Being whole is boring and amazing at the same time

Yesterday was Duncan’s 14th birthday. Despite the fact that he spent a couple of hours doing homework and he’s got a nasty cough & congestion, he had a good day. Duncan is, as I imagine most boys are, a collection of contradictions. He defies stereotyping and every time I remember that, I am rewarded by watching a part of his well-rounded masculinity grow. This year I gave him a bouquet of sunflowers and the exclamation of joy for “Birthday flowers!” and the attention he gave to that gift all day reminds me that flowers are not just appreciated by females. I gave him a funny card, because I like making my kids laugh. But I also wrote of my heartfelt pride for the young man he is becoming, with details and anecdotes. And the biggest, most heartfelt hug I got all day was after he found that card on his bed last night (because I’m busy and frazzled, it didn’t get put out with the gifts earlier in the afternoon!)

Duncan is a whole person, developing a complex relationship with how society demands that men behave. We’ve had a number of joking interactions about how asking for help is a sign of weakness and making mistakes is shameful. I know that these messages are coming through loud and clear from the world outside. I also know that now that as I’m unfolding from the stress of our previous family dynamic, I’m more accessible to my kids as a human than I was before. I yell less, I joke more, I am more flexible and I own up to my mistakes regularly. No longer do I see shock when I respond to a “Why did you do that?!?” inquiry from my all-knowing teens with “I made a mistake.” Their mom screws up, regularly and daily. And yet, she also runs a household and has a very demanding job. So screwing up is clearly not a disqualifying event for adulthood. Neither is asking for help. I am working very hard to show the kids that we are not doing this adventure alone, there is help coming from all sorts of places in our lives.

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It’s raining in Oregon. This is a very good thing.

My mom evacuated from her home in Florida, now it seems that the mighty Irma is tracking along the other coast of Florida and is headed HERE! Maybe my mom is a weird hurricane magnet. :-)

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I’m on vacation this upcoming week. Though it’s been a good, quiet weekend, I feel a little bit of pressure to be doing MORE relaxing, MORE home chores, MORE on my To Do list. I feel pressured to relax more. Which is totally insane. At least I can acknowledge those crazy thoughts for the irrationality that they are. I wish they’d just shut up. Most of my To Dos are administrative life things that require M-F 9-5 time - getting an ID, an eye exam, registering to vote. City council primary is coming up in October. Time to get involved in the new political climate! There are stacks of boxes in the office space that is the loft above my bedroom. I can feel them leering down at me from up there. That is my big home project. I’m glad the weather is cooler, that is the one place that collects heat in my new house. Which is probably why it’s the one place that hasn’t been unpacked yet. Hopefully I will be able to do some exercise this week too. I’m on the very early downside of a rotator cuff injury that has been annoying and debilitating. Not being able to do my usual body-weight exercises has me out of my fitness groove. Not super exotic goals for a vacation, but honestly, the simple joys of grown up living feel pretty sweet.

Fire on the mountain

There’s a huge fire on the Columbia river gorge right now. Many of my FB friends are posting about it so I’ve been seeing articles, pictures, thoughts and opinions about the situation across my feed for the last couple of days. I’m just starting to get a fuller picture of the devastation that this fire is bringing to a beautiful natural resource and one of the most lovely parts of a state that is pretty beautiful at baseline.

This is making me think of the attacks on 9/11. On that day, I was home with an 8 day old infant. I was focused on mastering diaper changes and figuring out how to gently wake a sleepy baby for feedings. I was in a gauzy cocoon of the 4th trimester. Of course we spent the day watching things unfold on TV, but the scope of the disaster did not fit into my brain. Tim had to go into work for some disaster management meetings during his 2 weeks off. He came home with stories of soldiers on the streets of DC, of quiet skies and meetings with Secret Service representatives who honestly said they never wanted to open National airport again. Ever. It still didn’t fit into my brain. It took me a while to catch up to the nation’s trauma because I was shielded on that day by my baby.

I’m not in a baby haze now, but the problems of my own life are very pressing, making it hard for me to process much that is happening outside of my personal existence. I feel disconnected from the world, from things that matter to me. I want to act - against the racism & bigotry that has been given license to freely express what has been fomenting under the surface of our nation, against the political environment that is acting against the best interests of our nation, for the many public health issues that mean a great deal to me personally and professionally. But I’m squarely in a “making the trains run on time” mode - do we have groceries, did you do your homework, what’s my laundry situation, crap when’s payday. I’m mired in the minutia of keeping my family operating, there’s no time for the top of the pyramid. It feels painfully self-centered but there isn’t much to be done about it except continue to console myself that This Too Shall Pass and some day I will have the space to act on my principles. Not acting doesn’t mean they aren’t there.

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This week one of my FB friends posted about the passing of a woman who has affected my life quite adversely. She was a new age guru author person who wrote at least one book (I’m sure there were more, but the one was enough for me to loathe her). The premise of this book was that physical ailments were manifestations of psychological...something. I don’t know what because I never actually read the book. And she wasn’t in any way qualified to be dishing out medical nor psychological advice. She was a voice for “alternative healing” during the AIDS crisis who claimed that a “lack of love” caused people to contract HIV. I really dislike this woman. In hindsight, I can see that her presence in my home was a sign of things to come, 2 roads slowly diverging. I don’t consider myself to be radically or unreasonably advocating for mainstream medicine, but I was too conventional for my partner. Our ideas of how to manage real, chronic health problems were fundamentally incompatible. That the problems were mostly experienced by one of us was not the issue. Rather, it seemed our differing adherence to Ms. Louise Hay’s notion of “dis-ease = disease” was the beginning of a wedge that took years to cause a split. I will confess, there were times that I saw that damn “You Can Heal Your Life” book tucked under a couch or about to fall behind furniture and I just left it where it was. Maybe even nudged it a little as I walked by, tucking it safely out of sight. I have no feelings about Ms. Hay being dead. I have only feelings about what she chose to do with her life and how it affected my own. And I have feelings about unqualified self-help gurus.

16th Birthday - My milestone as well

Today was my daughter's 16th birthday! Despite having to work overnight, it was a good day, packed with Ainsley-centered activities like eating bacon, watching movies on the couch and reading books. We tried to go out to eat and ran into a street festival downtown. It made our dinner plans complicated but it turns out eating street festival Indian food and wandering some crafty booths was just the familiar topper Ainsley needed for her day. On our way home she thanked me for a "good birthday" which made my heart light.

In turn, I would like to thank my dear friends and wonderful coworkers who helped make the day special. Catalina and Diana - I can't say enough how much I value all the love & support you've given me! Lindsay - the gift of the Sky Zone passes was more than just an afternoon of fun for me and my kids, it was a gesture of welcome that touched both my kids' lonely new-in-town selves. Mimi & Lauren thanks for the help figuring out the local options and making the shopping trip logistically possible. 

When I decided to move and do residency as a single parent, I knew that it was going to be hard and that I was going to need a deep bench of support and assistance. I had the idea that it might be easier than the isolating stress I had been feeling during med school - when I was poor and poorly supported - because I would have the space to ASK for help. At times that felt like a horribly naive sentiment but I held out hope that even though things would be hard, they would still be better. 

Having successfully navigated a milestone birthday, I feel like it is no longer doe-eyed for me to say that things are going to be better this way. I didn't do it alone. I couldn't have done it alone. Fortunately it turns out I don't have to do it alone! 

Today was about Ainsley, the beautiful, self-possessed, nerdy, strong young woman who I am so very much enjoying watching come into her own. But it was also about me, the peace of mind that having friends I could talk to, people who could help me, substantively and emotionally, create a memorable day for my daughter. It was a good Birth day for me as well. 

Spatial distortion from the bottom of the learning curve

A week from today I will be on vacation. We get 2 weeks vacation (one in each half of the year) plus time at the winter holidays. Because of my rotation schedule and the kids’ school schedule, I won’t have a vacation when the kids are off of school except for winter break this year. This was a bummer but also a reality of the logistical challenges of organizing resident schedules. We are going to work to coordinate my schedule with the kids’ next year so that I can have some vacation time with them in 2nd year. (I’m profoundly grateful for the lengths my coworkers were willing to explore to try to find a way to get me a vacation during Spring Break. This program is so supportive) This vacation is going to be a stay-cation. I’m going to unpack my office and have a housewarming party. I’m really looking forward to being able to finish that last room that is filled with boxes. I have a whole wall of built-in bookshelves waiting to be filled. A meditation corner that is itching to be set up. A storage closet that is currently empty while its potential contents clutter my space. I’m going to hang art and go for hikes with my dog. It’s going to be awesome.

The L&D rotation was intense, repetitive and high volume. I got to do many things over and over again. In the midst of it, unsurprisingly, I was feeling overwhelmed. I comforted myself by acknowledging that this was not reality - this was not what my eventual career would look like. This was a training environment. One of the differences between L&D and GYN is that, I think, GYN looks a little bit more like a real world job. Mixed responsibilities, some days clinic, some days OR, some days a combination of both. Not a lot of repetition. It is less exhausting and overwhelming but as a learner, that repetition is important for building skills. I improved significantly on post-partum tubal ligations because I did 7 or 8 of them in the 4 weeks I was on L&D. I participated in over a dozen surgical births, either as primary surgeon or as first assist. I started to gain some muscle memory and automaticity in my technique and generally became less terrified in the OR. (Less, not none) The good news about being an intern is that there is so much to learn that even in a less intense, less repetitive environment like the GYN rotation, I have no doubt that I will learn things - from nurses & scrub techs, from listening to attendings & upper levels do the complex cases that are not appropriate for my level of training, from having time to read practice bulletins and committee opinions and textbooks and Up To Date.

Yesterday I made an off-hand comment about the difference between a 401k and a 403b and one of my colleagues said, “You’re a real adult, aren’t you?” I forget how many things I’ve learned about the world in the years between when I was a young professional and today.

I just finished a week of the benign GYN rotation. This rotation has a much lighter patient load in the hospital, which has meant later starts in the morning. It also has me in clinic most afternoons instead of in the OR or working on an inpatient team, meaning earlier release times as well. The flip side of the extra time is being cast about to different locations (outpatient & hospital-based surgery as well as clinic time) and not having a base ops like the L&D unit. BUT, my chief introduced me to the OB Intern call room - a space that is not convenient to the floor (so a bad place to go when you are monitoring patients in labor for example) but is very cozy and complete unto itself.

I’m really bad at letting go. I guess I prefer the sting of painful confrontation over the emptiness of the unknown. Right now I’m struggling with the very modern problem of navigating a social media relationship with my ex-husband and would be co-parent. I am trying to be my best self, to retain empathy, to remember that the person we show on social media is never the whole of our lived experience. But juxtaposing his quasi-introspective public posts about enjoying life in SoCal against the harsh private realities of my and the children’s lives just makes me too angry. I’m too tempted to write snarky comments about issues that do not belong on social media platforms. I’ve tried to unfollow in an effort not to expose myself to triggers that will cause me to think bitter and angry thoughts about the fact that he is behaving entirely consistently with the sort of person he was before we separated (and then dealing with the subsequent anger at myself for entertaining the delusion that he would behave differently after I left him). But as I mentioned I’m bad at letting go. I may have to escalate my digital separation if I can’t muster the willpower.

I'm learning, through this my training, to take things less personally. Many aspects of my work are easier if I can manage some honest detachment. Feedback isn't Personal, Pervasive or Permanent. We need, I mean NEED that feedback if we are going to be able to do our jobs. But it isn’t just the feedback, I’m also working to practice a certain amount of detachment from the patient experiences. We do things to patients, often to improve their health or to manage a dynamic birth process that is not going well. Sometimes the things we do bring about a desirable outcome - a baby is born before the distress is debilitating or a woman successfully VBACs. But sometimes we do things and less good things happen - more bleeding than usual, an injury to tissue that needs to be repaired or a surgical birth becomes necessary. Giving one’s self credit for the desirable outcomes is just as misplaced as beating one’s self up for the adverse ones. I’m working on letting go of ego and holding on to the evidence and Not. Taking. Things. Personally.

Dig deep

This batch of vignettes are more personal, less about residency. I started a new rotation this week, I"m on the benign GYN service for 3 weeks (I have a vacation week thrown in there as well). I will have more time to write in the coming weeks so expect more reflections on medicine soon...

I sorta want to start dating but not enough to write a witty description of myself or to go on the requisite adventures one needs in order to demonstrate through photos their enthusiasm for life and show off their body. My life is too busy to swipe left or right, let alone download and manage a dating app.

One of the things that strikes me when I talk to other women who are physicians (particularly Ob/Gyns, cuz like, those are the ones I am talking with these days), is that whenever I talk about missing something in my kids’ lives they don't do that instinctive “awww” or “tsk-tsk” thing that I’ve experienced from so many other kinds of moms. It isn’t just super judgy SAHM vs WOHM dynamic. I’ve had other working mothers (though with arguably less insane schedules) do the pity voice when I talk about how busy I am. It doesn’t really serve me to have people react like that. On balance, I’m really happy with my choices. I am struggling with many things, including having borne and raised these amazing humans who I don’t get to spend as much time with as I’d like. But that isn’t a lamentable fact, it is a fact that comes with doing important and meaningful work and knowing myself well enough to know that I operate better with many irons in the fire. I’m frankly a less good mother when I have more free time. In my experience, doctor moms understand that balance, we understand what we're giving up, we know that we've made our choices and we are not apologetic about them.

After spending time with several married female resident & attending physicians and their spouses, I’m realizing that my relationship, relative to my career and the realities and demands of its pursuit, was even less supportive than I realized. Almost every interaction I have these days reinforces for me that whatever my struggles, I’m better off with the choices I made to single-parent during residency instead of keeping the tepid and sometimes outright antagonistic dynamic that I dealt with in med school.

“Next year, in Jerusalem” is an expression that I have stolen from the Passover seder and use for my own purposes. I love the sentiment of hope & optimism and of having a home place that this phrase engenders for me. I struggle with patience, with the incomplete mission, with the life in progress. Next year in Jerusalem is another permutation of This Too Shall Pass, which is a life and sanity saving mantra.

I'm more into Tend & Befriend

“Misery loves company” has always sounded like an unkind expression. Unfortunately, “When struggling with difficult life circumstances, it is comforting to know that others in similar circumstances are also struggling” doesn’t quite roll off the tongue the same way. I know that there are people who do not seek companionship when they are stressed but I don’t understand how any of them ever survive their first life crisis with their sanity intact. I would absolutely be incapable of accomplishing the difficult things in my life - residency, moving, divorce, parenting teens, etc - if it weren’t for the people with whom I commiserate, vent, empathize, and seek distraction, connection and support. I’m so grateful for technology that allows me to stay connected to people who are far away.

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Tying knots is a lot more complicated than it looks when you are doing a “knot tying” lesson as a medical student. And different sutures feel different when you sew and tie with them. Figuring out which hand holds and which hand throws and remembering when you used your thumb and when you used your forefinger is a lot harder than you think it might be. Then there’s elevating the sutures and securing the knot with your finger. Every attending has their own tricks that they want to teach you and watch you master before their eyes. And the kinds of needles and the different suture materials. Sewing people up is a pretty complicated endeavor. Which, I suppose, it should be.

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Things that are going well:

• My job: I cannot overstate how much I love my job. I LOVE my job. The only bad thing about my job is that I often feel very inept at it. I am NOT inept at it, but I am a beginner at the bottom of a very long and steep learning curve. And I’m impatient and hold myself to high standards. But it is going well. I am progressing up the learning curve. I’m better at surgery than I was 4 weeks ago. I’m WAY better at writing notes. I am good with patients (if I may say) and I am enjoying speaking Spanish when the opportunity presents itself.
• My kids: They are spectacular! They don’t know anyone in town except me (actually my daughter is texting friends with an attending’s daughter, which is amazing) and I know they are sick of the limited social sphere. How sad that teenagers are looking forward to a new school & academic year. Poor kids. But they’ve kept up with their chores and are doing a great job settling into a new normal. They take care of their dog, they are learning to cook, they are doing a lot of household chores and supporting themselves. They are getting really good at asking me for things when they need them, since our face time is limited. I’m very proud of the composed and conscientious people they are showing themselves to be.
• My dog: He’s cute, he loves me, he gets so excited when we go for walks. I like to take him to the park and let him run off leash (don’t tell!) and there is a cute little creek that he loves to go lay down in and then explore and dig and drink in. He needs another haircut, which he is going to get this weekend. But even brushing him out and getting rid of the matts on his fur is a relaxing pasttime for me in the evenings.
• Sometimes I need to remind myself that vast aspects of my life are amazing and wonderful, when I find myself frustrated by the lingering rotator cuff injury or worried about tight finances or when I have to talk my kid through things I would rather be in the room for instead of across town. Fortunately it is easy to remember!  

I can't think of a witty title for this post. I'm going to stop trying and just publish.

Regarding my earlier post about forgetting the thrill. I want to just dial that back a little. Different, more skilled tasks are now giving me that thrill. I can prescribe and it even is becoming routine for me to reconcile meds and send prescriptions when I transfer or discharge a patient. But this week I’m thrilled that I am starting to really get knot tying and elevating my sutures is not the dismal event it was 2 weeks ago. Integral to the practice of medicine is lifelong learning. I think the goal line for the “thrill” is going to just keep moving for the rest of my life.

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Earlier this week I made a mistake. It was a process error - the decision I came to would have been different if I had followed a different process. Fortunately the decision I made didn’t harm anyone but it left me feeling like a dumbass. I’m deeply grateful the patients involved were not affected and I’m grateful that my learning moment didn’t come at anyone’s expense. I wish I could guarantee that all my learning will unfold in that manner.

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One of the hard things about the current state of my life is a lack of intimacy. I don’t (just) mean sex, I mean the whole kit and kaboodle. I move through the world from one important task to another yet I often feel like I am not *seen*. I miss having a sweetie. I miss having someone play with my hair. Look me in the eye for what might otherwise be an uncomfortably long time. Sit close to me on the couch and hang out. Hearing about their day and telling them about mine. Talking about these terrible and important things happening in the world from a place of common values. These things that I miss are not a new loss, there is a reason I sought a divorce afterall. Yet they remain a source of a dull, itching ache in my soul. The ache does come with a sense of loss when I let myself feel it, I was in a relationship for over 20 years afterall. I have known many wonderful forms of love and friendship. I *have* many forms of love and friendship. I am loved beyond measure, I know that. But every once in awhile I dwell on this missing piece.

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Today I introduced myself to someone on rounds and said “I’m your doctor.” And I meant it.

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It is hard to have someone with mental illness in your life. That feels bad to say because however hard it is for you, it is exponentially harder for the person themself. An important part of having someone with mental illness in your life is recognizing that you are not responsible for the mental illness, you did not cause the angry outburst or depression relapse, it is not appropriate for you to try to fix the circumstances and you are not responsible for the outcome of their actions or their mental illness. It is very hard to remember this. You live your life as best you can, with loving kindness and compassion for them, but there are parts of their experience with which you just cannot engage. And you hope that they find a path out. This is the perfect place for a “you can lead a horse to water” metaphor because you cannot compel a person with mental illness to seek the treatment you want them to have or you think they need. They will engage with their wellness how they see fit. And if you disagree, you lose. End of story. No matter the role you play in their life, you do not get to tell them how to manage their disease. It is hard to have someone with mental illness in your life. And that feels bad to say. However hard it is for me, I know that it is exponentially harder for you.

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My residency program is really humane - there is daily emphasis on maintaining schedules for our shifts and leaving the hospital ON TIME. There is regular “admin time” (occasional afternoons off to finish notes or do outstanding paperwork, run errands, see your family) and there are, relatively speaking, a lot of weekends off in the first year schedule. I just happen to be coming to the end of a string of weekends with work - beginnings or ends of night float, weekend coverage, etc. I’ve had time off, but for the last three weekends (which means 4 weeks) I have had some sort of work on either or on both Saturday or Sunday. I have this weekend and the next off. I’m very much looking forward to catching up on sleep. I’ve been sacrificing sleep to do things during this time - go for a float on the river with my kids, grocery shopping, talking to friends, chatting in the living room with my mom, take my son to soccer practice, etc. Without diminishing any of the joy or enthusiasm I have for my work, I’m getting tired and I really need a break. 3 more days until I get to sleep in 2 days in a row!

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Already I’m starting to forget the thrill of being the ultimate responsible party in patient care (though one could quite validly argue that the patient herself is the ultimate responsible party). I remember my first prescription I wrote in the outpatient setting all by myself. Most of the sense of mastery at that point was that I had figured out how to work the electronic health record. I mean, when I say “by myself” I’m really exaggerating. Interns don’t really do anything by themselves, not for the first 6 months or so anyway. I did meet the patient by myself and I did create the plan by myself and I did put the prescription in the EHR by myself (eventually) and I did talk to the patient about the plan by myself. But tucked into that process was the crucial step of Discussing the Plan with the Attending Physician. Discussing the Plan is part presentation, part mini-individualized Socratic seminar and part instructional process. I tell the things I know, I get asked questions until I don’t know the answer to identify my knowledge base, then I get instructed on the gaps in my process or knowledge. Patients who come to see residents often don’t have a choice in the matter (they are often publicly or un-insured and have little say in where their care takes place) but they are still the most patient patients you can imagine. And I SO appreciate them!

These are the sorts of things I want to write more about - I want to have time and energy to craft an essay or a thoughtful post about the responsibility that I’m being given and how it feels to take up a mantle that literally has people putting their lives in my hands. I’m writing these bits on a Google doc entitled “Vignettes”, adding new passages as often as I can. But a vignette doesn’t get to the heart of why I wanted to start blogging again. I’ll have to work on that.