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?

 

Just Be With It

Yesterday was a bad day… It’s a really long story, the kind that requires knowledge of the background situation and a good handle of what my day-to-day job entails.

Originally, This blog entry included all the details of what happened. I decided to delete it all though, because it just made me feel so bad and I don’t want to give the situation that much power over me.

Ultimately, I received a poor evaluation for my last rotation before El was born. This shocked me for a number of reasons, but mostly because I felt that the rotation went very well and was no different than any other rotation I’ve done.  Also, at no point during the rotation did anyone tell me that they thought I was acting or performing so far below their expectations that I deserved to fail. In fact, I only ever got positive feedback from people.

I know this evaluation is inaccurate and untrue. I have my beliefs as to why this may have happened and I have started the process of appealing the evaluation. Regardless, it made me feel horrible about myself and it made me feel completely helpless in the face of the guy who seemed more than satisfied to give me a failing evaluation.

In light of my recent feelings of inadequacy at home, this certainly didn’t make me feel geat about myself at all.  I am trying to do a good job of everything in my life and I feel like I am falling short everywhere (even if I’m technically not). It just constantly feels like I’m doing something wrong.  This meeting completely ruined my day yesterday, and it ruined my night. I am trying hard not to let it ruin my whole week.  While this situation does need to be sorted out and rectified in some way, I’m going to try hard to just “let it be.”  There has to be something to learn from this situation.


(Thanks to a wonderful blogging friend who posted this image on that other big social networking site… I needed to see this today)

First Steps

Today I was supposed to be at a conference for work.  Initially, I was determined to go despite being on maternity leave; I wanted to show that I am hard working, committed, and engaged.  I also worked very hard all year to plan an important even that is happening at this conference – today actually.

Going to the meeting, however, would have meant travelling by plane, alone with baby El.  It would have meant staying in a hotel room alone for 4 nights and single handedly taking care of the baby, while also trying to attend the meetings and give off the vibe that I have it all together.  It would have likely been far from enjoyable.  So, I decided to stay home and enjoy this time with my family.

Staying home also means that instead of spending over $1000 to attend a conference, I can save that money and use it towards a family vacation.

Despite the overwhelmingly good reasons to stay home and not attend the conference, it was a difficult decision to make.  This is the first decision (I guess the second decision, if you count having a baby and taking a maternity leave) I have made in my career that puts my family ahead of my desire to be “the best I can be” in my work life.  This is like the first step in “retraining” myself to put my family and my role of Mother ahead of work and my role as Doctor.

This was not a hard decision to make, but it was difficult to execute, mentally.  I knew the right thing to do was to not go and stay with my kids and baby at home.  But I feel sad and I am mourning: I feel like I have thrown away an opportunity to show myself off as a dedicated, hard working, and committed resident.  Likely, it wouldn’t have made a difference to anyone but me.

Hopefully these steps get easier as the time goes on.  I feel it is imperative that I make this change in my life

The Real Struggle

I woke up this morning feeling like today would be a struggle.  I have these days every so often, and it is always the same thoughts and issues that plague me.  I feel lost and lonely – like I haven’t navigated my way through life very well at all.

I am days-to-weeks away from having a third baby.  For this whole pregnancy, and even the months leading up to it, I have questioned whether this is a reasonable step to take in my life.  I obviously can’t go back and change things now, but it doesn’t make me feel any less stressed about how everything is going to fit together in the coming years.

I know I should be looking forward to my maternity leave, and I *kind of* am.  But I am nervous about what I’m going to do with all that time at home!  I know I’ll be taking care of my baby and for the first weeks I will be so exhausted that I won’t know night from day (can you tell I’m looking forward to this?), but sometimes I find that my home is not the peaceful, relaxing place where I imagine spending my down time.  There is so much to be done around my house: teach my nanny how to cook, deal with the clutter that has accumulated over the time that I’ve been neglecting housework (and letting my nanny do a sub-parr job of keeping up), figure out how to discipline my children, decide if I need to hire a new nanny (since the one I have seems to have difficulty with all the above things that I have to remediate)… That just part of the home list.

Then there is my anxiety about work.  Failing my exam has certainly not made me feel any better about my position and my performance at work.  I know that I likely didn’t prioritize studying as much as I would have it I actually had to pass the exam.  However, I feel like it reflects poorly on my ability to balance my work like and my home life, and in the coming weeks that struggle is only going to get worse.  Add in the fact that I am going to be taking 5 months off work and will be that much behind – I feel like I am going to have a target on my back, setting me out as “the weak one.” Any why am I the weak one?  Because I have kids and a family, and I can’t make my work my top priority all the time – especially when something in my work world doesn’t really matter (like a test that I don’t need to pass).

I struggle with finding people to connect with in my life.  All of my good mommy-in-medicine friends are back in the place I left behind when I moved here for residency.  I have yet to find some good friends here.  I marginally succeeded in finding some out-of-work friends, but since work has gotten so much busier in the last year, those relationships haven’t been well maintained.  Not to mention, I can’t really talk about most of my difficult struggles with them… I mean, when someone tells you they had a bad day because their kid’s school bus was late so they missed their aerobics class, how do you respond when your bad day was doing a STAT c-section on a full-term baby who didn’t survive?  And there is the opposite situation with friends from work.  All my co-residents are wonderful people, but most of them don’t have kids and that makes it very difficult to commiserate with them.  Who can I talk to about my feelings of inadequacy as a mother, or about my decisions to prioritize my life differently because my kids and my family are an important (arguably the MOST important) part of my life.  Mostly, I feel like this position is a very lonely place to be and I don’t know how to make it better.

I’m sure that in a few days I will be feeling better than I am today.  For today, though, I have to push through the discomfort of the struggle.

 

First Failure

After almost 6 years as a learner in Medicine,  I have received my first failure. 

A few weeks ago I wrote a surgical theory exam. This exam was annoying and difficult both to wrap my mind around as well as to study for. The exam is not designed for Obstetrics and Gynecology residents, but in an attempt to align us more with other surgical specialties, our program enrols us in the program for this exam. Since it’s not designed for us, it’s difficult to study and prepare for, and since it’s not required that we actually pass the exam, our program doesn’t make a huge effort to help us adequately prepare for it. Regardless, we all want to pass and most people do. 

Except me. I got my results today, and I was “unsuccessful.”

I have had failures in my life – some bigger and more consequential. However, this is the first time I’ve failed at something in Medicine. 

Why should I care that I failed an exam that I didn’t even need to pass?  I made a decision to prioritize my family and my health in this pregnancy over preparing well for this exam. Regardless, I did spend some time studying… And I think I hoped to actually pass. 

For my entire medical training I have maintained that I can do this “Mommy in Medicine” thing well. I struggled endlessly with feelings of guilt that I was only ever a mediocre mom and a mediocre medical student/resident because each role was competing with the other. Up until now, my kids have survived and have done okay, and I’ve always done okay in my assessments and very well in my clinical evaluations: there has never been a reason for me to believe that something was really suffering. Until now, that is. 

Now I am weeks away from having my third baby, all under this illusion that I can do it all. But maybe I can’t, and I find that reality upsetting and worrisome. Life is only going to become more difficult with anther child and the increasing demands of my training program.

 My confidence is shaken and I’m just not sure I can pull this off anymore. 

Nearing the End

This afternoon I will be writing the first part of a two-part surgical exam.  This exam is the reason I haven’t been around blogging and reading other blogs much in the last few weeks.  I just want this exam to be over.  The saddest part about this exam is that I don’t even need to pass it – it is the biggest waste of money and time away from my kids and my life ever.  However, when is a Type A personality like me ever going to be okay with failing a test?

Don’t ask me too much about the reasons why I need to write an exam that I don’t actually have to pass – it’s all “politics” within my residency program.  Let’s just say that after tomorrow, it will be over and I can stop feeling guilty about being poorly prepared for it and for spending time away from my kids to prepare so poorly.

I am also nearing the end of pregnancy.  I have, though, reached that point where I wish the end was here now.  I have begun suffering from the “pregnancy insomnia,” to help round off the extreme fatigue I had before that. My poor pubic symphysis is ready to tear apart and my left SI joint is in collaboration with the pubic symphysis to make all daily activities a living, painful nightmare.  My physiologic dyspnea is getting worse and I am starting to have tachycardic, bordering on pre-syncopal episodes every day.  However, I don’t want to start medication for this because I am so close to the end, and I remember from my last pregnancy that the medications just made me more tired.  Plus there is all the other non-pleasantries that go along with the end of pregnancy.  Almost 35 weeks!  The end is close!

I am stressing out about the end of work, as well.  I am still having a hard time accepting the idea that I am taking off the next 5 months of my training – and postposing the completion of my program by as much.  I feel lost with the idea that I will fall behind my cohort of residents, but that i won’t actually be part of the new cohort – I will be floating in this in-between, neverland space, like I already feel I do in most of my life.  I know I am taking this time to be with my baby and with my family, and I will never get it back, but I can’t seem to get over that right now.  I am also supposed to be starting a new, 4-week rotation next week and I am uncertain as to how it will go.  Will I be able to finish enough of the rotation that it will be considered complete?  Will I be able to stand all day in the OR?  Will people just wonder why the heck I decided to try and work right up until I go into labour, instead of taking time off to relax and prepare for the baby’s arrival?  I just don’t know!  I am motivated to finish this rotation because it means that I don’t have to do it when I come back from my maternity leave (and I don’t have to do call right now, so that makes it more pleasant).  However, I just want my pregnancy to be over and the change over from one rotation to the next seems like a good time for this baby to come!

Despite wanting this pregnancy to be over, I am actually really nervous and scared about the changes that come along with bringing home a new baby.  Like most people, I hate change.  I fear change.  I feel like I am in a holding pattern, waiting for this monumentous change to happen so that I can stop fearing it.  I am beginning to feel sad that the life as I know it, with my two boys, will be over soon.  I remember feeling this way before E was born, but he came only such a short time after A and there wasn’t much of a family routine at that point.  But this baby… she’s coming after 4 years of us being a family of 4.  We have family vacations, traditions, memories, and a large family portrait of the four of us over our mantle.  This is a really big change and I’m not sure I’m ready for it.  I feel very out-of-touch with the reasons why I wanted a third baby; now that she is almost here, I fear that having three kids won’t be what I expected it to be.  Obviously, there is nothing I can do to change this now, which leads me back to the beginning of my circle: I just want it to be over so that I can stop worrying and fretting and just live!

 

Spinning Life’s Tires

I have days like today, and weeks like this week, where I feel like I am spinning the tires of my life.  My day-to-day life is is routine, ordinary, and far from exciting.

I am acutely aware that my work is my training.  I have yet to reach a point in my career where I love my job.  I know this is because I am not in control of my daily choices.  Work, therefore, becomes a place I go because I have to.  It is paying my dues and eventually it will be over.  Just last month I was starting to get to a point where I felt like I was almost over the worst of it.  This year of residency – the workhorse year – where I we are expected to work like slaves, it is almost over. But then this week we started planning out the schedules for the next year of residency (which is supposed to start in July) and once my maternity leave is incorporated into the schedule, I won’t actually start that year of training until November/December.  I thought I was so much further ahead.

I know – I am taking off that time to have a baby:  Time I will have to spend at home with my new addition and the two boys I already feel I never see.  I shouldn’t complain, because it’s not time that I’m working, it’s time that I will be investing in something else… Something arguably more important than work.

This belly of mine, it continues to grow, yet it feels slow.  In two months this pregnancy will be over and life will never be the same.  But it scares me to think of this change.  Why did I decide to do this again?

76e54768477746b60f20cfb43bd40995It’s hard to see that life is moving forward when each day is a repeat of the last.  The mornings are rushed to get out of the house and start a 10 hour working day.  The evenings are a blur of kids activities, snack time, reading, bedtime routines, and exhaustion.  My bedtime quickly ensues.  And so, from day to day, nothing changes.  I feel like I’m stuck in a hamster wheel and that my efforts are taking me in circles.

How, exactly, do you step back to appreciate the way your life evolves over time?  How do you come to understand the role of the little things in the “big picture?”  I want to feel like I am moving forward every day:  I want something to change, to be momentous, and to remind my why I am here and living and working so hard.  What is the answer?

 

Pregnant at Work

“Oh wow, look at you! How many weeks are you now?””30 weeks already!? It sure is going by fast! How much longer are you planning to work?”

Indications: This 36 year old G3P2 woman was admitted to hospital with a history of a missed first trimester abortion. She was referred to our care after a community ultrasound performed on [date] at 17 weeks 5 days gestational age revealed a fetus measuring 11 weeks 6 days with no fetal heart rate activity. She was recommended to have a D&C by aspiration. The risks of the procedure, including infection, bleeding, and uterine perforation with injury to adjacent pelvic viscera were discussed with the patient, along with the benefits, and she gave informed consent.

“You’re having a girl!?! Oh, I didn’t know that! What do you have at home again? 2 Boys – oh, you must be so excited!”

“You must be getting tired now, with all these hours that you work. Are you done call now?”

Procedure: The patient was taken to the operating room and received a general anesthetic by Dr. X. She was placed in the dorsal lithotomy position and prepped and draped in the usual manner. Examination under anesthesia revealed a 13 week sized uterus and no palpable adnexal masses.
“Well, you look great! It is your third after all, everyone looks a little bigger the third time around.”

“I had a boy and two girls, and let me tell you, it was the time of my life! This time will go by so fast!”

A weighted speculum was placed into the vagina and the anterior lip of the cervix was grasped with a double toothed tenaculum. The uterus was sounded to a depth of 16cm. The cervix was dilated without difficulty to accommodate a size 14 suction curette. We then proceeded with the suction curettage. Tissue was obtained and sent to pathology. We then proceeded with a gentle blunt curettage and no tissue remained.

“Are you all ready at home yet? Oh, the boys must be excited to share a room, no?”

“They must be thrilled to be having a baby sister! Do they understand what’s going on? Maybe they’re still too young yet…”

The patient tolerated the procedure well and was returned to the recovery room in stable condition. Estimated blood loss was 100cc and there were no apparent complications. The patient is requested to follow up with her practitioner in 6 weeks time.



“I don’t think they’re too young, they know exactly what’s going on… for sure.”

“I should get going and eat some lunch, you never know what the afternoon will bring.”

And, so I walked briskly out the of the recovery room.

End of dictation.