A Break From Authenticity

Last night I picked up my copy of Brené Brown’s Daring Greatly. This book has been sitting on my shelf, unread, for almost three years.  My mandate to begin “Living Authentically” started shortly after I read Brené’s earlier published book, The Gifts of Imperfection. Since moving, starting residency, and having another baby, my goal to read Daring Greatly kept getting pushed to the bottom of my list.  Within the midst of my current existential life crisis, I decided it was time to pick up the book and stare Wholeheartedness right in the face.

I didn’t even get through the prologue before realizing that I no longer live, or even embody, the qualities of wholeheartedness and authenticity.  Maybe I used to, but in the struggle to keep up and keep going, I’ve let these important aspects of my life fall to the side.

Our willingness to own and engage with our vulnerability determines the depth of our courage and the clarity of our purpose; the level to which we protect ourselves from being vulnerable is a measure of our fear and disconnection

~Brené Brown, Daring Greatly

The one thing I know for sure is that right now, I have no clarity of my purpose.  I am filled with fear and disconnection from my life and my purpose.  I feel confused and I lack direction because my viewpoint on life is clouded by outside expectations, judgement, and comparison.  My internal dialogue is lost and disguised by everything that defines fear and vulnerability.  These definitions were very well delineated by Brené Brown in The Gifts of Imperfection and I know that reading that book changed my life.  I blogged about that change on the old blog and I will find that post to re-post here in the coming days.

Ironically, The introduction to Daring Greatly literally reminded me of these imperfections and what needs to be shed from my life:
1. Letting go of what people think
2. Letting go of perfectionism
3. Letting go of numbing and powerlessness
4. Letting go of scarcity and fear of the dark
5. Letting go of the need for certainty
6. Letting go of comparison
7. Letting go of exhaustion of a status symbol and productivity as self-worth
8. Letting go of anxiety as a lifestyle
9. Letting go of self-doubt and “supposed to”
10. Letting go of being cool and “always in control”

Each of these ten imperfections, every single one of them, comprise the mental roadblocks that I am struggling with right now.  These imperfections are preventing me from committing to the decisions I am faced with in my life today.  I need to lean-in to my fears and rediscover my vulnerabilities.  I need to embrace them and re-discover my own authenticity

 

Distressing Dreams

The past has been coming back to haunt me.

Over the past few weeks I have been having a series of distressing and upsetting dreams about people and events from the past.  I have spent an inordinate amount of time trying to process and accept the misfortunes that serve as the basis for these dreams, but clearly, they are still stirring around in my subconscious, waiting to haunt me at the least opportune times.

It is coming up on that time of year again: the residency matching saga where medical students scramble to apply to, interview, and eventually get offered (hopefully) a residency position where they want.  If you followed my old blog, you will know how distressing of a time this is for me.  If you are new to my blog, I’m sorry that this post will make less sense to you – I will try to find a way to explain the terror that this time of year was for me when I went through it a few years back (perhaps in another blog post).

Intertwined in the match saga is the surge and then eventual demise of my relationship with my old friend and mentor, Kay.

Unfortunately the dreams that have been occurring lately have all involved Kay or other people that elicit the painful and undesirable memories that this time of year holds for me.  I know that my current levels of dissatisfaction and confusion about my career choices makes these memories and events even more difficult to tolerate.  After all, if I was very happy in my current situation it would be easy to say that “this was the best thing that could have happened to me.”  But, I can’t say that.  So, my subconscious continues to dwell on the “what if” and “if only” byproducts of my past misfortunes.

One dream that is recurrent, but seems to be more prominent now, involves the resurgence and reconnection of my friendship with Kay.  It plays out exactly how I wish it would have long ago.  It is a beautiful dream filled with honesty, forgiveness, understanding, and starting anew.  However, too much time has passed now and having this dream only causes pain because I know it will never come to be.  I end up asking myself why I still dream of having her back in my life as a valued friend, after everything that’s happened.  I want to believe that she is a good person who either did what she needed to do at the time, or realized she made a mistake with how she treated me.  Unfortunately, as more time passes, I come to believe more and more that she feels that she made the right decision by removing me from her life.

I have “recollection dreams” about how important Kay was at this time in my life, those few years ago.  I recall her supportive words and her sympathy and empathy over the catastrophic events.  I re-experience all the good and wonderful times we had in our friendship and I wake up to the sorrow of knowing that something so wonderful no longer exists.  And to make it worse, that sorrow is filled with feelings of guilt and anger towards myself – reminding me that I am at fault for the absence of this beauty in my life.

Last night my sleep was riddled with variations of the same dream: This one involved interactions and observations of the people who didn’t experience my same misfortunes.  These people are, in essence, living the career life that I had imagined for myself… The life that was shattered for me with little explanation, but that was given to them as they expected.  I watched them as they expressed satisfaction and happiness with where their lives are going, all while I am lost in the confusion and distress of my own life.  The variations involved them coming into my world, and me going into their world, and regardless of where we were, I felt resentment and anger towards them and the system that allowed this to happen.

It is not helpful for me to experience these types of dreams while I am in the midst of trying to overcome negativity in my day to day life.  It is difficult for me to get out of bed after a night of distressing dreams and say to myself, “today is going to be a great day!”  It is next to impossible to keep looking forward and push through my day -to-day challenges when my subconscious continues to drag my back into the past I am trying to overcome.  I can’t control what I think about when I sleep, and I have no solution to overcome this problem.

Late Termination

1.
I punched the 5 digit number into the phone and waited for someone to answer… “Hi, this is the gyne resident, you paged?”

“Yes.  The induction is here. Can you please come and write orders and get things started?”
I wasn’t aware of any induction, nor was I in the right frame of mind to initiate an induction.  Where I live, “late terminations” by induction of labour can be performed for lethal or life threatening fetal anomalies up to 24 weeks.

I went to the ward where the patient waited for me.  She was likely not expecting the person about to initiate her induction to be just as pregnant as herself.  Her chart was clear – her due date only 2 days before mine.  Her unborn baby the same size as mine… moving and kicking and full of life, just the same as the one inside of me.  The only difference: my baby had a normal heart, and normal kidneys, and a normal bowel.  Hers did not.

I went into the room to find her laying still on the bed.  I hoped my scrubs were loose enough to disguise my swollen belly, even though I knew it wasn’t likely.  I explained to her the procedure – how I was going to giver her some medication that would make her cervix soft, and that I would put a small balloon inside her cervix to help it open up.  Essentially I would be inducing her labour, and then she would give birth to a pre-viable fetus that would not survive.  My baby in.  Her baby out.

I sat on the cold, metal stool between her trembling, spread out legs.  I placed the speculum and opened to find her swollen, closed cervix.  “You might feel some cramping now,” I said as I slid the catheter into the opening.  I began filling the balloon.  She winced.  Bright blood started to trickle from the end of the catheter.  I slid the speculum out and placed the medication in its place.  “We’re done.”
I felt my own baby kick me from the inside.

2.
It was 5pm and my night shift was just getting started with handover.  “The woman in room 6, she’s  an indiction for cardiac anomalies.”  I cringed.  It had been less than a week since the last induction.  I didn’t think I could handle another one so close.  “The patient and her partner are not coping well, just so you know.”
This time the baby was already gone – the family had chosen an intracardiac injection prior to induction.  This time her due date was the same as mine.

I decided not to meet the patient – unless there was a medical issue that needed attending, there was no need for me to go in.  I hoped that it would be a slow process and that I could get through the night without being called to see her or her stillborn baby over the next 14 hours.  It almost came to be.
But 30 minute before the end of my shift the nurse called me: “I’m really sorry, but her foley came out and Dr. X called and wants you to break her water.”  It would have been “inconsiderate” for me to leave that task for the person coming on after me.  So I went.

Again, I was too conscious of my own pregnant belly – of my own live, healthy baby who is perfect and who is still alive.  I pulled the scrub gown I was wearing backwards around and over my swollen-ness.  I introduced myself with trepidatious confidence and then sat at the end of her bed.  I proceeded to do what I do so often for women in labour with babies that they are going to bring home with them.  I felt her cervix and stretched it open.  With elegant ease I slid the hook up against my fingers until it reached the tough, premature membranes.  I felt sick at the thought of my hand being so close to a dead baby, the same size as mine.  I almost said that I wasn’t able to reach, even though I could.

I tore the membranes apart and watched as the clear, straw coloured fluid poured from her body.  Suddenly my fingers felt vast space and openness.  I felt my heart skip a beat as I was unable to tell if her cervix fell from my grip and I was feeling her vagina fill with fluid, or if her cervix was suddenly wide open and at any moment I would catch her baby with my fingers and deliver it right at that moment.  The water seemed to gush forever and my hand was paralyzed in place.  I feared that I would feel the delicate touch of her baby’s hands or feet or head and I wanted that moment to be over.  When I could no longer handle the thought of delivering a stillborn baby the same age as mine, I pulled my hand out and tried hard to stand without fainting.

It was the end of my shift.  I went home to sleep.  I woke up hours later and decided that I was done doing late terminations as long as I am still pregnant.

Rampant Guilt

When my kids are sick, I am usually the one to push through the sleepless nights, make my husband mostly deal with them, and leave them home with the Nanny while I go to work.  I don’t have a lot of flexibility at my job to take days off (I get 5 sick days a year and 4 EDOs which need to be scheduled in advance).  This makes the decision when it comes to caring for my sick kids very difficult.  I almost always go to work when the kids are sick and spend the whole day worrying about them and feeling guilty for not putting them before my work.

I already have a significant amount of mommy guilt when it comes to dealing with my vomiting kids.  I have extreme emetophobia (fear or vomit/vomiting) and usually can’t be near my kids when they are vomiting or I think they will vomit.  I also fear that by being next to them, I will “catch” whatever bug they have and then I will get sock too.  I hate myself for it, but I can barely put my fear/anxiety aside to comfort my kids when they are sick.

Yesterday my son developed a horrible bout of gastroenteritis.  At least I figured it was gastro, until he could not stop vomiting (no matter what medications we tried to give him) his entire stomach contents, then bile, then just poor retching.  Even a sip of water to wet his mouth would lead to more retching.  Through this all he was complaining about a really bad stomach ache and the pain seemed to be  getting worse as the night progressed.  After already being awake all night and finally overcoming my vomit fear to lay down with him and rub his back (at this point he was barely even retching anymore), I began to worry more about his abdominal pain.  He wasn’t sleeping, I wasn’t sleeping, and he was obviously dehydrated.  I felt like he needed to be seen in the urgent care centre, at least to check out his abdominal pain, and to possibly give him some stronger medication and rehydrate him.  Making the decision to do this meant that I for certain wouldn’t be able to go to work today.  So after weighting which guilt would be worse – that of not taking care of my sick son or that of calling in sick to work for the second time in the span of a week – I opted to take him in.

I put his cool little feet into his socks and piled him into the car with his blanket, giraffe, and a little puke bowl.  I drove across the city at 2:30am and listened to him moan in pain from the back seat.  I checked him in to the urgent care and waited for the nurse, then the doctor, then the medication, and finally the rehydration.  My 5:30am alarm rang and I made the call to my chief resident.  I felt horrible for that.  Eventually my son’s lips started looking less dry and his face less pale.  He was more talkative again, and we got the go ahead to leave.  We drove home and got into bed and slept most of the morning,  However, when I woke up, I felt an extreme amount of guilt for not being at work.

It feels like I can never win the battle against Guilt.  For every “good decision” that is made, there seems to be an equal and opposite “bad decision.”  I feel like I am always trying to decide which decision is actually the good one…

 

Oh, Eleanor

“Do what you feel in your heart to be right –
for you will be criticized anyway.
You’ll be damned if you do, and damned if you don’t.”

~Eleanor Roosevelt

From The Old Blog, November 12, 2014:

Eleanor Roosevelt has got to be my most favorite woman in history.  I don’t know much about her, but anything that I ever find written by her or about her always makes a solid and lasting impression on me.  This quotation, while I have come across it before, has probably never meant as much to me as it does now.  If I look back at all the events and interactions that took place in my life leading up to this present moment, it occurs to me that I often did what I felt to be the the right thing.  I truly believe that.  Unfortunately, I have been criticized in some of the harshest ways (in my opinion).  And, what if along the way I did the opposite?  Well, I would have likely been criticized too.

More than ever I feel this quotation to be true and accurate.  I have had my fair share (and I’m sure there is more to come) on being damned for doing something I should have or haven’t done – The old “Damned if you Do and Damned if you Don’t” paradigm.  I’ve realized what it all comes down to in the end, is doing exactly what you feel to be the right thing to do in that situation.  What is going to make you feel the best about yourself?  What is going to make you happiest in the end? What values and believes do you want to stand for and represent?

Too often our fears of criticism and prosecution get in our way of making the right choice.  I have to admit: after everything that I’ve been through in the past year and a half, including the discovery, criticism, and backlash of my old blog (and now my decision to start over), I have sometimes made a decision to do something that didn’t feel right just to avoid causing problems for myself.  Maybe in the end it is the right decision for me because I am saving myself from trouble… Who knows?

I have sometimes overcome the fear of criticism  by simply convincing myself that the excuse for not doing what I feel to be right is just not justified.  It is hard to not pull back out of fear, but sometimes it is harder to push forward through the fear, especially when you’ve experienced the ultimate criticism.  As always, Eleanor Roosevelt has the best and most simple solution: just do it anyway, because it will be wrong (and possibly right) no matter what it is you choose to do.

And just for fun, here are a few of Eleanor Roosevelt’s other quotations that I love:

“The future belongs to those who believe in the beauty of their dreams”
We are afraid to care too much, for fear that the other person does not care at all.”
We gain strength and courage and confidence by each experience in which we really stop to look fear in the face… we must do that which we think we cannot.”

Starting Again

We both ordered a diet coke. I secretly love when other people order diet drinks… They get it.

This was the first time we planned a meeting outside of the office and I’m sure neither of us knew what to expect. She’s off on her maternity leave now, so we figured it was a good time to meet.

Before we got too far into our casual conversation, I started with the awkward conversation: “I thought more about what we talked about last time we met… About transferring my care to another doctor. It’s not often easy to find friends who are in this medical-motherhood lifestyle and it just seemed ironic how our private lives kind of meshed and it would be great to be friends. But, You are also a really great doctor and didn’t want you to feel like you were obligated to be my friend if you transferred my care to one of your colleagues.”

I first met her just over a year ago when she was the only female GP I could find in my area who was accepting new patients. I knew instantly that I liked her. She’s my age. Over time I learned that she has kids the same age as mine – we kind of bonded over the challenges that come with kids of this age. She was open to me about her struggles balancing life as a doctor, a mother, and the wife of a professional husband.

One night I was at a community association meeting and I met a man with the same last name as her. “My wife is a GP at [the clinic at the hospital where I work], maybe you know her.”

Spring time came and we started seeing her at the community playground with her kids. We walked past her house on our way home from our community garden. We shared our bounty of green beans and snap peas. We mingled together at a community association BBQ where we laughed over virgin margaritas and watched our husbands talk about who-knows-what.

The last time I saw her in the office I talked to her about my recent thoughts about possibly changing specialities to achieve better work/life balance in the future. I asked her if she would be willing to meet with me to talk about what her work/life balance is like and what her road in her career choice has been like. Of course, she was more than willing to meet with me, and that’s when we briefly talked about whether there was more value to me in a friendship or a therapeutic relationship. At the time I didn’t know what to think. Becoming friends with someone who used to be my doctor… Well, it was complicated last time. I just said that was wasn’t sure, but that I also didn’t want to make her feel uncomfortable. She gave me her cell phone number and I left the office. I waited until I knew she was on her maternity leave before I contacted her.

We had a great time at lunch. I wished her all the best in her upcoming delivery and we parted ways. We have no plans to meet up again, but I know it’s only a matter of time before we run until each other again. And, it will be at least a year before she’s back in her office.

Hopefully this friendship turns out a little differently than before.

Ultrasound Nightmare

I walked into the little ultrasound room and sat up on the bed. The screen was facing me, which was immediately odd to me because they usually never let you see the images as they take them. The technician started scanning my abdomen and I watched the screen diligently. I didn’t see a nice, large, well defined gestational sac. Instead I saw grapes.  Grapes – small, copious numbers of little round focuses on the screen  inside my uterus. 

The technician left the room without saying anything. Quickly, she returned with the radiologist who them confirmed what I saw on the screen: a molar pregnancy. No baby – gestational trophoblast can disease – could become malignant if I don’t get rid of it right away. 

No baby.  

I got off the table and cried as I changed. 

And then I woke up. I looked at the clock on my night table as my confusion subsided: 4:06. I couldn’t help but worry about my nighare for the rest of the morning. 

When I went for my real scan, I was extra nervous. This time the screen was facing away from me and the technician clicked away, pushing unimaginably hard on my full bladder. Quiet, save for the sound of the machine snapping screen shots. Then she broke the silence: “have you ever had any surgery in your pelvis?” The probe was over my right lower quadrant. What did she see… Or not see? An ectopic pregnancy, or maybe just an elusive appendix.  I told her that I had my appendix taken out. She was satisfied. 

Eventually we changed over to the endovaginal scan. As I got up to use the washroom and take off my underwear, I sneaked a look at the monitor: a gestational sac – no grapes. But nothing else. 

More scanning in silence. I saw her scrawl the little ball backwards, which is what I do when I’m checking for a heart rate: Thats’s a good sign, right?  Eventually she was done and she went to talk to the radiologist. I sat on the corner of the bed watching the same shift loop play on the screen: an intrauterine gestational sac with a tiny fetal pole and an even smaller yolk sac. I resisted the urge to scroll through the other images on the screen – no control. 

The technician returned to the room alone. She told me that everything looked good and she offered to show me some pictures. She showed me the yolk sac and the fetal pole inside the gestational sac inside my uterus. 

No bad dreams. 

“Did you find a fetal heart rate,” I asked? 

“Yes. About 119.”

Relinquish Control

It hit me like a tonne of bricks this morning: Everything about my Freak out yesterday stems from my pathological desire to have control over everything.

I am imagining the conversation I will have with my psychologist later this afternoon: “I wanted to control something that I can’t control… it’s not my job to control this and really, it can’t be controlled.”

This control problem that I have is something that I’ve suffered with for a long time.  It has been an ongoing theme with my anxiety issues and something that my psychologist and I have been trying to work through for many many months.  Learning to recognize what I can and can’t control, and then accept those limitations is something that I am not very good at doing.  But then again, I suspect that many people have this problem as well; isn’t there a prayer for this exact problem?
Perhaps the reason I am feeling so bad about what happened yesterday is because subconsciously I know that I was trying to take control of a situation that I cannot control.  Not only can I not control this situation, I can’t change what happens.  What if that number had really been zero?  Or what if it was dropping – there would be absolutely nothing I could do to prevent the inevitable.  Yesterday, I clearly lacked the Wisdom to make such a differentiation.  I also lacked the serenity to accept the fact that this is something out of my realm of control.

It is a hard thing to accept – a lack of control.  In my life I struggle with the knowledge that I have control over very little.  I know this adds undue stress and anxiety.  I know I need to accept this truth and find peace with it.

God, grant me the Serenity…