You may recall that I set some pretty ambitious (for me) goals at the beginning of the year. So how is it going one month in?
The Good:
"meditating every day" I have done this! I was pretty well established with my weekday morning practice, so my main challenge here was finding a way to meditate on the weekends. Initially, I thought that I would meditate first thing in the morning like I do on weekdays, but this literally never happened. Turns out, I really enjoy sleeping in and getting a lazy slow start to weekend days, and there is no part of me that wants to start the day on a meditation cushion. So I have been doing it before I go to bed on weekends, and it has gone perfectly so far.
"I mostly just want to keep working and
hoarding money for the future" I had nine days of very busy call this month, so I have done a lot of hoarding of money. It's lovely for the net worth, but I would honestly like to do a little less earning and a little more resting.
"I want to keep building on
the friendships I have." I've also been doing this! Even though it's been a busy month, I've made time to go with friends to see our local queer choir, to visit my godson and his family, to go for dinner with my brother, and to go out for dinner and a play with my mom and her partner. (I think there has been more? It's a bit of a blur.) For an introvert who has been busy with work, it has been about the maximum amount I can expect of myself.
The Not As Good:
"I would like to work on keeping up with everything." This has been very mixed. One of my proposed ways of achieving this was "just doing the shit now", and I have definitely incorporated this approach into my life, to good effect. I am constantly trying to spend a few extra minutes to do all the nagging little tasks as they come up, and as a result I'm getting a lot more done without it feeling overwhelming or like a giant burden. And I'm worrying less about missing things. Perfect example - I got an application for reimbursement of a work expense, which isn't due until April. My initial instinct was to put it in my to do pile (I had three months to do it, after all), but instead I took the five minutes required to fill it out, put it in the return envelope, and put it in the mailbox. And now it's done, and I don't have to worry about missing the deadline for getting money back.
The biggest challenge has simply been that work has been really busy. In addition to nine busy (and really emotionally exhausting) days of call, I had a week of teaching, and I've taken on a new volunteer position with a national organization (You know. Because that helps with burnout.) I've worked at least part of one weekend day every week since the beginning of the year, and still things are slowly starting to build up. It's frustrating.
And as for my "go to work earlier and stay later" approach?
Ha.
Ha.
Ha.
When I was writing my original post, I had the (utterly ridiculous, I don't know where it came from) idea in my head that I sometimes go to work late or leave early because I'm lazy. This past month has reminded me that it's actually because I'm tired. I have a limited number of productive work hours in me every day, and once they are finished, there is no value in me sitting in front of a computer trying to work. I need a mental break. So those days when I leave early are usually because I'm mentally shutting down and ready for the day to be over. And the days when I arrive late are usually because I've been suffering from insomnia and have allowed myself an extra hour to catch up on some sleep.
This has been an important reminder to not be too hard on myself and to extend myself a bit of grace. I am human, and I can only do so much. It's also a really important reminder to set boundaries and to not apologize for doing so. At the moment, I'm having to set some boundaries on fun things in my personal life, but I'm hoping as the year goes on and my call schedule settles down a bit that the boundaries will be more towards work. I've also firmly decided that I'm going to give up a volunteer commitment at the end of the year (I reeeeealy should've given it up at the beginning of the year, but I got talked into agreeing to another year), which will free up one precious evening every month.
The Total Nope:
"I'm aiming for a regular practice of four yoga
classes per week" At best so far I've made it to three classes in one week. Things have just been busy, and in some cases (call) I've had to skip yoga, and in other cases (social life) I've chosen to skip yoga. Part of me is sad, because I really do love it and am seeing a lot of progress, but I'm also making peace with it. I have a really full life, in mostly good ways, so it's okay that I'm not being absolutely perfect at everything.
So that's the one-month check in. As for February? I have three more weeks off call (yay!), during which I'm fully intending to get caught up on everything work related (plausible if I do some work on weekends), after which I have one week on, one off, and one on. Ugh. I'm intending to keep up with the daily meditations, as I do think they help keep me present and calm, even though my brain feels squirrely while I'm doing them. I'm going to try to do three yoga classes a week, as I think it's more realistic than four right now. And, perhaps mostly importantly, I'm going to keep learning from the process and being kind to myself. I'm actually doing pretty well at things that are hard, and I deserve to be proud of myself for that.
Showing posts with label Work. Show all posts
Showing posts with label Work. Show all posts
Friday, January 31, 2020
Saturday, January 4, 2020
Four Days into 2020 - Getting My Ass Handed to Me By Call
When I wrote my post about resolutions for 2020, I was very intentional in talking about "experimenting". I knew that I wasn't going to be able to change everything the moment the clock struck midnight (I am not a magician), so I wanted to give myself permission to do things gradually and to falter along the way.
Well.
This was a good thing.
I went back to work on Thursday, and I am starting the year with four days on call. And what a call it has been. I've had multiple really sick people spread all over the province, and my pager has been going off seemingly constantly. Whereas I thought I'd be staying late to keep up with paperwork, I've had to stay late just to get the bare minimum done.
It's honestly a little demoralizing. I'm only three days into the work year, and I already have new letters that need to be dictated and old letters that need to be edited. And I've had one night of insomnia, followed by a sleep deprivation-induced migraine. (Awesome combo)
But...it's a process. And I know that call is the hardest part of my job, particularly when it's busy call. So I'm breathing. And focusing on what I can learn from this experience, rather than on all the things that don't seem to be working.
When I reflect on the past few days, the biggest thing that I'm reminded of is how much I dislike the uncertainty of call. This isn't really shocking, as I'm a person who hates surprises and likes to have everything planned. Carrying around a tiny piece of plastic that can scream at me and derail my day without warning is really not my favourite thing.
Fortunately, there are things that I can do to make this easier to cope with. The biggest one, and one that I've been leaning towards but not quite willing to commit to until now, is not making plans with other people while I'm on call. In theory, the best thing about home call is the fact that I can continue to live a normal life while I'm call, but in reality, everything is made worse by the pager hanging over me. I hate planning to meet someone and then having to cancel (or getting called away in the middle of doing something). It happened on Thursday night when I was planning to meet a BFF for my favourite yoga class, and then it happened again on Friday night when I was supposed to go to a party for people from my residency. And it sucked.
Not to say that I will never make plans (I would still try to make it to the Friday night party, for example, as the date was fixed), but that I'm going to try to keep my call days as flexible as possible. Some of this is more mental than anything - trying to not get attached to any idea of how the day will look, but rather take things as they come*. If the day is busy and I have to work until late, I'm mentally prepared for that. If it's not and I have time for non-work things, then it's a bonus and I can use the opportunity to go to yoga or wash dishes or sit on the couch with the cats playing Stone Age online with The 76K Project. (Mostly the latter).
I'm trying to approach my current weekend this way, and so far it seems to be helping (?). When I got up this morning, instead of trying to map out the weekend, I made myself a list of things from highest to lowest priority. Providing good patient care was #1, with prepping for my upcoming lectures (which I technically should've had done by yesterday) #2. While I was responding to pages this morning, I spent a few hours getting the lectures done, thus getting the most important (as well as the most stress-inducing) task out of the way. And then the pager was kind to me, and I was able to go to an hour ofthe worst suffering I would ever willingly subject myself to yoga. I've also managed to get a few other important items knocked off my to-do list, and if I ever stop playing online games I will even do my dishes.
The change in approach and mindset has already made me a little less emotionally reactive when the pager has gone off. It has still been annoying, and I'm not looking forward to starting my day at the hospital tomorrow, but it's better. Will it help in the long term? I guess I'll see...
*I feel like call gives me some sense of what it would be like to be a parent. Everything is going well, then *BAM*, one kid spills a 2 L of milk on the floor and the other is running around naked drawing on themself with permanent marker.
Well.
This was a good thing.
I went back to work on Thursday, and I am starting the year with four days on call. And what a call it has been. I've had multiple really sick people spread all over the province, and my pager has been going off seemingly constantly. Whereas I thought I'd be staying late to keep up with paperwork, I've had to stay late just to get the bare minimum done.
It's honestly a little demoralizing. I'm only three days into the work year, and I already have new letters that need to be dictated and old letters that need to be edited. And I've had one night of insomnia, followed by a sleep deprivation-induced migraine. (Awesome combo)
But...it's a process. And I know that call is the hardest part of my job, particularly when it's busy call. So I'm breathing. And focusing on what I can learn from this experience, rather than on all the things that don't seem to be working.
When I reflect on the past few days, the biggest thing that I'm reminded of is how much I dislike the uncertainty of call. This isn't really shocking, as I'm a person who hates surprises and likes to have everything planned. Carrying around a tiny piece of plastic that can scream at me and derail my day without warning is really not my favourite thing.
Fortunately, there are things that I can do to make this easier to cope with. The biggest one, and one that I've been leaning towards but not quite willing to commit to until now, is not making plans with other people while I'm on call. In theory, the best thing about home call is the fact that I can continue to live a normal life while I'm call, but in reality, everything is made worse by the pager hanging over me. I hate planning to meet someone and then having to cancel (or getting called away in the middle of doing something). It happened on Thursday night when I was planning to meet a BFF for my favourite yoga class, and then it happened again on Friday night when I was supposed to go to a party for people from my residency. And it sucked.
Not to say that I will never make plans (I would still try to make it to the Friday night party, for example, as the date was fixed), but that I'm going to try to keep my call days as flexible as possible. Some of this is more mental than anything - trying to not get attached to any idea of how the day will look, but rather take things as they come*. If the day is busy and I have to work until late, I'm mentally prepared for that. If it's not and I have time for non-work things, then it's a bonus and I can use the opportunity to go to yoga or wash dishes or sit on the couch with the cats playing Stone Age online with The 76K Project. (Mostly the latter).
I'm trying to approach my current weekend this way, and so far it seems to be helping (?). When I got up this morning, instead of trying to map out the weekend, I made myself a list of things from highest to lowest priority. Providing good patient care was #1, with prepping for my upcoming lectures (which I technically should've had done by yesterday) #2. While I was responding to pages this morning, I spent a few hours getting the lectures done, thus getting the most important (as well as the most stress-inducing) task out of the way. And then the pager was kind to me, and I was able to go to an hour of
The change in approach and mindset has already made me a little less emotionally reactive when the pager has gone off. It has still been annoying, and I'm not looking forward to starting my day at the hospital tomorrow, but it's better. Will it help in the long term? I guess I'll see...
*I feel like call gives me some sense of what it would be like to be a parent. Everything is going well, then *BAM*, one kid spills a 2 L of milk on the floor and the other is running around naked drawing on themself with permanent marker.
Friday, December 27, 2019
2019 - The Year of Breaking Open
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.
"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.
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.
Thursday, October 31, 2019
The Return of Happiness
Years ago, when I was early in residency training, I wrote a post on the first version of this blog called "Fundamentally Happy"*. In it, I talked about how, despite the many challenges of residency, at my core I was happy. Satisfied with where I was in life and with where I was going.
Earlier this year, I lost that feeling. Not just for a moment, but for months on end. I felt like I was working constantly and as if life was a perpetual slog through overbooked clinics and piles of paperwork. In the beginning, I was having trouble staying caught up for more than the briefest of moments, and eventually I lost the ability to ever catch up. I was slowly drowning.
It has taken a lot to come back. I have drawn on every resource available to me to get through this, and I have been so lucky to have been met by nothing but support everywhere I went. Support from friends, colleagues (remember the one who took three weeks of summer call for me?), and even my department head. I am so thankful to have had a good experience, because I know that many physicians who burn out don't.
Life is different now. My clinics are capped, so even on days when everyone shows up, I usually run (at least close to) on time. I don't run over too often, and some days I finish early. I still get behind on paperwork sometimes, but it's usually because I've taken something extra on (like travelling to a remote community to share my knowledge with a group of rural physicians) and not because the work load is too much. And when I get behind, I can catch up again.
I can finally breathe again. Not the shallow, panicked, desperate breaths that I was breathing for months. Deep, calm, happy breaths.
Things are so much better.
*I think. My memory is crappy.
Earlier this year, I lost that feeling. Not just for a moment, but for months on end. I felt like I was working constantly and as if life was a perpetual slog through overbooked clinics and piles of paperwork. In the beginning, I was having trouble staying caught up for more than the briefest of moments, and eventually I lost the ability to ever catch up. I was slowly drowning.
It has taken a lot to come back. I have drawn on every resource available to me to get through this, and I have been so lucky to have been met by nothing but support everywhere I went. Support from friends, colleagues (remember the one who took three weeks of summer call for me?), and even my department head. I am so thankful to have had a good experience, because I know that many physicians who burn out don't.
Life is different now. My clinics are capped, so even on days when everyone shows up, I usually run (at least close to) on time. I don't run over too often, and some days I finish early. I still get behind on paperwork sometimes, but it's usually because I've taken something extra on (like travelling to a remote community to share my knowledge with a group of rural physicians) and not because the work load is too much. And when I get behind, I can catch up again.
I can finally breathe again. Not the shallow, panicked, desperate breaths that I was breathing for months. Deep, calm, happy breaths.
Things are so much better.
*I think. My memory is crappy.
Monday, August 5, 2019
How FIRE led me to Burnout
For a physician, I think and talk and write a lot about taking time off. Two years ago, I committed to taking vacation every three months, and I have done a pretty good job of sticking to that ever since (I even took an extra vacation this year!). I talk to trainees all the time about taking time away from work in order to maintain their mental health and have some joy in their lives. So, until recently, I really thought I had the right mindset with respect to so-called work-life balance.
Except...underlying everything has been the idea of FIRE. Work my ass off for a few years, save as much as possible, and then run away to a life of complete freedom and constant joy. The dream! While I still allowed myself vacations, the desire to have enough money to retire as soon as possible led me to make other bad decisions that were perhaps worse than never taking time off. Sure, I'll add more patients to my already overbooked clinic. Sure, I'll take on some lucrative contract work that I don't have time for. Sure, I can do an extra Friday afternoon clinic even though I'm barely clawing my way to the end of the week as it is. I convinced myself that I was being a good doctor by seeing more patients, but if I'm being honest, the real driver was the extra money that could go directly into my retirement savings.
And so, as I've already written about, I crashed in a somewhat spectacular way.
I'm actually kind of thankful for the crash (or, at least I think I will be when I look back on it someday), because it has forced me to reevaluate my decisions. And two big things have come out of my months of self reflection. First, continuing to work at as a physician is the best option for me, at least in the present. I have contemplated taking a significant chunk of time off or quitting to pursue another career altogether, but when I look at it in the most practical of ways, doing so doesn't make any financial sense. I could go part-time as a physician and earn more than I would doing most other jobs. In the years it would take me to study to do something else, I could work full-time as a physician and save up most of what I need to retire. My current reality is that I need to work to pay bills and save for the future, and medicine is by far the most efficient way of doing that. As an added bonus, I also often like my job, at least when things aren't as overwhelming as they have been recently.
Second, and probably the more important, is that I need to stop making my decisions from a place of fear. While part of my motivation for achieving financial independence has been a desire to not work, most of it has been a desire to not need to work. To know that, whatever illness or mental health crisis or government overhaul of the healthcare system may hit, I am going to be okay. Because as a single person with no one else to rely on, I worry a lot about my financial future, even when there's zero necessity to do so. And that is a really unpleasant and unhealthy approach to money.
Thankfully, things at work are starting to get better. I have only one slightly overbooked clinic left, and my clinics are going to continue to get lighter over the next few months until I achieve a point of actually being slightly underbooked. I'm at the point where I can usually get my work done within the 45 hour a week maximum I've set for myself. I'm scheduled to start six days of call tomorrow, and I'm not having panic attacks or suffering from intractable insomnia.
There are moments when I'm actually enjoying my work and remembering why I became a physician in the first place.
So I am going to keep practicing at letting go of all the things that have been driving me to burnout. Letting go of my obsessive tracking of my net worth. Letting go of the countdown to retirement. Letting go of the belief that the future is going to be so much better than the present, and the desire to burn through time in order to get there.
I'm going to try, as much as I can, to live in the now. To enjoy what I have, to be grateful for all the good, and to simply breathe.
Except...underlying everything has been the idea of FIRE. Work my ass off for a few years, save as much as possible, and then run away to a life of complete freedom and constant joy. The dream! While I still allowed myself vacations, the desire to have enough money to retire as soon as possible led me to make other bad decisions that were perhaps worse than never taking time off. Sure, I'll add more patients to my already overbooked clinic. Sure, I'll take on some lucrative contract work that I don't have time for. Sure, I can do an extra Friday afternoon clinic even though I'm barely clawing my way to the end of the week as it is. I convinced myself that I was being a good doctor by seeing more patients, but if I'm being honest, the real driver was the extra money that could go directly into my retirement savings.
And so, as I've already written about, I crashed in a somewhat spectacular way.
I'm actually kind of thankful for the crash (or, at least I think I will be when I look back on it someday), because it has forced me to reevaluate my decisions. And two big things have come out of my months of self reflection. First, continuing to work at as a physician is the best option for me, at least in the present. I have contemplated taking a significant chunk of time off or quitting to pursue another career altogether, but when I look at it in the most practical of ways, doing so doesn't make any financial sense. I could go part-time as a physician and earn more than I would doing most other jobs. In the years it would take me to study to do something else, I could work full-time as a physician and save up most of what I need to retire. My current reality is that I need to work to pay bills and save for the future, and medicine is by far the most efficient way of doing that. As an added bonus, I also often like my job, at least when things aren't as overwhelming as they have been recently.
Second, and probably the more important, is that I need to stop making my decisions from a place of fear. While part of my motivation for achieving financial independence has been a desire to not work, most of it has been a desire to not need to work. To know that, whatever illness or mental health crisis or government overhaul of the healthcare system may hit, I am going to be okay. Because as a single person with no one else to rely on, I worry a lot about my financial future, even when there's zero necessity to do so. And that is a really unpleasant and unhealthy approach to money.
Thankfully, things at work are starting to get better. I have only one slightly overbooked clinic left, and my clinics are going to continue to get lighter over the next few months until I achieve a point of actually being slightly underbooked. I'm at the point where I can usually get my work done within the 45 hour a week maximum I've set for myself. I'm scheduled to start six days of call tomorrow, and I'm not having panic attacks or suffering from intractable insomnia.
There are moments when I'm actually enjoying my work and remembering why I became a physician in the first place.
So I am going to keep practicing at letting go of all the things that have been driving me to burnout. Letting go of my obsessive tracking of my net worth. Letting go of the countdown to retirement. Letting go of the belief that the future is going to be so much better than the present, and the desire to burn through time in order to get there.
I'm going to try, as much as I can, to live in the now. To enjoy what I have, to be grateful for all the good, and to simply breathe.
Sunday, March 24, 2019
Why Saying No is Hard
In retrospect, I'm a little surprised that it took me as long as it did to start protecting my time. I've known from the very beginning of my training that, in order for my career to be sustainable, I need to have some time to recharge. And I've done very well at protecting my time when it comes to vacations. I've taken all of my allowed vacation days, and I've refused to do any work or studying when on vacation. But when it comes to the day to day, I've let myself take on far more work than I can handle permanently without being miserable. So why?
Conditioning:
I spent nine years in medical training (4 years medical school, 3 years residency, and 2 years fellowship), and seven years in undergraduate/graduate school before that. As a trainee, I got very limited choice about things. My courses were mostly decided for me, someone else set my schedule, and saying no to things was almost never an option. So I just sucked it up. For years. I suppressed my desire to sleep and eat healthy food and have strong relationships as much as I possibly could, and I survived in a sugar- and caffeine-fueled haze because I had to.
And then, I came out on the other side, and it took a while to occur to me that I was in charge for once. Since starting my job, I've somewhat reflexively said yes to things, because that's simply what I've always done. But I actually don't have to do that. For once, I get to make the decisions.
Denial (It'll Get Better Soon):
Whenever I look at my schedule, I think "Once <insert current thing that is taking up too much of my time> is over, I'll get a chance to catch up". Except I never do. Current thing gets replaced by next thing, and my schedule stays busy and overwhelming. It has been like this for almost four years, and yet it is only now that I'm really waking up to the fact that my schedule will always be overwhelming unless I deliberately take steps to slow down.
Money:
I really have absolutely zero to complain about when it comes to my money. I am paid very well, and since I started working in 2015, I've paid off my six-figure student line of credit and accumulated almost 1/3 of what I need to retire. I am doing great, and I know there are a lot of people who would be very happy to swap financial situations with me. I recognize how fortunate I am financially, and I am incredibly grateful for that.
And yet...I still worry. What will happen if I become disabled*? If my province radically cuts healthcare funding and my job changes or disappears? If I burn out and am no longer able to work?
The worry drives me to accumulate. To build up my cash savings and my investments as protection against all of the uncertainty of life. Working less means earning less, and while it would still be more than enough, it feels scary to someone who is as security-focused as I am.
Shame:
Other people do more than me. They see more patients, do (waaaay) more research, and have more administrative responsibilities. Lots of them have spouses and/or children, so they have a whole second set of duties to take care of when they go home. And when I look at these people, I wonder "Why am I complaining about my much emptier schedule? Why can't I do as much as they do without complaining so much?"
It is hard to accept that I simply can't. Whether it's because of my anxiety, or being an introvert, or my perfectionism, or some combination of that fabulous trifecta, I simply cannot do as much as other people do. And more importantly, I don't want to. I want to not panic if I have to add an extra patient to a clinic because of an emergency. I want to sleep through the night without experiencing anxiety-induced insomnia. I want to have unstructured time at home to just breathe and exist, without having to constantly run through my to-do list in my head.
I want to be happy, at least most of the time.
What makes it hard for you to say no?
*I have some, but not enough, disability insurance right now. This is one of those "important but not urgent" things that I've been putting off for too long.
Conditioning:
I spent nine years in medical training (4 years medical school, 3 years residency, and 2 years fellowship), and seven years in undergraduate/graduate school before that. As a trainee, I got very limited choice about things. My courses were mostly decided for me, someone else set my schedule, and saying no to things was almost never an option. So I just sucked it up. For years. I suppressed my desire to sleep and eat healthy food and have strong relationships as much as I possibly could, and I survived in a sugar- and caffeine-fueled haze because I had to.
And then, I came out on the other side, and it took a while to occur to me that I was in charge for once. Since starting my job, I've somewhat reflexively said yes to things, because that's simply what I've always done. But I actually don't have to do that. For once, I get to make the decisions.
Denial (It'll Get Better Soon):
Whenever I look at my schedule, I think "Once <insert current thing that is taking up too much of my time> is over, I'll get a chance to catch up". Except I never do. Current thing gets replaced by next thing, and my schedule stays busy and overwhelming. It has been like this for almost four years, and yet it is only now that I'm really waking up to the fact that my schedule will always be overwhelming unless I deliberately take steps to slow down.
Money:
I really have absolutely zero to complain about when it comes to my money. I am paid very well, and since I started working in 2015, I've paid off my six-figure student line of credit and accumulated almost 1/3 of what I need to retire. I am doing great, and I know there are a lot of people who would be very happy to swap financial situations with me. I recognize how fortunate I am financially, and I am incredibly grateful for that.
And yet...I still worry. What will happen if I become disabled*? If my province radically cuts healthcare funding and my job changes or disappears? If I burn out and am no longer able to work?
The worry drives me to accumulate. To build up my cash savings and my investments as protection against all of the uncertainty of life. Working less means earning less, and while it would still be more than enough, it feels scary to someone who is as security-focused as I am.
Shame:
Other people do more than me. They see more patients, do (waaaay) more research, and have more administrative responsibilities. Lots of them have spouses and/or children, so they have a whole second set of duties to take care of when they go home. And when I look at these people, I wonder "Why am I complaining about my much emptier schedule? Why can't I do as much as they do without complaining so much?"
It is hard to accept that I simply can't. Whether it's because of my anxiety, or being an introvert, or my perfectionism, or some combination of that fabulous trifecta, I simply cannot do as much as other people do. And more importantly, I don't want to. I want to not panic if I have to add an extra patient to a clinic because of an emergency. I want to sleep through the night without experiencing anxiety-induced insomnia. I want to have unstructured time at home to just breathe and exist, without having to constantly run through my to-do list in my head.
I want to be happy, at least most of the time.
What makes it hard for you to say no?
*I have some, but not enough, disability insurance right now. This is one of those "important but not urgent" things that I've been putting off for too long.
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!)
Tuesday, January 16, 2018
Life as a Highly Sensitive Physician - Part One
A little over a year ago, I stumbled across an article about highly sensitive people. I had never heard the term before, but as I read the article, it resonated very strongly.
Feel more deeply?
Emotionally reactive?
Take longer to make decisions?
Detail oriented?
Cry more easily?
That's me! After reading the article, I went on to do a self quiz, and the answer that came back was basically "You fit this profile so perfectly, why did you even need to take the quiz?"
So yeah. I'm a highly sensitive person. Meaning that I tend to respond very emotionally to things, that I am very sensitive to criticism, and that I can get overwhelmed easily. These were all things that I knew before reading the article (and the subsequent articles/blogs/books on the subject that I have read), but the concept of a highly sensitive person was helpful to me for the way that it presented my individual traits as something bigger, some complete personality type that described me shockingly well.
It also helped me by explaining why some aspects of work were much harder for me than for other people. All through medical training (and into my first years of practice), I would look at the high achievers around me and wonder how it was that they were able to accomplish so much more than I did. How could they work a long day and then come home and raise a family and do research projects? And without hating their lives?
Identifying myself as an HSP has helped me to realize that things exhaust me more than they do other people. I engage deeply with everything I do, and so I use up a lot of energy doing my work. One challenging conversation can deplete a lot of my emotional reserves, so when I have a day with multiple tough patients, it isn't surprising that I have no energy for anything else in the evening. I'm simply done.
This happened to me last week, when I had to tell a long-term patient that he was dying. That interaction was difficult enough, but then it was followed by a number of really tough disclosures about personal trauma from other patients. I did everything I could to be present for my patients and to help them get the resources they needed, but by the end of the day I had nothing left. I spent my evening on my couch binge-watching Top Chef and eating leftovers from the fridge, physically and mentally unable to do anything else.
When I tell stories like this to some of my colleagues, they look at me like I'm crazy. It's not that they're not empathetic or that they don't care about their patients*, it's just that they don't personalize things in the way that I do. They can detach from their patients and move on quickly, whereas I struggle to not be too deeply affected by my patients' stories.
But it's something I'm working on. I have zero desire to burn out early, so I'm constantly looking for ways to do my work well without giving so much of myself.
Which will be a subject for a future post, because for the moment it's time to read a book and recharge for work tomorrow.
*Well....for some of them it is.
Feel more deeply?
Emotionally reactive?
Take longer to make decisions?
Detail oriented?
Cry more easily?
That's me! After reading the article, I went on to do a self quiz, and the answer that came back was basically "You fit this profile so perfectly, why did you even need to take the quiz?"
So yeah. I'm a highly sensitive person. Meaning that I tend to respond very emotionally to things, that I am very sensitive to criticism, and that I can get overwhelmed easily. These were all things that I knew before reading the article (and the subsequent articles/blogs/books on the subject that I have read), but the concept of a highly sensitive person was helpful to me for the way that it presented my individual traits as something bigger, some complete personality type that described me shockingly well.
It also helped me by explaining why some aspects of work were much harder for me than for other people. All through medical training (and into my first years of practice), I would look at the high achievers around me and wonder how it was that they were able to accomplish so much more than I did. How could they work a long day and then come home and raise a family and do research projects? And without hating their lives?
Identifying myself as an HSP has helped me to realize that things exhaust me more than they do other people. I engage deeply with everything I do, and so I use up a lot of energy doing my work. One challenging conversation can deplete a lot of my emotional reserves, so when I have a day with multiple tough patients, it isn't surprising that I have no energy for anything else in the evening. I'm simply done.
This happened to me last week, when I had to tell a long-term patient that he was dying. That interaction was difficult enough, but then it was followed by a number of really tough disclosures about personal trauma from other patients. I did everything I could to be present for my patients and to help them get the resources they needed, but by the end of the day I had nothing left. I spent my evening on my couch binge-watching Top Chef and eating leftovers from the fridge, physically and mentally unable to do anything else.
When I tell stories like this to some of my colleagues, they look at me like I'm crazy. It's not that they're not empathetic or that they don't care about their patients*, it's just that they don't personalize things in the way that I do. They can detach from their patients and move on quickly, whereas I struggle to not be too deeply affected by my patients' stories.
But it's something I'm working on. I have zero desire to burn out early, so I'm constantly looking for ways to do my work well without giving so much of myself.
Which will be a subject for a future post, because for the moment it's time to read a book and recharge for work tomorrow.
*Well....for some of them it is.
Friday, November 24, 2017
When Other People Screw Up
Once a month or so, I do an extra Friday afternoon clinic in a different location from my usual clinics. It involves rushing out as soon as my morning clinic ends, driving 45 minutes across the city, and generally arriving 10-15 minutes late at the second clinic. It isn't my favourite thing in the world, but it is necessary for a whole bunch of reasons, so I just suck it up and do it.
Today was one of those days. When I was about halfway between locations, I got a call from the second clinic.
"Did you forget that you had a clinic today?"
"Uhh...no. It's 12:55. I'll be there in 15-20 minutes like usual."
"Oh. Uhhh...there are patients here for you."
I didn't think much of it until I arrived at the clinic to find eight patients already waiting for me. It turns out, for reasons that are unclear to me, the clerk had booked my clinic starting at 12:30. Even though I've been doing this for over two years, and I never arrive before 1 PM.
Gaaaaaahhhh!!!
And this is just the end of a week of screw ups. Misplaced requisitions, incomplete tasks, and other things done wrong. It is driving me nuts. We're professionals working in a healthcare setting - just do things right people! I do not have the time to double check everything you are doing to make sure you're doing it correctly.
/end rant
Thankfully, my patients are all lovely, and I didn't have a single complaint despite being over an hour behind at the end. But I just wish that I didn't have to be the person who is ultimately held responsible for everything, including the incompetence of others.
Have a great weekend everyone. It's time for a book and some popcorn. And wine.
Today was one of those days. When I was about halfway between locations, I got a call from the second clinic.
"Did you forget that you had a clinic today?"
"Uhh...no. It's 12:55. I'll be there in 15-20 minutes like usual."
"Oh. Uhhh...there are patients here for you."
I didn't think much of it until I arrived at the clinic to find eight patients already waiting for me. It turns out, for reasons that are unclear to me, the clerk had booked my clinic starting at 12:30. Even though I've been doing this for over two years, and I never arrive before 1 PM.
Gaaaaaahhhh!!!
And this is just the end of a week of screw ups. Misplaced requisitions, incomplete tasks, and other things done wrong. It is driving me nuts. We're professionals working in a healthcare setting - just do things right people! I do not have the time to double check everything you are doing to make sure you're doing it correctly.
/end rant
Thankfully, my patients are all lovely, and I didn't have a single complaint despite being over an hour behind at the end. But I just wish that I didn't have to be the person who is ultimately held responsible for everything, including the incompetence of others.
Have a great weekend everyone. It's time for a book and some popcorn. And wine.
Wednesday, November 15, 2017
The Weight of Work
I am caring for a lot of very sick people right now, which isn't typical. Most of my patients have chronic, slowly progressive illnesses, so a lot of the work that I do is just checking in on generally healthy people to make sure that everything is okay. Lately though, things haven't been okay. I have patients going for major procedures, patients in hospital, and patients approaching the end of life.
I know that this isn't about me. The people most affected by this are of course the patients themselves and the people who love them. And yet, this is hard for me too. It is hard to be witness to suffering, particularly when there is nothing in my medical bag of tricks that I can use to change the outcome. I can of course offer comfort and support and symptom control, but dammit, sometimes I just want to fix it. I want life to not be the way it is, with illness and death and all of the other bad things.
So tonight I'm lying low. I've passed on trivia night, and I'm sitting in my sweatpants with a steaming bowl of spaghetti bolognase and a cuddly cat. And I'm grieving all of the things I cannot change.
I know that this isn't about me. The people most affected by this are of course the patients themselves and the people who love them. And yet, this is hard for me too. It is hard to be witness to suffering, particularly when there is nothing in my medical bag of tricks that I can use to change the outcome. I can of course offer comfort and support and symptom control, but dammit, sometimes I just want to fix it. I want life to not be the way it is, with illness and death and all of the other bad things.
So tonight I'm lying low. I've passed on trivia night, and I'm sitting in my sweatpants with a steaming bowl of spaghetti bolognase and a cuddly cat. And I'm grieving all of the things I cannot change.
Sunday, August 13, 2017
Why Are You Thinking About Retiring So Early?
As I was reviewing the consult service list with my resident earlier this week, I started to feel strangely unwell. Cold, clammy, nauseated, and dizzy to the point of almost passing out*. The feeling passed quickly, so I did what any "good" physician would do and soldiered on through my day. Unfortunately, the feeling came back twice while I was talking to a patient and his family, and I felt so sick that I thought I might black out in the middle of the hospital, so I finally conceded that I couldn't stay at work any longer. Thankfully the service was slow, and I was otherwise just catching up on paperwork, so it was possible for me to make a quick exit and drive my sick self home.
My sick self was pretty darn sick, so I spent the rest of the day lying on the couch with two cats applied to my abdomen. After exhausting my blogroll and all of the interesting television that I'm allowed to watch (I mostly watch shows on Netflix with M, who would not tolerate me getting ahead of her), I started reading through some of the old comments on my blog. One of them in particular, from Zed at Mind the Medic, stuck out:
"I hope you don't mind me asking but why are you thinking about retiring so early?"
I was apparently too lazy to respond to the question at the time, but I feel like it deserves to be revisited, as it's something I think about often. And the answer is pretty simple:
"Because I'm often happier when I'm not working than when I'm working."
This isn't something that physicians talk about all that often, because our careers are supposed to be our callings. We're supposed to be happy to make all the sacrifices of time, energy, and stress that we do because they are more than made up for by The Great Privilege of Saving Lives. And yes. Some days my job is a great privilege, and some days I even get to save lives. But a lot of days my job is exhausting and tedious and almost unbearably stressful. And on those days, I sometimes dream of being retired, even though I'm only 40 and two years into my career.
Over the past 14 months, since I achieved the much coveted net worth of zero, I've managed to save up enough money to live off of for about 3 1/2 years. At my current rate, I expect that I could retire in as little as seven years, although that would definitely be more a state of Financial Independence than Financial Freedom. It gives me great comfort and a feeling of security to know that, if I want to or need to, I could walk away from working at that time.
Although, the reality is that I may choose not to walk away. The more financially secure I become, the more freedom I have to do things that make me happy at work, like take time off. Financial security also makes me feel much less stressed about work and and how much I'm earning, which in turn makes it easier to like my job. My dream is to hit the point of being Financially Independent but to enjoy work enough that I have no desire to retire yet.
But if that isn't the case? Then it will be really nice to have the option of retiring early.
*The eventual diagnosis: possible early anaphylaxis to a medication that I've been taking for 18 years, complete with really spectacular urticaria. I may need an Epi pen.
*Edited to add: Thanks to Physician on Fire for including me in his Sunday Best list. If you've just discovered this blog through PoF, then welcome! Please leave me a comment to let me know who you are.*
My sick self was pretty darn sick, so I spent the rest of the day lying on the couch with two cats applied to my abdomen. After exhausting my blogroll and all of the interesting television that I'm allowed to watch (I mostly watch shows on Netflix with M, who would not tolerate me getting ahead of her), I started reading through some of the old comments on my blog. One of them in particular, from Zed at Mind the Medic, stuck out:
"I hope you don't mind me asking but why are you thinking about retiring so early?"
I was apparently too lazy to respond to the question at the time, but I feel like it deserves to be revisited, as it's something I think about often. And the answer is pretty simple:
"Because I'm often happier when I'm not working than when I'm working."
This isn't something that physicians talk about all that often, because our careers are supposed to be our callings. We're supposed to be happy to make all the sacrifices of time, energy, and stress that we do because they are more than made up for by The Great Privilege of Saving Lives. And yes. Some days my job is a great privilege, and some days I even get to save lives. But a lot of days my job is exhausting and tedious and almost unbearably stressful. And on those days, I sometimes dream of being retired, even though I'm only 40 and two years into my career.
Over the past 14 months, since I achieved the much coveted net worth of zero, I've managed to save up enough money to live off of for about 3 1/2 years. At my current rate, I expect that I could retire in as little as seven years, although that would definitely be more a state of Financial Independence than Financial Freedom. It gives me great comfort and a feeling of security to know that, if I want to or need to, I could walk away from working at that time.
Although, the reality is that I may choose not to walk away. The more financially secure I become, the more freedom I have to do things that make me happy at work, like take time off. Financial security also makes me feel much less stressed about work and and how much I'm earning, which in turn makes it easier to like my job. My dream is to hit the point of being Financially Independent but to enjoy work enough that I have no desire to retire yet.
But if that isn't the case? Then it will be really nice to have the option of retiring early.
*The eventual diagnosis: possible early anaphylaxis to a medication that I've been taking for 18 years, complete with really spectacular urticaria. I may need an Epi pen.
*Edited to add: Thanks to Physician on Fire for including me in his Sunday Best list. If you've just discovered this blog through PoF, then welcome! Please leave me a comment to let me know who you are.*
Sunday, January 22, 2017
What is Done, and What is Left to Do
It will probably come as no surprise to anyone who reads my blog that I am feeling pretty burnt out at the moment, as the few posts that I've had the mental energy to write over the past few months have been all about work stress and feeling exhausted and being too much of a grouch to even want to buy Christmas gifts. I think I've done a decent job of hiding my dissatisfaction at work, but my poor partner, M, has had to put up with some pretty spectacular wallowing when I haven't been working. It is frustrating, and frightening, to have put 16 years into training only to find myself feeling this level of unhappiness with my work.
So I've been thinking a lot (i.e. pretty much all the time) about what to do about it. I've been reading blogs and journaling and talking M's ears off in an attempt to figure out some way of becoming happier. (I haven't been exercising or meditating, of course, because those things might actually work.) I even bought a book about physician burnout, despite absolutely hating the last physician burnout book I read. And, much to my surprise, the book has been kind of helpful.
One of the ideas in the book is that, as physicians, we are always focused on what remains to be done: how many letters we need to dictate, how many patients we need to see, how many bloody multi-page forms we need to fill out. By constantly thinking about what still needs to be done, however, we inevitably feel like we aren't accomplishing anything, and we get discouraged by the seemingly neverending to-do list. Instead, we'd be much better off putting our focus on what we've already done, so that we are positively celebrating our accomplishments instead of always negatively dreading the work to come.
It's a pretty simple idea, and it requires pretty minimal energy and absolutely zero time, so I decided to try it out this week. No longer was I going to count the patient files on my desk that needed to be dictated (about 20 at current count); instead, I was going to count the ones in my outbox that were already done. Instead of focusing on the number of patients remaining to be seen, I was going to focus on the ones that had already been dealt with. Pay attention to the positive, not the negative.
It sounds cheesy to even write this...but it kind of helped. It made me realize that my list of things that I have already accomplished is pretty enormous, and it dwarfs the few hours of paperwork that I left undone at work on Friday. It felt surprisingly good to be a bit of a cheerleader for myself, instead of the evil taskmaster who is always yelling at myself to work harder! and faster! and better!
It worked so well that I decided to apply this mindset to an area of my life that causes my unnecessary anxiety: my finances. I'm in pretty good financial shape for being 17 months into practice, yet I waste a lot of energy thinking about how far away I am from being able to retire. This week, instead of constantly thinking about the minimum of 10 years of work that I will have to do to save up a decent retirement fund, I took a few minutes to list the major financial accomplishments I've made over the past 17 months:
I know that there are still a lot of things that I need to do to feel happier with my work, but I think that changing my mindset has been an important first step. Despite being on call again this week**, I've been in a much better mood than I have been since my really stressful department meeting. I now have six weeks of no call, which includes a one-week trip to Cuba, so hopefully there are even better things ahead.
*My job isn't actually all that miserable. I'm just feeling so exhausted by it that I am having a hard time seeing the good things. Which I'm working on.
**I sat down this week and figured out just how much call I've been doing lately, and I realized that I've been on call 1/3 of the time for the past 3.5 months. That's the amount of call that I should be doing in a 6-month period, and it's equal to the maximum amount of call that a resident is allowed to do. Suddenly I don't feel so guilty for feeling tired! As a result of this realization, I've reviewed my call schedule for the upcoming year and identified a few similar problem periods that can hopefully be improved by a bit of swapping with my colleagues.
So I've been thinking a lot (i.e. pretty much all the time) about what to do about it. I've been reading blogs and journaling and talking M's ears off in an attempt to figure out some way of becoming happier. (I haven't been exercising or meditating, of course, because those things might actually work.) I even bought a book about physician burnout, despite absolutely hating the last physician burnout book I read. And, much to my surprise, the book has been kind of helpful.
One of the ideas in the book is that, as physicians, we are always focused on what remains to be done: how many letters we need to dictate, how many patients we need to see, how many bloody multi-page forms we need to fill out. By constantly thinking about what still needs to be done, however, we inevitably feel like we aren't accomplishing anything, and we get discouraged by the seemingly neverending to-do list. Instead, we'd be much better off putting our focus on what we've already done, so that we are positively celebrating our accomplishments instead of always negatively dreading the work to come.
It's a pretty simple idea, and it requires pretty minimal energy and absolutely zero time, so I decided to try it out this week. No longer was I going to count the patient files on my desk that needed to be dictated (about 20 at current count); instead, I was going to count the ones in my outbox that were already done. Instead of focusing on the number of patients remaining to be seen, I was going to focus on the ones that had already been dealt with. Pay attention to the positive, not the negative.
It sounds cheesy to even write this...but it kind of helped. It made me realize that my list of things that I have already accomplished is pretty enormous, and it dwarfs the few hours of paperwork that I left undone at work on Friday. It felt surprisingly good to be a bit of a cheerleader for myself, instead of the evil taskmaster who is always yelling at myself to work harder! and faster! and better!
It worked so well that I decided to apply this mindset to an area of my life that causes my unnecessary anxiety: my finances. I'm in pretty good financial shape for being 17 months into practice, yet I waste a lot of energy thinking about how far away I am from being able to retire. This week, instead of constantly thinking about the minimum of 10 years of work that I will have to do to save up a decent retirement fund, I took a few minutes to list the major financial accomplishments I've made over the past 17 months:
- Saved up enough money in my investments that I could pay off my line of credit if I wanted to;
- Saved up enough money that, between M and me, we can make a 20% downpayment on a nice house in our chosen neighbourhood; and
- Saved up enough money in my investments that I could live at my current level of spending for approximately one year (or for a very long time if I stopped eating out so frequently).
I know that there are still a lot of things that I need to do to feel happier with my work, but I think that changing my mindset has been an important first step. Despite being on call again this week**, I've been in a much better mood than I have been since my really stressful department meeting. I now have six weeks of no call, which includes a one-week trip to Cuba, so hopefully there are even better things ahead.
*My job isn't actually all that miserable. I'm just feeling so exhausted by it that I am having a hard time seeing the good things. Which I'm working on.
**I sat down this week and figured out just how much call I've been doing lately, and I realized that I've been on call 1/3 of the time for the past 3.5 months. That's the amount of call that I should be doing in a 6-month period, and it's equal to the maximum amount of call that a resident is allowed to do. Suddenly I don't feel so guilty for feeling tired! As a result of this realization, I've reviewed my call schedule for the upcoming year and identified a few similar problem periods that can hopefully be improved by a bit of swapping with my colleagues.
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.
Wednesday, August 26, 2015
Evening Routines
OMDG posted today about her challenge with evenings, which got me reflecting on my own evening routine since starting back at work. When I was on holidays, my plans for my work evenings were very ambitious - cook tasty dinners with my girlfriend, clean the kitchen, take care of housework/paperwork, exercise, and read stimulating and erudite books. Shockingly, the reality has been somewhat less impressive. Despite not actually working that hard yet (I'm only working about half-time at the moment), I've been coming home mentally exhausted every day, and I haven't been able to motivate myself to do most of the things I would like to.
Currently, my post-work schedule looks something like this:
1) Arrive home and dump all possessions (lunch bag, purse, backpack, jacket) in the front hallway. Ignore voice in the back of my head that tells me that I should be putting things in the spaces I created for them.
2) Cook dinner with my girlfriend. This varies from spending 2-3 hours making an elaborate dinner (we love cooking) to BBQing hot dogs and eating potato chips from the bag.
3) Spend way too much time on the computer. Facebook, blogs, news, repeat. I haven't mastered the art of turning off the computer when there is nothing good left to look at, so this eats up a lot of time. On a good day, I write a blog post of variable quality.
4) Watch something on Netflix with my girlfriend. Lately we've been watching Human Planet, which is actually a decent and not entirely mind-numbing show, so it could be worse.
5) Look at the stack of library books on my coffee table. Decide it isn't worth the effort. Possibly watch another Netflix show, usually of lower quality than Human Planet.
6) Feel progressively more exhausted. Resist the urge to go to bed like a reasonable human being. Repeat item #3.
7) Realize it's past my bedtime. Rush around trying to make a lunch, pack my work bag, feed the cats, and do anything else that needs to be done. (Feeding the cats is the only thing I consistently accomplish before bed, and that's only because they meow at me.)
8) Finally get to bed much later than I should. Realize that eight hours of restful sleep has become an impossible dream.
9) Lie awake staring at the ceiling, regretting all of the things I didn't do.
This is something I need to work on, because evenings make up a lot of the quality time I have for myself and my girlfriend outside of work. Looking back on this time of my life, I don't want Facebook and Netflix and a cluttered apartment to be my most vivid memories.
How happy are you with your evening routine?
Currently, my post-work schedule looks something like this:
1) Arrive home and dump all possessions (lunch bag, purse, backpack, jacket) in the front hallway. Ignore voice in the back of my head that tells me that I should be putting things in the spaces I created for them.
2) Cook dinner with my girlfriend. This varies from spending 2-3 hours making an elaborate dinner (we love cooking) to BBQing hot dogs and eating potato chips from the bag.
3) Spend way too much time on the computer. Facebook, blogs, news, repeat. I haven't mastered the art of turning off the computer when there is nothing good left to look at, so this eats up a lot of time. On a good day, I write a blog post of variable quality.
4) Watch something on Netflix with my girlfriend. Lately we've been watching Human Planet, which is actually a decent and not entirely mind-numbing show, so it could be worse.
5) Look at the stack of library books on my coffee table. Decide it isn't worth the effort. Possibly watch another Netflix show, usually of lower quality than Human Planet.
6) Feel progressively more exhausted. Resist the urge to go to bed like a reasonable human being. Repeat item #3.
7) Realize it's past my bedtime. Rush around trying to make a lunch, pack my work bag, feed the cats, and do anything else that needs to be done. (Feeding the cats is the only thing I consistently accomplish before bed, and that's only because they meow at me.)
8) Finally get to bed much later than I should. Realize that eight hours of restful sleep has become an impossible dream.
9) Lie awake staring at the ceiling, regretting all of the things I didn't do.
This is something I need to work on, because evenings make up a lot of the quality time I have for myself and my girlfriend outside of work. Looking back on this time of my life, I don't want Facebook and Netflix and a cluttered apartment to be my most vivid memories.
How happy are you with your evening routine?
Friday, August 21, 2015
Doing the Unthinkable
Yesterday afternoon I left work at 1 PM.
This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours. What made it amazing is that I had absolutely nothing to go to. I was simply done my work for the day*.
As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day. The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?" It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home: if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.
As an attending, on the other hand, I set my own schedule (within certain limits). I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all). The freedom is awesome! And while I have no intention of abusing this freedom, I do intend to make the most of it. Before starting work, I decided that I will no longer stay at work just to make an appearance. If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital.
I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM. But on the days when I can go home in the early afternoon, I fully intend to do it. And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.
*Of course, as soon as I left the hospital I got paged to go back, but such is life.
**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry. My chosen career is awesome.
This may not sound all that amazing to you, given that people sometimes leave work early for doctors' appointments or other things that need to be done during working hours. What made it amazing is that I had absolutely nothing to go to. I was simply done my work for the day*.
As a fellow, I never intentionally came late or left early; it was completely unacceptable to not be at work for the full day. The few times I was late because of a missed alarm or unexpected traffic, I was inevitably met by a supervisor who would look at his watch and say "Slacking off, are we?" It didn't matter if I was finished my work for the day or if I could accomplish my work more efficiently in the quiet of my own home: if it was between the hours of 9 am and 5 PM**, I was expected to be at my desk or in the hospital.
As an attending, on the other hand, I set my own schedule (within certain limits). I decide when I take call, I decide how many clinics a week I work, and I decide when to do research (if at all). The freedom is awesome! And while I have no intention of abusing this freedom, I do intend to make the most of it. Before starting work, I decided that I will no longer stay at work just to make an appearance. If I finish my work before 5 PM, I will go home early and enjoy my life outside of the hospital.
I don't expect this to happen often, and I'm sure there will be days when I make up for it by staying far past 5 PM. But on the days when I can go home in the early afternoon, I fully intend to do it. And I intend to enjoy every minute of the kitchen gadget store browsing/cooking with copious amounts of zucchini/napping that I do with my time off.
*Of course, as soon as I left the hospital I got paged to go back, but such is life.
**If you're a resident/physician/other hard-working person who can only dream of a (mostly) 9-5 schedule, I'm sorry. My chosen career is awesome.
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.
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