Lack of Headspace: Mind Mapping

 Recently, a blogger/influencer I follow on Instagram introduced me to the concept of a mind map. Basically like a giant plan of what is going on in my life, what is taking up my headspace, what I am thinking about, worrying about, need to accomplish, hope to accomplish. 

Basic Idea linked here

I have just been so mentally exhausted lately. My mind has so many "things" going:" passion projects, work projects, home projects, relationship projects, mom projects. In addition to the mental load of end of school year/ camp/ summer/ moving/ COVID testing/ travel etc that takes place on a daily basis. I was told in the beginning of medical school that training is like a treadmill. You just have to keep going. Well, now it's going just a little too fast for comfort. 

The mind map helps me see it all laid out. It helps me prioritize, create and construct a to do list, allows me to cross things off that are complete, or are deemed unnecessary once written out in a bubble on a piece of paper. It helps transition the sensation of "busy" to "productive." It is definitely something I plan on using going forward, and wish I would have known about it sooner. 

Tonight, instead of crossing off a bubble, I chose to write. Reaching out is a passion, sending good vibes to this community of supportive people is my way to refocus and set the tone. What do you do to decrease or organize your mental load? 

Girls Day and Hurricane Dorian

Since my husband and son left town for a family event, I spent the entire past 2 days alone with my 7 year old daughter. It's been amazing. Thinking back, I think we have only had a handful, if that, of "alone time" opportunities since I started residency over 2 years ago. She is so fabulous. We did all the "girl" things that she loves; went shopping, Sephora, manicures, brunch, and pizza dinner. (How these are her favorite activities, I have no idea, since I am not particularly into fashion, makeup, or sparkles, and I  specifically chose a field where I can wear socially sanctioned glorified pajamas with my hair in a bun every day for work.)

We live in the southeast, where Hurricane warnings closed school the past 2 days, but the hurricane never did arrive in the way we feared. (But the devastation caused by Dorian is heart breaking, shattering, and completely devastating. There are many charity organizations already established and I encourage you to do your research and choose to help as you can. I have added some links below.)

This time with her made me realize the toll of the treadmill that our little family has been on the past almost decade of med school and residency. Between homework, dinner, bath, work, camp, sleep(?) and everything in between, I think that I lost sight of the down time, and effortless sense of "being together" necessary to strengthen relationships and get to experience my kids as they grow up as individuals. While initially I was sad that my call schedule didn't allow me to attend the family celebration, I am so thankful for this time at home. Staycation alone time is definitely something I want to do more of in the future.


Here are links that highlight some of the ways to help those affected by Hurricane Dorian
https://www.newschannel5.com/news/heres-how-to-help-communities-affected-by-hurricane-dorian

https://impact.publicgood.com/campaign/3267a266-ee73-4daa-b7fe-778d036c5e6a

https://www.globalgiving.org/projects/hurricane-dorian-relief-fund/

Getting down the mountain with Pizza turns.

A few weeks ago we took my kids on their first ski trip. Actually, it was the first time my younger one has ever seen snow!

The first 2 days, the kids were in ski school and my husband and I got to go ski the "fun stuff." We are both pretty advanced skiers so it was great going down the mountain, together, without kids,  like we were dating again. I love anything outdoors and active, so this was the perfect antidote to the recent run of a lot of ED shifts.

But on the last day of our little trip, the kids revolted. They were exhausted from learning this new skill, in this new environment, in a new climate. No one wanted to go to ski school, and the only way we convinced them to get up the mountain was if we promised "family day." So, to the bunny hill we went.

The 4 year old rode the gondola down to town with me after 2 runs, but my 6 yo was still ready to show off her new skills. So she and my husband decided to try to ski down the longest run to the base of the mountain.

The look of sheer disbelief, awe and pride she wore when they walked off the slope 40 minutes later mirrored my own. She had "pizza turned"* the whole way down. Slipped and slid across parts of it, tumbled in others, but she did it. All 3 miles of snowy slope. Some of it way harder than her 2 day total skill level. All of it an entirely new experience.

I felt that way after running my first code. A mix of "what just happened" and "wow, I look like someone who knows what they are doing." Disbelief and gratitude and pride and fear. As this academic year starts to wind down and senior year is approaching, I look forward to having more of those moments. Medicine is humbling. The human body and whatever otherworldly spirit that accompanies it, is capable of incredible, unpredictable, and inspiring things. Our capacity to learn, study, and train in order to impact the course of the life of another person, or use our skills to intervene and directly affect their future, the future of their family, their destiny, is uniquely motivating.

I hope to keep motivating my children to push their limits and challenge themselves. Parenting my children gives me a window to parent myself. Motivate myself. As lifelong learning is a huge tenement of our field, I hope that lesson of small, slow, pizza turns, sticks with me.

* For those who don't ski, "pizza turns" refers to the wedge shape you make with your skis to slow down and control your speed.

Bad Habits and how to (attempt) to kick them

When my mother went in to have her diagnostic laparotomy for metastatic disease, my father said that he knew everything was going to be okay because the surgeon had "beautiful, clean, well-kept hands."

Since that day 10 years ago, I have started to take more notice of hands.  As a doctor, the state of a patient's hands, and feet, can suggest underlying disease, hygiene, social situation. Manicured fingers, dirt under nails, dry skin, scabies rashes, diabetic ulcers, clubbed nails of hypoxia.

As I look down at my own hands, though, I'm constantly ashamed.

Confession:
I bite my nails. Not my nails, exactly, and not biting, technically. I pick my cuticles. It's gross, I know. Disgusting, I get it. It's an infection risk, a way for patients' MRSA, fungus, and ESBL infections to get inside. A risk for herpetic whitlow, paronychia. There is an official medical name: Onychophagia.  It looks unkempt. I KNOW.

I've tried getting regular manicures, but that gets a) expensive and b) time consuming. I tried moisturizing, creams, potions, and lotions and gels and ointments. I've read blogs. (link below). This repetitive behavior is SO HARD TO KICK.

Over time, we as individuals develop so many different habits and routines. The way we brush our teeth, which side of the bed we sleep on, which shoe or pant leg goes on first. What we eat for breakfast, which coffee we order, what we reach for when in need of comfort. Take a minute to pay attention to the things that make up your daily routine. We are creatures of habit.

Diet and lifestyle habits and routines are hard to change as well. With all the focus on "new year new you," the explosion of health and fitness "influencers" on Instagram, and the renewed energy that comes with a dedication to a new diet, eating plan, workout regimen, or health motivation, it should be easy. We have so many cheerleaders; however, ingrained habits require a lot of mental energy to change.

So I definitely have a little more compassion for patients when they tell me it is hard to take a new medication, change their eating habits, work out more. I can't seem to do it myself, honestly. (My 15 lbs- 4 years post baby- prove that) The constant reminder of my raw hands is the sign of a continuous struggle.

How do you motivate change? Have you found success with breaking a habit or changing your diet or lifestyle? What resources do you use, or guide your patients to?



Blogs I referenced:

https://www.glamour.com/story/how-to-stop-picking-your-cuticles-tips

Who gets to decide if you are too busy?

I talk about my kids. A lot. I mentioned them in my residency application, during my interviews, and share anecdotes at work with my attendings who have kids the same age. We share pictures, school recommendations, fun Sunday activities, etc.  All the attendings with kids, however, are men. My residency program, in a field with a growing feminine presence, is amazingly family friendly, with at least 3 other dads/residents and 1 other mom. It's a fun, sharing atmosphere.

Until it's not. While casually discussing the possibility of becoming chief resident next year (it's not a dedicated year- you still have the same clinical responsibilities just with extra admin ones as well)  one of the attendings, who has a direct role in decision making for the residency,  made an off-hand comment along the lines of "well, you are busy enough, you probably wouldn't want to have anything extra." When I approached him privately after and let him know that I was, in fact, interested and hoped to be considered for chief, he was welcoming and supportive. But the off-hand comment made me think.

Are the biases and expectations and assumptions about what a mothers' role fair game for deciding promotions, responsibilities, career trajectory? Who gets to decide how busy, or not, I want to be, or am? Do I now have to "tone down the mom factor" and work extra hard, just to be considered for the same position as someone without children? Other residents talk about dating, drinking, their dogs, other parts of their outside lives. Do kids not count as an approved extra-curricular activity?

The most frustrating part for me, is that I'll never know. There are a few other amazing residents hoping for the position. If I don't get chosen for the responsibility, will it be because the admin thought the others were better for the job? It's a completely realistic possibility. But what if it's because I have kids and they have assumptions on what I can/want/will handle? Part of me wants to eliminate the possibility of that frustration and uncertainty by denying any interest in the position and just letting it go. But I  have decided I am just going to work harder, smarter, work on being a team player, and keep at it. And maybe share stories a little less.

Have you been in a position where your home life was questioned? Your choices judged? Your responsibilities and commitment challenged?

Intern Year Recap

Intern Year Recap

As my kids end school and I start power- reading to get ready to be a 2nd year resident, I want to take a chance to recap this crazy roller coaster/ transformative/ at times impossible/ at time inspirational year.

Top 10 ways to rock intern year.

1. Make friends with your co interns. Your nurses. Your seniors. Basically, anyone in the hospital. It is the place where you will spend the bulk of your time, so having people you look forward to seeing, talking to, working with, will make the tedious hours go by shorter, the hard times a bit easier, and the terrible days a little less terrible. You may even have fun.

2. If you ever are doubting your abilities, teach something, anything, to a medical student. You will be amazed at how much you actually do know. You will help them learn something. And you will feel like a better, kinder, and more capable person for it. Teaching also helps solidify information, so if there is something you struggled to know the day before, teach it to a medical student today. Believe me, it is a huge ego boost and a way to help out someone who will one day be your colleague.

3. DO NOT LIE. If you didn't order a test, or do a complete exam, or replete lytes, or order an antibiotic, DO NOT LIE. Just be honest. Admit mistakes, and work to correct them.

4. Invest in really comfortable shoes. I wore worn out tennis shoes for 6 months and my feet ached. every. single. day. When I finally bought a better pair of supportive, soft, arch-supporting shoes, I felt 100 times better at the end of a shift.

5. Check in with yourself. At some point, I realized that I (a little curvy to begin with) had gained 10 pounds during my first 6 months of residency. Check in. Run, Exercise, Eat right. Come up with a plan. Bring lunch instead of ordering in or buying cafeteria food. Skip the muffin at the free breakfast. The past month I have been committing to 2BMindset (on the Beachbody website) and I lost those 10 pounds. It was a lot of effort and commitment, but I feel better, healthier, and am inspired to keep on a weight loss track to lose the rest of the "curvy" that still has me 20 pounds over my pre-baby weight.

6. Find something you love and make time for it. I love cooking. I stalk instagram food bloggers, hoard too many cookbooks, and screenshot recipes compulsively. Cooking gives me a creative outlet and also lets me feed myself and my family in a healthy, affordable way. Having an outlet outside of the hospital is essential for your wellbeing.

7. Drink water. Being dehydrated is awful.

8. Remember your "Real life" friends. There was  period of time where I had not spoken to my best friends (non medical, live in a different state) in over 2 months. I missed the birth of their babies, kids' birthday parties, their birthdays. I felt terrible and lonely. I just wanted to go home and give up. Luckily, face time and whatsapp goes a long way and I was able to realize why I felt so lonely and make an effort to reach out. Don't forget those who loved you and supported you along the way.

9. If you have a significant other/partner remember them. Try not to come home so utterly depleted that you have "no nice left to give." Your relationship deserves it.

10. Make every day a learning day. and try to end every day with positive thinking.  When you get home, think about 1 thing you learned. Think about 1 thing that made you happy. Think about 1 think you are excited to do tomorrow. (Bonus: think of 1 thing you did to make someone ELSE happy.) Thinking positively and productively will help you sleep better and be happier overall.


* Bonus- remember that your kids will think you are the coolest person ever no matter what. Love them unconditionally, the way they love you. If you only have energy to cuddle in bed, then do that. They don't care if laundry isn't done. One thing I learned this year is that my kids are freakin awesome. Resilient. SO. Much. Fun. Way more social than I am. Adaptable. And as much as I feel like I am never home, they have taught me to appreciate the time that I am.

Off to Year 2!

Mommy time/ whenever I can get it

How do you fit your "mommy time" in?

I love residency. I love what I do, love my work colleagues, and am so thankful for my attendings and program director. I could not have imagined a more supportive community. 

One thing I'm grappling with right now is keeping any sort of structure for my kids when I am at home. When I am at work, the house runs like clockwork. My husband gets them to school on time, the nanny has them fed, brushed, bathed, and in bed by 7:30. No fuss, no problem. 

But when I'm around, it's chaos. And not the controlled choreographed chaos of the ED. It's pure, unpredictable, chaos. For example, this morning, all before getting to school by 845 (very late- they start 745), my daughter "ran away" from home down the block, the kids put on a puppet show, everyone ate pancakes, and only then did we start getting ready for school. 

As an EM resident, my schedule is varied. I work a lot of later day shifts (10-10) or mid shifts (2-2) and at least 2 full weekends a month. I usually average about 1 dinner/bedtime/bathtime home a week. During that night, we try to fit in all the homework for the week, I try to hear all the stories about their friends, cuddle time, book time, story time, song time, just-be-with-mommy time. Needlessly to say, bedtime gets substantially pushed off. On the mornings when I'm home before shift, I'm usually exhausted, but, as I have not seen them for 2 or 3 nights already, we morning cuddle, make pancakes, read books, play dress up, etc. Trying to fit all this "mommy" time into the 1 hour or so between wake up and school is impossible. So we are late. Consistently. 

I know that once they are older, getting to school on time will be more important, but it's been a challenge to balance between maximizing every second I get to be home with them with sticking to a routine. Some days are better than others, but I'd love any tips! 

How do you maximize quality time when you don't have the quantity time to give? How do you balance discipline/structure with just enjoying their company?

Chocolate Sprinkle Sandwhiches

I cannot believe it has been so many months since a post. A quick update...

1) Biking to work is so unbelievable. When we moved across the country, one promise I made myself was that if I had to fly 3000 miles to train in my dream specialty, there was no way I was going to sit in traffic every day. So we found a house that is a good bike-able distance from the hospital. I have composed so many posts in the many early morning and late (and odd, 2 AM post shift) rides home, but none have translated into an actual post. I'll catch up.

2) Time is a great healer. A great equalizer. A great decompressor. When we first moved, everything was so raw, so scary. It stayed that way for a while. That fear, uncertainty, difficulty, and stress was only compounded by having our moving truck arrive a month late, evacuating for a hurricane, and realizing that being a resident is really intimidatingly scary stuff. Also, my son HATED school. And my husband realized finding a job was not as easy as it seemed in a new city with no contacts or networks. But all that is over now.

Which brings me to now...

Some days I feel like super mom. I have prepped meal plan organized food in the fridge, menus written on the kitchen chalkboard, cut up fruits and vegetables to snack on. My kids have their backpacks and lunches packed by the door, clothing laid out on their beds. I'm rocking this mom/resident thing. But then there are days like tonight. I was coming off a really hard stretch of super intense 5 nights in a row. Working over Xmas in a vacation spot is like Target on Black Friday in the ED. So. Many. Patients. So. Many. Drunk. People. So. Many. Lacerations/Holiday Hearts/I left my meds in another state. Just. So. Many. So when I had a "switch day" from nights to days, I slept. Then I made a cake. Then I went out for a manicure. I had no energy for the market, meal prep, lunch making, and homework organizing, so we took a night off. But today, I had an early morning shift, that stretched from "I'll be home by dinner" to "I'll be home after a central line/LP/all my notes." Our wonderfully flexible nanny texted me at 5 pm asking dinner plans. At 5:30, I got a picture of my kids eating their favorite go to snack-for-dinner: Chocolate hazelnut butter sandwiches with rainbow sprinkles, on whole wheat bread. At least it's whole wheat? And the "healthy" brand chocolate butter instead of Nutella?

One thing I am learning as a resident/mom without my family around is that I can't do it all, and I can't pretend to do it all. I have learned to be okay not looking put together all the time (ie: show up to the holiday show post overnight in scrubs), be okay that my kids eat the provided lunch plan instead of a cute bento box, and be okay that I have yet to attend a single PTA function and don't really feel guilty at all.

Hope to post more often,
Boxes

Moving with Boxes

Hi! I am so excited to join this community. I have been following since applying to medical school 6 years ago and now, med school and 2 kids later, am honored to be able to share with this community more regularly.

I am usually an upbeat, sunny side up, West Coast girl. But I would like to introduce myself with a post that bares my soul and reflects a more raw version of myself. Below is what I wrote 3 days ago, the night before getting on a plane with my husband, kids, and dog, to fly across the country to start EM residency. With the chaos of moving I didn't have a chance to share until today. I'll hopefully post a more positive update later next week!

I'm flooded. And overhwlemed. and the dam that has been holding my emotions at bay has broken and every thought, fear, feelings of guilt, absolute fear, and sense of desperation keeps washing over me, unrelenting, like a wave, as I fight the current in the tumult of emotions  that keeps pounding relentlessly. 

let me backtrack. 

when I fell in love with emergency medicine the beginning of 3rd year, I knew that was the only field of medicine for me. the pace, the variety, the sense of camarederie, the fast paced atmosphere. I was hooked. I also knew that getting a residency position in my home town would be a stretch. my step 1 scores were okay, but test day was blunted by braxton hicks contractions and running to the bathroom with my 8.5 month waddling belly and I underperformed all my practice tests by about 10 points. so when eras and interviews started, i knew that moving away from my hometown was a real possibility, if not probability. 

on match day, i told me parents and grandparents and aunts and siblings  (who all live within a 5 mile radius of me and the med school) not to come. i knew i would not get in to the top 10 rated programs in my hometown. i was right, and opening that envelope ensured that my husband, 2 kids, and i would be traveling for an adventure across the county for at least the next 3 years. 

i went into GO mode. i found a house, registered the kids for school, hired a moving company, organized a goodbye party. but we leave tomorrow. and i am now terrified. 

i had my daughter, Chicken, a few months before starting med school and my son, Monkey, after Step 1. My kids go to my parents every day after school and most weekends when i need to study. They play at my grandparents' house on Sundays. My aunts and siblings have driven more carpools and orgsnized playdates and provided last minute babysitting more times than i can count. and now i am leaving the village that helped my little family thrive in med school and we are leaving so so far away where we have none of that.

i am just so scared. so scared that my kids will feel lost and alone. so scared that they wont be able to continue strengthening the amazing relationships they have with their grandparents and great grandparents. so scared that i will ruin or permanently derail my husbands career. so scared that it is all my fault because chose too competitive of a residency and wasnt good enough to get in at home. 

i love my program. i am going to love residency. im just so scared of what i am going to mess up in the process.