Wednesday, July 12, 2017

It Wasn't About the Fireworks

As I was writing my most recent blog post, I was under no false illusion that my partner and I were in the right to be trespassing on private property.  I didn't even totally disagree with people's comments on the post, even though some of them seemed unnecessarily harsh to this delicate Canadian.  And yet, I was angry.  I was angry when I wrote the blog post, and angry when I reflected back on it.  Almost inexplicably so.

And then it finally occurred to me.  What I was feeling really had nothing to do with the woman who yelled at us.  Sure, it wasn't the nicest or most neighbourly of things for her to do, but she may have had her reasons for doing it.  Maybe her property gets destroyed by drunken yahoos every Canada Day and she's sick and tired of it.  What do I know?  The real reason that I was so upset about the whole incident was that, to me, it was reflective of a much greater greed that seems to be pervasive in our society.

I believe pretty strongly that personal wealth is partly the result of an individual's hard work, but it is also almost always the result of a tremendous amount of privilege.  In my own case, I had to work my ass off for years to become a physician, but I was helped a lot in the process by living in a safe country, by having access to a good public education system, by being born into a stable and supportive family, and by having the physical and intellectual ability to survive medical training*.  In other words, I was lucky.  And I believe that anyone who is as lucky as I have been should do what they can to share some of their good luck with others.

But unfortunately, a lot of wealthy people don't feel that way.  They feel that they're entitled to hoard their wealth, even when they have far more of it than they could use in many lifetimes over.  Republicans think it's okay to cut health care coverage for the poor as long as it lowers their own premiums.  The Walton family sits on many billions of dollars and gives almost nothing away.  And on and on.

It angers and saddens me to no end.  Because this "every man for himself" mentality doesn't make for good community or for a good world.  And it isn't the way that I want things to be.  So sometimes I get frustrated by it all and get mad at people for not wanting me to sit in their field.

(This is not as articulate a post as I would like it to be, but in the interest of getting something out there and getting past this event, I'm going to hit publish.  Please feel free to gently and kindly share your thoughts in the comments.  This is probably an idea that I'll revisit in the future, hopefully in a more completely thought out way.)

*To give but a few examples.  I could add in many more, such as the fact that I grew up middle class, that I'm not a visible minority, that women are more widely accepted in medicine than they were a generation or two ago, etc.  You get the idea.  Privilege

Wednesday, July 5, 2017

Greedy Rich People

For the Canada Day long weekend, M and I left the city to camp in front of a lake for three nights.  It was an amazing escape, complete with star-filled skies, late evenings in front of the campfire, and tasty but not-so-healthy camping food.  I felt more relaxed than I have in months, and I constantly found myself saying that I didn't want to go home (and particularly not back to work).

We had planned to completely avoid the Canada Day celebrations, as we both had some reservations about celebrating 150 years of colonization and abuse of indigenous peoples, but while stopping for gas we heard about "the best small town fireworks show in the province" from the sales clerk, and we decided to go.  So on Saturday night, we left our refuge in the woods for the relative civilization of a town of 1,000 people.

When we arrived in town, there was a small area by the waterfront that had been designated the fireworks viewing area.  It seemed that all 1,000 townspeople had come out for the celebration, as there wasn't an inch of available space on which to sit or stand.  So we walked down the street until we found a lovely grassy area on which many people had set up blankets to watch the show.

Unfortunately, the area had been blocked off with orange plastic fencing; however, there was a steady stream of people walking under the fencing, so we followed suit.  We found a great spot on the grass with a clear view of the water, and we settled in to watch the show. 

And then, an angry woman came over and started yelling at us.

"This is private property!  What are you doing here?"

We were a bit surprised, as there were easily hundreds of other people lying on the ground, so we explained to her that we were looking for a place to watch the fireworks and had simply followed other people into the area.

"Well!  It's private property!  You can't stay here!  You have to leave!"

Now...I understand that no one wants their property trespassed on, and I do recognize that we were trespassing.  However...it was an enormous field that easily could have accommodated many more people than were sitting on it.  The woman who was yelling at us was part of a group having a large bonfire, and they were taking up only a very small portion of the grass closest to the fireworks, so the people watching the show were not impinging on their space in any way.  And the people who had come for the show were sitting quite peacefully, not appearing to be disruptive or damaging to anything.

And yet, this woman didn't want any of us there.  Because it was part of her property, and heaven forbid someone else enjoy something to which they aren't entitled.

Which I completely don't understand.  If I have something that I'm not using, such as a giant piece of land that is too large for myself and my small group of friends, I would happily let someone else use it.  This woman and her group could easily have let us all sit and watch the show, at no harm to them.  If they'd been concerned about crowd control, perhaps they could have negotiated with the town to block off a portion of the property for the public, so that the space could have been enjoyed by everyone while still "protecting" the group who owns it.

But no.  It was her property, and she didn't want anyone else to enjoy it.

Fitting metaphor for the celebration of 150 years of colonization.

Am I wrong about this?  I was and still am horrified by the way that this woman treated us (and many other people who had come to watch the fireworks).  The pure selfishness of it offends me so much.

Sunday, June 18, 2017

One Year in the Black


It has been just over one year since I reached a net worth of zero.  After being in debt for almost ten years, it has been a welcome change to open the Excel file in which I track everything financial and see that my investments finally exceed the balance on my line of credit.

As a medical student and resident, I hadn't thought much about finances.  I was surrounded by people who came from wealthy families, and it didn't take me long to adopt their spendy habits and to accumulate a lot of debt.  I reassured myself that "everyone was doing it" and that the debt was okay, because it would be easily repayed once I became a physician and started getting paid in bags full of money.  I rarely looked at the balance of my line of credit, and whenever I did it was just a quick glance, followed by a nervous chuckle at the ridiculousness of owing the bank such an enormous sum.

It wasn't until my last year of fellowship that I actually woke up to the reality of how much money I owed and started doing something about it.  I went on a budget, and I actually started spending less than I was earning for the first time in eight years.  I didn't save a lot of money in that year, as it was a major adjustment just to start living within my means, but at the very least I laid some groundwork for financial responsibility as an attending.

And then I finished training!  And got an adult job!  And suddenly there was a lot of extra money to put towards savings and debt repayment.  Every day that I worked, I got a little bit closer to the longed for balance of zero.  And yet, my anxiety about money actually got worse.  When my line of credit was ridiculously big, I comforted myself by saying that I could declare bankruptcy if I ever lost my job*, because there was no way I could pay it back on anything other than a physician's salary.  As it got smaller, and my investments bigger, I suddenly entered territory where I would be expected to pay back my loans, regardless of whether I could continue to work as a physician.  And the idea of earning a non-physicians salary but still being $50,000 or $60,000 in debt was terrifying.

Thankfully, I have kept my job, and after ten months of working and saving I got myself back into the black.  I expected that the anxiety about money would resolve instantaneously after achieving that milestone, but oddly enough I didn't take a lot of comfort in being a 39-year old with a net worth of zero.  I still felt vulnerable to the possibility of becoming disabled** or burning out of my career and not having enough money to have good options.  So I kept saving and repaying debt and watching my net worth get healthier and healthier.

In the past year, I've increased my net worth by enough that I could live at my current standard of living for about three years.  While I hesitate to share actual numbers here, I will say that my net work growth breaks down roughly as follows:  10% from growth on investments; 10% line of credit repayment; 30% cash savings (for a down payment on our first home); and 50% long-term savings (RRSPs and a TFSA to minimize taxes). 

My savings vary a lot from month to month, due to a fluctuating call schedule and taking time off work for vacations and conferences, but the overall trajectory of my net worth has been pleasantly positive.  And finally...FINALLY...I am starting to relax a little.  It is comforting to know that I could become disabled and live comfortably off my disability insurance payments.  Or I could burn out from medicine and pursue a different career, and I would be absolutely fine.  For the first time in a decade, I feel like I have some real security and real options.  I'm still a long way from financial independence, but at least I'm sleeping more peacefully at night.

*I only had private student loans, so I think they would have been cancelled out by a bankruptcy.  But don't quote me on that.  And don't be an idiot like me and think that bankruptcy is a good financial strategy!

**Yes, I have disability insurance.  As should every physician.

Sunday, June 11, 2017

Retiring To, Instead of From

One of the nurses I work with in my inner city clinic retired last week.  I'm in a bit of denial about the whole situation, as she takes with her over thirty years of relationships with patients and experience in the community, and it is going to be a terrible, horrible adjustment to run the clinic without her.  It's a bit like a body trying to function after a left main occlusion has knocked out most of the heart.  Still possible (hopefully), but irreversibly impaired.

I've known that her retirement was coming for most of this year, so there has been plenty of opportunity to prepare for the transition and to hire a replacement.  Fortunately, we've managed to poach a really excellent and experienced nurse from another physician who practices in the same field (sorry colleague!), so the new nurse will be about as good as possible for a replacement.  I've also had some time to mentally prepare myself for the change, although I haven't done as much as I probably should have (see above statement re: "bit of denial").

Interestingly, from talking with the nurse who is leaving, it doesn't seem that she's done that much mental preparation for her retirement either.  She seems to be very financially prepared - house paid off, full defined pension from over 30 years of service, personal savings beyond the pension - but she seems to have very little idea of what she's going to do with herself after working her last shift.  When asked about her plans, she will say "Well....I have a lot of sewing I'd like to do".

She's not even 60!  And she's been working full-time in a busy, stressful, and emotionally challenging medical practice.  How does one transition from that to a life of doing "a lot of sewing"? 

I worry about her, a little bit, at the same time as I am insanely jealous of anyone who has managed to permanently free herself from the need for full-time employment.  I wonder if this incredible opportunity she has to explore new interests and do anything she wants to is going to feel like a disappointment, because she hasn't taken the time to figure out what she wants to be when she grows up. 

If I continue at my current savings rate, and there are no major economic collapses in the near future, then I'm on track to be able to retire in about nine years.  And while I try not to focus on retirement and to live in the present moment as much as possible, you can bet there is part of me that is always dreaming about what I will be able to do in the post-employement stage of life.  There will, of course, be many books to read, and as many places to travel as we can afford.  But there will also be volunteer work, and community involvement, and learning to speak a second language, and writing, and so many other things.  I will probably be busier in retirement than I am in my working life, because I will be able to choose to do whatever excites me most instead of doing things I don't love out of necessity.  (Hint:  It will not include dictating clinic letters.)

When I retire, it won't be just because I've saved up enough money and that's what people do as soon as they can afford to.  It will be because whatever I have planned next is even better than the crazy but wonderful world of medicine.

---
On a completely unrelated note, if you like cats at all, then you should really find a way to see the documentary Kedi, which is about the street cats of Istanbul.  It is beautiful and touching and funny and filled with cats, which makes anything in life better.  M and I saw it yesterday, and even she, the intransigent dog lover, thought it was worth watching.


Tuesday, June 6, 2017

How To Be Less Stabby While On Call

As a resident, I couldn't wait for the day that I would be an attending and would get to do fewer call shifts.  In my last two years of residency, I did 130 days of call per year, while as an attending I do about 70 days per year.  I anticipated that my attending schedule would feel positively luxurious by comparison, but of course, as with many things in life, that hasn't been the case.  Somehow doing less call makes me less accustomed to it and even more resentful of it when I'm in the midst of it.

Generally, I spend my weeks on call in a self-indulgent funk.  I whine about how busy I am and how long the days are; I neglect anything that isn't work-related (thank all that is holy for housekeepers); and I live off of all the foods that I tell my patients to never eat.  I'm about as miserable and self-pitying as an adult can acceptably be.  Possibly more so.
This call period, however, things seem to have shifted, if only the slightest bit.  I hate my life a little less than normal.  My smiles for patients and co-workers are a little more sincere.  I spread a little less misery everywhere I go.

Being caught up on everything at the start of the call period has probably been the biggest contributor to my slightly less horrible than usual mood.  My state of being on top of things lasted for all of one day after I started call, but at the very least I've only had to scramble to keep up with the additional work of call*, rather than struggling not to drown under call work and leftover work from the weeks before.  There is comfort in knowing that, at the absolute worst, I'm no more than two weeks behind on things.

The slight reduction in overwhelm at work has carried over into not feeling like I want to die when I get home, which in turn has led to me actually doing productive things in the evening.  Where normally I would binge watch Gilmore Girls with a peanut butter chocolate Drumstick** in my hand, I've actually gone for walks to enjoy the beautiful Spring weather.  I've done dishes.  I've paid bills.  I'm actually adulting!

http://hyperboleandahalf.blogspot.ca/2010/06/this-is-why-ill-never-be-adult.html
Maybe forty will be the year that I actually grow up?

*Unsuccessfully, of course.

**Immediately after writing this I ate a peanut butter chocolate Drumstick.  Because I'm only human.  I would've turned on Gilmore Girls, but the girlfriend isn't home, and I think watching our show without her is probably grounds for divorce.

Thursday, May 25, 2017

Parkinson's Law

Subtitle:  Work expands so as to fill the time available for its completion

Just over a year ago, I wrote smugly about how I had gotten caught up on all of my tasks at work and about how wonderful it felt.  At the time, I fully intended to keep up with everything, always and forever, so as to keep the wonderful feeling going.

I think I may have lasted a month.

Inevitably, I got behind during a busy time at work, and then I never seemed to have enough time or motivation to get caught up again.  So for most of the past year, I've left work every day knowing that there were piles of charts and long to-do lists waiting for me the next morning.

For me, the worst part about never being caught up isn't the overwhelming feeling of always having too much to do:  it's the terrible lethargy that comes from doing the same thing over and over again without seeing any progress.  There is nothing quite as demotivating as signing off on a letter, only to be greeted by 50 other letters that need signing off.  For the past year, work has felt like a neverending slog through the same neverending tasks.  Day after day after day.

A few weeks ago, I had a brief but welcome break from the teaching and presenting and administrative duties that fill my non-clinical time.  And I thought to myself "Now!  Now is the time to get caught up again."  So I took the extra time I had and phoned every last patient and dictated every letter and signed off on every chart.  For the first time in way too long, I was caught up.

And I've stayed that way for the past three weeks.  And once again, it has felt amazing.  I feel a little burst of joy every time I open my letter queue and see the words "You have no new letters to sign off".  Or when I look at my empty inbox.  Or when I look at the folders in my desk, and there's absolutely nothing in them.

The second best part of being caught up is that I've regained the efficiency that I had lost.  When I have just a few tasks to do, I can plow through them quickly, knowing that I'm going to get the satisfaction of being done, once again.  And it's much easier to let go of my relentless perfectionism when I know that it's standing between me and being caught up on everything.

The absolute best part?  I get a bonus day off today because I'm done everything!  I was finishing up my tasks yesterday, and I realized that there wasn't anything that needed to be done today, so I didn't have to come in for my usual catch up day in the office.  No dreaded Thursday paperwork day.  I've taken my car in to get the winter tires removed (just a wee bit late), gotten a haircut for the first time in eight months, and now written a blog post.  Next is lunch and then reading for fun.

https://en.wikipedia.org/wiki/Life_After_Life_(novel)

Life, for this moment at least, is good.

(If you are hating me and my smugness right now, please note two things:  1)  I start two weeks of call on Monday, which is going to destroy everything I just wrote about; and 2) When I say I'm "done everything", I am ignoring the paper I need to write and the CV I need to update and a number of other longer-term tasks that will forever be on my to-do list.  No matter how efficiently I work or how late I stay, there will always be something left to do.)

Thursday, May 11, 2017

The End of the Thirties

When I was a few months into dating my girlfriend, we celebrated her birthday together for the first time.  For me, birthdays have always a pretty understated affair, marked by a single special dinner and maybe a cake.  Not so for my girlfriend.  For her, birthdays are an event...or more accurately multiple events involving as many different activities and as many people as possible.  I was somewhat stunned that first year by the number of celebrations that a single person could have in honour of her birthday.

It took me a few years to realize that this was something that I could use to my advantage, but now that I'm three years into the relationship and a few days away from my fortieth birthday, I know to milk it for all it's worth.  I'm not having a single birthday this year; I'm having a birthday month.  Dinner with friends, dinner with both sides of the family, an Escape Room with other friends*, and birthday tapas with the girlfriend.  I will be celebrated!

And, inevitably, I will be a bit melancholy.  Because there is something about turning forty that feels...old.  Forty marks the end of the decade in which I went through medical school, residency, and fellowship.  It marks the end of the decade in which my father died.  It appears to mark the end of my single life and of dating new people**.  Realistically, it probably marks the end of any chance that I will have a biological child.  While I am hopeful for good things in the upcoming decade, I can't help but feel a bit wistful for the things being left in my thirties.

How does one let go of so many things that made them who they are?

*Have you ever done an Escape Room?  Puzzles and friendly competition all in one?  Yes!  Love them.

**If my girlfriend reads this, which she only seems to do when I write something she would find remotely bothersome, I can just hear her saying "Appears to?  What does 'appears to' mean???"

Saturday, April 1, 2017

Mistakes, I've Made A Few

When I started medical school, I believed wholeheartedly that physicians were perfect.  I fully expected that, over the following 6-9 years of training, I would fill my brain with everything I needed to know about medicine and that I would learn how to use this information correctly, in every patient encounter, with 100% accuracy.

I'm not sure where I got this idea from.  Certainly I recognized (probably too clearly) that I was a fallible human being, yet I somehow thought that medical training would beat the fallibility out of me.  I envisioned the epic 28-hour-plus call shifts transforming me into someone perfect, someone who never wrote down the wrong drug dose and who never froze, uncertain of what to do, in the middle of a code blue.

It was a shock to me then, as I progressed through my training, to discover that my human imperfections didn't go away.  I certainly learned to be much better - to double check my orders and to write list after list in an attempt to never miss anything - but the promise of perfection has remained elusive.  Sometimes I slip up.  Sometimes I forget to do something important, or I fail to take something into consideration when making a treatment plan, or I misjudge just how sick the patient in front of me is.

Imperfection feels horrible as a trainee, but it still feels bearable.  As a trainee, right up until the last day of fellowship, there is always someone watching, someone double checking.  Someone who ranks higher than you on the list of people responsible.  Someone who retains the burden of final responsibility.

And then you graduate.  And now you are the person in charge.  And suddenly the weight of the work you do, the importance of every decision you make, seems ten times greater.  Double checking becomes triple checking.  Minutes of insomnia turn into hours.  Precious time outside of work, which is finally not quite as rare as it was in training, is spoiled by endless questioning and self doubt.

Did I screw something up?

Is someone going to die because of something I did?

And the worst part of it is, almost no one talks about it.  If you ever dare to talk to a colleague about your fears, they will minimize them, reassuring you that you're one of the good doctors.  You're not one of the ones who makes mistakes.

Almost no one acknowledges that we all make mistakes.  And that it isn't enough to learn how not to make mistakes or, more realistically, how to make fewer of them. What we really need to learn is how to cope with the fact that we are fallible humans, called upon to do superhuman work despite our inability to ever be superhuman.

Monday, February 20, 2017

Usted Esta Aqui


M and I just came back from a lovely week in Cuba.  It had been seven months since my last true vacation (a week off at home for our local theatre festival in July), and I was starting to crack a bit under the strain of constantly having to be on for other people.  A week of sun and books and more alcohol than is recommended was somewhat desperately needed.


The setup was perfect for relaxing.  We were in an all-inclusive resort, so the most strenuous thing required of us was walking from our table to the buffet to refill our overflowing plates.  And yet, despite being on vacation, I found it hard to turn off the constant chatter in my brain.  When eating, I would be thinking about the books that were waiting to be read; when reading, I'd be wondering what was going to be served at our next meal.   When on the beach, I'd be wondering if I would've been happier spending the day in Havana; when in Havana, I would dream about the beach. 


My distractible brain, my ever present companion at home, had followed me to paradise*.


I am so accustomed to my constant thoughts about what else I should be doing and what needs to be done next that it took me days to recognize how ridiculous they were in paradise.  My moment of clarity happened on the beach, when M was snorkeling in the shallow water and I was walking beside her.  I had just come out of the water myself, and I was feeling a bit chilled, and all I could think about was wanting the walk to be over so that I would be back at my beach chair and wrapped in a warm towel.


And then I paused.  And I thought "Why on Earth am I wishing this time away?"  Wanting to be back at the beach chair wasn't going to make the distance any shorter or make M swim any faster.  All it was going to do was rob a perfectly good moment of any potential for happiness.  So I stopped, and instead of feeling my usual impatience, I took a look around me.  At the people and the palm trees and the mountains all glowing in the warmth of the late day sun.  And I realized that I was literally in the middle of a postcard.


A postcard that I had almost missed, because all I know how to do anymore is rush from what I am doing to whatever it is that comes next.

*I recognize that I am very privileged to view Cuba as "paradise", as that isn't the experience for many of its citizens.   

Saturday, February 4, 2017

Making Peace with My Food Budget

When I first put myself on a budget about 2.5 years ago, I had to cut out a lot of things to make it balance.  Things like clothing and online shopping got essentially eliminated.  Travel changed from fancy overseas vacations to trips within Canada that I purchased with AirMiles.  Visits to my favourite independent bookstore were replaced by the public library.

But one area that didn't get cut much was eating out.  Throughout training, eating out was my main form of entertainment and relaxation.  It was also an essential way of staying connected with friends and family at a time when my apartment was too messy and my fridge too empty to ever entertain at home.  So despite being ruthless with my spending in many areas, I averaged about $300 a month on eating out throughout my training.

And then I became an attending.

At first, I stuck to essentially the same budget, as I was somewhat obsessed with reaching a net worth of zero.  Once I had worked for about nine months, and I had achieved the long-dreamed-of positive net worth, I started to relax a bit more.  We started eating out a bit more often than before.  And ordering a few cocktails or a bottle of wine with our meals.  And dropping $100+ on dinner at a fancy restaurant, instead of $20 at one of the tasty dives that had previously been our favourites.

When I reviewed my spending for 2016, I was absolutely appalled to discover that I had averaged $600 per month on eating out.  SIX HUNDRED DOLLARS!  Which is utterly ridiculous.  And to make it even more crazy, that only accounts for my contribution to eating out.  My girlfriend was also paying for restaurant meals, and although she tends to pay for the less expensive meals given that she works for a non-profit agency and doesn't earn a physician's salary, she was probably still contributing a few hundred dollars a month to our eating out budget.  And, the $600 was an average for the year.  At the beginning of the year, it was closer to $300 a month, meaning that it was well over $600 a month by the end.  RIDICULOUS!

So in early January, I said enough is enough and put myself on a slightly strict eating out budget of $300 per month.  I figured that I had lived with that level of spending as a fellow, so it wouldn't be all that hard to go back to it.  I motivated myself with calculations of how much $300 a month would be worth at retirement (about $138,000 if I retire in 20 years).  I promised myself that it wouldn't be the end of eating out, but just an opportunity to recalibrate my spending.  I was ready.

I lasted approximately two weeks.

It took me two weeks to realize just how many of my favourite moments happen in restaurants and how much I would miss out on if I based my spending on an arbitrary budget instead of conscious choice.  In those two weeks, I spent a Friday night eating takeout with a friend and her young baby while talking about the crazy rollercoaster ride that is being a new attending.  I spent a Monday night at a ramen bar with another friend hearing about her struggles with infertility.  And I spent another Friday night with my partner eating in a cheezy 80s style Greek restaurant because we were both too worn out from the week to even think about cooking.

After the two weeks, in which I didn't quite manage to stick to my eating out budget, I realized that food is my sacred cow.  I'm quite happy to live in a modest home and drive a car that my physician friends make fun of and never own a Coach purse.  But I'm not happy saying no to friends or my partner when they want to get together over food.

So bring on the ridiculous food budget.  I'm ready for some tapas.

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:
  • 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).
That list makes me feel vastly better than saying to myself "I have to work at this miserable job* for another 10 years before I will feel happy again" all the time.

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.

Friday, January 20, 2017

Today's Patient Encounter

The waiting area for my clinic has a big-screen television, and it was of course* broadcasting the inauguration ceremonies this morning while I was seeing patients.  I called a new patient into my examination room just as the swearing in was about to start, and as we were walking away from the waiting area she said:

"Oh thank God you came when you did.  I can't stand to watch that vile man become president!"

My patients are awesome.

*By "of course", I in no way mean that I "of course" chose to show the vile man becoming president.  I share my waiting area with multiple other physicians and sadly have no say over what is played on the tv.

Sunday, January 8, 2017

2017 - The Year of Saying No

I suspect that I'm not the only person in medicine who is a people pleaser.  Since elementary school, I've always been very academically successful, and the resultant praise from teachers and relatives has given me a lot of pleasure and personal satisfaction.  Going to medical school and becoming a doctor took this to the next level, as suddenly patients and even strangers were regularly praising me for the work I did. 

The big problem with getting so much validation externally is that you start to be dependent upon it.  You need people to tell you how important you are and how no one else can do what you're doing.  And so you constantly seek ways to keep that validation coming.  You say yes to giving one more presentation or fitting another patient into your clinic or teaching one more tutorial.  Even when you don't really want to be doing any of those things.

Over the past few months, I've been feeling depleted, as I keep telling my partner.  I've been feeling overwhelmed by work; I've been having difficulty sleeping; and I've been hit with a bone-weary exhaustion that reminds me of my residency days.  I had hoped that a recent trip to a cabin would fix things, but four days away just wasn't enough.  I'm tired. 

And despite this, people keep asking for more.  Start a research project.  Do more training.  Teach another academic half day.  More, more, more, when all I want to do is stay in bed with my cats.  It has reached the point where I feel anxious not only when my pager goes off, but also when my inbox pings, signalling the arrival of another email asking for my time and energy.

So this year, I'm going to learn to say no.  Thank you for the opportunity, but that isn't my priority.  My priority needs to be finding balance, a level of work and engagement that I can happily sustain for the next 20 years, not saying yes to every single request that comes my way.  I need downtime and sleep and yoga classes and running and home-cooked food and time with the people I love, not another item on my to-do list.

No.

It sounds straightforward, but it goes against the very essence of medical culture.  Physicians pride themselves on being able to work a 28-hour shift and then go climb a mountain on their post-call day.  Medicine is the North American worship of busyness and achievement taken to the extreme.  Saying no means being inadequate and not measuring up to the standard.

And Medicine doesn't always listen to no.  A few weeks ago, I was emailed a request to help someone out with a presentation.  My stomach sunk when I read the email, because it was something that I really didn't want to do, even if I had had an abundance of time in which to do it.  So I sat on the email for weeks, debating the merits of saying yes versus no, until I finally got up the guts to sent a polite email declining the request.

The response?  Within seconds, a return email that basically said "Can you do part of the work for me?".

No! 

I'm still completely flabbergasted by the response.  Why is my attempt to protect my happiness and my time not respected?  Why am I expected to say yes to every request that comes into my inbox?

Learning to say no isn't going to be easy.  It's going to mean letting go of the need for other people to tell me how wonderful I am and what a good job I'm doing.  It's going to mean letting go of the belief that if I were just better, just like every other physician, that I would be able to say yes to everything.  It's going to mean ignoring the blogs of the overachievers, who have a medical practice and children and exercise daily and cook healthy food, and setting my own standards for achievement.  Because ultimately no one cares about my happiness as much as I do.  And no one else in Medicine is looking out for my well-being as much as I am.