Wednesday, August 13, 2014

Taking Care Of Ourselves

Genmedmom here.

A patient of mine recently asked me how my kids are, and what cute things were they doing nowadays? I'm very open about my family with all of my patients. They've seen me huge and pregnant, and they've seen my colleagues during my maternity leaves. My kids' photos hang in my exam room. We often trade parenting experiences as part of the visit.

So, I was not at all put off by her asking about my kids. Her visit was over anyways, and we were only making small talk as we wrapped it up. I described how Babyboy is a little engineer, always building and figuring things out, and that Babygirl is full of sass and song, teasting and challenging and singing all day long. She laughed and said a few things about her kids, how they were all grown up, how she missed their little days, but didn't miss how hard it had been.

"Make sure you take care of yourself," she said, suddenly not laughing anymore. It was a bit abrupt, this serious turn of mood.

"I mean you need to take the time for care for you, because you need to replenish your strength, to be able to care for your kids. Exercise, salon time, friends time, it's really important. You need to do that." She was beseeching me.

"Uh, okay, yes, I know what you mean, absolutely..." We were moving towards the door.

She stopped, and said, quietly: "No, really, I can see how tired you are. You're really, really tired. Remember to take care of you. I need you to, too!" Here she smiled, and the door opened and she was gone, leaving me unusually flustered, standing there for a few seconds, wondering what next.

I know I carried on with my clinic, and then went home, and did the dinner/ bathtime/ bedtime routine with my kids. I know I crammed in some mail opening, bill pay, and reading. I know that sleep was likely disrupted by something... If not one of the kids (usually Babygirl) then the cats, or this nagging cough I've had. I know I am really, really tired.

Now, I have alot of help from a wonderful husband and my untiring mother. I do get to exercise twice a week. I write, which is therapeutic. Hubby and I sit down for dinner every night that he's not traveling, and we have family dinners every week. I don't shop much, or see friends that often, and I can't remember the last time I went to a salon.

I honestly can't tell if I'm taking care of myself enough or not. I think I am. But if patients see me as exhausted, drained, that's not good. I'm not sure how much more time I can carve out for "down time" things, and I'm not sure I feel that strongly about making that happen.

What do others do to take care of themselves? How much down time do you need?


  1. Monique - great post, and great question. I love that your patient cared so much about you. You must be a really terrific doctor to have your patients care for you like that. That is gratifying in and of itself.
    I think the answer to knowing if you are taking care of yourself enough or not all lies in how you FEEL. Some ppl require more "down time" than others to thrive. It's very individual. I'm not trying to give you a non-answer, but I truly think that rather than counting the number of "activity x" we think is down time, we should use ourselves as the barometer. But here is the caveat: I think that as MiMs we constantly function at a higher level of stress than the general population. We get used to be chronically stressed, chronically sleep deprived. It becomes normal and we do not notice it any more. As a result, I think that we may not be as in-tune with that inner voice that tells us what we need - we are so used to ignoring it, or not being able to follow its wisdom. So if your patient thinks you look tired (bold of her to say so!), and you confess that you feel very tired - perhaps you are not getting the down time that you need. Your life sounds like so many of ours - prep kids in morning, rush to work, work hard, home, spend time with kids, supper, bedtime routine, try to do something productive out of the twenty-five things on your to-do list, collapse to routinely interrupted sleep and start over. Over and over again. Though we all may sustain this for years, I think in the long run, it takes a toll (though hopefully the kid-induced night wakings cease after a few years!)
    I say all this as someone who took ZERO time for self care, for many, many years, through all my training and residency and early practice years - it was all kids (three of them, all born in training), work, study, maaaaybe time for husband when I felt too guilty to let that slide again, pets, extended family, and me, dead last. And I had classic, classic burnout - no feeling, unable to cry, stopped caring, panic attacks - the whole thing. It was awful. I regret it deeply. But I sustained the pace for seven years, so I spent seven years ignoring that inner voice, constantly telling it I was "too busy" (which I truly was).
    So now I know that I need down time, I listen to the voice, I am no longer in training and have the freedom to do some self-care. My husband covers virtually all kid night-waking now (and they are less common). This means I am able to get up 15 minutes earlier to walk the dog in the morning - an activity that I personally find extremely relaxing and a wonderful way to start my day, along with completing a chore! I try to take a few minutes each day at lunch to either go outside or at least stare out a window, with no phone or book - just to be. I still never go to the spa, rarely meet up with friends (though I enjoy it when I do), don't go to yoga class or any of those other "down time activities" - I actually find that , for me, the scheduling and having to be somewhere adds to my stress. But of course it is all very personal. Some weeks I need more down time, others I need less. I am trying and learning. But taking daily time to be still and alone, for me, is what I need. What you need may look different, of course!
    I think my reply is longer than your post:-) I hope you have the opportunity, soon, to spend a few minutes with your inner voice, and decide what you need, then do it. I wish you happiness, rest, and peace!

    1. Thanks so much for your reply, I'm sure this will be more helpful to folks than my post! Congrats on meeting your self-care needs. I think a dog would be wonderful for us, as well, but not quite yet...

  2. Thanks to both of you for the post (Genmedmom) and the reply (MDH). I am burnt out. I sleep 3-4 hours a night, I do lots of childcare, I literally feel like I can't breathe. I have a lot of the things described above - no feeling, panic attacks, can't cry, feel like I need to scream, etc. I know these things, but the reality of training from a time standpoint and a brokeness standpoint is that I don't really know what else can be done. We have no family here, my husband could maybe be more helpful but he already does way above and beyond what most dads have to do. I want to exercise and buy clothes that fit and have 5 minutes of non-work related adult conversation without the palpitations of feeling like I'm wasting time, but I don't know how! This is a long reply saying nothing I realize, but mostly thank you for posting this. Hearing that I'm not alone helps. Reminding me of how outsiders can sometimes see through the facade is also useful and sort of challenges me to find my moments of calm some way.

    - Cutter

    1. Training is so hard. It is a time when being out of balance is the norm. That doesn't make it right, or good. Just know that training ends, and then you will be more and more in charge of your time.

    2. Cutter, I'm sorry for what you are going through. Your posts always seem so positive, so I am sure that you do everything you can to "look on the bright side" - but as a friend of mine once said, "you can't have work-life balance when you work 80 hours per week". It's so true. It is a time where being out of balance is normalized - and it's not right. It's dehumanizing, actually. I have sincere empathy for you. I hope you make it through and get a chance to get the rest / help / space / peace you need. You so deserve it. Hang in there!!!

  3. This is a great question, and great replies. I think its very much down time, and what type of down time each person needs. And its easy to feel pressured to get more or less based on what others tell you. I also think there is no amount of salon pedicures or shopping that can cure sleep deprivation. You need to use your down time to TAKE A NAP if you are truly tired. For me, I focus on the things I NEED to feel better---sleep, exercise, time to read, and at least an hour off on a weekend day if AT ALL possible. Sometimes I just go upstairs, turn the window AC on for white noise, and lay in bed for an hour. I just need a break. When I skip that hour, oh man, I am no fun to be around by Sunday evening.

    1. Yes, sleep. Elusive sleep. Wonderful sleep. I agree. Working on it. Thanks Ana!

  4. I've had, on a few occasions, patients comment that I look tired. I replied, once, that it was exhausting taking care of her. She looked a bit taken aback, but I smiled and she got the joke. That night I went to bed early and felt better the next morning.

    Great post, so timely for me as the baby has been sleeping through the night now for a few months (he's almost a year old) and I am just starting to feel like I'm catching up on my sleep.

  5. Sometimes I look back on all I did during residency and having two babies and nursing all night and being chief and fellow and passing boards and wonder, how am I still sane? And my sanity is in question, ha ha.

    I was in big time denial that I was burned out, depressed, and my marriage wasn't going well. Not only was I fooling my co-workers and attendings and friends (and I think they saw more objectively than I did) I was fooling myself. I had zero time for me, and I finally realized that I was hurting my children more than harming them by staying in an unhealthy marriage, so I began the slow climb out of my own abyss.

    I'm not implying that your marriage isn't healthy, just empathizing with the tiredness. And like the first commenter, I believe that you can be so consumed with your duties that you don't see how tired you are. We MiMs are like vacuums for work, but does being Superwoman help us or harm us? For me, it was definitely the latter. And I am still Superwoman, by the way:) Just Superwoman with more me time.

    It does get easier as your kids get older, but I think that if you try to take some time to do things you enjoy - whether it is reading or writing or walking around the neighborhood for fresh air (I am still not ready for a dog either luckily dad and stepmom do that) or going to get a massage or do yoga - I'm listing what I like ha ha - you will find that you are happier when you are with your family. Pot/kettle, but I am a better person when I get my me time, I see that.

    I've had histotechs tell me I look tired on days when I want to lock my door and crawl under the table and cry (days in the past-if I could only cry). People see us, even if they don't know us very well. I took it as a negative comment and self-flagellated that I didn't cover up my inner pain enough. Now I see, in retrospect, that the person just truly cared enough about me to speak up.

    Get a sitter. Go for a walk. Stare into space. Go to a movie. Drink wine. Do something you want to do just for you. Breathe. Good luck. I'm talking to myself too by the way. Great post:)

  6. I stayed at work late just so I could chat with a co-intern yesterday. I felt bad that I didn't just rush home immediately to see my daughter, but I also felt a lot more relaxed when I got home. I wasn't nearly as frazzled by the nightly bedtime tantrum, and I enjoyed the pre-tantrum time more than usual. Then I went to bed at 8:45. I'm still tired and strung out, but even these little things help so much.

  7. I spoke at a 'work-life balance' panel here a couple years ago. The med students asked me what I did for 'me time.' I answered, in all seriousness: "I walk to work." The room erupted in laughter and med students come up to me and remind me about it ("You're the person who walks to work for me time!!"). But let me tell you, that 20 minutes makes the rest of the day go right!


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