Not glamorous

This week I deeply felt whatever it is that fundamentally altruistic people who go into medicine but end up not practicing altruistically feel that makes them not do so. I’m tired, physically, existentially. I’m sick of delaying gratification and waiting for the time I can do the things I want to do. I want to travel, read books, do crafts, travel, fix up a house (just a little, not like Money Pit style), walk my dog, oh and travel. I can see why private practice life has such a siren song to those folks who started med school thinking they’d end up on a reservation or in the inner city or rural hospital or at an FQHC. I don’t think it is going to fundamentally change my plans, but I can see why we have a crisis of distribution in medicine.

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Today I was reminded that days of constant pain are exhausting and emotionally stressful. And that pain relief brings with it the sleep of the innocent. I mean, I knew those things before, but today I experienced them again. I got a steroid shot in my L knee. Long standing issues, my L knee has. Missing a part, kind of unstable, makes trouble for the neighbor joints. In the 30 years I have struggled with this knee, I have developed solid strategies for dealing with the pain & injury when it comes up (off the top of my head, I thought of 7 times but there are probably more that weren’t as emotionally charged and therefore memorable). Unfortunately those strategies involve rest, proper exercise, regular pain meds (hold on, forgot my nightly ibuprofen…), icing & probably physical therapy. I cannot rest, I don’t have time or access to a pool for swimming, time or extra cash for PT, regular pain meds & icing are the best I can accomplish. Unfortunately dosing q6h is a bit challenging to my memory, even if I carry ibuprofen everywhere with me.

So, steroid shot. With lidocaine. Which has worn off by now but still it feels so much better. But more full of fluid than I’ve ever had it. Residency is a very deconditioning event, especially in middle age. If residency were designed for 40 year olds, it would take longer but be less time consuming from moment to moment. People in their 40s are not is the same hurry that people in their 20s are in. There is a sort of existential urgency that slows over time. Like the escape velocity from childhood is still driving them forward. Telling a person in their 20s that it is okay to take a year off, go a little slower, don’t worry about getting there just yet, is like speaking to them in a way they literally cannot understand. “Why the old lady suddenly talkin’ in word salad?” they think to themselves.

I don’t begrudge them the urgency at all. I had it when I was their age. I remember feeling absolutely justified in the decisions that my urgency inspired: marriage, graduate school, home purchase, childbearing, job changes, religious pursuits. I **needed** to do those things RIGHT NOW. I don’t regret those decisions, I just realize that I’m making my plans with a different background velocity these days and it is hard for me to muster the same sense of urgency that many of my peers show about life.

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Parenting teens subjects One to a regular whiplash. I have gone from feeling horribly desperate on Tuesday to feeling a bit more put together and calm on Thursday. Feeling like my children were suffering, I was not fixing it, I had no idea how to fix it and dear sweet ever loving Honey God, how was I ever going to find the time to deal with All. These. Things.

Turns out that my kids were having a hard time, but it was mostly transient (I need to reflect on how they spend their vacations and how it impacts their overall well being going forward). The things I was doing WERE helping, and I thought of some new stuff and got that on board as well. But I still don’t know either who this Honey God is I’ve suddenly discovered or how I’m going to find time to deal with everything. One bite at a time, I suppose. And I was instructed to pursue treatment for my stupid knee by someone I trust and respect. And she was right. Because being in pain makes everything harder. Now I will just try to do the next right thing, and the next right thing and the next.

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I’m now 1 week post-steroid shot in my knee and 3 days into some simple PT rehab exercises. I’m a highly adherent PT patient. They hurt so bad the first day, I could only do 4 of the 10+ exercises in the regimen. And the second day I honestly considered skipping bc I was worried the pain would be too bad. But it was better, and today was even better. Ainsley & I have joined a kickboxing gym (called 9 Rounds, it’s like Curves but with punching & kicking. I’m very excited). She’s gone twice now and I haven’t been able to work out yet (the registration was a really good deal so I just went for it, even though I know it will be a couple more weeks until I can workout).

Happy New Year

I’m really grateful for my dog. And my friends. Who help with my dog. But mostly my dog. He’s sweet and loves me and makes me laugh. I mean he’s the kids’ dog but I’m really grateful that he stays here with me when they go away. He’s very snuggly.

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Do you ever have those days where you’re just in a foul mood? I’m having a stretch of them right now. I know that it is temporary, but it still sucks. Some of it is because of the time of year. Some of it is burnout. Some of it is because of the day I had. Some of it is because of adulting life stuff. None of it is world-ending, but taken together they are pretty crushing at the moment. I’m fantasizing about holing up in bed for days on end, my appetite is shot. I really wish I could sleep in or nap. Probably both. Let’s break it down one by one.

1. Time of year: In this instance I don’t mean December or “the holidays” I mean time of year in the resident calendar. With the “new year” being July 1st, I’m in my 2nd year hump time right now. It’s been a hard year, I know that I am getting better at my job but I haven’t had a chance to really demonstrate mastery yet. I have done a LOT of nights and weekend call and it is exhausting and I still have 6 months left. BUT. It will get better. The second half of the year is reallyreallyreally nice. I remember thinking the second half of last year was lots better and people generally agreed that for all years of residency, the second half of the year is a great time. 
2. Burnout: One of the hard things about this schedule with lots of days in a row and lots of weeks of nights is the quantity of time I have to ON. I am craving a few days to just lay around in my pajamas and watch crap TV. I want to not have to decide things. I want to have some fun and relaxation. But my kids will be back in 2 days and in 4 we are going to NYC for vacation and I’m so very much looking forward to that. 
3. Ugh my day: I wrote before about delivering a preterm baby that had died and I remarked that in my anxiety and focus about taking good medical care of my patient, I somehow forgot to FEEL any kind of way about the experience. I postulated that when I was more comfortable with the role, perhaps I would feel more. Well, today, unfortunately, I can report that to be in fact what happens. Few things are more tragic than a fetal demise except maybe a fetal demise at Christmastime. I felt all kinds of ways about this today. It was harder than last time, for lots of reasons. 
4. Adulting: You know, this is a really unrelenting part of life that I look forward to being able to outsource in the future. I’m going to have people, minions, assistants, something. People to clean things, wash and fold and walk dogs and pick up poop for me. I’m going to be less stressed about paying bills and I’m going to feel safe and secure enough in my financial status to be able to use autopay more than I do now (too many years of living hand to mouth with a very unstable income have left me scarred). Being an adult is so tiresome. 

I’m not prone to ennui, depression or self-defeating attitudes. I know this will pass. I’m sure there are more reasons than these for me to feel existentially tired. But it will pass. I largely define my self-image as a Woman Who Takes Care of Things. Every once in a while I need to let myself feel this fatigue. I’ll get bored of it very soon. But right now, it is making me feel heavy.

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I just finished my last shift of the Stretch of DOOM. I will now be off of work until next weekend. I have very many observations and lessons from this stretch of time that I need and want to put down on the page but tomorrow the kids & I are going to NYC to see friends and visit the city for their first time. The alarm goes off in too few hours for me to get settled into writing. More later…

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The kids & I are in NYC, Brooklyn specifically. We are staying with friends and having a fantastic time. We’ve explored Brooklyn, gone to the Met, seen the High Line, shopped at some amazing place called Century 21. Tomorrow we’ll see Book of Mormon and explore a little bit more (D was promised an arcade and A was promised the NYC public library). I’m not taking pictures because I don’t want to look like a dork and it makes my kids roll their eyes. Also it is cold. My friend got some nice pictures of D climbing scaffolding with the Empire State Building in the background. I’ve got one kid who is loving NYC and another who isn’t really, aside from the shopping. I mean it is hard to not be impressed by the Metropolitan Museum of Art but if anyone could do it, it would be a teenager, right?

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Part of what has made this vacation nice is the lack of plan. I didn’t have time to set an agenda and we’ve decided to be pretty organic about what we are doing. Which means some sleeping in, some laying around in the evenings, and long lazy rides on the subway home. After just 2 days of reduced responsibility and increased sleep, I felt ready to study again. It only took a teeny tiny break for me to be interested in work again. I love my job. I can totally listen to CREOG topic podcasts and compose op notes in my head while I’m on the subway. Decision fatigue has hit me hard with the latest string of work. I’m glad to have a break.

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I am a supporter of out of hospital birth. I am a supporter of midwifery care. I am a supporter of delayed cord clamping, water birth, low intervention, unmedicated labors and even of lotus birth. I’m pretty grossed out by placenta encapsulation from a food handling and meat preservation perspective but I’m not opposed to it out of hand.

In addition to all these things, I’m also a supporter of trustworthy prenatal care, appropriate scope of practice, timely referral to higher levels of care as needed and respectful transfers between home and hospital (with respect going both ways).

As safety net providers, we often see patients who are home birth transfers, at varying stages in their care - prenatally, intrapartum and postpartum. When we care for these patients, I am full of empathy and respect for their choices, things haven’t gone how they’d hoped if they are with me, but that doesn’t mean it has to be a bad day. I sometimes have less respect for the providers who set us up as slice-happy demons, hospitals as dens of horror and worst-case scenarios, who’s propaganda indoctrinates patients to make choices that can harm their and their child’s health. I have little patience for out of hospital providers, doulas, childbirth educators or anyone who sees their role as protector, with a chip on their shoulder, who prefers to foment conflict. It doesn’t help anyone - not your patient/client, not you, not your reputation, not your profession.