Around we go

The Wiccan calender is all about new beginnings. Yeah, Samhain is the "new year" for most of us, but really the whole frickin' thing is about renewal and fresh starts. Now I have another New Year celebration - July 1st. Thus begins my second year of residency. Happy New Year. 

***************

I’m now 3 weeks into second year and I can report a couple of things: I like not being new at my job, surgery is fun, complicated pregnancies are complicated.

I’m on the benign gyn rotation during the week but second year involves lots of weekend call so I’m also spending time on L&D. I had an absolutely insane shift the first time I worked a solid 24 hours (we don’t do 24 hour shifts as interns, a hold over from some old duty hour restrictions that got lifted but our program kept them. I’m eternally grateful). The second 24 I worked was THIS weekend and it was a bit different, I worked my regular day shift job and then showed up on L&D to take report from the day team and work a second shift on L&D until morning. I managed to sneak in about a 40 minute power nap prior to my shift and the night was a steady stream of busy but not the insanity of over a dozen deliveries, half done by me, that last weekend brought us.

I have admitted a couple of people with some interesting problems to our Maternal Fetal Medicine unit on my weekends on L&D. It is interesting how much of a Black Box Warning pregnancy is for every other kind of medicine. If someone happens to have something else going on - Lung infection? Cellulitis? Broken bone? Odds are good that we will either be called to consult or be asked to admit a person to our service even though we have no idea how to manage the medical issue that brings her in! We had someone who was miscarrying recently and still the medicine docs would not recommend surgery for an unrelated and REALLY IMPORTANT problem she was having. Instead they opted for “conservative management” which involved NOT fixing the problem that they wanted to fix surgically before they realized she was pregnant. The consult note from my gyn-team colleague had very explicit ALL CAPS instructions about recommending “DO WHATEVER THE HELL YOU WOULD DO IF YOU DIDN’T KNOW SHE WAS PREGNANT!!)”

***************

Two small raccoons, one lying, still, on the side of the road. The other approaching carefully, tentatively forward from the tall grass. Nose to nose. Heartbreak in a flash of my headlights at 5am

***************

Laparoscopic surgery is a different kind of frustration. There are issues of dexterity and muscle memory with all surgery but this year I’m getting more exposure to laparoscopic surgery. It’s making me wish I’d played a LOT more video games in my youth! It is so frustrating to be looking at my tools on a screen, trying to grasp and maneuver, find the right angle.Trying to make the tools do what I need them to do, while remembering they are on a fulcrum, that levers move backwards (If I want the grasper to go up, I move my hand down). And on a 2 dimensional screen. And that is real tissue you are grasping, so don’t pull too hard, watch where the instruments are going, and please for the love of everything holy, do not require us to open because you perforated the bowel or tore open a blood vessel. Also, I’m trying to remember crucial details like the names of the different types of graspers and when you use them, a Maryland is different from a Prestige which is different from a Hunter Bowel (really, you have to know what to ask for. Often the scrub knows what I need before I ask for it, but sometimes s/he is wrong and I need to adjust my field of view. AND I need to remember the steps of the surgery - DON’T FORGET TO INJECT THE DILUTE VASOPRESSIN!!!!! WHY DO I ALWAYS FORGET THAT STEP?!?!?! Sigh, anyway, it’s July again and I love my job but I am going to be a LOT better at it in six months!

***************

I just had an amazing half day in clinic. As I think I mentioned, as a 2nd year a lot of your responsibilities increase. We have a lot more people on our clinic schedule and they can be more complex than return OB prenatal visits. This time, I had 8 patients on my schedule - and they all came!! That in and of itself is a little unusual for me. I usually have at least 1 no show to give me a little breathing room. Today I had 3 Spanish speaking patients, 3 return patients, a consult for PCOS, a woman needing a new contraception plan (one of the Spanish speakers), a woman with gestational diabetes who wanted a trial of labor after cesarean and didn’t have her sugars with her and didn’t know how she was supposed to be testing her sugars (also a Spanish speaker) and what turned out to be a VERY complicated IUD removal. I didn’t get a single note done before the end of seeing patients, but I got all the prescriptions done as I went, I had all the salient details either in the notes or in my head or written down someplace so I could write my notes afterward. My last patient had a 4pm appointment and I walked into her room at 4:22. That is running spectacularly on time in a resident clinic! Then I stayed after work and finished my charts before heading home. I’m getting good at this!

***************

I’m on vacation as of this afternoon.. I haven’t started packing yet. I need to be at work in 40 minutes and I’m still in bed. I will be driving to DC at some point today. I should probably get up!

Highs and lows, but mostly highs

I just had the best day ever!!!

It started with an interesting surgery, that I did not actually do but rather watched 2 community docs work together to do. It was interesting because of the problems of approach and there were some techniques that were used to accomplish the surgery that were the very definition of mastery. The problem was not one either had exactly seen before, the situation required flexible problem-solving, innovative application of familiar surgical techniques and a good bit of communication and collaboration. It was an interesting bit of medicine. And an interesting bit of people watching, to see a relatively recently graduated physician (it was his patient) work with one of his more experienced partners.

After the surgery, I found out that I PASSED my Step 3 exam! Last hurdle before I abandon general medicine and start focusing on Ob/Gyn stuff exclusively!! The stupid exam administrators send you an email, make you log into a rarely used account, download a score report and THEN open the report to find out whether or not you passed. Believe me, doing all that shit then seeing the word FAIL on your score report is heartbreaking. But no more!!!

Then I did a cool ED consultation for a patient who needed to be admitted. I got a lot of the workup right and learned a lot about managing this diagnosis. She’ll be my patient for the next few days.

In the afternoon, I got to do a cool in office procedure that we have done exclusively in the OR until very recently. It was a boatload of fun. Then I put in an IUD, and THEN I put in a Nexplanon. Birth control!!!!

Then I met the boy who is dog sitting for me and found out that he and his mother are lovely and are going to watch Bear for me while I’m on a 24 this weekend. I had dinner with my dear friend Christy from Portland who is here with her extended family on a vacation. She dragged them from Nashville for the week so that we could hang too! Efficiency!

Finally, my swipey app has born some interesting fruit and I’m enjoying some texts and planning some dates. This has been an all around amazing and fun day. Yay!!!!

***************

I think it is safe to say that I’m having a good week. I’m so fucking relieved not to be an intern anymore I can’t even tell you. I underestimated what a difference it would make to my coping, my mood and my performance. Being just a resident (well and a dog mom) is so much easier than being a singlemotherresident. I had aspirations of getting some home updates done but I find I’m not focusing on that as much after all. The time I’m not parenting, I’ve filled with other things. I’ve done some administrative and educational tasks, I’ve done a few things around the house, I’ve spent some time with friends & on dates. But honestly, I had a lot bigger to do list than what I’m accomplishing. Part of the issue is that I’m saving money for my vacation, part of it is that if I have time, I’m choosing to use it to relax or have fun. Errands and buying house fixer upper things is not as entertaining.

***************

I worked a 24 hour shift this weekend, something doesn’t happen in intern year in our program, but will happen a LOT this year, and continue but to a lesser extent for 3rd and 4the year. It is actually more than 24, I started at 6am on Saturday and left around 8:15am on Sunday. It was an absolutely insane night after a series of what were apparently record breaking days on L&D. I personally attended 6 deliveries, was primary surgeon on 2 cesareans, assisted another, and did 3 vaginal deliveries. I could have done a cesarean delivery of twins too if I hadn’t felt like I was losing my mind by that point. Plus the 2nd year answers the answering service pages and there was a fair amount of helping the intern figure out how to do her job. July is a nutty time. I am a bit intimidated by the 24 hour shift. I am worried it is going to kill me. That is only a little bit of hyperbole.

***************

Power napping seems to be a crucial element to managing my new weekend work schedule. I took a 20-30 minute nap the 2 days following my weekend and I was able to go to ballet class and take the dog to the vet and make dinner (well dinner happened on the not-ballet class night at least). I set my timer for 30 minutes and just let myself drift off. I don’t think I slept hard but it was very restorative!

***************

I’m only going to parent full time living with me children for another 3 years. One of my kids only has 2 years left on her lease. I can’t believe it is almost over! Thank goodness for the dog.

***************

Until recently I was struggling with temptation to suggest reconciliation to my ex-husband. To be clear, the idea is a product of a tiny minority portion of my mind. The rest of my mind is working on bringing her around, but she’s pretty stubborn in the notion that the only happiness in my future lies in the past. and is gone now. When I realized how such an action would be repeating self-defeating behaviors of the past, a lot of the wind was taken out of her sails and she’s been pretty quiet since for a few weeks.

But right now my co-parent is with the kids, staying with my parents at a property that we have in Northern California. A place my children will someday own. He’s helping clean up from a tragedy there and doing traditional fun things - swimming hole & soft serve - with the kids. So last night that tiny short sighted part of my brain did something only your brain can do. It delivered unto me a dream, full of visceral, physical sensations. Reminding me what good parts of a long marriage include. It wasn’t a sex dream. That I could handle. It was a dream of walking next to someone, hands gently intertwined, feeling their breath on your neck. The comfort, familiarity, intimacy were overwhelming. But it was a dream, the reality was starker. My body aches for something it hasn’t had from my ex in years. My stupid brain doesn’t care how long it’s been, it’s so sure we could have it again if only I would…

Even in the dream I managed to stop myself. I left the room, I tried to walk up stairs but they were covered with obstacles (tiny stupid part didn’t want me to leave I guess). I’m left this morning with the aching feeling of a missing touch. Grief is a circle.

(Has anyone noticed I have 2 terms for the same person? He is my ex-husband when we are talking about the relationship between us that is gone. He is my co-parent when we are talking about the relationship I still have with him. That’s deliberate)

Summer snippets

I wondered how I was going to manage with meals while the kids were away, cooking for one and for my own tastes & preferences is very different from cooking for myself & 2 teens. It’s been going pretty well. I think I may have mastered the pork chop! I made 2 the other night and it gave me 2 meals worth of main protein source. I’ve been eating a LOT of broccoli & cauliflower. I’m struggling with reducing my portion sizes (to reasonable sizes, not diminutive ones, fear not) so I’m trying to fill up on veggies and water if I find myself wanting bigger portions, carbs, seconds or dessert. I bought a Brita water pitcher, I think I have FINALLY tired of drinking only seltzer water. I need to get a new water bottle too, the handle of my current fave is broken. Also the charger for my computer finally kicked the bucket (it’s been frayed and precarious looking for a while) so I’ll need to get one of those soon. And I need a shop broom so I can sweep water out from under my carport where my fancy new outdoor seats are. It’s been rainy in the afternoons the last few days and it is pooling and cramping my style. This evening Bear and I sat outside together for a bit next to the big puddle, I didn’t make him go out in the rain again!

***************

I wrote about my chronic occasional health thing recently. I just realized that the likely source of my recent remission was my abstention from alcohol. I didn’t drink from January through April. In the last 2 months I have had more symptoms despite being okay during spring allergy season and while sleep deprived. I am going to start a new experiment. It’s not super complicated: I’m going to stop drinking again and see how I do. I’m pretty irritated but on balance I would much rather not drink than have the annoying and often debilitating symptoms I have to deal with. I’d be curious if the aforementioned provoking factors would still provoke symptoms if I’m not drinking at all. I look forward to this new era of discovery. 

***************

Today I started my second year of residency. It was mostly a fun day. Figuring out how much time I had to teach and how much time I had to do my own work was something of a task. And watching the new interns work gave me a little PTSD flashback and I had to remind myself that I never had to be at the bottom of that learning curve again. It was a little like the feeling I had during my second pregnancy when I viscerally remembered the experience of labor and was like “Oh SHIT” about having to do it again. Except this time it came with the happy reality that I DON’T have to do it again. Second year will be hard in a different way but it won’t be hard in the myriad of ways first year was hard. Learning to be a doctor, manage orders, notes, pages, locating places in the hospital, meeting my superiors (literally everyone on the care team) and managing expectations...breathe, breathe, breathe. Anyway, suffice it to say that it’s a new year and I’m pretty happy about that! 

***************

Today I went for a swim after work. It was perfection, floating on the cool water during a hot evening, staring up at the puffy clouds in the sky. I almost went to ballet but I decided against it. The class tonight is a 90 minute class. Not sure I’m up for 90 minutes of ballet just yet. Maybe next week! 

***************

I have gone to 3 ballet classes during my “summer vacation”. Last night I inspired 3 of my co-workers to go with me to that 90 minute beginner ballet class. It was a good class! Not too many jumps (which I have to sit out due to old injuries I’m not quite ready to poke) It is also closer to my house. I liked it a lot! And it was fun to go with friends. Ballet is hard but also something I feel competent at. It challenges me but is also meditative. 

***************

That person I was falling out of interest with ran out of patience for my schedule so they have been “archived” per their request. But now I’m back on one of those swipey dating apps and I’m surprised by how much choice I have in dating options. I’m quite limited by my own availability but otherwise I feel really good about my options. And I continue to be completely unapologetic about my availability or lack thereof.

***************

Until recently I have been overwhelmed by an urge to act in a way that is contrary to my best interests regarding my ex-husband. I know that these urges are part of the grief process and that I shouldn’t act on them. Last time I was bowled over by these desires, I also realized that if I were to cave into them, I’d be investing emotional labor into a relationship that already showed me that my emotional labor did not bear fruit. Something about that realization has helped free me from the fantasy of reconciliation. Also I’ve had a few opportunities to cry about the whole thing that have been very cathartic.

Fewer children, more blog posts

This evening I had a massive craving for chocolate. But I don’t have any in the house. The craving was strong enough that I drove to the grocery store with my mind’s eye specifically on a raspberry dark chocolate I am a fan of. I walked through the bakery, considered some dangerous things, turned the corner to the cookies & candy aisle (conveniently located together, right next door). I walked between the mint oreos and the chocolate bars (alas, no raspberry dark chocolate bars). I felt like I was playing with the tip of a knife on my skin. I walked out without buying anything. 

***************

Maybe it is a product of the individual, maybe it is a result of where I am in my relationship arc, but right now, I’m falling out of interest in someone I’ve been seeing. This is a perfectly nice person, and someone who is doing interesting things with their life. But if they were to spontaneously not exist on this Earth, the greatest loss for me would be the occasional opportunities to scratch an itch. While I have enjoyed time we’ve spent together, in no way do I crave their attention, time, conversation, company. I have no idea if I will at some point develop those feelings toward another person. I’m sitting with this emotional place and letting it be. I will date when it is fun, stop when it isn’t, and not make myself go out to dinner with someone when all I want is to make a pork chop and hang out with my dog. I have a huge hole in my heart & soul. This is not a hole that can be filled by pouring someone else into it. It has to heal by secondary intention. This is a slower path, it requires me to create MORE of myself to fill the hole. Why isn’t there a Spiritual WoundVac?!? I wonder what my emotional & relationship landscape will look like when I am healed. From where I stand right now, I can’t imagine loving someone else again. I can’t imagine craving someone’s presence in my life. I’m have faith that it may happen, because I have enough trust in the infinite capacity for healing for the human spirit. But I’m not there yet. 

***************

My dog has gone completely soft. It was lightly raining this evening and I took him out and he was like, NO I WILL NOT. Refused to walk, tried to go back under the carport. When I managed to get him around the side of the house, he went behind some bushes to a space under the neighbor’s walkway and sniffed around and peed UNDER COVER. He’s completely abandoned his PacNW roots. 

***************

A few times a year it becomes necessary to take a chunk of our residency team out of commission. We run skeleton crews and mostly throw the rotation schedule out the window. We call these weeks Freak Week. Some people find their existence stressful. Probably because they have more responsibility than I do. This week, our 4th years are graduated and getting ready for written boards which are the last week of June for all Ob/Gyn program grads. Our new interns are still in orientation. Yep, it’s Freak Week. I’m in clinic 2 days and on L&D for 4 (I’m working Sat but not Sun). Then next week starts our first rotation of the new year. I’ll be a second year on the benign GYN rotation. This week I’m an intern plus. Or a second year light. Everyone is anticipating the move up to the next rung in the ladder.

So, me too, I guess?

Big test starts tomorrow. I am ready. I have been performing adequately on the practice questions, I have worked out the kinks (mostly) for the simulator for the cases (that’s Thursday). I have the address and my testing permit printed out up on my desk. By this tie, much of the prep is pro forma, I know what to wear (layers, comfy), what to bring for lunch (turkey sandwich) & snacks (chocolate for a PM pick me up), how to spend the night before (a tiny bit of studying, mostly resting). In the past, I had an inkling that I wasn’t ready for exams but I took anyway. This was universally a mistake, bourne by my fear of admitting weakness or denial of the possibility of failure. So now I just reflect, do I feel ready? Does the objective data demonstrate that I am ready? Yes, I am nervous, but it’s going to be just fine. I look forward to being on the other side of this.

***************

Kids have been gone a week already! I am slowly chipping away at the list of things that I wanted to get done. And forgiving myself for not being nearly as driven as I imagined I was going to be. I’m getting things done, to be sure. But it turns out I’m not nearly as interested in working out in the morning as I am getting an extra 45 minutes of sleep! I’m eating more spinach and fewer carbs (it helps that I’ve eaten everything up not am buying more!). I predict this 8 weeks is going to fly by. It seemed like such an eternity before they left.

***************

Apropos of nothing, I have a story spinning around in my head that I recently thought about in a new way. A couple of years ago, I went to a beer festival at Tom McCall park on the Portland downtown waterfront. I was a PSU student at the time and had a bus pass and ended up taking a bus home from the event (this was the days before Uber came to town). If I walked over a bridge and caught a bus away from the event, it would be the bus that took me directly home. It was a frequent flyer so I didn’t worry about when the next bus was coming, I just finished my night and then headed up to the stop on the bridge.

There were 2 drunk guys up there. I think they were also waiting for a bus, maybe they were just fucking around. (You can already see where this is going, can’t you?) One in particular wanted to chat me up. My usual cold, terse responses were not effective in getting him to leave me alone. In fact, they riled up the classic “She owes me something because I complimented her body” responses. He was “just being friendly,” why didn’t I want to talk?!? While he was making me VERY uncomfortable, it wasn’t too late out, it was a well lit, high traffic area with cars and foot traffic. Because of the beer festival, lots of people were walking across the bridge to their parked cars in East Portland. He didn’t touch me. I wasn’t in physical danger. But it was one of the more unpleasant drunk asshole confrontations I’ve ever had.

I haven’t thought about this event very often, and in the rare occasions when I have thought about it, I haven’t thought much about what came next. On the bus, away from the drunks, another guy sat near me (the seat behind mine) and talked to me. He had been at the bus stop. He had been watching what happened. He wanted to commiserate about how inappropriate and drunk and aberrant those guys were. I’m sure he was trying to put me at ease, chatting me up in a friendly, non-threatening, not drunk way.

But lately I’ve been just as pissed off at that quiet, nerdy guy who didn’t speak up while I was being harrassed. Who used my discomfort after the fact to make himself separate from Those Kinds of Men. He was invisible to those guys (though not to me because I had been surveying the terrain and I saw him hovering on the other side of the bus shelter), and he didn’t say a damn thing to endanger his anonymity, his comfort or his safety while I was being involuntarily drunk dialed while waiting for a bus. The more I think about this guy, the more pissed off I become.

Feminism has reached the end of what it can accomplish in the changing of women’s lives. Now if we want our lives to be better, men need to step the fuck up and change things on their side of the court. I’m not here for your entertainment, for your viewing pleasure. And I’m NOT here to make you feel better than the guys who think that I am. Unless you are actively and loudly rejecting that behavior in public and private, you are just as much of a problem, as far as I’m concerned. Time for the men to clean their house. We’ve done what we can to change ourselves. Your turn.

***************

I have this little health problem that bothers me very rarely. I take a daily medication to manage it (well, the allergy meds are a crucial part too though for a separate issue) and beyond that, there’s very little I can do. I will either have symptoms or I won’t. There are a few provoking factors but few palliating ones. Once it starts to bother me, I just have to ride it out. If I have to beg out of things, I usually claim a headache. It’s easier than explaining. I mention it because I’m bothered by it today, because of an unavoidable obligations that was a provoking factor. Now I’m begging off some social fun because it will be loud (which will makes things worse) and my head hurts. I’m trying to be zen with the reality of my limitations but it’s hard.

Have I used "This Too Shall Pass" as a blog title before? It probably won't be the last time...

This weekend made me feel really good about my kids being settled in Asheville. Duncan is hosting a series of friends at the pool in our complex, he’s got a core group and they have friends who come too. Only 3 or 4 friends at a time to comply with the HOA policy and they are doing a great job following the rules and being good neighbors while there. On Saturday Ainsley went to Queer Prom, sponsored by a local LGBTQ youth organization. But before that she had a friend come over and help her dye her hair blue. And then this evening she went to an outdoor performance of Midsummer Night’s Dream with some friends (where other friends were performing).

Also I learned where a bigger Target is, and there’s a Big Lots and World Market right next door. So Ainsley got a new Pride tank top (Target has Pride wear and they get so much of our business because of it!) and I found a relatively inexpensive set of outdoor furniture that we put under the carport - 2 chairs, a loveseat and a table. And a nifty outdoor rug/mat as well. All it’s lacking is a citronella candle! I had a portion of my state tax refund that I wanted to use to get some outdoor furniture. I always think of my friend Shannon chastising me for giving the government an interest free loan (that’s what tax refunds are, apparently) but given the tight margins of my life, I wasn’t going to save on my own so instead I’ll just thank them for the service and appreciate my new outdoor space!

Of course, the kids are leaving a week from tomorrow, they’ll be gone for 8 weeks. Just as they are getting really settled in! But the pool with still be here, the outdoor community theatre will still be here, they will come back and maybe plug back into their lives pretty much where they are leaving off right now. That’s my hope, at least. We’ll see. It won’t be as hard as last year!

I got a haircut! I heard about this salon and this gal from a few people, it was very reasonably priced and she cut curly hair very well. It’s funny because I didn’t get a lot of length taken off but when I got up there were PILES of hair at my feet! I have soooo much hair! But now now, now I have a reasonable amount of hair. It’s been about 14 months since I got a haircut but this place is inexpensive, really good, and you can make appointments online so I’m optimistic that I’ll be able to be better groomed despite my busy schedule!

***************

This is the kids’ last weekend in NC for a couple of months, mostly they are enjoying being done with school while packing and cleaning at a snail’s pace. I’m distracted by studying for Step 3 so they’ve got some slack to work at their own paces. Their rooms & public spaces are slowly getting clean, laundry is getting done and packing prep is starting to happen.

Unfortunately blogging about parenting a teen means there are parts of the story I can’t tell because they aren’t mine to share. I’m having a bit of one of those times with one of my kids right now. It is something of a big deal but a lot of it will be taken care of by the temporary displacement they are about to experience. I have had more conversations with my co-parent in the last week than probably the last 6 months combined. He was a bit taken aback by the news of teen drama and the notion that that they were going to be out there “just for a visit” was shattered mercilessly. I mean clearly he knew that the honeymoon phase would not last 8 weeks, that there will be snark, PMS, hangriness (dear lord, this family is full of people who are terrible about self-regulating our blood sugars!), irrationality, health problems and moodiness. But knowing that there was a pretty big issue he was inheriting right off the plane, that was harsh. He took it well. I still have to tell him that we had lice and he will need to do head checks next week. I should get on that… :-)

I’m grateful that my troubled child is going to get some time with Dad and that the impetus of the end of the school year stress and the imminent departure was able to unroof some poor coping and existential pain. Admitting you have a problem is the first step right? So we’re on to step 2 now. Fortunately for this particular flavor of problem, co-captain and I are firmly aligned. The messaging will be united and the East coast/West coast plans for addressing the issues will dovetail nicely with each other.

I’m looking forward to having a break. I will miss my kids like gangbusters, but I am also pretty excited to go on dates, clean my house, get some residency shit done, study and get started on my new life as a Second Year Ob/Gyn Resident without the omnipresent distraction of daily parenting.

***************

One of the things that is harder about blogging honestly like I was in the beginning is that I feel less anonymous. I know there are people reading this, including people who I work with. I have been hesitating about pushing into this latest soft spot and digging around because I don’t want people at work to think I’m pathetic, that I’m not handling my life as well as I want them to think I am. I don’t want pity, but I want a place to speak truth to my hardship. So don’t pity me, I’m just more honest about the hard parts of life than most people. We’ve all got ‘em. Here’s some of mine.

***************

Today I’m remembering what it feels like to be relocated for a year. I remember that I felt like I should be more settled than I am. I remember thinking that I didn’t have the friends, networks and connections I wished I had. I remember thinking I’d feel more settled than I do now. I remember that eventually I realized it really takes a few years (in Portland I settled in 3, it took 3 years to get settled in Portland), more than I wanted it to take.

So today I’m sad that I don’t have friends, I don’t have people to spend time with when I’m not working or parenting. I’m tired of having to do the work to make friends. The constant putting yourself out there, asking people if they are available and for some reason or another not connecting. And working not to take it personally. I’m lonely. Maybe my co-residents don’t invite me to socialize with them because they think I don’t want to. Maybe they don’t want me to. Maybe I really don’t want to. Who knows. But they don’t ask. At least I don’t think they do. Maybe they did in the early months when I was overwhelmed and couldn’t leave lonely kids to have my own life while they were isolated and sad. Maybe I missed it and now it’s too late. There are a few people who aren’t residents who I have connected with, but they all have full lives that were going strong before I got here. Trying to merge into their flow often means they are not available when I am and when they are available, maybe the are making plans with the people already in their lives, but whatever they are doing, they aren’t connecting with me.

It takes longer than a year, that’s what I’m remembering. And that’s okay. It doesn’t mean it isn’t going to happen. It just means it hasn’t happened yet.

This too shall pass.

***************

Like I said a few days ago, I’ve been talking with T (that’s my co-parent) more this week than I have in a while. We’re talking a lot about the kids but there have been personal conversations as well. I really missed the easy communication between us. Now that we are not as wrapped up in how much the other has disappointed us or not met our needs, we are able to talk more like the old friends we are. When you’ve known someone 25 years, there’s an ease to talking. And some predictability too. He’s working a lot. Which means he’s skipping meals and being hyper-focused on work. Which doesn’t bother me the way his poor self-care when he’s busy used to. Why did it bother me so much? Because it scared me, if he wasn’t going to take care of himself, then maybe he’d die, or at least not live as long as he could. There was an aspect of my control and co-dependency that was triggered by something as little as him skipping lunch. If he didn’t do it, it was one more thing that I had to do. Did he ask me to do it? No! In fact, we probably would have been better served if I had not taken psychological ownership of things that were clearly his to take care of. Now he tells me he skips lunch and I find that reaction has been deactivated. It isn’t that I don’t care about him, or that I no longer want him to live as long as possible, but that wasn’t ever really a rational fear. We were too closely intertwined. It held us both back. Together we became better versions of ourselves than we probably could have alone when we were in our 20s and 30s. Now in our 40s we are becoming better versions of ourselves than we could while we were together. Not going to lie, watching him become better fills me with pride and deep sadness. It makes me miss those great decades when we were able to grow ourselves together. I’m never not going to be sad that we had to part for each of us to be our best selves. The rough edges to the sadness are slowly smoothing over time. Every so slightly, it isn’t as hard to be sad now as it was 6 months ago.

***************

Something great is happening at work: I’m getting good at my job! I did a repeat cesarean recently at which I got only positive feedback. Even with regard to one part of the surgery that I’m still working on. I’m doing everything right, the muscle-mind connection just hasn’t clicked yet. (Getting the baby’s head out the uterine incision is a specific combination of wrist movements, flexing the baby’s head, being a lever and a shoehorn that I understand in theory but just can’t quite put together unless everything is perfectly aligned) On the theme of anniversary reflections, I remember what it was like to do a cesarean last year, I had the stamina to do about the first half of the surgery, then when I had revealed the uterus, I was HAPPY to pass off the scalpel and have someone else finish. It taxed the limit of my stamina and concentration to get that far. Now I can do the whole thing, ask for the instruments, even figure out which suture we are using and how many knots it needs (except PDS, I still can’t tell PDS from monocryl, but I do know it needs more knots!).

And during that same shift, I cut my first episiotomy. This tiny infamous procedure looms large in the psyche of women. In this case, it was a very necessary intervention due to specific details relevant to that patient. And even though I’ve never done one, I realized it was going to be necessary, mentioned it to my attending, who listened to my whispered diagnosis and did her own assessment and agreed with my recommendation. My only reflection is that we did not have time to talk it through more with the patient. That place where babies are on the brink of being born is a tenuous one, it is hard to monitor their heart rates, they often experience the most stress we see and we often have to act quickly to get babies out. Given the totality of the details of that case, the episiotomy was a small matter. In reality (it was only about a centimeter long) and symbolically (there were other things that happened that mattered more to her during delivery). But it was a big deal for me to be able to see something I’d never seen before and successfully evaluate and address it!

Catharsis

I haven’t written much the last few months. In part because I’ve been busy but also because I’ve had this huge 800 lb gorilla standing in front of my view, blocking the flow of any simple, smaller vignettes that might want to come trickling out. And until I get rid of the gorilla (don’t worry, I’m only going to write her away), I’m stuck. So here she is…

I hate the health care system.

This may not sound shocking and it may not sound debilitating but it is tripping me up. I am a “work within the system” sort of woman but right now I'm having a hard time seeing my path. I want to go "Hulk smash!" on the whole damn thing. Which isn't productive for a number of reasons. 

The thing is, I don't feel disillusioned about choosing to revolt from within. I have few illusions about the difficulties that entails. I’m not romanticizing how much of a difference I can make or how much I can even change said system. But the realities of the role of physician as cog in the wheel are pretty fucking demoralizing. In time, I will arrive at a place where I have power and influence (to a limited extent) within the system. Until then, I’m at the bottom of the pile (can’t say bottom of the totem pole anymore, even in hyperbole, since I learned that’s where the important folk go). And the bottom of the pile is a shitty place to be.

During my brief 2 year stint as a public school teacher, we had some union troubles. Just short of striking, we adopted a “work to rule” position for some time. We came to work, we did our jobs, but only what was required by our contracts. The point, I suppose, was to show the powers that be just how much they were already getting out of us.

If physicians were to “work to rule” the entire health care system would grind to a shocking halt. The things that are required of us, they are not actually possible for a human to accomplish.

There’s this thing called the Hidden Curriculum of medicine. People have varying opinions about what exactly this curriculum teaches us but it is the implied undercurrent messages that we absorb as we progress through our training & careers. The problem with a Hidden Curriculum is that there’s no telling what people will learn from it. The lessons aren’t explicit and a great deal of one’s own personal baggage informs one’s lessons from the Hidden Curriculum. Handling criticism, giving feedback, working in teams, managing colleagues and underlings, these things are not taught in medicine but they are key, KEY parts of your work as a resident. If you internalized self-loathing (not hard to do) from the Hidden Curriculum, then you are going to be a crappy manager and mentor. But there isn’t a lot of room (like, any) in the Hidden Curriculum for self-examination, self-reflection, self-awareness. We aren’t encouraged by the system to reflect, just push on through and Do. The. Job.

(Parenthetically reminding everyone that I work at a fantastic residency program where these sorts of things are things we can address, we talk about respect and teamwork and we have opportunities built into our curriculum to reflect with our class and plan as a cohort for the next year. I never violate duty hours, we have great administrators. And I’m doing okay, this isn’t a desperate plea for help or a cry of despair. This is observation, reflection because I’m incapable of NOT navelgazing, this is me coping with the reality of the broader system I am becoming a part of. I’m just writing away the 800 lb gorilla that is blocking my Qi)

My plan will allow me, ideally, to live apart from this hierarchy someday. I’m going to open a community based clinic, it is going to have family medicine services, Ob/Gyn services, birth & abortion care, trans care, it is going to have a community board that helps us run it. It is going to be constructed specifically to deconstruct colonialist, patriarchal, capitalist power structures that oppress, oh, just about EVERYONE. I’ll get there. I’ll have my ideal clinic someday. Because I have a plan, I will have the skills, the connections, the capacity, the social capital and the power to create this sort of existence. I’m really looking forward to it. But to get there I’ve got to get through several years of learning from, working within and tapping into the current resources available for my training (and a few years after that to get financially stable after hundreds of thousands I had to borrow to get here at all). These all require me to work in a system I HATE. Most of the time I’m totally okay with that. Fight the power. From within. Change the system. From within. Often I forget that to do that, you have to KNOW the system. You have to be able to function within the system first. I can do that.

Bye-bye Gorilla.