Days 208-210: Pediatrics

Yesterday was my first day with the pediatric palliative care team.  I felt like a fish out of water.  For the most part, the people I see in the adult world are older.  They have lived a full life, have children, grandchildren, sometimes great-grandchildren.  Certainly, not all the adults I see are older.  There are the few younger adults who had, unfortunately, developed cancer when their children are still young.  They are faced with the knowledge that they may not see their children graduate high school or college, see them get married, or have grandchildren of their own.  But the grand majority are older.  The children are more difficult for me.  I cannot fathom what it would be like to have a child who you know you will end up burying.  I cannot imagine having to make decisions that would lead to my child's death.  I also struggle to understand what quality of life looks like in a person with severe disabilities that make it so they are dependent on others for everything.  I realize that they do enjoy life, but that's so beyond what I can understand.  I have never truly had a disability.  I have been fiercely independent for as long as I can remember.  I also do not have any children, so that bond from parent to child is also beyond me.

The other thing that gets me are the patients we have that are practically health illiterate and don't have any of the support they need.  In part, there is always a pride issue.  No one wants to admit that they have troubles affording the necessities.  I felt bad getting impatient today, only to realize that there was a lack of support, reading difficulties, and a lack of understanding of the whole picture.  I wish I'd had more time to talk about where things were, but with urgent issues and lack of time, that wasn't feasible.  I only wish there was more I could do to help.  He, in a way, was like a child that didn't have a parent to help protect him.  He had to fend for himself.  How do we help support in this situation?  It breaks my heart.

Days 201-207: Out of the Funk

For the last several months, I feel like I have been in a funk.  I felt like I wasn't doing enough of anything well.  I was failing at the wedding stuff, work, life, relationships.  I wanted to curl up in a ball and hide from everyone and everything.  Instead, I slugged through each day, feeling even more and more incompetent.  It wasn't until sometime in the last week or so that I feel like my sense of ineptness lifted.  I may still have as much that I need to do each day, but it seems more manageable.  I've started my new QI project.  I got the letter that stated that I passed my geriatric boards.  My new boss at work sees him as a colleague.  I've had great conversations with the different radiation oncologists, and have built connections to this department.  I've only got a few more things to settle with the wedding.  I am finding more time for peace at home.  The animals have settled down.  LOML and I are enjoying our time together.  We finally have central heat again and now have central air conditioning for the summer.  I don't think that I would be able to make it through each day without his constant support.  He helps me stay sane.  I will hopefully get back to posting my narrative medicine prompt responses since I haven't done that since October, I think.  I'm glad to be back to feeling like normal again.

Days 198-200: The Contract

It still feels a little unreal.  Yesterday, I signed the contract for my new job.  I emailed it back in last night, so I don't feel like its official yet.  There's no confirmation yet, but I can't believe I've signed the contract for my first job out of training.  I have been working toward this for the majority of my life.  I can't believe it's already here.  I'm still really nervous about my ability to meet my goals and the expectations on me.  It's scary and exciting.  What if I'm not as good as everyone seems to think I am?

Days 196-197: Snow Day

We were only forecasted to get 1-3 inches initially.  With that knowledge, I went into work today despite the poor visibility, slushy roads, and the fact that I was really only shadowing today.  In fact, the main reason I went in was because I thought we were supposed to have a meeting at noon that was canceled at 10 AM.  The attending I was supposed to shadow was also unable to come in today.  So going into work was a bust, adding in the fact that I couldn't safely drive my car home and had to get a ride.  I feel like all I do is complain.  I feel like part of that stems from feeling inadequate.  I feel like my purpose in life right now is the please everyone else, and I don't think I am doing a good job at that.  I feel like I just don't quite make snuff at work, that I am a slacker, or that I am a failure because I'm not meeting expectations.  I feel like my family is annoyed by my presence, that I'm not doing things the way they want me to, that I'm just using them.  So I do everything I can to not ask for anything from them, and then that upsets them because then I make them feel like I don't need them.  I feel like a terrible friend because I constantly prioritize all the things I feel like I need to get done for work before anything else.  I am irritable because I'm not meeting any of the expectations I set for myself based on what I think other people expect of me.  And then I feel guilty because I feel like I should be beyond worrying about what other people think of me.  I feel like I should be more self assured and worry less, but in telling myself I should be that way, I get more anxious because I'm not.  It's a vicious cycle that leaves me feeling like LOML is the only person who can stand being around me.  I'm probably reaching a point in my life where I should seriously consider getting a therapist to start working through the baggage I cling to like a life-saving flotation device that is actually pulling me under and causing me to drown.

Days 187-195: A Week of Silence

I have not written a post in over a week.  I haven't had the energy or desire to write.  I suppose the winter finally dragged me down.  I found my way out, although I still have my moments in the darkness.  Since my existential crisis, I have had a few more.  I try to open up to the people I work with, but right now, it is strange feeling like I am in a sort of limbo.  I know I'm not an equal, but the possibility of becoming one seems closer each day.  I need to maintain my focus on being a learner for another six months.  I still have so much room.  But I also need to ease up on myself.  Any and all suggestions for improvement at this point are designed to help me become great.  I am already good.  I have many blessings.  I don't have to worry about whether I'm good.  I can also decide when and how I will implement the suggestions.  I don't have to do it all at once.  I am still going to put my focus on regular self-care, acknowledging how I've taken care of myself each day, and slowly building in the new suggestions.  I also need to keep improving on what I am already good at.  Even if something comes naturally, I need to keep improving.  Slowly.  I have a lifetime to keep working on the practice of medicine.  I need to pace myself, otherwise, I'm going to burn out before I even begin.

Days 185-186: Case Conference

As the lone fellow in the hospice and palliative medicine fellowship, it can get kind of lonely sometimes.  This is especially true when it comes to me having to present case conference each month.  There are many cases when I feel like the cases I have to present are too simple or not what are expected of me to present.  I am left trying to scrap together a presentation that may not fit what should be presented.  I feel guilty, like I'm letting down the fellowship director.  The fact is, I'm likely putting too much weight on what I'm doing.  I want to be able to stay on as faculty, and because of this, I feel like I always have to be on my A-game.  That the days I'm not on my A-game, or I do my best but it's not enough, will be held against me in my ability to graduate fellowship and get a full-time job after graduation.  I set the expectation bar far too high.  So high that there is probably no one out there that can hit it, let alone me.  I need to come to the realization that I am good at what I do, I will always be learning something new each day suntil the day I die, and I need to cut myself some slack.  Impostor syndrome likes to drag me down.

In other news, I registered for the AAHPM annual meeting, including a pre-conference event directed at narrative medicine.  I am excited to find some many lectures at the conference devoted to narrative medicine.  It will be a great jump start to the curriculum for the geri-pall fellows.  Plus, it will hopefully give me some contacts in the field who I can reach out to when I need some guidance, ideas, or topics to discuss.  My goal for the curriculum is to have it more interactive, and eventually have it be something that involves the interdisciplinary team, not just the fellows.  That's the pipe dream anyway.  For now, I am going to learn as much as I can from the experts and make as many new connections as possible.  I need to start utilizing the mentors I already have...

Day 184: Animals

I have only had a few animals over my lifetime where I was the primary provider.  Five, to be exact.  I have to admit, none of them have been easy from a health standpoint.  My first cat, Chewy, was geriatric when I adopted him, and he had a cold that required two different kinds of antibiotics (link).  He ended up developing kidney disease (typical for most elderly cats), but lived to be 16.5 years old.  Boris came to me overweight and terrible GI problems which turned out to be related to a grain and gluten allergy (link).  Unfortunately, this discovery was only made after three emergency vet visits, two of which were due to bladder blockages from crystals caused by the grain/gluten free dry food, and one requiring a weekend stay in the kitty ICU.  Fortunately, he has settled out, is the correct weight, and no urinary issues thanks to using only wet food for his diet.  Odie, the dog, was the third addition to the family.  He is a Chiweenie, so we have to be careful with his weight.  He's also prone to deciding he doesn't want to eat his food because it's "stale".  He's a finicky little pooch with very expressive eyes and ears.  Julia is the third cat, and she has asthma.  This means we have to do regular inhalers with her.  Fortunately, we have only had to rush her to the vet once, and were able to avoid some hefty emergency vet bills.  However, in order to get her inhalers, we have to order them from Canada otherwise they would be ridiculously expensive.  She is very sensitive to air changes, not surprisingly, and stress.  Finally, we have Alex (the cat who jumped out of the tree in October... link).  Now part of his regular vet visits (pretty much every three weeks since October) have been for his vaccination cycles and neutering.  In addition, however, he also developed a "hot spot" or wet dermatitis which is basically a skin infection that he then aggravated by continuing to lick it or scratch it.  We think it was related to him attacking the Christmas tree and developing an injury from that.  The tree is gone and the hot spot is almost completely covered with hair again (it was a big, nasty, weeping, bald spot on the front of his neck).  Unfortunately, he now has an eosinophilic granuloma (fancy name for an ulcer on his upper lip caused by his immune system attacking normal tissue).  Now, this granuloma had not been bothering him until recently when it flared because of the stress of his surgery (he was neutered on Tuesday).  Oh, and he is teething so he looks like a shark with his adult canines coming in behind his baby teeth.  He's pretty miserable right now between everything.  Needless to say, everyone at the vets knows us, and they haven't even met Boris yet who is the most healthy of all the animals (which is really a shock considering where we were when he was adopted...I still have nightmares about those days in intern year).

Now don't get me wrong, I love every single one of these babies.  I could not imagine life without them.  I do worry about their health.  I likely over react in some situations.  Sometimes it is stressful having four animals that all need love, attention, and special health needs.  I wouldn't give them up for anything.  They are sweet and funny and keep us on our toes. 

Days 182-183: The Half-Way Mark

I have officially reached the half-way mark of my final year of training.  It was topped off by the heat going out.  So, backing up.  I moved in with LOML in March 2017.  His house was built in 1932, and then had an oil furnace placed at the beginning of the 2000s.  The oil furnace is wonderful, but the frigidly cold weather finally got to it.  Around 7:30 last night, I realized cold air was blowing out of the vents.  So LOML went to look and couldn't get it started.  We got lucky that the oil company was able to get a technician out around 9, and they changed the filter and the sprayer.  Finally, they figured out that the line from the oil tank that is outside the house to the furnace underneath the house was blocked due to frozen condensation.  We finally had heat back by about 10:30.  I find it interesting that LOML and I time our freak outs pretty well.  LOML tends to be pretty calm when I'm panicked, and last night LOML was really upset about the heat being out.  Meanwhile, I was getting things ready for us to tuck in and have everything we needed for the night in case we didn't get heat back and had to turn the water to the house off to prevent the pipes from freezing.  I'm glad we did get the heat back, though.  Much more enjoyable than living in a cold house for a few days.  Especially when the high for the next couple days is 30.

As for self-care, yesterday, I did some of one of my exercise videos.  It was cut short due to the heat issue.  I also listened to my meditation music to go to bed.  Today, I redid yesterday's video, and will be getting into bed and reading once I finish this post.  Tomorrow, I may work on some knitting that needs to be finished for a friend's baby (that was supposed to be a baby shower present and is now becoming a first birthday present).  I also want to start looking for quotes to paint on canvases to put in my office.  Finally, another self-care activity will be working on some prompts for writing which may become more helpful in the future than simply ideas for blog posts.  More to come on that nugget, later...

Day 181: New Year's Resolution

Each Monday, I get a comic strip in my email called Every Vowel (link) which is about the letter Y and his life lessons.  Today's was about setting and failing to keep New Year's resolutions.  After the comic, the writer makes the point that, "resolutions aren't about grandiose goals but constant habits".  Usually, I make some resolutions about being a better doctor or eating better, losing weight, exercising more, being happier or more appreciative.  I, like most people, make it about two months before faltering, before stress or work takes over.  Then I feel guilty for having given up, and end up faltering more.

This year, I want to try something different.  My resolution will cover all the things mentioned above, but is not based on any one alone.  My resolution is to do one self-care activity per day.  This is everything from writing, painting, knitting, reading, exercising, eating mindfully, mindful meditation, massages, yoga, hiking, etc.  The list goes on and on.  I can do more than one, if I have the time, or start one.  It doesn't take much time, 10-15 minutes on a busy day, or more if I want.  The goal is simply to do, so that maybe by the time I get married and start my new job and buy a new house, I will be less stressed because I know what I need to do for my mental health.  Even if I do end up getting stressed out, I will have a tactic to help combat the spiral.

Today, I finished a knitting project I started this time last year.  It's a cute sweater for my Chiweenie so he finally has one that is long enough for him.  I taught myself how to make cables.  It is the first thing I've knitted that wasn't just a fancy square. It took most of the day to complete it, but it is done.  I can move on to another project.  Here I leave you with a picture of sweet little Odie wearing his new sweater: