How Time Flies...

You know you've been living in a sheltered bubble when you think that 1/28/07 is a week or more away. Doh.

Or when you get the annual registration sticker for your car, and seem to remember that you had just put last year's sticker on the car... can it already have been another year?

How come when you're five years old, it takes forever before you're six, and when you're sixty, you have no idea how the years have passed so quickly?

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Are You Living a Lie?

My friend's post really hit close to home. I've had the same thoughts he has, and wonder how many more of us there are out there. I think anyone in a stressful job, feeling the pull of work vs. family life/relationships/social life/other responsibilities can relate...

[From http://tim-and-angela.squarespace.com]

It is January and I am officially six months into my residency. So how am I doing? I'm not gonna lie, it's a beating. If you happened to peruse the blog that I have been much better at keeping up than this journal, you will note that I have been going through a bit of a rough patch lately. You know what it is? It's the old tunnel analogy. Maybe I was just a rambunctious little boy, or maybe this truly is a universal experience, but we used to do some pretty stupid things when we were young, and one of them was to walk through on old storm drain tunnel. This particular tunnel was so long that when you were in the middle, it was so dark that you literally could not see light at either end of the tunnel. That is where I am, six months in, with six months to go.

I will say this though, I am more comfortable in my own skin when I am at work these days. I feel less and less like a fraud, and I have ever increasing confidence that I can actually help my patients. However, the trade off is my personal life. I spend so much time away from the things I truly care about that it makes my choice to be a physician seem like a betrayal of self at times. How can you purport to hold certain values and then choose daily activities that directly refute that claim and not feel conflicted about your own identity? I have not yet figured this one out, and to be truthful, the old "it won't be like this forever" addage doesn't really cut it. Is there any guarantee of that statement? More importantly, if it is true, is their any guarantee that I will not have strayed so far away from my purported beliefs by that time that I will not even care to return to those previous priorities once the training is complete? That is a hauntingly scary possibility that I have to this point largely skirted around in my mind.

6 months in is the hardest time, Tim. Everything you've said is true. You find yourself putting up with *crap* and doing silly things that take you away from the things in life that truly matter. And you tell yourself it's worth it because you're working towards something. But the tricky part is, who can accurately predict the future? Who can say that we'll be around when the "worth it" part finally rolls around? Or will we be always trying to work towards something that's "worth it" and lose sight of the really important things in life? And is this "worth it" dream all it's made out to be?

If we knew how long we were going to live, it might be easier to make today's choices. No, I wouldn't go to work, scutting for most of the day, if I were going to die tomorrow. Or if any of my loved ones were going to die tomorrow. But would I do it, SHOULD I do it, if we were going to live another 10, 20 years? And since my real answer might depend on how long we'll be around, does that mean that the way I'm living now is a lie? That I'm hiding behind the delusion of temporary immortality for myself and loved ones, so can get away with neglecting really important things in life? That I'm not being true to myself, what I think is important, and what I want out of life?

I don't know what the answer is. I'm not sure I know how to operate without these assumptions. I struggle with the same questions you have, and have not found solid answers. The only solace I've found is that perhaps the "meaning" of a good life lies less in where you are and whose company you're in, than how you carry yourself through the "life" you happen to be in. And that perhaps, things always happen for a reason.

photo credit - beautiful yellow mountains

Trust

Was really taken aback by a couple of patient comments today. One was from an elderly woman who we were asked to consult on. She refused to have anything to do with us, stating that we were there to experiment on her. Didn't think too much of this comment - the lady could have had a touch of paranoid schizophrenia, or schizotypal personality. But then later in the day, a family member of another patient jokingly said, "are you guys experimenting on XXX?!" Although it was meant to be a joke, and I don't think the family member really believes that we would be experimenting on their loved one, all jokes come from some version of reality...

The comments really caught me off guard. The more I thought about where they were coming from, the more I realized that, for all they knew, we could be experimenting on their loved ones. After all, unless they were in the medical field, all they knew was that teams of physicians came in and out of the room, all of them perplexed by the strange medical condition affecting their loved one, all of them poking and proding, all of them asking for different tests to be done to try and see if they could figure out what was going on, and day after day still with no good answer as to what the medical problem was. Meanwhile, from our point of view, there was a multi-disciplinary team including almost all the subspecialties of medicine consulting on this complex patient, trying to figure out what in the world was causing his constellation of symptoms, and truly, no one having a clue.

I can see how it could be extremely difficult on patient's families to see their loved ones sick and see physicians struggling with figuring out what is going on. But the leap from "how come these doctors can't figure it out" to "gee, they must be experimenting on my loved one" is still a hard one for me to take. I mean, I guess it's a possible reaction to stress. And fortunately most patients give us their trust without asking for much proof. But to think that there may be a significant number of patients who suspect that we may not be honest, or that we may be trying to trick them, or experiment on them, makes me nauseous. I've heard two such comments this week. How many more patients think these things but don't say them?

To these people, I'd really like to say - do you know that I swore an oath never to harm and only to try and heal? Do you know that I've been working like a madwoman, up at odd hours, tired beyond belief, for you? Do you know that the thought of "experimenting" on any living being had never, ever crossed my mind before you brought it up? And that while I'm sacrificing the best years of my life to take care of you and others like you, hearing that you think I may be trying to harm you makes all the long days and nights that much harder to bear?

I'm as human as you are. I'm not saying that we will always know the answers. We may not always be able to heal, or cure. I chose this profession to try to relieve suffering. But I can't help you if you don't let me. All I'm asking is that you trust that we have your best interest at heart. Because if you don't trust me, how can I take care of you?

While trusting us may seem like blind faith, it's not that new of a concept. After all, you trust that the Starbucks kid isn't lacing your coffee with arsenic. You have to believe that the babysitter isn't going to harm your kid. You trust that the random taxi driver isn't going to take you somewhere and kill you. You have to operate with a level of blind trust to get through the day. Is it so much to ask that you trust us as well?

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Five Things Of Note

Just realized that I forgot to do a meme from dear Ipanema - well, better late than never, eh?

Let's see, five things about me...

1) Am a sucker for animals. Anything that has fur is something that I'd like to get to know. You know the look that most women get when they see a baby in the room? That's me, except the "baby" is a furry animal :D

2) Have no idea how I ended up in medicine. No one in the family is in the medical field, and I certainly didn't know what "being a doctor" meant before starting this whole process. That being said, I truly enjoy taking care of patients and am very fond of dermatology.

3) Believe that life is a spiritual journey and a gift, and that "spiritual progress" is much more important than worldly things like fame,social status, money, etc. Also believe that one doesn't need to be a nun sequestered from society to achieve this progress. However, there are certainly days when renouncing the world and worldly posessions has its appeal ;)

4) Motto is live and let live. We should celebrate the similarities and respect the differences between people/cultures/belief systems. Just because I feel strongly about a topic doesn't mean others should hold the same beliefs, or that I would think less of them for not doing so. Imagine how boring life would be if we were carbon copies of each other!

5) Am easily inspired by things of beauty. I've been known to pull over on a road just to watch a beautiful sunset. Prefer nature over man-made (ie travel to Jiuzhaigou rather than Rome.) The most recent inspiring thing was seeing a mother's love for her very sick daughter.

Am tagging Tundra Med, Keagirl, Dr. A (oops Moof got there before me!), and anyone else who'd like to think this through :D

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Chronic sleep deprivation, Stress, and Depression

Happy New Year!

Sorry for the recent shoddy posting. I'm on a new rotation, and am getting worked! The past week has been very long hours (12-20+hrs a day) and very stressful. By day two, I woke up dreading work like never before. And on that day, was REALLY sad that I still had a full month of it to look forward to. Details to come later. I've snapped out of the funk, because things are running smoother.

But being in the funk made me realize how many residents are probably depressed. I've recently seen a lot of med school friends while running around in the hospital doing derm consults. I have to say, they've been pretty toxic. And most who aren't are depressed. Most residencies run very close to 80 hours a week. For 12 months non-stop. At least I'm only going to be unbearably tired for a month. I can't even imagine doing it for a year, much less three or more!

A close friend put it best: "I put on a happy face for the world, but deep down, there's some baseline depression going on." This is coming from one of the most cheerful people, who has been chronically sleep deprived for the past year and a half.

If any of you have personal experience, you'll know that not sleeping well makes the world seem more blue. And add on stress at work, and the fact that you're always at work - it's enough to make anyone depressed! I think there may be a silent epidemic going on, and that the majority of housestaff, being chronically tired and stressed, are depressed.

It's not healthy, and it shouldn't have to be this way.

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