. It was the perfect escape.
I had hoped that my trip to Chicago this past weekend would be just as amazing. And I will say that it was mostly fun, lest I seem ungrateful for having the good fortune to be able to travel to such a remarkable place. I got to show my Mom a city that I love; I got to meet Carlos from Top Chef season 11 and eat in his amazing restaurant; and I left the pressures of work behind for four days.
But.
My family is not always easy. My Mom is going through a difficult period, still struggling to cope with the death of my father six years ago, and there was understandably a lot of time and attention devoted to what she's going through. She also snores. Loudly. And unpredictably. I spent the first night on the couch to get away from her, and the second night I severely pissed her off by making her sleep in my brother's room. Thankfully he is so perpetually exhausted that he can sleep through anything.
And then there's my brother. While I love him (really...I love him), he and I see the world through very different lenses***. I am an unapologetically left-wing, environmentally minded, socialistic granola cruncher. My brother takes ten napkins at Chipotle and throws out nine unused ones. If we could simply agree to disagree, we would probably get along much better; however, we both think that we have all the answers to the world's problems, and we are determined to share them with each other. So there was some conflict. He said I was judgemental. I may have called him an asshole.
The good thing about family is that they are always your family. Even if you call them an asshole.
*The resident contract in my province stipulates that residents cannot take call more than once every four days, on average; however, in situations where "patient care would otherwise be compromised", that rule can be overlooked. Hence the one-in-three call.
**I refuse to believe that this reflects on my skill as a physician in any way. The patients were simply that sick. Most of them didn't make it to the end of the code blue.
***Thankfully he isn't a Trump supporter. There are some things that I cannot forgive, even when it's family.
By the time I left on my recent trip, I was in desperate need of a break. I needed to not have to make life or death decisions and to not carry a pager and to not have to be witness to the inevitable human suffering that accompanies medicine. I was spent.
Unfortunately, the Middle East is not the most relaxing place to visit*, and traveling with one's soon-to-be-ex-girlfriend and her family does not make the experience any easier. At the end of my trip, I felt just as stressed as I had been at the beginning, and things have only gotten worse as a result of 1) the subsequent breakup and 2) a very long and busy week on call.
Thankfully, I'm spending this upcoming weekend in Chicago. My Mom turned 65 last December, and my brother and I decided to mark the occasion with a family getaway**. We leave at 8:30 tomorrow morning, and I can't wait to be away. I am ready to see beautiful architecture and eat tasty Top Chef winner cooking and not worry about anything. All of the problems of the real world are just going to have to wait until Monday.
*Particularly as an LGBTTQ person.
**We deferred the trip until the weather was likely to be good and until my brother's and my call schedules aligned. Bloody call.
After a day and a half of lying in bed, never far from the bathroom and a large bottle of water, we recovered from our food poisoning and resumed our traveling. We had a few more days in Cairo, followed by three nights in Athens, three nights on a Greek island (Aegina), and a week in Amman, Jordan. The days were very full, between being tourists and visiting family, so there never seemed to be a spare moment to update the blog. Even my Facebook photos are a solid two weeks behind.
I would like to say more, but at the moment I've been awake and traveling for almost 26 hours (it's like being on call), and the cats get annoyed when I use my hands for typing instead of petting. All I will say for now is that it was an amazing trip; the Middle East is a place unlike any I've ever been before.
Me to my girlfriend at 3 am this morning: "I think I'm going to have diarrhea again. Do you need to vomit, or can I use the bathroom first?"
#alwayssaynotouncookedvegetables
It took three flights, almost 24 hours, and a small meltdown in the Frankfurt airport, but my girlfriend and I are now comfortably settled in an apartment in the Heliopolis neighbourhood of Cairo. The two days since we arrived have been devoted to seeing as many people as possible (my girlfriend lived in Cairo for three years and, being an extrovert unlike me, left behind a long list of people who love and miss her), adjusting to the seven hour time difference, and challenging the defences of our gastrointestinal tracts with street foods. Shawarma...mmmm...
As we were waiting in the airport in our home city, we ran into our accountant, who was waiting to fly to his vacation home in Phoenix. The girlfriend and I were already in vacation mode, eating hot dogs and deciding which of the many ebooks we had downloaded to read first, while the accountant was surrounded by his computer and cell phone and stacks of papers. When he saw us, he quickly picked up his phone to call the Canada Revenue Agency about an issue with my tax return, and after speaking with someone, he called over to me to let me know that he had resolved the issue. His voice was eager, like a child seeking praise. "Look at me! I'm on vacation but I'm still working for you! Aren't I great?"
And then he chatted with us about where we were going and how long we were going to be away. When I told him that we were traveling for three weeks, and that I had left all of my work at the hospital, a momentary flash of disgust passed over his face. He recovered quickly, but he still made it clear that he didn't approve of my prolonged absence. "Three weeks? No doctor goes away for three weeks! That's crazy!"
Which it shouldn't be. When I am at work, I work very hard, often giving up lunches to finish paperwork and coming in early so that I can fit in another urgent patient. So why on Earth should I have to apologize to my accountant about wanting to take some time away for myself? Why does medicine (and North American society as a whole) fetishize work so much that people are viewed as weak or as failures if they choose to do anything other than work?
I refuse to apologize for not wanting to give my entire life to medicine. The further I get into my career, the more I realize I'm going to have to fight the dominant culture of medicine in order to take time for myself, but I'm prepared to do that. Life outside of medicine is too sweet to squander it all simply to meet other people's expectations of me.
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.
Years ago, soon after I had started medical school, a friend of mine who is a physician came in from out of town for a visit. During his stay, I inundated him with questions about medicine and work life balance and time off for physicians. When the subject of vacation came up, I was quite surprised to hear that he could take almost as much time off as he wanted to, but he didn't. It was, he said, too hard to give up the money.
At the time, I didn't understand. I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.
Fast forward eight or nine years, and I understand completely. When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work. Every day off is a calculation:
One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.
It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy. Except that I do. And it isn't.
So I'm learning to value my time more than my income. It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance. And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival. A week! It took me hours to commit to the decision, but now that I've made it, it feels right. It feels entirely right for me to make time for something that I love that gives me joy.
(This post might be a bit obnoxious, as I'm writing about finances from the perspective of a well-paid physician with no children living in a low cost-of-living area. Feel free to skip it! Please don't hate me. I do recognize the incredible privilege and good fortune in being able to write a post like this.)
November started out as a really good month financially. I was on call for nine days, which meant that I was earning an on-call stipend and consult fees on top of my usual clinic income. I had recently increased the number of patients I was seeing per clinic, so even my relatively constant clinic income had taken a jump. I felt flush. Money was coming in more quickly than it ever had, and so it seemed silly for me to be sticking to a budget and limiting my spending.
Big mistake.
My change in spending habits started slowly, with a takeout meal on a night when the fridge was full of leftovers ("I work hard! I deserve sushi instead of spaghetti!), but it quickly escalated. Soon I was eating out in the fancy restaurants that had never seemed remotely worth the cost, and I was offering to pick up the tab for my friends.
And then I went to San Francisco.
The trip was a combined conference and brief vacation with my girlfriend, so I convinced myself that I could completely ignore my budget and classify most of my spending as business expenses*. $20 tequila sampler at the hotel restaurant? Business expense. $39 flight of port and $20 plate of cheese at a wine bar? Business expense. In just over a week, I spent more money on restaurants and new clothes and Trader Joe's chocolate than I had spent in months.
And I'm not going to lie - it felt amazing. It was fun to spend without thinking about money or entering expenses into my budget. $20 plates of cheese are tasty. And I felt strangely powerful sitting in Jardiniere, which was filled with the pre-opera crowd dressed in tuxedos and ball gowns**, eating fancy french fries and ordering overpriced wine from a sommelier. After 16 years of sacrifice, it felt like I had arrived.
Reality hit the day after our dinner at Jardiniere, when we had to pack to go home, and we didn't have room in our suitcases for all of our new things. Then, when we were preparing our forms for customs, we realized that we had spent almost to the very generous customs limit, something neither of us has ever done. The worst moment, however, was getting the credit card bill in December. The only time I've ever had such a ridiculously high credit card bill was when I paid my fees for my licensing exam. It was painful.
As a result of the overspending, I ended up in the red in December. This was a huge (and painful) contrast to previous months as an attending, during which I'd been paying back some of my student debt and making healthy contributions to my retirement savings. The whole month of December felt like a terrible hangover, as I watched all of my earnings go to MasterCard.
My initial take home lesson from November was "Stick to the budget! Keep living like a student!", and for a while that's precisely what I did. But as I look back at the month now, I wonder if that's the only lesson I should take from it. Because although the month was way beyond sustainable spending for me, there were also a lot of good things about it. While eating the flight of port and the cheese plate, my girlfriend and I had a wonderful conversation about our relationship and the future that makes me happy whenever I think about it. While having dinner at Jardiniere, we realized that we never want to become people who own ball gowns and think we're special because we're eating in an expensive restaurant. And we got to see Idina Menzel in a shitty musical, which was on my girlfriend's bucket list. (Seeing Idina Menzel, that is. Not the shitty musical.)
So...what to take from this experience? First and foremost is the recognition that it is easy to spend a lot of money in a very short time. And although I am earning more than I ever had, I can't afford to spend indiscriminately when I still have a six-figure debt. (Or probably ever.) Second is the reminder that people adapt to things very quickly. While the unrestricted spending felt exciting in the beginning, after only a month it was starting to feel very ordinary. And going back to my previously comfortable budget felt horrible.
Looking back at the month now, I think the overarching lesson I'm going to take is that splurging is fun, but it can't (and shouldn't) be an everyday thing. I'm going to keep sticking with my budget and dutifully saving my money, but I'm also going to make sure that I leave some money for the really self-indulgent expenses that are worth it (like going to wine bars with my girlfriend).
Balance. Once again, the lesson is balance.
*Please note that this was only from a budget perspective and not a tax perspective. Hi Revenue Canada! I'm not evading taxes by claiming booze as a business expense! Please don't audit me!
**I was in jeans, because I hadn't realized from the website just how fancy the restaurant was. Awkward!
For days I have been wanting to write here, to share my thoughts
about the conference I'm attending in San Francisco and to tell you
about the places we've visited and the food we've eaten during the gaps
between sessions. To talk about things that are light and fun and
pleasurable. But I've felt like I can't talk about lightness and
trivialities until I say something to acknowledge the recent attacks on
Paris.
But what can I possibly say?
This is the third attempt that I've made at writing a post, and every attempt has seemed too....earnest? Cheesy? Ignorant? In my attempt to write something meaningful, I've given myself an incurable case of writer's block. And now that it's late, and given that we have tickets to Alcatraz for early tomorrow morning, I'm going to say something quick to simply get it over with.
All that I'm going to say is the one thought that enters my head every time I hear about the attack on Paris and the resultant escalation of the war in Syria: we have to find a better way. As the (purportedly) most intelligent species on Earth, we need to acknowledge that our endless cycles of war are failing. We aren't making the world safer by constantly responding to violence with more violence; we're simply creating more enemies. And destroying the lives of more innocent people, both civilian and military.
We have to find a better way.
---
Because this post isn't nearly as good as I would like it to be, here are the thoughts of some other people that I think are worth sharing:
Feel free to share any other links that you think are interesting/relevant (as long as they aren't racist or xenophobic) in the comments. Or tell me your thoughts about all of the horrible things that are happening in our broken world.
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.
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.
