Is Life a Highway?

Life is a journey, not just a destination.

As an aspiring physician, I was focused, goal-directed and hard working. There were times that things didn’t go my way but I found hunkering down, working harder, working different, staying focused on my goal was enough to get me where I needed to go. As a resident, I find myself surrounded by hard working, focused people with similar temperaments who like to solve problems and who work really damn hard. The road we are on is an Interstate, speed limit 75, no sleep til Brooklyn.

As a parent, putting my shoulder to the grindstone doesn’t yield quite the same result. Working harder as a parent doesn’t necessarily get you anything. And it isn’t just your work that matters. As my kids get older, I have less and less control over anything. And that is so frustrating for the hard-working, goal-directed Interstate driver in me. This is more like being on a city bus that’s going to the general part of town I want to be in but maybe not exactly where I want to go and makes who knows how many stops! I don’t always know what the right thing to do is, I can simply do my best and LOVE my children through whatever life throws at us.

According to my plans, this second year in Asheville was supposed to be an easier year for our family. The kids were going back to a school they’d been to before, they had made it ALL school year last year without missing the bus, now it would be even easier. This would leave space for me to be more focused on my residency, which would be harder than last year.

Make plans and the Gods laugh, right?

This year has NOT been an easier year for my kids. They’ve both had some problems that many of my friends probably already know about but I’m not putting on the internet. Teens have their own stories that they control and my blog isn’t the place for me to talk about them.

In my residency program there are only 11 other people who can do my job. At home there’s only one. And that job has become a job that cannot be done by the many surrogates and supporters I have. It can’t be outsourced, it can’t be done over the phone or by text. I have to be here, putting in the face time, navigating daily life with them. There are good days, where they are doing well and don’t seem to need me much, but there are bad days too, where a high-touch parenting approach is needed.

The unpredictable nature of good days vs bad days, and the crucialness of my presence on those bad days, makes me a terrible team member for those other 11 people (and the 4 interns who do important work, just not my job yet). They deserve to have a reliable team. I’ve been working very hard to try to be all things to all people but I just can’t do it.

I can’t do it. As much as I want to. As hard as I’ve tried. Some things can’t be accomplished with grit and hard work.

So, for the next little while, I’m going to stop pulling myself apart. I'm going to stop being a resident, for just a little while. I have the most amazingly supportive residency program, they are going to hire me to use my MPH and my clinical skills together to do research. As a single mother, I need my salary and working a 40 hour work week will seem like half a job (it will be about half the hours I was working before!). With flexibility to work from home sometimes and no nights or weekends, I can be the parent I need to be right now.

One of the people I sought advice from this week while figuring all this stuff out gave me some great advice: Think about what difference this choice will make in 5 days, 5 months and 5 years. In just the last few days of being more accessible, I can see my kids unfolding and coping better. In 5 months I hope that their lives will be stable again. Maybe I’ll be able to use this time to take care of myself as well - to exercise, socialize and get some regular therapy. I still have a bit of healing from my divorce and resettlement process that could benefit from some time to reflect. In 5 years, everyone I’m inconveniencing will be finished with residency, so will I. They will have made it through the Larissa-sized hole I’m putting in their lives. It won’t matter as much to me that I didn’t get to graduate with the class I started with, that my residency will be finished in October or November instead of July like nearly all residents everywhere. My little ego bumps and their big scheduling nightmares will be over.

Sometimes the road of life has unexpected curves in it. It still gets you where you are going, but you’re going to have to slow down, take the corners carefully, maybe stop and get gas or a bite to eat off the beaten path.

Life is more than a destination.

These can't be Still Life because I never stop moving. How about Blurry Snapshots?

That Teen Whiplash is hitting me again, but the other way - my kids are incredible humans. They are strong, resilient, emotionally intelligent, compassionate, well attached to their loved ones (including each other) and are all around awesome human beings. Between them, they made dinner 3 times this week, once at my request and twice just to be nice to me. Explicitly because they wanted to do something nice for me. These amazing humans.

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I did the better part of a vaginal hysterectomy this week. It was spectacular. Some of the things I really like gyn surgery: it is fascinating to work in the pelvis - getting a uterus out without messing up the bladder, the ureters, the rectum or the clitoris is a technical challenge that requires solid technique and knowledge of anatomy. At the same time, it is not all consuming - there are surgeries that general & other specialist surgeons do that last many many hours. Most of our cases are a couple of hours long. I have no desire to test the limits of my physical endurance by operating for 5 or 6 hours in a row if I can ever help it.

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I have 2 and a half days off in a row this weekend - half day b/c I spent most of today taking an annual Ob/Gyn resident exam, 2 because I also get MLK Jr day off! We take turns getting these bank holidays off (also 4th of July, Labor day, Memorial day). Four residents in each class, four bank holidays. I’m really grateful to get a couple days where I get to sleep in to the limits of my distorted circadian rhythm. I’ll be up early by most standards, but the peace & quiet of a cup of tea and no place to be is just as restorative for me now as sleeping until noon used to be. (Edit: I ended up sleeping until nearly 11 am and both kids were up before me! So much for peace and quiet, but it felt good!)

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There are a number of things that I think about during the day and think “I should write about that” and then when I get home I have forgotten that there was minutia in my day that I wanted to explore. I need to make some sort of notes about it but I always think, “Naw, I’ll remember! This is really interesting!” (Edit: still haven't worked out a system yet)

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I had occasion to be on Peds this week, just meeting a co-worker who was seeing a patient there, not seeing someone myself. But it was the first time I’ve been on that unit since my son was a patient there. It was hard and I had to do some work to shove it down and move on with my day and then some more work to dig it back out again and look at it. Things are better now, but they were pretty scary that weekend.

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I am at the phase in my rehab that the exercises are working, my knee feels better and then I do something really nutty like putter around the house for a half a day and then it hurts more the next day. I hate this phase. I’m actually a pretty good PT patient. I do my exercises, I don’t over do it, I don’t try to get back to working out too soon. But I’m really bad at remembering that I can’t do basic life things. Yesterday I hung pictures, I put away clothes & did laundry, I spiffied up my room a little - fixed a broken picture frame, got rid of some junk. Unfortunately, I have a multiple story home and I went up and down stairs and I walked around Target & the grocery stores. Today was a day of rest - the most vigorous thing I did was go to a movie with D (we saw Glass - it was good, which you never know given M. Night Shyamalan’s track record, still haven’t forgiven him for The Last Airbender). I’m hoping that some RICE treatment will make tomorrow a better day but we’ll see. And now my room looks nice & D has some pictures up so there’s that.

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I seem to have done something spasm-y to my back. Throughout today on the left very low it has been painful and tight, to the point of taking my breath away and making me nauseated. I spent many hours with a heating pad on it. That seems to help. I am not used to back problems. It makes me feel helpless and old and decrepit and irritated. I want to help my mental and physical health by working out and I can’t even effing stand or walk.

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Nothing like working nearly every weekend, being sleep deprived, isolated, exhausted and injured to really cheer you up. Calgon take me away!

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I have used all the advice I could muster and managed to minimize a rather debilitating back spasm in less than a week. I’m still a little sore but feeling better enough that I almost forget to do the stretches that are helping. I was a bit worried about how my 24 on Friday night would impact my back but other than some stiffness from sitting to do notes for too long, I think being awake and moving all night (no napping this time unfortunately) actually kept it from getting too stiff.

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I really want a hobby but I am having a hard time mustering energy for anything. I have yarn, hooks and patterns for crocheting amigurumi, a simple DIY embroidery project kit I bought and have completed about 25% of, coloring books, markers & pencils, and of course I still have roving and felting supplies. I have a couple great books, a cool graphic novel and some around the house things I want to do. I’m not depressed, I want to be clear. I don’t have anhedonia, I have exhaustion. It is very boring.

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.

Mishmash

I just finished day 14 of 26 in a row. Because I just got off night shift (no weekends while on night shift) and because I chose to work Xmas instead of NY, I’m working many days in a row.

Today I broached the subject of the divorce with my kids. It is not something that they’ve really wanted to hear about before but since their dad is coming out here again in a few days and since it was a HUGE elephant in the room that caused all manner of psychic distress for my kid, I thought we should at least start a discussion. I think it took nearly this long for me to be able to have this conversation and be as fair as I needed to be to my co-parent in explaining the whole thing to them.

I studied today for CREOGs. This is an annual exam we take in January to evaluate our knowledge of the content you need to know to be an Ob/Gyn. It was a day that was busy in pieces, but gave me time to answer questions and review my notes. Not as many deliveries in the last couple of weeks, but I’m in for the long haul, I can wait.

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Been feeling pretty crappy lately but it turns out I wasn’t burnt or depressed, I was just in need of a damn day off. Mercifully, once I figured out that I was working 26 days in a row, we were gifted with the world’s slowest Monday on L&D and my chiefs let me go home for the day. I walked my dog, cleaned my room, did some fun errands, made dinner, did stockings with the kids and baked peanut blossoms. I didn’t swing a nap but the day was great anyway. Only 2 weeks (well 12 days) until my next day off. Can’t wait to do it again.

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Every service has its upsides and downsides. When I’m on an L&D rotation I’m reminded what a creature comfort predictability is for me. On L&D from day to day, hour to hour, you never know what you’re going to get. I guess that you can remember that Tuesday is high risk clinic day and to expect a bunch of you-know-what to hit the fan in the afternoon - patients coming for extended monitoring, to rule out pre-eclampsia, ultrasounds, EKGs, etc. The sucky part is when that semi-reliable day happens in addition to a bunch of walk-ons with all manner of complications. Life on L&D is like a box of chocolates, you never know what you’re going to get. And sometimes it just kicks your ass.

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We got an admission recently that is making everyone varying degrees of sad and angry and frustrated. A patient with a terribly sad, avoidable outcome has been handed into our care by an out of hospital birth attendant who works in the area. This is my own personal first horror story of tragic, avoidable outcomes due to this person’s poor standard of care but I understand that it isn’t likely to be my last. There have been reports to the medical board, by patients and doctors, yet somehow this person is still peddling their toxic product. I have known that there were people like this out there - allowing women to get sick or permanently injured and babies to die (I’m not exaggerating) and still offering substandard prenatal care that doesn’t provide recommended evidence-based surveillance or have necessary back ups in place. 

I can only imagine safe out of hospital birth when it is coupled with seamless integration into higher levels of care - knowing when you are performing at the edge of your scope and where to get the next level of care and accessing it quickly. I think the thing that bothers me the most about this is that even in the setting of harming women and babies, this person sets themself up on a pedestal, revels in the title of “infamous” and considers themself the one true champion for women & babies in Western North Carolina.

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I get a lot of feedback. My actions are under a lot of scrutiny and that is right and good. I need to be careful, precise and as correct as possible in my actions and decisions. I accept this as necessary. At this point, I’m not (usually) a danger to patients, so the feedback is mostly fine tuning. It seems to be having unexpected consequences on my psyche.

I get correction from 3rd & 4th year residents frequently. Sometimes we have responsibilities that overlap. So I might see a note or orders placed by someone who is also responsible for making sure I do my job correctly. Because they are also still being trained and learning, they do things incorrectly as well. Also because they are human. None of these things are dire or consequential. Like much of the feedback I get.

There is this little “first thought” that I get that is a petty “A HA!” when I see a mistake made by an upper level. As in, “Not so perfect, are you?!?” I’m immediately layering a second thought that gently reminds myself that they never claimed to be perfect and to stop being petty. But the first thought is there and I need to recognize it so I don’t let it sneak into my attitude and relationships with my co-workers.

Halfway

I feel like I haven’t published in a million years but I see that it has been less than 3 weeks. (It's been longer than that by now but it was about 3 weeks when I wrote this)

I noticed recently that my posts that talk more about work seem to get more views and I was trying to think of things to say about work but having a little bit of writer’s block for lots of reasons.

Today I managed a 16 week loss. The patient was admitted and stable when I came on this morning but she was going through something called an “inevitable spontaneous abortion.” The pregnancy wasn’t over yet, but we knew it was just a matter of time.

This wasn’t a situation where the pregnancy was no longer viable, when there’s no heartbeat and we’re just waiting for the body to notice that it was no longer gestating. This wasn’t a “passenger” problem, it was a “passage” problem. These sorts of problems can be infections, very early rupture of membranes, labor, painless cervical dilation to name a few. In these cases, there’s still a heartbeat and if we were cruel enough to put an ultrasound on the uterus, we’d see it. And the fetus moving, oblivious to the looming danger.

In these situations, there are a few ways we can manage things but before I do I want to state very clearly that this is a pregnancy that Is. Going. To. End. 100% chance of miscarriage. No chance of survival. No chance of waiting until the fetus is big enough to be viable and benefit from a neonatal intensive care unit. This is a hard, hard day, for everyone involved. It is heartbreaking and tragic and absolutely no one’s fault. It didn’t happen because someone was fat, used drugs, had bad teeth, didn’t pray enough. ANYTHING. I really don’t want some anti-abortion troll to find this post randomly and call me a baby killer.

Patients need some time to come to grips with this reality. It doesn’t fit in a brain - the baby is alive, but it won’t be for long, and there’s nothing I can do about it except choose the manner of its passing. Sometimes while they are coming to grips, the situation changes and our path is limited by the circumstances - bleeding, infection, retained placenta. This is exactly what happened today. Our stable, very sad patient was taking some time with family to mourn when her body decided it was time.

Had we not had our hand forced by our patient’s uterus, we would have offered her 3 different options: (continued) watchful waiting, induction of labor or dilation and evacuation or a D&E. I think a D&E is what is known as a “partial birth abortion” in political spheres but I couldn’t honestly tell you because there is NO SUCH THING as a partial birth abortion. It is a made up term used by non-medical people to misrepresent a heart breaking and sometimes life saving medical procedure.

We know some things about placentas in the middle of pregnancy - they are now big enough to do work and pool blood, despite what else is happening. And they are often still very adherent to the uterus, if they don’t come out all the way, we need to go in and get them or they cause deadly trouble. If a patient is already sick or just doesn’t want the risk, a D&E is, hands down, unquestionably the safest way to get to manage a second trimester loss. The downside from patient perspective is that they don’t have a baby to hold, For some people that is very important and they are willing to risk needing manual extraction of a placenta, a D&C, a blood transfusion. It isn’t a guarantee but it is common.

You may have noticed that this is a fairly clinical description of these events. It was an oddly clinical day for me - I kind of forgot to be sad about the baby dying. I was thinking about managing a sick patient who was not conveniently (or as it turned out, safely) located relative to the supplies, staffing and OR. I was deciding about when to give her medications, how much to give and what signs would mean I needed to do something different. I actually had to make an emergency call at one point. People were moving slowly toward a goal and I said “We need to go NOW” and what do you know, people reassessed their needs and moved a lot faster after that. This was MY patient. I managed her (with help, guidance, supervision, of course), I counseled her, I met with her family afterward. I was very busy and it was a huge growth experience for me. But I forgot to feel sad. And now its been a few days (I’m finishing this post up a few days later) and I don’t think I can unpack that sadness at this point. Maybe later, when managing the medicine is not as new and intense, I’ll be able to hold sadness while getting shit done. Life goals.

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Today in clinic I helped a experienced nurse practitioner diagnose an unusual problem she encountered in a postpartum patient visiting for an IUD. Bodies are weird, this one was doing unusual things and she couldn’t make heads or tails of it. I did an exam and identified and evaluated the problem. Then I put in the IUD. Proud little “I’m becoming the next level provider” moment.

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Had something of a personal curveball last week. I’m on a leave from work for the last 7 days, will probably be heading back in about 4 days. It wasn’t my curveball, it was a parenting curveball. No, I’m not going to say more about it than that at this point. When your kids get older, the stories aren’t really yours to tell anymore. This is going to be one of those things that comes out over a series of small posts, peppered throughout my blog. Stand by for more.

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I've not been feeling great recently, realized that I haven't been reaching out, not trying to talk to friends, just keeping my head down and moving forward. Feeling a bit out of sorts. I'm publishing this stuff that I've already written so that I can clear the plate and maybe do some blogging again. I need to get back to the quick vignettes so it can feel more accessible to blog. My life is hard but my life is also amazing. I need to remember the second part a little more readily. 

We're about halfway through 2nd year and it has indeed been a tough year. Last year I liked the second half a lot better, I sure hope that's the case this year too. 

Clowns to the left of me, jokers to the right, where the heck am I?!?

My life is so topsy turvy, I don’t think I should try to make sense of it. I think I need to just grow sea legs. Some good things happened today for my daughter, some things made me realize that my son was having a harder time than he lets on with his teflon smile. I had a pretty chill day at work, which is a nice change and helps me get some administrative stuff done and be rested so I can have some active recovery time this weekend. I’m lonely for friends but don’t have much time to arrange social events and I rarely know when I’m going to feel up for the adventure of hanging out. I love my job but it is so...consuming. I am consumed.

The bullshit that is happening in the Senate judiciary committee this week is not helping me. Like many (most?) women in America, I’m a sexual assault and trauma survivor. I don’t think about it a lot but it’s there and it has come roaring back to my front burner this week. I’m dreadfully proud of Dr. Ford, not just that she came forward, but how she did it and how she comported herself during the process. And the whole damn thing is triggering, a word I don’t particularly like, but it’s appropriate in this context. I feel like I’m listening to a loud drippy faucet ring out in a quiet night while I’m trying to sleep. Just as I’m drifting off *PING* there it goes again and my adrenaline surges. I want to do something incredibly restorative and self-soothing tomorrow but I’m not sure what it would be. A hike someplace beautiful, maybe. Where I can get my feet wet if I were so inclined. Western NC is known for its beautiful waterfalls. Hmm. That sounds very grounding. Bonus if I can take the cute pup with me. 

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I am now one-quarter of the way through what is arguably the most inhumane of my 4 years of residency. This year I will have 12 weeks of night call, much more frequent weekend coverage, the god damned 24 hour shifts (those don’t go away). This job is back breaking, it is destructive to one’s psyche and it is murder on any notion of balance. Despite how upsetting it might sound, I state this without emotional distress. The material is difficult to master and it should require superhuman effort to do so. We hold life in our hands. We have to know our shit. And despite all those practical and logistic realities, it is not an abusive environment. The superiors are supportive and there are many structures in place to help diffuse the hardship. I don’t feel like I’m on the receiving end of a psychological beating. I’m just really fucking tired.

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I have been delayed gratification girl for so many years. I have recently been prompted to make more declarative statements to someone about “what I want.” This person is not necessarily in a position where such requests/demands are going to be met but it has gotten me thinking. What holds me back from really living, and not just surviving. I’ve been in survival mode for so long, I need to deliberately break out of the mindset, it isn’t just going away. Conversations with people who ARE on the inside, who get to hear my process and know my heart, have helped me realize that I have a great big psychological boogey man standing between me and my goals. I have a Dweller on the threshold and I’m calling it the “BUT HOW.” Because when I think about things that I want - friendships, romance, socializing, etc. I get a huge BUT HOW thrown in my face by this archetype in my mind that I cannot yet get around. I don’t know how I could fit one. More. Fucking. Thing. into my life, but I still want things! Like many problems at this point in my life, this is not a new issue, this is just a variation on a theme. I must know the whole path before I take the first step. Obviously I’ve gotten over that compulsion or I never would have gotten married, had children, gone to medical school, gotten divorced, moved across the country so many times, etc. But here I am, thinking about what is missing from my life, wanting to make a plan to add it, and the BUT HOW is standing in my way.

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My co-parent is planning a visit. As a result we are thrust into conversation more frequently. I’m not enjoying how these talks are going. I value having him more present in the kids lives, but it is hard for us to navigate this stuff. We cohabitated (so awkwardly) then I left, the kids followed suit shortly after. We haven’t had to manage family sharing much beyond managing vacation times. I want him to come see his kids. I want them to have time together. I’m pretty sure it is going to be painful and hard for me. I still want it.

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If all goes well, I am going to have 3 days during this rotation at a local FQHC that has services for trans patients - I’ll be shadowing and learning from an MD and a PA, and they have a support group that I’ll be attending as well. I’m trying really hard to get some experience that is going to be helpful for my eventual post-residency career. Plus I get to queer up the residency program. Win-win.

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I miss being in the OR. That is an unusual sentiment for me, I was kind of surprised by how much I like surgery. I always thought of it as a means to an end (the end being patient care) but the fact is I actually like OR days. The work is gratifying.

That being said, I’m still chipping away at my emails and just finished 2 writing projects that were anticipated several weeks ago. I am enjoying having my brain back and being able to see my kids more. So all OR all the time, not really what I’m looking for either.