Tuesday, June 15, 2021

Achievement Without Self-Care Is Empty

 “I made a big mess over here!” my daughter yelled gleefully from the hallway. When you’re 5, making messes is just part of the fun. I reluctantly peered around the corner to find pink kinetic sand all over her legs and the floor.

Cursing my mother silently for gifting her that kinetic sand, I sent her to the shower and attempted to sweep it up. After three iterations, I still felt sand crunching under my bare feet. Then I looked around. The floor tiles were dingy, and the baseboards were covered with scuff marks. So were the walls and the banister.

So instead of taking my planned solo walk that Sunday morning, I got out the cleaning materials and went to work.

I scrubbed on hands and knees, did many mini squats and deadlifts, even resurrected “wax on/wax off.” This long hallway had been neglected for a while. We walk through it every day, but it’s not really a central part of our living area. It’s an entryway, a makeshift messy play area, and the transport conduit for bikes and scooters and gear and even garbage to go from inside to outside and back again. So I started at one end and proceeded to deep clean this important yet quite underappreciated hallway.

As I was working, I realized something.

Scrubbing walls and tiles and baseboard on hands and knees is hard work. It wasn’t the most pleasant thing to do at first, and yet the more time I spent, the better it looked and the more appreciation I felt for the space. I even noticed improvement in my scrubbing technique; I was honing my system. I ignored voices from the other rooms. In my focus, I became invested in this improvement project and the intended outcome.

In medicine, we sip from the fire hose and then quickly dive into the trenches, and it’s not particularly fun at first. We put our heads down and study and work. We gain incredible amounts of knowledge, we see improvement, and the further we go down the path, the more invested we get in the pursuit of mastery. When the outcome we've been working toward appears in the light at the end of the tunnel, it becomes almost addicting to continue chugging along in a linear fashion.

When my scrubbing neared the end of the hall, though, I got fatigued. My shoulders were burning and my kneecaps hurt. There was just one little section left, over to the right where the hall opens up near the front door. I thought about stopping early and just leaving that area the way it was. Does some dirty tile in that one little area really matter that much when I “checked all the boxes” on rest of the hallway?

That’s where it hit me.

If I left that last section unexamined and not tended to, would I really appreciate the whole of the accomplishment? What about my other family members who share the space? A big project, whether it be a home improvement project or a career advancement project, can never be complete if you neglect a part of the work.

For us high achieving professionals, the often neglected section on our path is our self-care. We focus on the endpoint in front of us (which is often a false summit anyway), continuing on the treadmill of achievement with heads down so we can just get done… all the while not tending to our own needs. And then, once we “arrive,” what’s it all for? Are you able to enjoy what your worked for, or are you left wondering who you even are anymore? Finishing tired is one thing, but neglecting ourselves during our pursuits might lead to full-blown sickness.

So of course, I finished the whole thing and basked in my clean hallway despite really wanting to ignore part of the job. Tell me, how do you fit self-care into your busy life of projects?


A version of this post first appeared on the blog Practice Balance.

Friday, June 4, 2021

Standing ground

 On the way to practice, Coach called my daughter.

"Are you headed to practice?"

"Yes."

"Is your mom driving you?"

"Yes."

"Will she be around in practice?"

Me on the speakerphone: "I can be. What do you need?" 

Coach was in traffic and would be late. She would have my daughter and the team captain start dynamic warm-ups and a full-field game. I would hang around until Coach arrived, just in case.

I'm the travel team manager. This a role that I secretly love. Not that I need more things in the day, but to have a job with discrete roles the I can do like a boss is a point of great joy for me. My other roles are complex with difficult success metrics and involve a lot of thought. Being team manager is something I can do relatively easily and really well. That feeling of accomplishment and easy service is hard to beat. I am team manager and team photographer and coach supporter and logistics queen.  I can provide information for the weekend's games and COVID protocols of our opposing teams like nobody's business. I can provide a game day roster with our guest players' information without breaking a sweat. I can book a hotel room block at the right distance from our tournament. I have my team binder that I put together lovingly with sheet protectors, player cards, extra rosters, medical releases--and it rocks.

I can't say that I'm so smooth with the girls and prefer a back seat role on the team. Don't get me wrong. I cheer like a former competitive cheerleader - individually and for the whole team - but I'm not fist bumping each girl as they come off the field and not one of those parent managers that everyone chats up. I do my thing and let them do theirs.

So this day, I let the team captain start the team with dynamic stretches and hung back under the tree next to the field, surrounded by the foul-smelling cicadas.

I noticed that the club team who had the field before us were wrapping up and a group of men were standing by the side of the field with pop-up goals, looking as if they intended to take over the field. The field that we had for practice.

I started walking towards them as a family came on to the field with their soccer balls. I told the family that our team was about to practice on the field and they stepped off to find another place. The men, though, they hovered nearby and started to take steps onto the field. This was an imminent takeover.

This was the only soccer field in the park, although there was a grassy area beside it. This field, though, was flat and clearly marked off for soccer. I saw the girls start filing on to the field at the north end and the captain was starting to mark the goal boundaries for the north end. The men near me, a gaggle of 10 or so men in their 30s-50s, took some more steps onto the field.

I stepped in their direction. "We have the field from 6:30 - 8:00." I said this with confidence and authority. We had been practicing at this field for months at this same date and time and I knew our club had a permit. They kept advancing. "Show us the permit or we'll just split the field."

They were bold and undeterred. The Other Coach from the prior practice (our same club), came to support me. "You guys will need to practice somewhere else. Our club has the field until 8." The men, one by one, walked up to challenge The Other Coach and me. 

"Show us your permit or we take the field."

What was this? This was ridiculous! These grown men looked incensed. Did they not see the 16 yo girls on the field practicing?

The Other Coach kept fending them off and the men were irate. I got in the fray. 

"We have a permit. We've been practicing for months here at this time and day. See our schedule." I showed them our TeamSnap schedule which didn't seem to sway any minds.

"I pay $20,000 in taxes to this county!" yelled one man who seemed moments away from a stroke, forehead veins bulging, "I own this field!"

Okay, dude.

The girls had spread across the field taking their positions, looking nervous and not starting play as we were taking space on the side of the field still. I stood facing the men, my back to the girls, positioned as to prevent them from advancing further.

I said calmly, "Can we all be adults, gentlemen, and be a good example to these girls? Let's be adults here."

"Yes!" shouted one of these men, approaching me. "I told them let's not be like this. Let's be gentlemen. Just let us come on the field and show us your permit."

The Other Coach was on the phone with the club administrator who was going to send a copy of the permit.

The men took turns shouting in my face, like ridiculous babies. I stood my ground. I was not at all afraid of them. I was defending our team and our girls and our space. Eventually Old Coach convinced them to start playing on the adjacent grassy area since the permit was coming, and he'd show them. Old Coach waited with me. 

Our actual Coach then showed up and was like - what is happening here? She was trying to figure things out and as she was walking to the field, she saw one of the men yelling at me and wildly gesturing. We gave her the short story.

Old Coach got the email and showed it to a couple of the men, who eyed it suspiciously and finally accepted begrudgingly that we were allowed to be there. Note, they did not have a permit!

Seeing everything was tucked away and secure with practice going full steam, I thanked Old Coach and both us walked off the field. He would go home and I would start my run.

Later at home, I got a text from Coach.

"Thank you for being Security today...I was thinking on my way home that I never asked you if you were okay after that guy was yelling at you. I apologize for that. I hope you're okay and I'm going to get you a SECURITY shirt!"

I wrote back: "I'm so glad I could be there. That's so nice of you to think about that. I am totally fine and found it ridiculous that these grown men were acting like babies. I hope the girls saw the importance of standing your ground in the face of rude bullies. I also had nice workout afterwards. :)"

And that, folks, was practice.



Thursday, June 3, 2021

Texts from the pedi dental office.......

5/19, text message comes right in the middle of reading a gastric resection:  Hi, this is Lori at *** Pediatric Dental! We have Punky scheduled for an appt June 2nd at 8:00am. Please reply to confirm. Thanks!

......._stops working_ _opens work calendar_.......oh good, I'm not covering anything early that day, I can take her.....but *should* I take her?.......she's out of school and her father is home........but she always does better at things like that when I go.......and her father does need a break......he's been home with her for 1.5 weeks and camp doesn't start for another 1.5.........put it in the family calendar so you don't forget......oh, wow, I actually somehow remembered to do that back when it was scheduled, shocking........but make a reminder in your phone so *you* don't forget........do it for two days before so you can get mentally ready.........ok, done.........now back to this damn stomach case, stupid tiny signet rings.......you've done this hundreds of times, just get back to it........I know we hate these, just get to the lymph nodes, the worst part, the rest is straightforward..........._office phone rings_..........eff, quit bothering me!!!!.........hello, this is UnluckyPath..........okay, I'll be right over...........damn, another freaking frozen???............I just want to sign out my cases...........

45 minutes and 3 ENT margin frozens later:  okay, let me get back to this damn stomach..........oh wait, crap, did I remember to order the IDH1/2 and MGMT promotor methylation testing on that GBM earlier?........damn, I can't remember..........what was that case number?.........._digs case out of stack, types in to Epic_..............oh yeah, I did order it, but I forgot to link it to the freaking path case, ugh.........done...ok........I *will* finish these lymph nodes now.........how is this coffee gone already??......

24 minutes later, gastrectomy case is done, ypT3 N2:  okay, I'm going to sign out some easy crap now to decompress........GI biopsies will be good........_phone rings, EFF!!_..........hello, this is UnluckyPath......yeah, we do have to put in one per cm.......yeah, I know it's 17 cm, just shove like three pieces in each cassette......ok, thanks, bye........oh shit, did I remember to confirm that dental appt?.......of course I didn't........._hits 'C' to confirm_.......

5/26, text message comes right in the middle of the morning immuno ordering rush:  We have Punky confirmed for an appt on Wed, June 2nd at 8:00am at *** Pediatric Dental. See you soon!

........aw crap, right..........did I put that in the calendar?........oh, would you look at that, I totes did, high five!.........ok, I still have a week to figure out if I'm taking her.......oh wait, I'm off Monday?.....weird.....that makes no sense..........a holiday?.....what holiday?......oh, it's Labor Day.....wait....what month is it?......oh, right, it's Memorial Day....that's cool, I need that day off......oh, but wait......the cleaning lady comes the day after that, ugh......good lord that's an ugly breast cancer.......damn, guess I need to make sure it's primary......do I have to?.....asked the question, better do it........look at history first dummy........_opens Epic, looks for cancer history_.......okay, no other cancers, no melanoma........I guess I'll get a CKAE1/3 and.......wait.....the last time I only ordered that on this kind of thing it came back negative and I had to get the other one anyway, get both......wait......how much tissue is there?......it's a fat core, get both.......it's from the main hospital not ***, they always give good tissue, thank god.......ok, get HMB-45 and SOX-10.........no, wait, SOX might be positive in ugly breast, won't help.......HMB-45 and Melan-A.......and I guess CD45 in case it's a weird lymphoma.........I'll order the biomarker panel now, though, I'm sure it's just an ugly primary, save time.......crap, Punky's birthday is coming.......when do I have to order a cake?.........oh, I've got time, grocery store only needs a couple weeks.........damn there are a ton of breast biopsies today........ooooohhhh, a fibroadenoma, love an easy one............okay, so I'll have all day off Monday to pre-clean the house for the cleaning lady, so that's good........and Wednesday night isn't a workout night, so it's okay if I get home even later.......and it would be nice to spend a little time with her before work......ok, I'll plan to take her to the dentist......

6/01, text message comes right after finishing an exhausting HR-type meeting with a PA who is really sucking right now:  We have Punky confirmed for an appt tomorrow June 2nd at 8:00am at *** Pediatric Dental. See you soon!

.........MOTHERughhhhhhhhhhhhh!!!!! I don't want to have to go to that!!!!!...........I'm so. Damn. TIRED........dementia dog had me up all night........hubs never wakes up for that crap.........so creepy all night........and then 7:30am meeting to discuss a bunch of super painful shit......seriously I got like 1, maybe 2 hours of sleep.......GAAAAAAHHHHHHHHHHHH.......I am so drained.......so tired of talking to people and doing things for people, I just want to sit alone in a dimly lit room for like two weeks.......why can't I just do that once?..........and the facility pending queue has 348 cases in it!!!!!!!!!................stupid long weekend, wtf................I'll never get all this crap done.............I haven't left before 7:00pm in like two weeks, ugh..................ooooh, I really need to sign out that lung bx before people start calling me.............yup, it's squamous like I thought...........damnit, I forgot to run the Roomba before the cleaning lady came..............when will fully automated cleaning robots be a thing?..........geez I hate it when she comes to the house...........I *really* need to find a good anxiety drug, ugh...........okay, I guess I'll still take Punky in the morning..........I promised her and I can't go back on it.........really can't do that....ugh, always disappointing that kid...........okay, I'm definitely taking her.........need to finish every case tonight so I have as much time tomorrow for new cases............ugh, and a 3:00pm meeting, crap..........

6/02, 8:35am, driving to drop Punky back home before turning around to go to work:  "Mommy, that was so fun! And he said the Tooth Fairy will be coming really soon, that's so awesome. Almost as awesome as seeing you before you go to work. Do you think she will leave the gold coins under my pillow, or somewhere else?

.............definitely made the right decision to take her...........freaking Peppa Pig and those gold coins........I'll have to tell her that the US Tooth Fairy uses dollars........or doll hairs......hehe, she loves that joke........would you like to have twenty doll hairs?.........OMG I'm not going to get to work until 9:30...........I'm so screwed............but she's happy, so that is awesome..........

6/02, text message comes just after finishing yet another freaking HR-type activity instead of real work:  Thank you for visiting *** Pediatric Dental! We're so thankful to have you a part of our family. We love feedback, so please let us know how we did by clicking the link below. Thanks again!

Wednesday, June 2, 2021

Guest Post: Has Pandemic Living Caused You Stress or True Distress?

When I turned forty, I tumbled slowly into a deep hole. While caring for a six-month-old infant, two older children, and starting a new job in a new city, I was expectedly busy, some days nearly frantic.  I had always been full of energy and drive, able to handle anything that either my NICU practice or my children hurled at me. We transferred to a new city and new jobs four months after my third child was born. Then I turned forty and everything changed.

Despite taking night call in the hospital twice a week, and pumping at work, I continued to enjoy nursing my last baby. She had been easy from the start, and I planned to cling onto nursing (and oxytocin) for as long as possible. At first, I noticed my sleep pattern changing, but assigned it to my workload, the stress of moving, and fatigue. I could not go to sleep, and when I did fall asleep, I awoke at 4:00 or 5:00am each day, ruminating over all my worries (call schedules, a new school, new teachers for the kids, a brand-new nanny). Despite running in overdrive, I rarely felt hungry, began to eat less, and lost some weight.

 

When I became grouchy and short tempered with the kids, I attributed it to stress and my workload. There was always so much to do, both at home and at work. However, sometimes I erupted in anger at my children for no good reason. They were adjusting to big changes in their little lives, too. I observed myself continually furious at my husband and resented his enjoyment of his new job (when I was not). Yet, because I continued to work full-time and take night call in the hospital, the fatigue I felt was extraordinary. Some days it felt like the typical “post-call” funk, and other times it felt much worse. I literally forced myself to drive into work for my night shifts.

 

Then one morning while in the NICU attending to sick babies, I noticed that I was unable to make the most straightforward of clinical decisions. Should we treat the patent ductus arteriosus with indomethacin or move straight to surgical ligation? My thinking had slowed until my brain felt foggy. This was noticeably different, since my pattern of practice had always been decisive, even borderline impulsive. I began to have terrible throbbing headaches, and my poor husband complained about my lack of interest in sex. I was so busy with work and the stresses of my new life, not to mention goings on with the children, that I had not noticed my lack of interest in intimacy.

 

For two months, my anger, irritability, and general unhappiness progressed until one day at lunch while whining about my situation to a colleague, also a critical care physician, she opined that I was depressed, and recommended I see a psychiatrist friend of hers. Fortunately, this physician worked me into his schedule quickly, put me on an effective medication, and over the next six months, I gradually recovered. Thank goodness I never felt hopeless or suicidal, as some women do.

 

As a neonatologist I knew plenty about postpartum depression but never considered that diagnosis for myself. It is amazing to me now that I was unable to identify what was happening. My symptoms of depression were both classic and comprehensive: fatigue, poor sleep, foggy thinking, inability to focus or concentrate, headaches, lack of interest in food, weight loss, irritability, inappropriate anger, and lack of interest in sex. I quite simply assumed that I was transitioning poorly to my new job and ruled out postpartum depression since my baby was already six months old when my mood changed.

 

During this period, my feelings of guilt and self-doubt were inexorable. I felt like the worst mother and wife ever. It is only because I saw a good psychiatrist, and because medication and psychotherapy worked for me, that I recovered. These last fourteen months - this stressful pandemic living - have been difficult for many working mothers. Our jobs and our home lives have changed dramatically.

 

If my story resonates with you, and you recognize any of these feelings or symptoms, please talk to someone – a counselor, a therapist, a social worker, a pastor. Feeling this way is not normal despite how much we may convince ourselves otherwise. These symptoms indicate a severely depressed mood, which may occur anytime within the first year after giving birth. Or you may have a major depression unrelated to childbirth.

 

You are not a bad mother if you develop depression. Mental illness is a genuine biological illness, like diabetes, or asthma. Moreover, depression is treatable. With medication and psychotherapy, you can feel better. I am living proof of that.


 

Susan Landers, MD

https://susanlandersmd.com

Her new book, “So Many Babies” can be found here

Tuesday, June 1, 2021

Lack of Headspace: Mind Mapping

 Recently, a blogger/influencer I follow on Instagram introduced me to the concept of a mind map. Basically like a giant plan of what is going on in my life, what is taking up my headspace, what I am thinking about, worrying about, need to accomplish, hope to accomplish. 

Basic Idea linked here

I have just been so mentally exhausted lately. My mind has so many "things" going:" passion projects, work projects, home projects, relationship projects, mom projects. In addition to the mental load of end of school year/ camp/ summer/ moving/ COVID testing/ travel etc that takes place on a daily basis. I was told in the beginning of medical school that training is like a treadmill. You just have to keep going. Well, now it's going just a little too fast for comfort. 

The mind map helps me see it all laid out. It helps me prioritize, create and construct a to do list, allows me to cross things off that are complete, or are deemed unnecessary once written out in a bubble on a piece of paper. It helps transition the sensation of "busy" to "productive." It is definitely something I plan on using going forward, and wish I would have known about it sooner. 

Tonight, instead of crossing off a bubble, I chose to write. Reaching out is a passion, sending good vibes to this community of supportive people is my way to refocus and set the tone. What do you do to decrease or organize your mental load?