Oh hello!

Wow, it’s been a while!

Well, I’m no longer in residency but I am still floating around. I finished chief year last year and started a new position in a new city (still in the US, still on the east coast). I’m in a non-ACGME fellowship which means I’m always confusing people if I’m a trainee or an attending (I myself am confused). This position has had lots of ups and downs, but with the semi-spring brewing outside, lately it has felt like more ups. It has given me a chance to travel to and work in a part of the States that I had never experienced before (the Great Plains) and maybe I’ll write about that a little here some day.

Part of the ups and downs of my new position (still new? I started it 10 months ago) is how different my schedule is. Residency was a non-stop blur where I was either working or sleeping. Chief year gave me weekends back (mostly) and more normal working hours, which was appreciated. Fellowship, at least this fellowship, has been a mix of intense balls to wall clinical work for a few weeks at a time, interspersed with days of unstructured time to work on “projects”. It’s like a strange mash-up of grad school and crazy clinic days.

They say that stress levels increase even when people go on vacation because it’s the change in pace that gets us internally riled up. I think that the unstructured time, after a few days, has riled up my anxieties because of how easy it makes it to procrastinate which leads to feeling unproductive which leads to those annoying existential crisis moments of what am I doing why am I doing this why am I even here?!

This is an expensive city and settling into a wooden chair in a coffee shop with a $4 drink that I could make at home for cents doesn’t make sense all the time but the alternative of staying cloistered at home seems to make everything described in the above paragraph worse. It kind of makes sense now why I’ve restarted this blog, hmm? (There is the third alternative of your lovely local public library, which I have recently discovered and praise everything that they allow drinks!)

Anyhoo, I’m glad this blog is still around to plop in a few words sometimes. Hope to keep writing more. If not, see you again in 4 years!  : )

Elections 2015

Feeling hopeful for Canada and proud to be Canadian tonight.

Not quite late night worries

First day in the ICU as the senior resident tomorrow, and I’m on call too. Feeling rather nervous. Reminders to self: Stay calm, save energy when you can, and keep breathing. Here’s to new experiences and always learning!

Tips for burnout

Obviously I’ve been feeling burnt out lately. Largely because of the stress that comes with working in an in-patient setting, feeling like there is drama and arguments and disappointment and passive-aggressiveness (and aggressive aggressiveness) with every step – with other doctors, consultants, nurses, nursing aides, case managers, etc. Everyone starting on the defensive and assuming the worst of each other. I was telling my mom about how it doesn’t all seem worth it to be a doctor. She told me things get better and that residency is the worst part of it. Here are some quotes I want to share and also keep to remind myself.

• Only the patients count
• U don’t get team players very often unless u pick your own team
• The others position themselves to be your competitors if they have the unfriendly mind set
• They sometimes have inferiority complex by attacking others it makes themselves feel better
• Analyze them as if they are patients
• They are not perfect (edit by me: and don’t need to be)

And my favourite:

• Keep up the current events in the world so that what’s going on is like a tempest in a teapot

P.S. I don’t forget that I used to hear my brother and his gf (now wife) complain about residency and get infuriated that they would just complain all day when people like me were trying so hard to get into med school. Oh life.

Hello second year

I’ve started my second year of residency and this means a new transition to being the senior resident.

My specialty is one of the only specialties where you’re considered the senior as soon as you’re no longer the most junior.

So I have an intern (first year resident) who I’m trying to be a good mentor to, to teach how to work in the hospital, and medicine, and overall how to get the stuff that needs to get done, done. But I’m struggling.

I thought I really wanted to teach for my career but these few weeks have me questioning that. I guess it’s the first time I’ve had learners who are really struggling themselves and just have such a long way to go. I have my junior resident who is trying but just still on the very steep part of the steep learning curve. And I have my student who is learning how to do tasks quickly but is so inappropriate attitude-wise. I’m trying to look at this month with them as a way to become a better teacher myself, to find a better balance between showing someone how to do something, doing it for them (to get the work done!) and letting them struggle through to learn themselves. I don’t look forward to the (what I think will be) awkward conversation with the student, telling him basically his personality needs to change. Or at least be covered up while he’s in the hospital. Inappropriate jokes, too much singing, all that needs to stop when we’re trying to get work done.

Overall this past week I’ve had rough days. At the end of my workdays I think to myself “I hate my life” and question if I’m clinically depressed. I don’t feel like I’m learning, I feel like I just follow algorithms and take orders all day. I don’t feel like I’m becoming a better doctor. I don’t even enjoy the opportunities to try to learn (noon lectures, etc) like I used to, I just sit there arms crossed feeling annoyed that the material isn’t relevant to what I’m trying to deal with that moment. Then on my days off I feel so happy and really enjoy life. Am I just in the wrong field?

Tonight I met up with some friends and they are feeling the same way. I was told recently by a faculty member that residency is hard everywhere.. but we’re not trying to crush your souls. I’ve been trying to check in with myself — is this just normal shittiness of residency, or is my soul being crushed?

My family reminded me tonight that residency is short and I’m already almost halfway done. That once I finish, I’ll be expected to know things and I’ll probably miss all the learning opportunities that residency had for me. My brother said he wished he worked harder in residency, that he would have learned a lot more. I guess I’m feeling like I’m drowning in residency right now but I ought to remind myself it’s just a short time in my life, and that all this deluge of work and hours and sleepless time and pages and rushing is all temporary, and inside it all somewhere are opportunities to learn. From here I’ll try harder, be more grateful, and be less afraid of being wrong.

Note to self

I think you gotta just be happy with what you have today (soooo lame! Cheese attack!) but it’s true. One good thing and one good day at a time, makes a life of it. Do good things that make you happy, be happy day by day, and then before you know it you’ve got a happy life.

– The one and only Wholly Marvelous

Life and loss imagined

When I was little, my family used to drive up to Toronto on weekends to have dim sum with the grandparents and cousins, and to pick up some Chinese groceries for the week. I didn’t want to go but once I was there I didn’t want to come back either. My mom would bribe me with Chinese candies and I’d drag my feet in our Toronto apartment, enjoying the plush carpeted floors while I could. These memories feel so far away, but also so familiar as if it could happen again this next weekend.

On the drive back I’d pop in cassette tapes of Fairy Tales – readings of silly and sometimes serious or creepy stories for kids – or Classical Music for Children – famous pieces done in synthesized beeps and boops. Being the youngest, I always wanted my brothers to be my friends, and I’d hope that they’d stay up on the car ride home and be in good enough moods to sing or joke with me. When everyone was too tired, I’d just look out the window at the stars and my mind would wander.

I’d think how amazing it was that the stars were so old and everyone sees the same ones. I’d think it’s strange how each of the other sets of headlights on the road had at least one person in them. I’d think how unbelievable it was that one day I’d be older and an adult and living a life somewhere. I wanted to live in an apartment with carpet and lots of Chinese sugared jellies and chocolate original Pocky. I wondered if my mom would still be nearby. I wondered if I’d still be alive when my mom died. I’d assume I would be, and I’d feel so sad that she would die one day that I’d start silently crying to myself while my mom, alive and well and unaware of her suddenly tearful distraught little daughter beside her, drove down the 401.

Obviously I’ve always been a sensitive kid. I grew up with anxiety, a healthy level usually but sometimes a little too much. It makes me indecisive but also careful and thoughtful. The trouble is I have a hard time telling when my worries are justified or when my mind is just getting away with itself.

I was driving through the ice sheets and snow today and my wipers were iced, useless. I was thinking about loss and feeling loss of things that haven’t happened. I’ve been mourning death of memories that haven’t been made, as if these moments once had life and now are sick, shriveling. There has been so much good and happiness in my life and in friendships but I find I’m wishing to have things returned to me that haven’t even happened. “Keep your promise!” I feel, out to life, the universe, or nothing. “I have lost!” I want help finding it, keeping it, preserving it before it’s all gone.

I’m not sad about anything that’s happened, which makes all this so strange. I’m so happy for everything. Yet I feel so much loss right now and I hope it’s just my mind getting away with itself but I think that I need to just let myself be quiet and let myself see that life continues to move and all it is in the end are memories made – lived, lost, and yearned for.

Halfway through intern year

Here are a few things I’ve done so far:

– felt cynical

– been humbled

– felt guilt

– went by someone else’s opinion instead of my own, and was burned

– cried at family meetings

– cried on the drive home

– hid in a bathroom and cried some more

– yelled at a patient

– felt disrespected/intimidated/supported/appreciated by other healthcare staff

– felt bad about myself for not knowing a fact

– treated someone rudely because i had just been rudely treated by someone else

– pronounced people dead

– broke it to an old lady that she had syphilis

– watched families watch their loved ones be coded

– felt like I should have been able to do more for someone

– felt like there was nothing else I could do for someone

– fetched drinks for patients

– gagged while examining someone

– woke up with anxiety cramps

– seriously questioned being a doctor

After 6 months of excitement, self-doubt, and growing pains, my morale had hit an all time low. I felt alone, isolated, and stuck. I thought it was maybe the weather, or maybe just me. I’ve wondered why I’m doing what I’m doing and why did I want this so badly – was I totally wrong? Is this what my life is going to be like forever?

It was a rough few weeks.

I’m not sure when things started to shift. Maybe it was from hearing so many co-interns mention something about feeling tired, feeling burnt out, feeling like they didn’t know why they were doing this. There was that time a 3rd year overheard us talking and sat with us for an extra hour after night clinic had finished, to tell us that he understood how we felt, that he was sorry, but that it’d be ok. He drew that graph someone had drawn for him, telling us that it’s half way through the year, the days are dark, and everyone at every level is feeling low. It’s expected and it’s ok. The more I confided in others, the more they confided in me that they too had been feeling dark and down, questioning themselves and where they are, lonely yet reclusive. In groups we wanted to appear confident and capable, but one-on-one we were openly vulnerable, anxious and insecure. One day while driving, it occurred to me how ridiculous it was to feel I was a bad person for not knowing something. Then you named this perspective and put this conflict into words.

A friend, a co-intern, told me of waking up devastated and guilty for not remembering what he had read the night before. Another told me of feeling it was time to quit. Another told me of anger over not being trusted, or fear of being thought of as not performing. And another told me how alone he felt. We all wanted so badly to show what we are capable of, to be told we are capable, to feel capable. We were falling apart.

It’s halfway through the year, and it’s some long dark days. But I’m feeling new. Newer than before when I felt like I was all untapped potential; vast and mysterious, awaiting the dramatic reveal. Now I feel like a sprout; little and very green. But earnest. Nothing more, nothing less.

The enemy

“The chronic pain patient who wants more and more pain meds isn’t the enemy. The pain meds are the enemy.”

Recap

So that wasn’t so bad at all!

I spent the day in the wrong place and I made the same mistake twice in a row but all in all it was a pretty good day. The best part was finding out I’d get an SSN tomorrow. Here’s to finally being able to prescribe and be paid!