Wednesday, June 13, 2018

Sustainable Living

I know that it's all the rage lately to make sure that our consumables are sustainable, our coffee free-trade, our packaging minimized and biodegradable. And I try to do all that, I swear. But today I'm here to talk about making life sustainable for myself.

I relate very strongly to this Hyperbole and a Half comic:

That was always my M.O., and I used to blame it on circumstance: plays in high school were six-week packages of balls-to-the-wall, barely-surviving craziness followed by an inevitable crash and sleeping for 24 hours. College and med school semesters functioned similarly. And residency was a marathon of the same. If you look at the numbers, my ability to sustain such a schedule seemed to be increasing over time.

But I never accepted these over-scheduled periods as My Life. And as the amount of time I spent running at 150% on all cylinders increased, my mental and physical health suffered. So sure I made it through high school, but I did a door-slam on my friends and developed an eating disorder. Med school ended with me almost dying because I didn't have time to get my obstructed lap-band removed until my potassium was so depleted (because I couldn't even drink water without vomiting) that I developed palpitations. And sure I made it through my medical residency...with seven cavities, an extra 80 pounds, and depression worse than anything I'd experienced before.

My focus in therapy during these years (I say that like it was a minor part of my life-- it was 15 years) was "just make it through this, then you can live." But living turned out to be something for which I was woefully under-prepared. I was never taught how to prioritize my health, develop good habits, say no when to live intentionally.

I struck out on my own four years ago, and while there have been some MAJOR growing pains, I've developed a lot as a physician (in knowledge and skill, but even more in confidence). I'm proud of my job and of my life. I have a pretty, cozy house and a functional marriage, I'm working out and eating in ways that are much healthier than previously, and I have friendships both online and in person that I greatly value.

And I worked really hard for all of it. I decided what I wanted and made it happen, often after a lot of soul-searching and talking with my (current, great) therapist. And, even more importantly, it seems sustainable (probably because Bill takes care of a lot of the household management).

But I still cycle through periods of fierce productivity and then lethargy at work. I don't run nearly as behind on notes or tasks as I used to, but I'm not the machine that my extroverted, male supervisors have become. And I still have periods where my mood and energy flounder. So I can't quite tell if this is "sustainable." I think I could do this for the next thirty years. That's my intention, anyway.

Tuesday, May 29, 2018

Worrying: Women's Work?

I visited my family this Memorial Day weekend. I tend to make two trips yearly across the State (about 300 miles--five hours driving). Once in a while, family comes to me. It's sufficient, but it does mean that I am occasionally very surprised by changes my nieces and nephews have undergone since I last saw them.

This visit, the object of discovery was my oldest niece. She's 21 and one semester from graduating with a bachelor's degree in dietetics. She rode back with me yesterday, and is going to rotate at a hospital here for her practicum.

And she's different than I thought she was in some ways, but similar to what I expected in others.

Her mother, my oldest sister (she's 47) is an unofficial town historian. She knows who is related to whom, what their great-grandmother's maiden name was, and whether there was an childhood or other traumatic death in that family line in the past six generations. She knows the gossip about everyone.

(She's also a huge practitioner of moral relativism, which I greatly appreciate. She's stood by lots of people who have been maligned by the rumor mill in our small town, telling their side of the story as often and as loudly as possible.)

I never developed this base of knowledge, because I moved out of town at age nine and resettled near a military base. Given the transient nature of station assignments, people in my new town didn't have such a prominent interwoven history. And I flourished as a free-floating, self-defined teen and young adult.

But here's the thing...because of socialization (?) or belief that it's the woman's place to keep such information straight (?), my niece also knows everybody and everything about them. This weekend, I noticed a distinctive slant to her choice of conversation-- she talked constantly about who is ill and their (very detailed) health status. She expressed worry and concern not only about her paternal grandmother (who was diagnosed late last year with pancreatic cancer), but about great-uncles once-removed and friends from elementary school who have fallen on tough times. A visit to the cemetery to clean up the family plot had her pointing out multiple graves of acquaintances and distant relatives.

She spends so much mental energy on borrowed worry.

I also noticed anxiety around her schoolwork, with perfectionistic attention to every detail possible, paired with a fierce defense of her self-worth which is clearly based on a (supposed or real) history of people underestimating her intelligence. I think there may be an anxiety disorder at work here.

She's currently planning on completing her (year-long) internship out of town (and expressed to me that she could see staying away, for at least a while). I think that is a wonderful idea. Perhaps moving away from the cloud of complications surrounding people with whom she's always been told she's massively interconnected will allow her some freedom, some peace. Maybe she will flourish despite any anxiety disorder, and become more fully her own person.

I sure hope so.

Friday, May 25, 2018

Shame Resilience

Wow, I'm really digging into the emotional/mental health issues lately, aren't I?

I've been to the dance with shame vis a vis the unattainable demands of perfectionism I discussed last time. I've shoveled through lots of it...TONS of it. And it simply stinks. For the uninitiated, check out Brene Brown's TED talk on the matter. Here's a quick excerpt (emphasis mine):

  • Shame is a focus on self, guilt is a focus on behavior. Shame is, "I am bad." Guilt is, "I did something bad." 

There's another component I think is important; I found it elucidated well here (emphasis still mine):

  • Guilt is an internal emotion. It's the general unpleasantness that you feel when you believe you have done something wrong, regardless of other circumstances. Shame is what you feel when people notice what you're doing, decide it's wrong — or just stupid — and look down on you. While guilt is associated with morality, shame is not. 

Shame is predicated on an outsider's idea of you, not your feelings about yourself or your (carefully crafted, I hope) moral compass. Shame busts in from the outside and tells you that you're rotten. It's like a reverse Kool-Aid Man. 

The guiding principle for me in differentiating these two is that GUILT can help us to change while SHAME serves to paralyze us. Shame is what fuels addictions, what holds us back from vulnerability in relationships, what makes us afraid to try where we might fail, petrified of disagreeing with the crowd. It's what keeps us alone and silent. But the thing is: talking about shame is the key to getting past it. The very vulnerability it keeps us from is what we need to fight it.

There is, obviously, a large culture of online shaming. A few friends (librarians, who are some of the wisest people I know and definitely have an edge with book recommendations) have recommended a book called So You've Been Publicly Shamed, which seeks to interrogate the cultural phenomenon and study famous cases, asking why this happens so often and if the spectacle is all it's cracked up to be.

Online shaming often removes the immediately available option of shining light on the situation via digital conversation. Even if the shamed individual tries to converse further online, to talk through the idea or even to apologize, the shamer(s) will descend to shut down conversation.

I look for online shaming by asking, "What is the intention here?" If the purpose seems to be to reform an individual's behavior, if a conversation with a reasonable person who honestly wants to change is welcomed, it's not noxious. But pseudo-anonymous public call-outs where the accusing party digs in their heels and violently doubles down generally aren't about change. They're about making the target feel small. They're about policing opinions and behavior and enforcing silence.

(A short pause to acknowledge power dynamics and my privilege-- I realize they play a part here. Certainly people who are disenfranchised for any reason have no obligation to help more privileged people learn. But the complete absence of any "Hey, maybe think about this...or read this..." by anyone in an online mob worries me. Groupthink is such a hidden evil.)

During treatment for my eating disorder (which happened during residency, when I spiraled out of control and my fear about my own health overwhelmed my shame at having to ask for help), I learned to recognize and work through shame. When I see patients who are displaying behaviors consistent with or expressing shame, I address it head-on ("It is so hard to come to the doctor to talk about your weight/depression/worries about STDs...thank you for being brave.") in the hope that it won't hold them back from enacting the plan we craft together. shaming behavior triggers my response to dissect and dissemble the feeling. And, even with practice, it takes a couple of days, and talking to some close friends (or into the void/to myself).

Recently, someone tried to enforce some moved goalposts in a way that activated my shame-dar. I knew the entire thing was not worth my time, but my brain had to unpack and sort through it. After a hard day at work, long talks with some good friends (including Bill- ye gods, having an intuitive feeler who's attending therapy school on hand is quite awesome) and a semi-sleepless night, I'm back on my feet and mostly past it. My resilience is there, but it's still not easy or fun.

Friday, May 11, 2018

Toxic Perfectionism (Is There Any Other Kind?)

I have always been a perfectionist. I've spent years in therapy trying to figure out from whence it came. (Trying to cheer up my chronically depressed dad? Penance for being an overweight child? Trying to make myself small and no trouble to anyone? Being really afraid that no one will every love me?)

This perfectionism has caused multiple issues over time, including, but not limited to:

  • Anxiety over many things, but especially writing patient notes, causing me to fall behind--dating from residency. It's gotten better as I've been forced, by volume, to get better, but it was so painful.
  • Issues with weight-- I've been up and down up to 150 pounds, been through two bariatric surgeries and a stint of intensive outpatient therapy for an eating disorder. Basically, I had an "all or nothing" approach for YEARS and it was horrible for my body.
  • Unhealthy measures to please people (see: fandom behavior and door slams)-- at times, I've held my tongue for too long about behaviors that are objectionable to me and exploded, which is...not good for my mental health, and not good for the people I'm around.

Perhaps the latest way perfectionism is holding me back can be seen in my recent attempt at bullet journaling. One part of the problem is: I run about 3-5 days behind notes for clinic, on average. And I feel compelled to list every day with pending notes, and all the notes, on my task list for each day (perfectionism). Then, when I inevitably underachieve (because there's only so much mental and emotional energy I have to expend each day), the practice is to carrot it to the next day and re-write it.

It's demoralizing. I know the message I'm supposed to take from it is to not over-schedule myself. But the problem is that the ENTIRE FIELD OF MEDICINE overschedules me. And even if 15 minute appointment weren't the standard, I'd probably see as many patients as possible because there are people who need me.

So I'm stuck. I guess the solution for now is to try to keep up as things go during the day, even if it leaves me entirely exhausted every evening. I'm also doing well at coming into work an hour early to catch up on outstanding charts. (Which puts me at a 7:30-5 workday, for everyone who says doctors are lazy.)

It's an unsolvable problem. There's no way to be perfect, and that drives me around the bend.

Tuesday, May 8, 2018

The Mother's Day Conundrum

Lying in bed last night, I was thinking about a conversation I had recently with a friend struggling with infertility, and about how often people (patients, family...people who don't know me well) ask when I'll be having kids. I asked Bill if he feels guilt or sadness about Father's Day (after all, he's a childless married man and his father is deceased- double whammy). He said No. Of Course Not.

So that made me wonder. If it's not about the presence of a holiday celebrating maternity/paternity, does the reaction women have to Mother's Day perhaps hinge on society's expectations and feelings of ownership over female bodies and reproduction? On either the pressure we feel to have children, or the feeling of failure if we want to and are unable? (Not to mention the ever-present scrutiny of how we're doing once we do have children.)

To slip in some post-fandom hurt here:

Is the anger women feel about this issue the reason that my posts about the feelings my friends and I had around the death of Mary Watson for Sherlock Holmes (that her motivation was not supported by the writing we saw on the show, especially considering her young daughter) were met with ire and seemingly deliberate misunderstanding of my entire point?

My point, of course, was that the producers of Sherlock Series Four relied on shortcuts and emotional manipulation of the audience rather than spending time in the story to develop naturalistic pathos for the characters and their actions.

The misconstrued point I was accused of making? That Mary should be a stay-at-home mom and never do anything about her previous job because I'm a backwards, anti-feminist bitch who understands nothing about pregnancy, childbirth, or motherhood.

So yeah, Mother's Day is kind of horrible unless you're in the minority who has done everything acceptably by societal standards, and have a living mother who has as well. And it's unavoidable. And mentioning motherhood in an online arena is an invitation to ignorant bullying.

Come at me.

ETA: On a happier note, I just realized that the first kiddos I delivered in residency will be turning seven soon. <3

Tuesday, April 17, 2018

Different Flavors of Dork

Yesterday I ended up cancelling my personal training session, going home, taking a benzodiazepine, and sleeping the anxiety off. Then I woke up and did some work catch-up. And here I am, back at work feeling not as strangled.

I think blogging yesterday--"journaling", so to speak--really helped. So I decided to make some time for it today. Who cares that I'm totally and completely booked this afternoon with patient appointments? I will persist and come out okay.

I get to see Hamilton tonight. I'm excited, because I really didn't think I would be able to see it in its short stay here, but I'd been hearing of people getting last minute tickets, so I hopped online to check. I'm not sure what happened to open up seats, but there were quite a few available, mostly limited view d/t their position in the auditorium. And the price was not all that much worse than I've seen in Chicago.

Bill has been putting up with seeing musicals around my birthday for the past couple years-- Fun Home and Rent. (What we each took away from those two, and how much it says about our histories and personalities is a blog post in itself). We already have tickets to see Phantom on the actual day this year, but those were from his mom so I pulled the "This is my birthday present!" card and bought some pretty great seats.

Bill is a different sort of theatre dork than I am. He has good memories of the musicals he was in during high school (Bye, Bye, Birdie, Pippin, and Godspell), but other than those and some of the albums he listened to from his parents' record collection (West Side Story and Jesus Christ Superstar), he's not really a fan of the form. And he tends not to get excited about new musicals or concepts.

I, however, gobble up the form. I love new and original musicals (Legally Blonde, Heathers, Urinetown, Jerry Springer the Opera, and the above mentioned Fun Home are just a few) as well as the entire experience of seeing a BIG show in a velvet-draped theatre. I was in plays in high school, including The Music Man and Guys and Dolls, and I did A Funny Thing Happened on the Way to the Forum in med school, but I'm not crazy about actually performing.

I think Hamilton is absolutely outstanding, for a whole lot of reasons. One of my all-time favorite musicals is 1776, so any art that takes our depictions of the founding fathers off the page and into the streets has a place in my heart. And the social issues that this play, producers, and cast have brought up only increase my admiration.

Bill's exposure has been minimal (I made him listen to the original cast recording during a road trip a year or two ago), so I'm looking forward to tonight. Part of really knowing and loving someone, I guess, is being excited about sharing experiences with them.

Monday, April 16, 2018


This weekend was odd.

First, and perhaps most obviously, I wasn't at 221B Con. That had more to do with work than my exodus from the fandom. I recently took off an entire week to go out of the country, and I am travelling again in another two weeks to go to a wedding. Being the junior physician (and not the owner of the practice), I just couldn't ask for the days.

And regarding work...I've been running ragged since coming back from vacation (hence the lack of updates) because we lost a provider. So, in addition to the actually "New Patients" I am seeing-- sometimes six a day-- I'm seeing all of this provider's follow-ups. And I'm not sure how in the world so many of them are coming all at once, because their schedule was never all that busy.

(For example, I saw 15 patients last Thursday, and 11 of them I was meeting for the first time. I don't care who you are...that's exhausting. Perhaps doubly so for an intuitive feeler.)

Anyway, back to Con. I had planned to remain blissfully unaware of the event, but I got hit with FOMO. There were lovely people there who I've never met in person, and even if I didn't go to a single panel, I would have been busy socializing.

True, I would have been thinking of The Thing, which would have upset me. But as it stood, I kept making excuses to check on Con on twitter. Did my pride bracelets get delivered? Did they sell well? Did Caroline get my shower gift? And in doing so, I saw lots of descriptions of panels and the general gay-ety. So I ended up missing out and thinking about The Thing.

The other half of my weekend weirdness was what I've termed "Fear of Messing Up."

This is a phenomenon many young physicians will recognize. I think it's in The House of God that an intern freezes and can't order ibuprofen for a patient because he can't stop thinking about every possible negative side effect. It's something that gets trained out of you pretty fast during residency, because of the volume of work. If you agonized over every decision, nothing would ever get done, which would ultimately be much worse for patients than the side effects of ibuprofen.

Add all that some Imposter Syndrome from being a woman in a competitive career and it can be a potent cocktail. Now that I've been out of residency for four years, practicing independently and doing well medically and with patient satisfaction, I don't get intense FOMU often.

But I saw an acquaintance (a friend of Bill's) as a patient on Friday, and this person was sick. I did what I could at the office (EKG, chest x-ray) and then admitted them to the hospital. I did think for a bit about trying to treat them at home with some new medication. But thank God I sent them in, because when I called the covering doc on Saturday morning to check in, this patient was in the ICU on dialysis.

Oh shit. Did I miss this case of renal failure? This patient could have DIED in a matter of hours if they didn't get admitted...if I had followed through on the plan to send them home with medicine.  The medicine I was thinking of would likely have made things WORSE.

But Tassy, you say. You didn't. You made the right decision, to send them in for more comprehensive evaluation and care. You did what you needed to do as a primary care doctor working in an outpatient setting. In all likelihood, your actions helped to save their life.

And yeah, I hear that. I recognize its truth. But when I got the news, I was suddenly that scared little intern again, afraid to move for fear I would inadvertently kill someone. This is probably the third most acute case of FOMU I've ever experienced. And it's still going on.

What it boils down to is that I spent the weekend drinking, eating, being awkward with my husband because he was stressed too, and reading fanfic. And now I'm back at work for another busy week, feeling not a bit refreshed.

It is what it is.

Sustainable Living

I know that it's all the rage lately to make sure that our consumables are sustainable, our coffee free-trade, our packaging minimized a...