Showing posts with label self-care. Show all posts
Showing posts with label self-care. Show all posts

Tuesday, July 28, 2015

Intern of the Year

Eight years ago this month, I entered the hospital for the first time with the label "MD". My assignment was a prestigious transitional year internship at a large private/academic hybrid hospital. Amongst my rotations would be Internal Medicine, Surgery, ICU, and some electives.

My internship year was wonderful. I relished in the new freedom of managing patients and writing orders. I thrived on the stress of the endless to-do lists; each time I checked a box on my paper, I got a sense of thrill. The learning curve was so steep, and I became addicted to finding ways to be efficient. I enjoyed my co-interns, the staff, and the attendings. At the end of the year, they voted me Intern of the Year!

Then I started my residency in anesthesiology. I had done no anesthesia rotations during my transitional year and had instead chosen to focus on getting exposure to things that I was likely to not see much in the future. The change was abrupt and was not exactly smooth. Like the swipe of an eraser on a white board, all the positivity and excitement quietly vanished. The sheer volume of material to learn was overwhelming, not to mention the technical parts of the job – placing IV’s, preparing and dosing drugs, mastering the anesthesia monitors and ventilators, patient positioning, and the delicate dance of the patient consent process that is unique to anesthesia. Every day was a great battle to keep wits and stay calm while learning the academic and procedural aspects of the specialty.

As the fall months spread into winter and the days became shorter, a gloom washed over me. Rushing to work in the dark and returning home in the dark… was this what I had signed up for? Were other residents feeling the same way? How did I compare? These questions never really get answered since we don’t work together in the same OR. Come wintertime, performance evaluations from faculty started to trickle in. Some comments were positive, but the negative ones cut deeply into my motivation and self-esteem. But I was the "Intern of the Year"; what was wrong with me?

I continued to struggle with procedures, and my In Training Examination scores were well below average. I suffered from incredible fatigue and knew deep down that something was wrong. It took many months, over half of my residency, to figure out what it was: a pituitary macroademona had taken residence in my sella and was wrapping its tentacles around my optic nerve. I was going blind and didn't even notice! Within a week after my MRI, I was on the OR table being anesthetized by one of my attendings. What followed was a long hospital stay and complications of hyponatremia requiring readmission. After a long period of healing, I returned to residency and finished my training.

A stay in a hospital ICU will change you forever. My achievement record during residency, despite having been crowned Intern of the Year, may have ended up being quite lackluster... but my experience as a patient was a priceless learning experience that I'm grateful to have had. It helps me connect with my scared and vulnerable patients every day, and it is a constant reminder of how lucky I really am. And as an attending, I now thoroughly enjoy the practice of anesthesia.

I'm shortening and simplifying a very long and detailed story, but I write this to inspire all the new interns and residents with their sights set on perfect ITE scores, accolades, votes, and awards. In the end, none of that matters. Your years of training will hold a mix of times of difficulty, times of gratitude and times of great learning. Do your best to navigate these times with balance, and make sure to take care of yourself!

Thursday, November 20, 2014

Vacation sans bebe

I read a few articles recently about Americans and vacationing. Of the only 25% of Americans who have paid vacation days, they have an average of 3.2 days left unused each year (OECD, 2013).

Unused vacation days. Not us!!! We use them all up. Zo travelled with us for the first close to 2 years of his life. However, once he was weaned and could no longer be lulled into a breast milk-induced-coma, we began planning trips without him. Many thanks to my parents and in-laws. And thanks to my cousin for letting us use her timeshare to enjoy fabulous, affordable vacations.

Here is my chronicle of our delectable and delightful second Vacation Sans Bebe, New Orleans style. I will focus on the food because New Orleans has to have some of the most amazing, creamy, luscious, sinful, gluttonous food around and there is just too much to write about (the wonderful people, the outstanding architecture, the cultures, the alcohol).

Best brunch ever - I can’t tell you how much O and I love an excellent brunch. My Sorority Sister B and her husband R who work for a major oil company in Louisiana met us at Slim Goodies. The french toast below was the best I have ever had; crispy French bread crust, fluffy middle, dusted with powdered sugar, and drizzled with syrup! Paired with mimosas that you prepare yourself (orange juice from Slim Goodies and prosecco from a neighboring restaurant they have an arrangement with), it was amazing!

(scrambled eggs, french toast, and large mimosa from Slim Goodies)


Best lunch - oooooh oooooh oooooooh. Gumbo and crawfish at Cafe Reconcile. Amazing nonprofit organization that trains local teenagers and young adults for careers in the restaurant business. Wonderful staff. Delicious food. The crawfish sauce was so complex yet not overwhelming. The grits were soft but had some substance to them and were perfectly seasoned.

(crawfish on grits, from Cafe Reconcile)

And the tie for best dinner - Bacchanal Wines and Houstons.

Bacchanal had to be one of the most fun experiences. We took a taxi into the Ninth Ward past factories and train tracks and end up in a cute neighborhood. You see a line on the corner entering a house with a big fenced in yard. You enter what may have previously been a living room, but has been converted into a wine and cheese shop. You purchase a bottle of wine, get a cheese plate (we unfortunately didn’t order one and the line was too long by the time we wanted some cheese), and go find a table. There are at least 100 people sitting and standing around. There is a live band playing in the courtyard. It is magical.

My husband and I failed on our first attempts to find a table, finally separating while he waited in the 20 person long food line and me making googly-eyes at folks with finished wine glasses taking up space. Finally, a very nice retired couple took pity on my and told me to pull up an empty chair. We sat at a candlelit table talking and drinking until they left.

And then the CHICKEN arrived.

Notice how I put that sentence on its own line. I had confit chicken that literally melted in my mouth with bok choy and a yummy carb I can’t remember. I did a little research on what confit means; it is to cook meat in oil at a low temperature (it’s not fried, it like melts away, oh goodness, soo yummy). That chicken was soo freaking good I am hungry just writing about it; the skin was crispy and perfectly salted and the chicken literally fell off of the bone and just melted in my mouth. O had a grilled tilapia that was equally divine. For dessert we had dark chocolate drizzled with olive oil and sea salt with even more wine.

(courtyard at Bacchanal Wine, image from http://fleurdelicious-nola.com accessed 11/1/2014)

Beignets - and on our last night in NOLA, we toured the city, stopping in shops. Eating. Drinking alcohol-containing beverages in plastic cups while walking (crazy that you can do that legally in NOLA). We ended the night on the banks of the Mississippi eating beignets from Cafe DuMonde with B and R. We heard approaching music as a first-line band leading a wedding party approached. As is the customary, we all stood up and joined in dancing and singing “As the Saints go Marching in” under the twinkling night sky.

Here’s to the best vacation sans bebe, NOLA, we love you bebe!


(Voodoo Tour, St. Louis Cemetery #1)



Our recommendations for excellent food in NOLA:

Slim Goodies, Cafe Reconcile (weekday breakfast and lunch only, nonprofit that does job development and career training for teenagers and young adults in the Garden District), Cafe DuMonde, Houstons, and Bacchanal Wines (get there early and just go ahead and get the darn cheese plate!).

Of note, I have no conflicts or disclosures, we went everywhere based on recommendations from friends and paid for everything ourselves. All pictures were taken by me and O unless otherwise mentioned and cited.

References:

An Assessment of Paid Time Off in the U.S. Implications for employees, companies, and the economy. Accessed Oct 16 2014.

Center for Economic Policy Research. No-vacation nation revisited. 2014. Accessed Oct 16 2014.

Work-life balance. Accessed Oct 16 2014.

Monday, September 1, 2014

Self advocacy - why is it so hard?

It’s funny how a few things collide, to suddenly make life crystal clear. It’s job application time for me, and I was lucky enough to receive three offers, strangely enough covering the gamut of work life balance from no after hours to full on subspecialty. After much deliberation, I chose the job that would best complement all my roles – mother, wife, doctor, furry friends owner, health advocate wannabe – you all know the list. I recognised I was burnt out, and at risk of leaving medicine altogether if I didn’t make an active decision to change my hours and where I was headed. Both my husband and I are in high level, full time roles, something I never felt comfortable with for the children. Here was my opportunity to make a change more in line with what I wanted for my family. I’m a firm believer in if-something-isn’t-right-fix-it, don’t just wish or whinge! Fast forward one week - past all the happiness at finally making a decision, the peace that the decision was right for me and mine, excitement of starting a new job, the daydreams and plans to incorporate fitness, walk the furry friends, spend more time with hubby and children - to today. I’m catapulted from a state of contented decision-making bliss into Guilt – guilt I now know is ‘doctor guilt’ (thank you Emily). It deserves a capital G, don’t you think, for the central place it often plays in women’s lives? So what happened?

Well a couple of things. Firstly, taking this new, wonderful job involves resigning from my current job, something that I’ve never had to do before (I’m yet to do this, because I’m waiting on a formal contract). It also means leaving a path I’d always thought I’d follow, and jumping into a reasonably unknown area for me. After making my decision, I had a conversation with the boss of the subspecialty I’d originally planned to follow, creating doubt in my mind that I’d made the correct choice. She wanted me to take her job offer, and I felt like I was letting her down in choosing not to. It was also ‘known’. After the ‘doctor guilt’ came self recrimination – in resigning, I am jumping ship, baling out, leaving colleagues in the lurch. In reality, my position is actually supernumerary at present, so in actual fact, no-one is left in the lurch, but my soon to be old hospital won’t remember that. I’m now the person I never thought I’d be – the one who leaves a post early.

This really forced me to choose what was important to me. I sat down and thought long and hard about my values, what I considered ethical, the life I wanted for my family, the sort of mother I wanted to be, and whether that married with my current workload (no surprises the answer is no). I pictured myself in each of the three jobs, and tried to see how I felt, what my reactions were. I read widely, trying to build a picture of my future career options. I came across an article about women failing to speak up when sexually harassed and why we are all so ingrained to be ‘good girls’, to not create waves, keep everyone else happy. I had many long chats with close medical friends, trusted senior colleagues, and my husband, who all agreed I should take this job. People who, like me, would never ordinarily leave a post early. I was told leaving a post early is common, people do it all the time. Not me though. Never me. In an ideal world, I would ask to start the new job when this one finishes, in five months time. That’s the path of least resistance.

But spending another week, let alone another month, in my current position is too long. My family needs to make a change now. As well as that, moving now saves me time at the end – possibly nearly a year of time (due to retrospectively counting some of this year, something that probably won’t happen if I don’t move until next year). The next five months in my current job is surplus to my training needs. So, for the first time in my life, I’ve chosen to do what is right for me. I’m going to take the community based, no after hours or on call job, and I’m going to start in 4 weeks. All I have to do now, is tell them. Resign. Although I’ve decided, I still question it, and probably will, until my contract arrives, and I have to make the decision final.

So I guess two questions. Has anyone else ever left a post early? Taken a leap of faith? Any advice on whether it turned out ok in the end? Fingers crossed.

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?