Thursday, November 24, 2016

Gathering my People

This has been a really, really rough week.

Really.

I didn't expect it at all.  I finished call at 8 am Monday morning; I had lots of uncommitted time in the evenings to relax with my couch and my cats; and there didn't seem to be anything unusually stressful in my calendar.  It was supposed to be a good week.

And then we had a department meeting.

There are changes happening at my university, and while logically I expect that the changes will all be fine (if not actually good), they do create a lot of uncertainty.  And as an anxious person, uncertainty is not my friend.  I've spent the whole week calculating how long I can survive off the money in my bank account, wondering what I could do if I was no longer a physician, and being tortured by my sensitive GI system*.  It's been miserable.

While lying awake on the couch in the wee hours of this morning, wishing that my cats would consent to me squeezing them like a security blanket, I realized that I needed to do something differently.  I can't live with this level of anxiety for the ten years or more until I've squirreled away enough money to retire.  This isn't working.

Thankfully, today was a paperwork day, so I had lots of time to figure things out.  And what I figured out was that I need a support system.  People who have been through what I'm going through who can offer me some advice.  Unfortunately, in Medicine this is a really, really hard thing to find.  We are supposed to all be perfect and to not need anything from anyone, so finding someone with whom we can discuss our challenges and vulnerabilities isn't easy. 

Coincidentally, just last week I had run into an attending who, years ago, had given a talk to my residency program about the challenges she had faced as a resident and young attending.  When I realized this morning that I need more people, my brain went "Ah-ha!".  That was who I needed.  Except...she is an attending that I don't know personally.  And I run into her about once every 3-6 months. 

So, going against every instinct of mine to be shy and quiet and never ask for anything, I emailed her to see if she would meet me for coffee.

And she said yes.

And then I emailed another attending.  Who also said yes. 

Suddenly, after a week of feeling alone and scared, I don't feel so much of either.

*For the record, none of this is rationally necessary.  Everything is going to be fine, one way or another.  This is just anxiety.

Sunday, November 20, 2016

How Am I Doing So Far?

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

And then the week arrived.

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

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

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

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

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

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

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

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

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

Monday, November 7, 2016

Ignoring Money

As a medical trainee, I pretty much ignored my finances.  Having been a disciplined saver of at least 10% of my earnings since I turned 18, it was depressing to watch my savings first disappear and then turn into a six-figure debt.  So I didn't.  I stopped looking at my bank account, I stopped filing my taxes*, and I essentially pretended that money didn't exist.

I existed in this world of willful ignorance for eight years, until a scare at work made me question whether I was going to get to be a doctor.  Suddenly the debt that I had thought would be easy to repay grew monstrous, as I imagined paying it off without a physician's salary.  So I started paying attention.  And budgeting.  And slowly I got myself to a point where my net worth went up a bit every month.

And then I got my adult job.  And suddenly my net worth was going up a lot every month.  Within 10 months of starting as an attending, I had saved enough money to repay my debt.  It felt pretty awesome.  But it also felt pretty obsessive.  Every day when I came home from work, I would check my bank balance and my credit card balance and my payment owed balance to figure out how much I was worth.

Every single day.

It got to the point that I was attaching too much of my self worth and feelings of security/insecurity to a single number.  On days when I'd have a good clinic (or, even better, have a good clinic and be on call), I'd feel happy, confident that I was moving towards a future of security and happiness.  On days when I'd pay my rent or my car insurance, however, I'd be miserable.  Any downward movement in my net worth felt like a failure.

So I stopped looking.

For all of October, I kept my net worth file closed and simply ignored it.  I kept tracking my earnings and my spending, and I must admit that I tried to mentally estimate my net worth a few times, but I didn't check my net worth obsessively.  And it felt so much better.  I didn't get angry at patients who failed to show to clinic, viewing them as a lost revenue stream.  I didn't get upset when I had to, or chose to, spend money.  I knew that, regardless of what was happening day to day, overall my net worth was going in the right direction.

I was going to be fine.

Ironically, October had the second biggest net worth increase of any month since I started working.  This was in no way related to my behaviour, and in every way related to the 15 days of call that I worked, but it was still really comforting to know that I could let go of my hypervigilance about money, and it would still be okay.

Now that October is over, and I can check my net worth as often as my heart desires, I'm trying hard to not fall back into my old patterns.  I don't want my happiness to be tied to money.  I don't want to be anxious on the days when my spending exceeds my earnings - which is every single weekend day.  I don't want to be constantly comparing myself to all the personal finance bloggers and feeling inadequate.  I want my money to be in the background, slowly growing, while my much more exciting and fulfilling life goes on in the foreground.

*This is a really, really dumb thing to do. 

---

Wondering what my November goal is?  ABSOLUTELY NOTHING.  I'm feeling burnt out at the moment, and all I can think about is spending four days this weekend at a cabin with my girlfriend.  And books.  And nachos!

Self improvement will have to wait for December.

Sunday, October 23, 2016

Surviving Call

When I wrote my most recent blog post, I was feeling a little bit smug about how well my life was going.  I was exercising, I was feeling calm, and my relationship was in pretty much the best state it has ever been.  I was happy.  I was about to start an 11-day stretch of 24-hour-a-day call, but I felt ready for it.

I've got this, I thought.

Except I didn't.  It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level.  I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves.  (How dare they?)  After weeks of respite, my mind was back to ramped-up panic mode.

And that's where it remained for most of my 11 days on call.  I worried and obsessed over the decisions I was making.  I felt stressed by the increasing pile of undictated charts piling up on my desk.  I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough.  As it often is, it was awful.

And of course, my life outside of work suffered.  My relationship that had, until that point, been ticking along nicely, suddenly struggled.  I was short-tempered.  Everything she did seemed wrong and irritating.  I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well.  Also awful.

In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year.  Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call.  I want my life on call to still feel okay.

So I've been thinking a lot about the things that I can do to make call less awful.  This is what I've come up with so far:

Undercommit:  I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities.  Evenings on my couch with a book and my cats are as essential to me as vitamins.  This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life.  Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.

The other downside to making plans when I'm on call is that I hate disappointing anyone.  Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me.  It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.

I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations.  I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.

Keep moving:  It always comes back to this.  Exercise is good.  I need to do it.  Regularly.  End of story.

Talk to M:  I have a really good partner who is loving and supportive and a good listener.  I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.

Let things go:  The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole.  I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book.  And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!

I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch.  I can eat a fried egg with toast or a frozen fish fillet and the world will not end.  Pozole can wait for a week when I'm not on call.  As can many other things.  Call weeks should be about doing what is necessary, not what is perfect.

Recognize my irrationality:  I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life.  When I'm in the extremes of my anxiety, it can lead me to think really irrational things.  Like that my relationship may not be a good one.  Or I'm not cut out to be a doctor.  Or I'm going to end up on the street if I don't hoard every penny I earn.  Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.


Keep going to counseling:  I am somewhat amazed at the difference that six counseling sessions made in my life.  It probably saved my relationship with M.  It certainly made work better.  It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.

Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth.  Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go.  I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.

UTTERLY AND COMPLETELY STUPID.  (I'm looking at you when I say that, Solitary.)

For now, call is done, and I am recovering on my couch with my computer/books and Callie.  It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.

Hopefully my next time on call will be better.

Monday, October 10, 2016

Movement - September Goal

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

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

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

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

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

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

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

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

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

---

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

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

Thursday, October 6, 2016

The Time I Failed At Meditation

A few months ago, when I was struggling with my recent breakup, I had the brilliant idea that meditation would make me feel better.  I searched around a little, found a legitimate-sounding course on Mindfulness-Based Meditation, and paid $500 to sign up.  The orientation session was last night.  It went somewhat like this:

Shit.  I'm late.  These things never start on time though, right?  

(Enter room in which people are sitting in a circle with their eyes closed and their hands in their laps.)

Crap.   

(Noisily take the one remaining chair at the front of the room.  Drop bag on floor, causing multiple people to open their eyes.)

Okay.  I can do this.  Close my eyes.  Ommmmmmm.  Do I smell like McDonald's?  Can the people around me tell that I just ate a Filet-O-Fish?

Ommmmmmmm.

Is it morally wrong to eat a Filet-O-Fish before a meditation class?

Ommmmmmmmmmm.

"Good evening class.  My name is <weird New Age name that I would bet money she made up>.  I will be your leader for the next ten weeks."

Ten weeks?  Shit.  

I'm not sure I can do this for ten weeks.

(Notice that the instructor is barefoot.  With her bare feet on the classroom floor.  Try not to be grossed out thinking about the number of feet that have touched the floor and are now contaminating her feet.)

Okay.  I need to pay attention.  What is she saying?

"...homework requiring approximately 45-60 minutes..."

Homework?  I didn't know there was homework.

It's okay.  I can do 45-60 minutes of homework per week.

"...per day..."

WTF?  45-60 minutes PER DAY?  Who has time for that?

Do these people not work?

(Look around.  Notice that many of the people in the class appear to be under the age of 20Suspect that they all live in their parents' basements and do not in fact have to work.)

(Notice really smiley girl across the room who is listening intently to everything the instructor is saying.  And nodding enthusiastically.  And smiling as if she took really good drugs prior to meditation.)

"Everyone taking this class will feel differently about the process.  It's important that you use your inner wisdom to guide you to your best possible outcome."

(Snicker at use of phrase "inner wisdom".  Notice that smiley girl is nodding as if the instructor is sharing truly profound insights into the nature of the universe.  Uncertain if I should be feeling vastly superior or inferior to smiley girl at this moment.)

"...inner wisdom..."

OMG.  I can't listen to this woman talk about "inner wisdom" for ten weeks.  I will kill her.

"...inner wisdom..."

AAAAAAHHHHHHHHHHH.

(Look around to see if anyone else is losing their mind like I am.  Notice more people smiling and nodding at the instructor.   Am now convinced that the instructor handed out drugs while I was stuffing my face with fries in my car.)

"And now we will work together to develop our guidelines for supporting each other through the next ten weeks, as we learn more about meditation and about ourselves.  Who wishes to suggest the first guideline?"

No.  OMG no.  Are we five?  This is what I used to do with the kids at the summer program I ran as a teenager.  THE KIDS WHO WERE FIVE.

(The woman next to me speaks)  "I think it's very important that we respect each others' inner spirits.  Because we're all here to make our inner spirits stronger, and if we say hurtful things, it can weaken our inner spirits."

(Officially hate woman next to me.  And do not ever want to hear the word "inner" used in any context ever again.)

(Notice that the name tag of the woman next to me says Beaghan.  Because her parents were clearly crazy.) 

(Smiley girl talks)  "I just want to say that I feel really lucky to be here.  So, so lucky."

Unnnngggghhhhh.

"I feel like the universe has presented me with a gift of wonderful people to learn from and to grow with."

UNNNNNNNNGGGGGGGHHHHHHH.

Shit.  I hope that noise is just in my head.  Am I making that noise out loud?

Do I smell like french fries?

"Alright class.  This is an excellent list!  I can tell that the next 10 weeks are going to be a joyful experience of learning and growing..."

No they aren't.             

"...and sharing..."

I'm not sharing anything with you crazy people.

"...inner wisdom..."

Stop saying that.

"...inner spirits..."

 Now you're just fucking with me.

"Now, some people decide after the first class that they simply aren't ready to take this journey that we're about to embark on."

Oooh...me!  That's me!

"Maybe their lives are too busy, or maybe their inner spirit just isn't in the right place to undertake a spiritual quest at this time."

Or maybe they think you're nuts, you barefoot hippy.

"If you are feeling this way..."

Yes!  Me!  I AM FEELING THIS WAY! 

"...you can receive a full refund on your course fees until 4 PM tomorrow."

And that is how I failed at meditation.       

Sunday, October 2, 2016

Hope

When I watch the election coverage coming out of the States, I am left fearing that the world is becoming an increasingly intolerant and hate-filled place.  This morning, however, I had a brief glimmer of hope that maybe things are actually getting better.  One of my friends, an open lesbian who is married to another woman, got ordained as a pastor this morning.  Surrounded by representatives from multiple Christian denominations and multiple churches, she was welcomed not only into life in the church, but into life as one of its leaders.  To the best of my knowledge, she is the first openly gay pastor within her denomination in Canada. 

Her denomination is not one that is commonly associated with progressiveness or open-mindedness, and I know that her journey to this point hasn't been an easy one.  There were people who resisted her advancement at multiple steps, and I suspect that there are people who will leave her congregation because they can't see past their bigotry to how fortunate they are to have her as their pastor.  For the people who remain, even the ones who are hesitant to be led by a lesbian, my hope is that they will see how utterly ordinary her relationship with her wife is.  The genders may be different, but they experience the same love and companionship and struggle of any heterosexual couple.  Different on the surface, but fundamentally the same underneath.

I hope too that Americans will come to their senses and not vote a dickhead for POTUS.