Expectations and Realities

I will finally sign out that last autopsy that is due in 9 days so that this time I don't wait until day 60.
*I call my husband on day 60 and tell him I'll be staying really late to finish an autopsy, but I'll be home for Punky's bed time, for sure; she gets to bed 30 minutes late.

Tonight I get home from work before 6:00pm and I'm definitely going to wash my makeup sponges and re-order whatever stuff I'm low on from Sephora.
*A friend texts with a work crisis and I write back-and-forth for 45 minutes until I have to break for bath time.

For sure this time I will buy our plane tickets for our holiday travel at least three months ahead of time to save money.
*Three weeks before the trip I'm scrambling for the last three seats on the plane, surely paying at least $200 more per ticket. Again.

After Punky's bath tonight, I am definitely going to change her sheets and thin out her clothing that she's outgrown for donation.
*I spend that 25 minutes recording (for posterity) the funniest conversation that she and I had about unicorns vs. mermaids while she was in the bath.

Today will be such a good day at work; I have been off for a week and I am back and refreshed with an empty queue to start.
*43 new cases in the queue, Pedi GI calls and asks for a stat run on a liver biopsy for possible atresia, three separate colleagues come in with "sorry, I have a few quick cases that need review, and they're kinda old" and then the outlying problem hospital calls to say that a surgeon is screaming about a lost specimen and I need to call him NOW.

I will be the first one to sign up for what to bring to the next pre-K class party; I will definitely get paper plates or napkins this time!
*The list comes out when I'm on call and can't bring Punky to school or pick her up for a week; I cut an array of colorful fresh fruit for 1.7 hours at midnight and arrange them into an appealing rainbow configuration in an act of self-flagellation.

I will schedule a nice, easy play date with Punky's school friend that has the really nice and friendly mom to bolster my only child's social skills.
*I finally text her 14 weeks after I first committed to it in my mind, schedule them to come to our house for the upcoming Saturday, spend three hours the night before cleaning the house,  and then drink a mimosa beforehand to ease the path to small talk. It goes fine. The anxiety regarding the next play date begins immediately after the front door closes behind them.

I will work extra hard to keep up efficiency today and just work on my cases, one after another, until they are all completed before I do anything extra because I know that I'm too far behind already this week.
*I work steadily for 45 minutes, then make a doctor's appt for myself that I've been putting off for two years, make sure bills are paid, finally order Christmas gifts for my oldest friend's five kids so they get there in time (converted from birthday gifts, because I decide to face it, remembering five extra birthdays annually is essentially never going to happen), and make that rage donation to Amy McGrath (because Moscow Mitch did something heinous *again*) so I don't forget to do it later. Only half of my cases are signed out. Crap.

I really want to spend the 20 min of Punky's bath time doing color-by-number on my iPad.
*I fold two more baskets of other people's laundry and force myself to put away the clothes.

Tonight I will definitely clear off the clutter from the kitchen table that we never use for eating, because I know that my husband hates this state of affairs.
*I put approximately four pieces of paper into recycling, photograph 16 pieces of artwork for Keepy and throw them away, then realize that I need to answer my MOC quarterly questions now since the thought just popped into my head and if I don't do it I'll miss the deadline.

This year, I will wrap presents as they come in to keep caught up.
*I place gifts in reusable cloth bags on a random midnight a few days before Christmas in place of sleeping.

I will definitely complete all four of the reminders I set on my phone for internet errands today.
*At 1:23 am, I sigh and change the dates on all four phone reminders to tomorrow's date. Well, technically *today's* date.

I will work on that amazing wooden puzzle tonight after putting Punky to bed and eating something.
*I scroll thru my Facebook feed for 1.75 hours reading the news, getting angry; I see a couple of cute kids and I feel a little better.

It's been weeks since I've had a work day off with the kid in daycare, I will definitely knock out at least four of my running to-do-at-home jobs off the list I keep on my phone, including setting up the Roomba that I bought two months ago which is sitting in it's box in the corner of the utility room.
*I drop off Punky, "stop in" to World Market for 1.4 hours, then head over to Target to wander around for another two, finally getting home at 1:45 pm and folding laundry/hanging clothes in the closest while listening to podcasts and scrolling Instagram until I have to pick up Punky at 5:30pm; the Roomba remains unopened.

I will make sure that this year, we get our family photos done in October so that I can get the cards completed in November.
*I panic and realize that the weekend before Thanksgiving is the last of the semi-decent leaf color and implore my husband to check out that spot that he's been meaning to look at for photography; cards are completed on December 8th and mailed on December 15th.

I will definitely go to bed in the 12:00 hour tonight; I really need a couple extra hours of sleep this week.
*I jolt awake at 2:34am, scroll back through the Schitt's Creek episode list to figure out exactly how many episodes I missed on auto-play, and finish cleaning up the kitchen before brushing teeth and falling into bed.

I will set a recurring reminder in my phone to write a blog post for MiM at some point so they don't kick me off the site.
*I sit at my desk at work at spew this out instead of signing out cases or validating immunostains, because, well, it's just time.

Forty years and counting......

Random ponderings on turning forty........

• There is genuine sadness and mourning when a favorite piece of makeup is discontinued.......it has taken me years to perfect the “easy, 5-minute, naked-face” look. Now I have to start that one piece over again and it genuinely hurts me..... 
• Alternatives to having a kid: 1) purchase $12,500 worth of organic produce and just pile it up in your living room. Leave to rot. Periodically stomp through it wearing Peppa Pig rain boots and a set of PJ Masks jams. Sometimes pretend to clean it up with a set of tiny wooden cleaning tools. When it starts to smell, scream at your spouse that it is his or her fault that the mess is there. Then toss in an emphatic “you hurt me, you’re not my best friend anymore!!” when he/she denies it. 2) drive to a bank on a tiny pink tricycle with streamers, rob it using only the threat of violence with your ridiculously fast-growing finger- and toenails, then take the pile of cash you claw away from the teller and just light it on fire in the middle of your living room. Repeat monthly. At least 10,000 USD should equivocate the experience of parenting. 3) buy some clothes that you really love, but get them two sizes smaller than your fit. Then look at them hanging in your closet every day while you pull on big shapeless scrubs, or Lycra yoga pants stained with unknown substances and with a forgotten mermaid sticker on the bum. Tell yourself that someday you will wear those again, but know that you won’t. In fact, you never did. Also, download an audio file of Honey Boo Boo complaining about a lack of syrup on her hot dogs and play that on an endless loop in the background. You know, just to sharpen your mind. 
• There are many trade-offs for waiting until later in life and marriage to have a kid. For example, with the presumed extra patience afforded by years of taking so much crap from the external world comes creaky, swollen and painful joints, stretching to their limits with every game of “pretend to be a floor worm with me!” or kneeling on the bathroom floor next to the bathtub, eating invisible cake slices out of bathtub toys with all of her rubber duck friends. But, when your kid makes you some fake strawberry shortcake out of a washcloth and some Paw Patrol purple body wash and hands it to you in a plastic cup with a star-shaped hole in the bottom, you eat that shit. Heck, I’m just happy to be invited to the party. 
• Alone time is the greatest gift the universe has to bestow upon me. There is never enough of it, and it nourishes my soul for when it gets people-y out there. The kid gets the majority of my energy, followed by job and hubs, mostly in equal proportions. Regeneration time is critical, and I’m learning to not feel guilty about it. 
• The more that I age, the more that I learn to stand up for myself and what I believe in a more fierce and unapologetic way. Being told how to use my voice by any number of different people with different agendas and issues is becoming harder to stomach. I genuinely appreciate differing opinions and polite discourse (the more animated, the better!), but when people try to strong-arm their issues and life views on me with tone-policing and gaslighting, well, Iam done sitting back and taking it, especially in my own personal space. I’m too old for that noise.
• Work-life balance is impossible (at least for me). It’s never balanced. One thing is always outweighing something else. It’s more about trying to keep my head above water, occasionally being really good at one thing or another, oftentimes just getting by, and hopefully not letting anybody die on my watch. There is also reminding myself that most of the time, the job I’m doing is good enough, and I’m learning to be okay with that. Being a doctor isn’t for the weak of heart. And being a mom isn’t for the weak of head. Sometimes my heart prevails in medicine and I cry. Sometimes my head prevails in parenting and I cry. It’s all so, so hard. But also pretty badass and (mostly) rewarding. And being a wife is a delicate and ever-moving target of balancing head and heart. Sometimes this is the hardest job, loving the one you’re with and nurturing that commitment. 
•  My husband and I have had an awful lot of loss in recent years, to include both of my parents, and his mother. Raising our daughter without these loved ancestors has brought on a lot of pain in such unexpected moments. She never got to meet them, and yet we see each of them in her nearly every day. Nature is a remarkable thing, perpetuating itself in this way. I wasn’t sure that I wanted to do this whole parenting thing for a myriad of reasons, but catching glimpses of my mom and dad again every now and again in my daughter’s face or voice is about as spiritual as it gets for me. I embrace this fully. 
• I’m truly happy to see forty, and I hope to have sixty more. I do love this life, including the joy, the pain, the humor, the tears, the angst, the stress, the happiness, the closeness and the love. Each new day is not guaranteed. The first forty (wow!) have been pretty damn good. Looking forward to what comes next.......

'Watching Your Toddler Drink Bathwater From a Hotel Tub', and other sordid tales of OCD exposure therapy

I've always been slightly more than casually OCD.  Not the flip-the-light-switch-seven-times-then-tap-dance-thru-three-choruses-of-I-Could've-Danced-All-Night-before-leaving-the-house kind, but more like the picks-stray-hairs-from-my-pillow-before-laying-down-and-always-on-the-lookout-for-dead-bodies kind.  I can't explain away the hair thing, but you try working for the body pickup service contracted to the medical examiner's office of a major metropolitan city for a year and *not* look for corpses on the side of every road and behind every hydrangea.  They're there, people.

Now, this has always been sort of quirky and cute to most that know me, and those that may have thought otherwise have largely been kind enough to at least refrain from open mockery.  "Oh, that TheUnluckyPath, she sure is hilarious, over there picking microscopic lint fragments off of her dinosaur print Boden top".  But let me tell you, shit got real when Punky arrived four weeks early.  I had what turned out to be straight up post-partum OCD/anxiety that might blow your mind.  I had no idea that this was even a thing.  You learn some (but not near enough) about post-partum depression in med school.  But I swear I had no idea that you could get heightened OCD associated with the perinatal and/or post-partum period.  It was absolutely heinous.  I've never been so terrified in my whole life.  I spent the first eight weeks of my daughter's life expecting to find her dead, in any and all manner of common and/or obscure/tragic/horrifying/violent ways, every single time I left her for a snooze.  And, presumably because I've seen some serious things in my life, I could picture in excruciating detail every single aspect of the fictional scene.  I became nearly-paralyzed by stairs, where I would clutch her to my body and get an iron-grip on the banister like I was free-climbing Half Dome every time I walked out to the garage (down four steps.....just four).  I would imagine that she, at four weeks old, had somehow freakishly developed musculature, climbed out of her crib, and rolled underneath only to suffocate on a blanket that she had carelessly wrapped herself in.  I visualized her tiny electrocuted body lying next to a wall outlet, no joke.  My heart was repeatedly broken day in, day out, every time that I left her and cautiously returned to see what I would find.  Because, even though she was perfectly fine every time I came back(if not sometimes poopy), I imagined her dead in more ways than anyone could ever believe, and it felt so real to me each and every time.  And a little bit of me mourned her faux death, so many times a day.

But that actually wasn't the worst of it.  The worst of it was that, in the majority of instances, when I imagined her death, it was me inflicting it.  It was me hurting her in all of those ways every time.  In the bath tub.  In the kitchen.  In her nursery.  It was so, so shocking and terrifying to have these scenes playing through my fractured, sleep-deprived mind.  The shred of myself that I was still clinging on to still knew that I did not ever want to hurt a single tiny spiky hair on my perfect little peanut's head, but it was so, so hard to reconcile this with the visions that I was constantly having.  I was beyond terrified.  I was so afraid to tell my husband about any of these things, for I didn't know if he would be afraid to leave me alone with her.  A few weeks in to this guilt-and-shame-filled struggle, I remembered an episode of the podcast Invisibilia that I had listened to the year prior.  It was called The Secret History of Thoughts, and it had made quite an impression on me at the time, especially the story about a young, just-married couple.  They had a relatively carefree and easygoing life, until one day out of the blue the guy started having obsessive thoughts of his wife being stabbed to death in their kitchen.  And he was the one doing it.  On one hand, he just *knew* that he had no desire to harm his wife in the least.  But on the other hand he was terrified that he must want to kill her, on some subconscious level, else why would he have such terrible visions?

Turns out, he had a specific subtype of OCD called Harm OCD, in which "an individual experiences intrusive, unwanted, or distressing thoughts of causing harm, and this is inconsistent with the individual's values, beliefs and sense of self.  These obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act." (that's a nice definition provided by the website of the OCD Center of LA)

So, I went back and listened to the episode again, and I felt an immediate sense of relief.  I remembered identifying with it to some degree the first time around, and feeling so deeply sorry for the poor bastard experiencing this terrifying thing.......but now I was was reasonably sure that I had become that poor bastard.  However, at least I had some hope that perhaps I could fix this somehow.  So I committed right then and there to myself that I would admit that I was having these thoughts to my lovely, compassionate therapist at my next appointment.  And, I did.  And doing so was the first step in my journey toward recovery from my post-partum Harm OCD.  And now that Punky is 2.5 years old, I'm back to my slightly more than casual OCD, right where I'm comfortable.

And that brings me to watching my daughter drink hotel bathwater in a borderline sketchy extended stay motel during our cross-country move a few months ago. Having a toddler is a long-haul treatment course of exposure therapy for OCD, which turns out to be very effective for me in dealing with my issues.  Identify the intrusive thought, analyze it and decide if it's valid and why/why not, then accept it or dismiss it as it's happening.  Gives me the sense of control that I need to feel comfortable and safe.  And then I can go about my quirky day.

Watching a toddler eat peanut butter off the floor of an airport.  Standing idly by while my daughter puts her hand in the toilet to retrieve a toy that needed a quick and refreshing swim.  Suppressing a scream as the kid covers the wall in crayon, grinning and singing with unabashed joy.  It's a constant barrage of borderline-horrifying acts of depravity, packaged in an adorable little bundle of cuteness and light.  And on that day a few months back, as I sat back on the yellowed and cracked tiles of that supposedly clean bathroom, I forced myself to let her be a toddler, feeling her way through the world around her and delighting in the new experience.  It was a super gross experience, but she thoroughly enjoyed it nonetheless.  And the reason that I finally got around to writing this five months after the fact is that it dawned on me a couple of nights ago that I haven't checked my pillow for stray hairs before falling (mostly happy and always exhausted) into bed at night since we moved to this new job and house.  There are tons of other stressors in life, including some new ones about kind of hating this new city, but overall life is pretty damn good.  And the older I get, the better of a handle that I have on my weird brain.  It's actually pretty interesting in here most of the time.........  :0)

Time To Move On

Hi, I’m new here.  And very honored to be here, at that.  I’m a pathologist, in private practice for > 5 years (settling in to the flatter portion at the top of the exponential career curve of knowledge/abject terror), but < 10 years (I suspect, the point on that curve at which cynicism overrides all other basal functions and drives one towards a retirement countdown sticker chart).

I’m in my second post-training big-girl-pants job, and I’ve been here for a little over 8 years.  I briefly tangled with a super-crap job, lasting only six months right out of training, working for a very bad man rocking various personality disorders.....but that will be another story for another day.  This current job is where I became an adult.  And this job is where I damn near had my love for pathology drained of my brain completely.  But it’s time to move on, and I’m doing just that.

Over a period of years, I had somehow found myself struggling to get through the work day, doing twice as much work as is safe to do, getting paid a quarter of the money being made off of my back.  I had become everything to everyone in my office and to the clinicians in the hospital, and nothing to myself professionally. I hated every minute of it.  And my marriage was suffering for the long hours, which I finally figured out after hearing myself in every conversation trying to justify my absences. It just didn't sound authentic to me. Working 60+ hours a week as a pathologist is not particularly normal. But it took a while for me to figure this out -- Stockholm syndrome is real, ya'll. And then, nearly exactly two years ago I had a gorgeous baby girl, induced at 36+1 weeks for oligohydramnios, weighing in at a whopping 4 lbs 15 oz.  And my placenta was just as small as that tiny girl, 5th percentile.  Everything was "fine" until it wasn't.  I've since learned that many of the births to female docs in similar situations to myself are premature for various reasons, commonly for oligo……………can’t help but think there is a link there. 

I’ve worked with some wonderful people over the years while doing this job.  Most of the ones who have stayed for longer than a year are the type that persevere long past the expiration date, and they just keep on going.  Each seems to have his or her own reason for doing so:  'finish what you start', 'I cannot be defeated', 'everyone will like me eventually', 'it’s not really that bad', 'I deserve this pain', 'it is too hard to change'.  What is my reason?  I’ve already made too many mistakes.  This can’t be another one.  I can make this work.  My family is depending on me.

Life is too short to stay in a job that is soul-crushing.  No job is perfect certainly, but no job should harm your psychic core or fizzle your spark.  If you don’t recognize the person that you were, that idealistic nerdling resident, marveling at those exquisite enterocytes mingling with those gorgeous goblet cells, and you can’t find her deep down in there somewhere………..it’s time to make a change. And preferably before that gal has packed up her shit and moved to the outer recesses of the universe, never to be seen or heard from again.  Mistakes will always be made, some big and some small, but they can always be corrected.  Be the change, as they say (whoever they may be).  You always have the power to make things better.  I have become a path beast during my time here, and now I’m doing my best not to become a pathological beast.  Put yourself into the situation that you want to be in, whatever that may be.  It could take awhile, sometimes may even take eight years and some major life changes.  Remove yourself from the people and entities who take everything from you and give nothing back in return.  I’m doing just that in short order.  Even though it’s a move to a more backward state than the one in which I currently reside, but that’s yet another story for another day………

Take care of yourself first, the rest will follow.

Progress and peace to my fellow burnout warriors :0)
TheUnluckyPath