Really important things like, what I smell like

It is not in my nature to stay down for long. If I can, I like to process, get help, resolve. If I can’t do that, I can compartmentalize like a BOSS. Also I have amazing, loving friends and family who are helping me with love, hugs, emotional and material support.

I wasn’t kidding the other day, with my post title that my mantras are efficient. These are a few that I’ve been collecting the last few months. I write them down when I think of them or hear about them. 

Here is my latest compilation:

• No Matter What
• Be here now
• My life is mine
• This too shall pass
• Comparison kills
• The next right thing
• Context
• “True joy is a serious matter” 
• Ebbs and flows

I decided that tonight the kids & I needed a little active fun. Not just a movie, which has been our standard entertainment in various forms, but something active and engaging. After celebrating National Popcorn Day, we discussed our options. We considered laser tag, mini golf, bowling, and other ideas. Ultimately we settled on ALL the things! There’s a place in town called the Fun Depot that has it all, along with bumper cars, go carts, arcade games, a rock wall and more. We had been planning a trip to Fun Depot since their birthdays in September (my mom gave them money to go, it had been sitting in an envelope on my bookshelf). We played games, we fed the fish in the koi pond, we played free for all laser tag in a pretty big arena with the three of us! Ainsley bought us pizza and we played until they closed the place down!

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I had a patient recently who had a rough course after a surgery and because I had the time and she was inclined to ask about it, we talked a lot about why certain things were done at certain points and why they were not repeated later and what different things were done later in her course. It was interesting to have such an engaged patient asking specific questions and wanting to understand more in depth what had happened and why we had decided to do the different things we had done.

As a part of these conversations, it came out that she disliked some of the people who had taken care of her over her >1 week stay. Actually it was more that she disliked what they were telling her (like that she was stable for discharge when she didn’t feel stable). And she asked me why when some of those people came in the room, I never said anything. It was interesting for her to learn some of the power dynamics and roles of a resident care team. I thought I’d share some of the insights with you.

When you have a resident taking care of you, she is absolutely going to be part of a multi-resident team that is led by an attending physician. “Attending” is anyone who is out of residency to whom residents report, usually it is a faculty member. (Physicians who are out of residency but don’t have a regular teaching role in a residency program are called “privates”)

In the morning, one of the residents will “round on” you. That means they will be familiar with your history, your overnight course and the general trajectory of your hospital stay. They will do a brief physical exam, maybe check out your incision if you had surgery and talk to you about how things went overnight and what might happen during the day. Then they will leave your room. They’ll have a note to write to document the encounter and they will present your case to the other residents and the attending where a final decision will be made on the plan for the day. Then the attending will come into the room (ideally, sometimes we can’t get to everyone before the first surgery of the day then we have to come back later in the morning). The attending will say hi, share the gist of the conversation that was had amongst the team and finalize the plan. And yes, when the attending talks, the resident is listening. Not talking.

When you have a resident care team, there may be multiple plans formulated in the morning before the final plan is communicated to you. And unfortunately different attendings make different plans so your plans might change from one day to the next. This can make the care of a resident team seem confusing. But it is also a case where lots of people are thinking about your care, attendings are trying to teach residents how to manage cases like yours and they are careful to be making thoughtful plans that are backed by as much research and experience as possible. There are downsides to being on a teaching service but there are also upsides. It is absolutely your right to understand the care you are getting, who the members of the team are and what their roles are in your care. If you don’t understand what is happening, always, always ask!

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What if I wanted to be a sillier, more joyful person? How does one go about making that sort of change? I spent some time yesterday with a friend who is silly and I was reminded how much I enjoy that sort of interaction and wishing that I could manifest that more in my life proactively instead of waiting for someone silly to come along. I am going to have to think about this.

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It turns out that one of the best things to do to be a more joyful person is to decide you want to be a more joyful person! And embrace the process of re-defining your daily experiences - sure teens can make me crazy but am I going to gnash my teeth or am I going to find the poignant humor available to me now that I’m not the one experiencing adolescence in all its power. And choose who you call when you are having a crazy time - call the friends who have easy laughs and can find the humor even when it is gallows humor.

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I want my house to smell good. Vanilla, tea tree, cinnamon, lavender, amber (not all mixed together!). I want to come home and be able to smell that I’m home. But I hate chemically smells and air fresheners. That’s not what I want. And I can’t do lots of incense, in the dry air it irritates my respiratory tract. I need to make a smells plan!

Even my mantras are efficient

I cannot believe the tight margins on which I am operating while my co-parent works part time and is so totally disconnected from the day to day operations of his kids lives. Honestly when we broke up I didn’t think we’d end up in this situation. After 15 years of being an engaged and loving father, I am totally puzzled that he has made life choices that both keep him living so far away from his kids and so incapable of supporting them financially. I’m not sure how I am going to make it through this winter. The weather here has been a lot colder than I expected and my utility bills are a LOT higher than they were over the summer. Meanwhile, I get serious pushback when I try to discuss expenses we agreed to share and the fact that our son has had braces on his face for 7 months without any orthodontist care. The psychological stress that I have trying to negotiate these conversations is immense. I get called greedy, told that “my financial problems” are not his responsibility, accused of suggesting things I have not suggested, like that he go live with his parents. It would seem that for now, divorce has not freed me from fighting with my co-parent about money.

My neck has been hurting so badly it has been giving me headaches. My shoulders are rock hard, I can’t turn my head, I wake up with pain. I’ve been trying to stretch my neck, work on the tension but really the thing I need is a massage. I need to figure out a way to get to the community wellness nonprofit place to get a massage. They are relatively inexpensive and I think I can swing it. If I can find the time. Maybe this weekend.

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We had some unexpected (to me, but I’m not really paying attention) snow and another brittle cold snap. The kids didn’t have school yesterday and it was also cancelled today. I had clinic in the afternoon. When people started cancelling, they sent some of us home. I unabashedly raised my hand and offered to leave. I know it is something of a faux pas to try to get out of even a little bit of work in residency, but I was so burnt I didn’t even care. After I got to my car, I thought I’d try to get a massage. Turns out the front desk lady had *just* gotten there (at 3:15) and there was one therapist who was willing to come in if there were any clients. We agreed to a rendezvous time and I had time to go buy groceries and a snow shovel before getting a very necessary massage. My shoulders feel so much better. I sprung for a 90 minute massage and it was worth it. It took most of the time for her to get my muscles loose enough for her to be able to get deep into my knots.

I love “alternative” health care. I actually cried while I was getting a massage and it helped me release some of the tension and pain I’m holding onto. My body is wearing my heartache right now and it is causing me physical pain. I’ve already blogged about feeling physically starved of touch and the hardships of being single, busy and not interested in cheap sex. I think if I could afford to get regular massages, it would really help my touch-starvation. It is something I aspired to at the beginning of residency, I went to this wellness center and got a couple of cheap massages when I first got here. But the truth is I don’t really have the money to spend on myself in this way. I did it this month because I was in pain. But I have a physical therapy bill that is gathering dust and some orthodotics that apparently I’m going to be paying for alone, and dear gods if the weather doesn’t cut us a break soon, our utility bills are going to break me. I’m depleting my hard won savings account for monthly expenses. For now, a massage is a luxury if it isn’t an emergency.

I feel compelled to remind myself that things are much better now than they were before. Every other Friday a magic fairy puts money in my bank account, reliably and predictably. Though I was depleted over the holidays and with the weather, I have been able to squirrel away money and I expect when my electric bill isn’t $200/month I will be able to do so again. The days are lengthening, I come home to West Asheville with a beautiful view of twilight over the mountains. Imbolc is on the horizon. Winter is breaking. Like many things before they end, Winter is storming and furious, fighting against the inevitable. But it will end.

This Too Shall Pass.

It's late, I can't think of a snappy title

Today was a post-call day. I worked the last 2 nights on L&D and today had no big responsibilities. The kids had a 2 hour delay (sooo cold!) so when I came home they were still asleep. I walked Bear and then watched some TV until they were ready for school. Because of the cold, I offered to take them to the bus stop but then we decided just to drive to school. I got a lot of lounging and some netflix in and a little nap. Post call days are a little tough bc I don’t want to sleep all day because then I won’t sleep at night! Even so, I’m sitting up in bed at 10:30 as bright eyed as if it were AM instead of PM. Thankful I can use melatonin to make myself sleep!

Tonight the kids & I watched a movie & had dinner & microwave popcorn on the couch. They were both very snuggly as seems to be the case when we’ve been parted for a while. Now I’m going to color and watch a little more of Season 2 of Travelers on Netflix and wait for the melatonin to kick in. Got an extra on the nightstand just in case!

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You know that old joke about making your headache go away by dropping a brick on your foot? Or the one about hitting yourself over the head over and over again just to see how good it feels when you finally stop?

That kinda sums up how I feel tonight! My son’s soccer practice was cancelled tonight (it is raining cats & dogs and the field is flooded). It was an amazing gift not to have to run around tonight and be out late (soccer goes until 9). It’s just a little too far to come home and I need something to do that doesn’t cost money 3 times a week. Even a cup of tea adds up to an untenable amount with that frequency. Yesterday I laid down in the back seat of my car and dozed while he was at practice. I never even left the parking lot! Earlier in the week I discovered that Whole Foods has free wi-fi and I sat and watched TV there. It felt really good to lay down on my bed and not HAVE to get up!

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I have a patient who nearly died and frankly isn’t out of the woods yet. She’s someone I know relatively well, seen her a few times in clinic and inpatient. She got sick really fast and all the teams who have worked with her (she’s been handed around a few times as the acuity of her situation increases), all of our heads are spinning. We are reflecting on what we did, what we could have done, what was happening in the past before we knew why she was getting symptoms that didn’t seem to fit. For all the many MANY medical inaccuracies of the TV show House, MD, sometimes finding one cause that explains the many symptoms is really what you need when treating a really sick patient. Honestly when you have a patient with many different symptoms, they are usually are caused by a bouquet of chronic diseases or complications but for this case, once we identified the root, it explained all the problems. Now that she is not under my team’s care, I’m still following her case, she was my patient before this admission and I feel very connected to her. I’m very worried about her. And I will never forget these symptoms and how quickly she became gravely ill, right after we thought she was responding to treatment.

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On the heels of telling you that I am very worried about and distracted by a very sick patient, I will note as well that I cannot muster the distress to cry about her hospital course, which would be an entirely appropriate reaction. I have a lot of reasons to cry and a lot of skill at boxing it away. I’m working on a moderate amount of unpacking of my emotions, trying not to keep myself totally walled off from an emotional process but also not allowing myself to be mired down by my many stressors. I know there are tears in my heart somewhere for my patient. I just can’t find them with all the boxes.

I consider it a win that I managed to find space to cry over my divorce earlier this week. And that I have also managed NOT to fall apart as my kids are distracted and distracting with their end of the semester projects and finals preparations. Their projects become my problem as well - I had to buy a printer, they need my computer and my room to type & work. It’s a razor’s edge, this balance!

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Deleted my dating apps from my phone today. Actually felt really good about it. I’ll get there, but I’m not there now. It feels better not to try.

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I’m really enjoying a level of comfort, familiarity and mastery at work right now. I mean it is a tiny amount of stuff, but still it is a portion of my eventual scope of practice. I’m familiar with the places we get information when we don’t know what to do, I’m starting to get comfortable with some simple, more frequent complications, like post op pain, postpartum bleeding, fetal heart tracings that look worrisome and most of the standard full term complaints & queries that bring people into triage/outpatient L&D. It is really easy for me to panic and feel inadequate when I see the 2nd years growing into their own comfort level with the content that they are mastering. Watching them precept births, manage complicated, sick patients that I’m not yet responsible for and so forth. I work really hard just to feel proud of them and remind myself of one of our programs mantras, “It’s a 4 year program.” Yeah, I’m not there yet. But I’m not supposed to be. There will be more learning curves and there will be more times when I feel overwhelmed but this isn’t one of them and I’m really grateful for that! 

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In 3 and a half weeks it will be my 20th wedding anniversary. Last year was awful. The year before that was rocky. The one before that I was pretty sick but the marriage was in ok shape. But the rest of them were normal, happy anniversaries. My marriage had a lot of excellent years. Dreams shared and achieved, milestones observed, laughter, travel, love, friendship, children, homes, cars, pets, careers, extended family, friends. I’m feeling a huge sense of loss for those beautiful years.

There’s a part of my mind that still blames me for the dissolution of my marriage. It says that I gave up, that I didn’t try hard enough or wait long enough for the great times to come back around. I don't think so, but maybe. But I don’t think people work that way. We don’t go backwards. We might be able to find our way forward to a new place that’s great, but we can’t go back.

Missing those beautiful years has me fantasizing, engaging in a bargaining phase of grieving. Thinking about making overtures of reconciliation - what I would say, how I would approach it, how it might go from there. Fortunately, I have been meditating for some time and have become quite skilled at just watching these thoughts, appreciating them as they bubble up and watching them as they float through my mind. I’m able to connect the dots and acknowledge that reconciliation is *probably* not what I really want, that I’m processing loss and missing a thing that is gone and wishing it could be here again.

A more mundane update of the last few weeks

I almost did a whole c-section as the lead surgeon, but for a bit of a tricky presentation (baby was not just butt first, but its little feet were sticking right out the incision) and some unusual bleeding. But the stuff that was “garden variety” was all me. Not perfect or with any finesse by any means, still.

I also had a teeny tiny shoulder dystocia (not in the c-section). It resolved very quickly and was quite straightforward. But I called it and I ran it and, I think, I kept a rather smooth head about me as I did it. Teeny, tiny. I mean wee. Really. But still, I saw it, I called it, I addressed it.

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Delivering babies is a fun job, no other way of looking at it! I enjoy working on L&D and I’m so glad that I’m gaining some confidence and some competence in that realm. This last rotation, I managed some things that were more complicated than I would have been able to handle in my first rotation - a few bleeding problems, some babies that needed help coming out, some labor patterns that looked not so great, some breech cesarean deliveries and evaluating and making recommendations for when my upper levels needed to take over and being able to give them a comprehensive report of the patient I needed their help with. I admitted one woman to the antepartum unit (we call it MFM, for the high risk pregnancy specialty) because the upper levels were handling emergencies. She ended up being a lot sicker than I anticipated and while I had lots of support from faculty in the management of her case, it was so stressful I was giddy with relief when things calmed down and I was able to hand her off to the usual high risk care team. I will be able to take care of these patients soon, but not yet! So far, I’m happy to report that my compassion is intact - when we get patients with really complicated situations - polysubstance use, undiagnosed pregnancies in the 3rd trimester, trauma, etc, things that make patients “difficult”, I find that I’m still able to engage with them and talk about their needs in ways that compassionately frame their circumstances.

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I really like living alone. Granted, it’s been 2 days. We’ll see how I feel in another 8 or 9. I’m especially grateful to have a dog while living alone. Bear gives me a little bit of a frame for my evening. Tonight I worked late, writing notes & orders for some afternoon excitement that got away from me. When I got home, I got a warm greeting, made some dinner and fed him. Then we went for a tiny walk. After a shower, I sat and watched TV while playing with various dog toys. Now we are in bed and we’re both ready to sleep, I think. I aspire to some meditation & shrine time during this break as well. I know I’ll get there, and I’m looking forward to it.

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The OB rotation is sort of the “why we are here” part of residency. Most people become Ob/Gyns because of the delivering babies part of the job. It is a big draw as a med student and really is (for me) the best part of this specialty. But I’m finding that the rotation itself is a rough experience. By its nature, Labor & Delivery is an unpredictable place, you never really know how your day is going to go. Will you be doing surgery? Planned or at least anticipated? Super urgent? Very tragic? Will you be delivering a baby? How will that go? Shoulder dystocia? 3rd degree laceration? NICU transfer? Maybe all of that, maybe none. Who will show up in triage? Will they be admitted? How sick will they be?

And the workspace is a loud, busy shared room - 8 or 9 computers, a conference table, right by the nurses station. Residents, attendings, midwives, community docs, regular rounds & huddles for all the teams to be in good communication. And for some reason playing music is the norm. Honestly, it’s a miracle I can get *anything* done in this space. I’ve got ADHD, hearing problems that are exacerbated by background noise and prevent me from wearing earbuds or ear plugs and I’m an introvert (albeit an outgoing one) and though the work is exciting and inspiring, this rotation also drains me in a way that none of the other ones do. They all drain me in different ways, this is just how this one does.

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My kids are spending a bunch of their break in California with their dad. They are about halfway through their trip and it has been just me and the dog. I’ve had a few busy nights but mostly I’m enjoying coming home from work and vegging out. I thought maybe I was getting a cold but some soup and early bedtimes seem to have nipped it in the bud (fingers crossed).

This solitude has given me an unusual space to think and feel. I’m *really* good at compartmentalizing, at protecting myself from hurt and getting shit done. Being busy taking care of my kids, my patients, my obligations to my education and my household are great distractions. Being here alone is giving me space to feel, to react to my life. My life is right now is exactly the way I have chosen for it to be: residency, divorce, single parenting, the whole nine yards. The things I lost, the things I’m grieving for, they were gone before I said yes to the things I have now. But I haven’t really processed that loss in any real way. I’m too busy keeping the trains running and I’m too good at keeping the sadness boxed up.

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The kids came back and I was so happy to see them, despite how much I enjoyed my Me time during break, I’m keenly aware that parenthood is a limited time offer. I can see the end of this part of our relationship and I’ll miss having them around, they are really great people. They come home on a redeye and the next day we drove down to Florida to see my parents. It was a loooong drive but when you go from 29 degrees to 70 degrees, some miles are worth it! We made the trip home over 2 days, stopping at our friend’s home in South Carolina, pretty last minute and very graciously received. Bear probably had the best time of all of us, there were dogs everywhere he went, and he had a great yard and some choice digging time in Florida. He’s filthy and exhausted now, fortunately it will be very boring around here for a few days and he’s going to the groomer on Saturday!

Wherein I process loss and try to learn from it

One of the things that I had over the break was processing time. It turns out, I’m really still very very sad about the dissolution of my marriage. 

Ah, the sadness, wow. I am so sad. I am not living the life I imagined for myself and I’m still mourning that loss. I don’t know what the future will hold, my friends who have been through this tell me that there is joy and life on the other side and right now I’m just taking their word for it. I hate mourning, it feels so futile. But I also have enough insight to know that it is necessary. That papering over it with my image of the person I want to be, a version of me that I hope will come to be someday, that doesn’t help. It just suffocates the person I am right now. Honestly the person I am right now isn’t really someone I want to be anyway. I am sad and scared and alone. It is so hard not to turn back to him, to re-engage in a friendship that has sustained me through so many hard moments in my life. I wish it could help me through this one. I want my best friend back. But the fact is my best friend has been gone a lot longer than this year. My best friend stopped caring about things that were hurting me a long time ago. He stopped seeing me as a whole person who was strong and weak, providing and needing, seeking and wise. We became caricatures in each others’ minds some time ago.

I have lots of conflicting feelings about the choices my ex is making. I also hate the term “my ex” it feels like it defines our relationship and our history by only the worst part of it. We were friends, lovers, each others’ biggest fan and cheerleader for over 2 decades. But we grew apart. So by all means, let’s focus on that last bit.

I continue to want well for him, worry about him and wonder how he’s doing. And from a practical perspective, our lives are still intertwined, while we are co-parents, and while I depend on him for child support, I am still invested in him. As much as it pains me, as much as I don’t want it, it is still true. But I have taken myself out of a role where I get any insight or any influence into this life that so much affects my own. That is really hard for a control freak to handle.

I am struggling with what to say next, it is all an unformed mass of inarticulate pain - regret, disappointment, sadness, failure, shame, defeat, helplessness. I didn't want this for myself and I keep coming back to that refrain, "This isn't how I wanted my life to turn out" I keep trying to make it look like something other than what it feels like - a failure. I guess what I'm trying to do is build the thing I'm going to have next before I've let the dust settle on the thing that fell down. Cart before the horse is really classic Larissa. Nice to know that I get to keep taking the same approach in a myriad of different ways (/sarcasm). 

The concrete take-aways from this break will be helpful, I think:

1. I need to carve out more Me time at home. There will be nights that Mom just goes to her room and disappears. No dinner, no dog walking, not much interacting with kids. I need more cocoon time than I’m getting.
2. I’m going to stop trying to date. It was a poor imitation and my heart was so not in it. I was like a robot and it felt so wrong. I am going to update my profiles to highlight my extreme unfitness for LTRs. If people want to make friends, I’m game. Otherwise, I’m officially off the market for the foreseeable future. 
3. I’m going to try really hard to get massages. Time and money are very tight but it would be a good thing for me to get some touch and some relaxation. I’m so human contact starved (and have been for at least a year now), but I’m not interested in hook ups and I don’t have the right kind of friends here yet to feel okay with a FWB set up. I’m a very sex positive person, but I’m also really not into cheap sex. I have expensive tastes, emotionally speaking, and it is taking some time to build up the accounts
4. Spend more time crying. Even if you have to write super emo blog posts to bring out the pain. I’m not nearly as cried out as I need to be. I imagine, theoretically, there will be an end to my tears at some point. But I can’t see it from here yet. 
5. For the love of all that is sacred, Larissa, be gentle with yourself.