Walking Tall

This month I’m traveling around the country to check out fellowship positions. It is exhausting, trying, lonely, and often confusing. Most of all, I miss my kids.

I spend a lot of time trying to figure out how fellowship and moving to one of these places would fit into the current, ideal, little life of mine, but it’s hard to do.

This morning, as I walk to the clinic, I am in awe of my own strength. This is not an easy task

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Paradox

When I was in medical school and considering my specialty, someone said to me: “You can train anyone to be a good obgyn.  What you can’t do is train someone to be a caring, kind, and compassionate human being.  People will see that about you and above all, that will stand out.”

Last week I had coffee with one of my current preceptors.  This man interviewed me when I applied to residency.  When I was accepted into this program, he told me that I was his favourite applicant that he’s ever interviewed.  He said I had a passion for life and a light about me that made him know instantly that I would make a great obgyn.  At our little coffee date last week he said to me: “Aggie, I have noticed that you are not the same person today that you were when I interviewed you.  I am so disheartened to see that our program has stripped away the best parts of you in an attempt to make you a good surgeon.  I don’t know why we do this to our residents.”  He continued, “I just wanted to tell you to not let residency win.  This is finite and when it is over, I hope that you will go back to being that person I remember from your interview.”

Both of these people, people I’ve respected and considered mentors, have spoken such true  yet conflicting statements.  In training to become the type of physician I want to be, I have lost the aspects of myself that would make me the kind, caring, and compassionate physician I imagined becoming.  Within this paradox lies my problem.  Can I ever come back from this?  Do I turn around now and work on nurturing myself back into the person I used to be, or do I risk continuing down this path I’m on and perhaps never recovering what I’ve lost?

Is there a right answer?

Queens Don’t Fail

 

 

Last week a friend of mine from medical school send me this snapshot from a book she’s reading: Constance Halls, “Like A Queen.”  She felt that this sentence embodied me.  Just the day before I told her that I was considering a specialty change.  I confessed that one of the feelings holding me back was that of failure.  In my mind, switching means failure.

The past few weeks have been a challenging time for me.  For years now, I have thrown around the idea of changing specialties in medicine.  Initially, the idea started because I struggled greatly with my work life balance: there is no room for family life in a surgical residency.  When A. was diagnosed with ASD, I took some time off and realized that I needed to give more to my family.  Despite that, I tried for a long time to convince myself that as long as I loved my job and enjoyed what I did while I was at work, the sacrifices at home would be worth it.  I honestly believe that, even now.  However, as more time goes by, I wonder if I really do enjoy my job as much as I tell myself I do.

Lately I find that I haven’t been as interested and engaged in my work.  I do my work and I take care of my patients, but I haven’t really been enjoying myself.  I wake up in the mornings dragging my feet and I spend a large proportion of the day waiting for it to come to an end so I can get home to my family.  Surgery is technically challenging and pleasurable, but I don’t feel passion when I am in the OR – Just a sense of obligation.  My call shifts are becoming more and more onerous, especially as they stack on top of each other: all I want to do is sleep.  When I think ahead to the heavy rotations, the year of being chief resident, and the studying that is going to have to happen, I cringe.  I know that not too far from now, I will have to neglect my family even more than I do now for an entire year if I want to pass my board exams.  And, I just don’t think I’m willing to make that sacrifice.

So, does that mean I need to change my goals?  Or am I just experiencing a bad case of burnout?  Maybe a little bit of both?  Is this really a good time to make a change in career paths?

I feel dissatisfied at work and I feel like I am falling short as a caring and engaged mother when I am at home.  I know, for certain, that these two feeling are not exclusive of one another.  Together these feelings play into a vicious negative-feedback cycle: I dislike my job because of how it affects my family life, and I feel guilty about what happens to my family because of how much I commit to my job.  Inadequacy in all aspects of life make for an unhappy life.  Despite all of this dissatisfaction, I feel frozen and unable to make a decision on how to move forward.  Staying in the same place, expecting things to get better feels like the wrong decision.  Yet, committing to change, admitting that I’m not happy, and taking a new path is frightening and feels like failure in disguise.

All these thoughts, ideas, and stressors have caused havoc in my mind.  Just a few weeks ago, after decideding to move ahead with the change, I felt empowered and giddy with excitement that I was taking control of my life.  That excitement has now completely dwindled away to leave only more anxiety and fear over the decision.  I fear that I am making this decision for the wrong reasons and that one day I will regret not “sticking it out.”  But I also fear the perception of failure.

I know I could finish this if I tried (and if I wanted to).  But is it what I really want?

 

A Different Decision

We face decisions everyday.  Some are those types of decisions that are made without even thinking: Starbucks coffee? Pants or shorts? Dinner in or dinner out?

But what about those decisions that feel impossible to make?  Those decisions that seem to have no right and no wrong choice? Each choice is equally good and equally bad… So the decision becomes an impossible one to make.

Or maybe there is a clear right and a clear wrong to the decision, but you are just unable to elucidate which is which.  There are those times when the wrong decision feels like the right decision and you get fooled into making the wrong choice.

Has this happened to you?

My maternity leave is coming to an end.  I specifically chose to only take 5 months of my full year leave because I didn’t want to put myself too far behind in my training.  I don’t want my surgical skills to wane, I want to write my exam on time, I want to stay with my cohort of colleagues, and part of me misses work.

The trade-off: I could spend a whole 7 more months at home with my kids.

I don’t feel ready to go back.  The time I have had off feels like it has been stolen from me because I’ve had to deal with work problems while I’ve been off.  We are losing our nanny and my husband doesn’t want a new one; therefore, our childcare situation going forward is rather precarious.  I feel, deep down inside of my soul, that going back to work in two weeks is going to cause my home/family life to spin out of control.

Lately I have been thinking more about extending my leave and taking off my full year.  The reasons I made the initial decision haven’t changed, but I feel like priorities have shifted.  Despite this shift, I find this decision is still impossible to make.  There is no clear right or wrong, and the advice I get from everyone I talk to is the same: Do what’s best for you and your family.

Unfortunately, I feel like what’s best for me and my family is not very clear right now.

Finding Myself

“One of the greatest tragedies in life is to lose your own sense of self and accept the version of you that is expected by everyone else.”
K.L. Toth

lollipop

Image Credit: Google Images

How do we know when we are on the right path in life?
How do we know that we made all the right decisions for all the right reasons?

I have come to a crossroads, perhaps a crossing of paths like the one famously described by Robert Frost’s most quoted poem.

I’m acutely aware of a dissonance in my life – the two largest parts of my life suddenly seem to clash with each other.  I am not a happy mother because I know that when it comes to my kids, I have sacrificed more of what they need of me than makes me comfortable.  I am not a happy resident because I’ve come to realize that perhaps the amalgamation of my parts – the very aspects of my life that make me the person I am – does not completely fit the criteria of what my superiors want to see.

I cannot take more away from my life at home – from my children; from me – and force myself to become someone who isn’t really the person I am meant to be.  If I continue down this path, I know that at the end I will be more unhappy than I am right now.

Unfortunately, the other path is scary, unknown, and not what I ever imagined in my life.  I don’t know what the end will look like or what I have to traverse to get to that end.

What I do know is this:
I am a mother to three beautiful children, and that should be celebrated.
I am a physician who is caring and compassionate, and that should be valued.
I work hard to bring balance to my life, and that should be what matters most.

I love my job, but do I love my job enough to let the other pieces of myself wither away?

Identity Crisis

For almost 6 years, I have been a mother.  For almost 6 years minus 13 weeks, I have been pursuing a career in medicine.  Neither of these tasks are particularly easy on their own, let alone together.  No one gives out medals and prizes to the Mom who “accomplishes” the most with her kids, or who “does it all right,*” or who raises the best kids.  It’s different in medicine, though.  In medical school there are awards for many aspects of study.  There is a constant, hidden agenda, enticing students to be better than their peers, to be the best student they can be, and at the end of it all, to compete with each other for the best residency positions.

*What does “doing it right” mean as a mother, anyway?

For 6 years I have struggled to be the best mom I can be, despite the overwhelming time and energy commitment that goes along with medical training.  Along the way I have received little recognition for my hard work (like every mother out there).  For 6 years minus 13 weeks, I have struggled to be the best medical student and then resident that I can be.  Fortunately, that role always came with significant recognition: Scholarships and Bursaries, conferences, accolades from my peers and preceptors, and the all too often phrase: “I don’t know how you do it.”

We all thrive on positive re-enforcement and recognition for our accomplishments.  As a result, I felt more reward from excelling in my work life because the rewards were tangible.  Even as recently as being pregnant at work, I had people telling me that they couldn’t believe how hard I was working, or how dedicated I was to be working so late into my pregnancy.  It made me feel good to know that other people noticed my effort, how much I loved my job, and how well I performed.  But now that I am off work, at home and being a full-time mom, all of that is missing.

I’ve been home for 2.5 weeks and I really miss work.  I feel guilty because I should be happy to be home spending time with my kids – I never get this opportunity.  I would argue that staying home with three kids (while one if a newborn) is tough work – tougher than my actual job.  The worst part of it is that I feel like I don’t know how to be this person… the mother who gives all of her love, attention, and effort to her kids all the time.  It makes me sad to realize that for the entire time I’ve been a mother (minus 13 weeks), I don’t know how to fully identify as a mother.

I have, somehow, let my life as “medical trainee” define my identity to a greater extent than my life as “mother.”  I feel like this is so wrong – like I have it all backwards.  I mourn for my children, who have never completely had a mother who knows what it means to be their mother.  They have always been competing with my other identity – an identity where they have merely been accessories to my apparent success.  And now I am home all the time and I feel lost.  I am having an identity crisis, and I only have 5 months to sort it all out.

The Oxytocin Effect

If you google “Oxytocin,” you will learn that it is a hormone that has many functions.  Primarily, it is the hormone responsible for contractions during labour, as well as for milk let-down while nursing.  It also plays a major role in human bonding – between newborns and mothers, between men and women, and even between friends.  It is quite an amazing and versatile hormone, and all of these hormonal effects has me thinking about what can happen when the different hormone effects cross paths and boundaries.

After giving birth 9 days ago, I immediately felt strong feelings of kinship and admiration towards the doctor who delivered El.  I found that in the days immediately post-partum, I was sad to think that I wouldn’t be going to see her anymore for my weekly appointments.  This seemed like a strange response for me to have, given that most of our appointments were a quick 5-10 min and were really just about the “business” of my pregnancy.  I did choose this doctor out of all the obstetricians in the city because she has a good reputation of being liked by her patients, she is one of the few people who does all her own deliveries 24 hours a day, and I also really enjoy learning from her and working with her as a resident.  Despite these reasons, my feelings towards her after my delivery felt out of proportion to what they should have been.  You could almost say that the feelings I had were bordering on those of maternal admiration, and I was mourning the loss of this type of care and concern in my life.

Interestingly, I don’t remember having such strong feelings of maternal admiration towards her before going into labour.  They only started after my delivery.  The timing of these feelings got me thinking about how the hormonal changes in my body may have affected my emotional attachment towards my doctor while she delivered El.  I also thought about how my feelings and admiration towards my old friend Kay developed after she delivered A all those years ago.  Finally, there is the most important consideration in all of this: the lack of close maternal bond and relationship with my own mother throughout my life.  All of these factors got me thinking about how the high levels of oxytocin in my body while I was in labour may have affected the “relationship building” pathways in my mind; perhaps my subconscious mind was trying to lay down or replace the maternal bonding-like relationship that I never really had growing up.  It makes me wonder if I would have had this response if I developed a normal mother-daughter relationship with my own mother as a child.

I have been trying hard to reflect on how I’ve been feeling in the last week and a half.  Specifically, I have tried to separate out logical from illogical feelings and evaluate what would be considered “appropriate” or “inappropriate” in terms of “normal human behaviour.  I have also been reflecting on what parts of my subconscious still need work and attention.  It is a little disappointing to think that after all my years of therapy trying to overcome the issues surrounding my childhood (and my relationship with my mother specifically), deep down there is still something missing.  Perhaps the fact that I am able to identify this change in feeling and attribute it to “something” suggests that I have made some progress in my therapy, but I’m not really sure.  Regardless, I will continue to reflect on my feelings and figure out a way to navigate through this mess and make it meaningful – both for my emotional recovery, as well as my future working relationship with my doctor (who will continue to be a teacher and mentor for me in my training).

What’s The Reason?

Last night I watched the movie “Sisters” with my husband. It’s not often that we get a chance to watch an adult movie together and we were both in the mood for some mindless comedy. I am also a huge fan of both Tina Fey and Amy Poehler. I enjoyed the movie enough, yet something about the last scene of the movie struck a sensitive chord with me.

This scene, which extended into the rolling credits, sees both women dancing with each other, obviously havin a good time just goofing off and enjoying the best parts of their friendship with each other. Watching this reminded me of the chapters in each of their books where they talk about the development, importance, and significance of their friendship with each other. I was reminded that I don’t have this kind of friendship or relationship with another woman. It makes me sad to realize that. 

This realization was significant for me at this moment. Over the past few days I have been having more dreams and pervasive thoughts about my old friend Kay, whom I’ve mentioned a few times here on this blog. While she is often on my mind more than I would like to admit, I don’t know why dreams of her and I becoming friends again seem to come back in waves and bounds and overwhelm me, with little explanation. Sine the middle of last week, I have probably dreamt about her 3 times and then spent the proceeding days fixated on why they are plaguing me, or what those dreams mean.

This week, however, has been different from the previous times I’ve thought about her. This time I have an overwhelming feeling that I should be acting on my thoughts: reaching out to her and somehow telling her how she’s been on my mind. I almost feel like there is some kind of “force” that is telling me that she needs to hear from me. 

But why?

When I am sad about how our friendship failed, I try to find solace in pictures, quotes, and memes that circulate through social media: Those ones that encourage us to let go of the people in our lives who hurt us, or to recognize when people are causing distress in our life and decide to remove them (as I try to understand why she ended the friendship), or just simply accepting that the sun sets on some relationships even when we don’t always know why.  So, I don’t understand why, after so long, I still feel compelled to reach out. What good will it do?

Besides likely lead to more rejection, what could possibly come from this? What do I think is going to happen?  It’s not like anything will ever be close to what it was before – it’s not like I will ever have the valuable closeness and sister-like relationship that I saw in its purest form at the end of the movie last night….

However, I can’t stop thinking about the one time, far back at the beginning of our mentoring relationship, when I took a step out of my comfort zone and sent her a letter of kindness and support. I feared, for weeks, that I had steeps over a boundary; yet it turned out that my letter was the exact offer of kindness and compassion that she needed in her moment of struggle.  It was that letter that really paved the way for what Our friendship did become. Are these dreams and thoughts just some calling that she needs this kind of compassion now?

I don’t know.  It’s doesn’t make sense to me. And mostly, I am just confused about what I am thinking about and why I feel so compelled to reach out to someone who hurt me so much an showed such little compassion to me in my time of need. 

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…