FOMO

I was talking to my dear friend C the other day on the phone and she asked me about my recent trip to Hawaii.  Except that it really wasn't that recent.  It was in December.  It has been over two months since I have seen or talked to her.

This month, I am on call for three out of the four weekends.  This has been pretty standard for most of my clinical year thus far.  Most of the time, the fact that I basically have no life outside of medicine doesn't really bother me.  Most of the time, I am too busy and too sleep-deprived to really even realize how each day melts into the next while real/normal life is going on around me.  I am always surrounded by my co-fellows (wonderful people without whom I'm not sure I would possess even the modicum of sanity that I have) and loads of people from patients to support staff.

And yet, if I stop for just a second (and manage to not fall asleep), I realize that there is something missing.

My co-fellow Thor described it most aptly: our lives are on hiatus.

I try not to say this often, but it's really something that non-medical people can't understand.  Just the level to which your freedom is restricted in the medical profession.  The times when I feel it the most are when I'm walking home from the hospital.  On a Friday or Saturday night at midnight, as I walk home from the hospital, looking crappy in my scrubs, exhausted and physically sore in every muscle from operating, I see all of the "normal people" sitting in bars with their friends, talking, laughing, enjoying a few beers.  Or on a Sunday afternoon, as I hustle back to the hospital to see yet another consult, I see "normal people" sitting outside enjoying brunch with their family or friends.  Even when I was a medical student, I spent hours at a Borders bookstore cafe with my best friend on a Saturday afternoon with a pile of medical reading.  Occasionally, we would look up, bleary-eyed, jealous of the people around us reading The Atlantic and Glamour.

I can't have a beer anymore--I'm always tied to my pager and worry that a patient may have an MI.  I can't make plans for Sunday brunch--I can't leave a certain radius of the hospital and I just don't know if I'll be able to get out of the hospital on time.  And on the precious weekends I do have off?  I take care of all of the errands I couldn't take care of--buying groceries, paying bills, watering plants, cleaning, cooking, laundry, calling my family.  And often those things go by the wayside because I end up not being able to move from my bed.  Trying to pay off my sleep debt.  Catching up on "medical jetlag."

I'm proud of what I do and love what I do.  I realize that I get to do something that few people get to do and that specialized knowledge comes with a price.  I also realize that, as a consequence, I will never be a perfectly "normal person" with a 9 to 5 job, but that there is going to be a time when I will be closer to that than I am now.  That in fact, this is a hiatus and one day I will be back to normal-ish life.  And when that day comes, I will order a beer at a pub on a Sunday afternoon, watch football with my friends, laugh and joke, and be grateful for every minute of it.

"Black Cloud"

We all know and love and fear the term "Black Cloud."  I'm never quite sure how to define this for my non-medical friends and family:


Black Cloud (adjective): 1. a term used to describe a medical trainee whose pager beeps incessantly, 2. a term used to describe a medical trainee who never gets sleep on call, 3. a term used to describe a medical trainee who admits multiple ("train wreck") patients per night, 4. a term used to describe a medical trainee whose pager number is on speed-dial in the emergency room

Pretty much every one of these definitions could be used to describe me over the past two months.  Hell, over the past seven years.  As a resident, there were some attendings who dreaded being on call with me, knowing that there would be multiple consults to round on and trauma to operate on all night. 

But we Black Clouds have to wear our pagers and dark circles with pride.  Pride (coupled with multiple cups of coffee) is the only way we can hold our heads up...from nodding off.  We chalk up our experiences to "learning opportunities."  There has been no shortage of learning for me recently.

As a result of my Black Cloud status, it's been a bit of a dry spell here at SATS.  Well, I take that back.  I am having a torrid love affair--with Hospital.  We spend all of our time together.  We call each other constantly.  We can't get enough of each other.  We learn more about each other every day and our bond just grows stronger. 

But in all seriousness, as a result of my love affair with Hospital, there hasn't been much room for anyone else in my life.  It's amazing how little time an 90+ hour workweek leaves for anything else.  Just trying to maintain relationships with my family can be a challenge.  I'm embarrassed to say that I finished my Christmas shopping on December 27th. 

I know that the love affair with Hospital and the Black Cloud status have an expiration date.  I know that I will eventually be able to re-enter normal life.  I know that the more Black Cloud experiences I have, the better physician and surgeon I will be.  But in the meantime, in these few days I have off for the holidays, I will slumber.

Beep, beep, beep!

All the Single Ladies

Grad Stud #2 recently sent me an email and re-entered my life.  Not to worry ladies, Grad Stud #1 is completely out of the picture.

Grad Stud #2 and I have an amazing epistolary relationship.  We fire emails back and forth regarding our mutual disdain for the Republican debates, the lack of universal health coverage in our country, NPR...I could go on and on about the email courtship of two left-leaning individuals.

So what's the problem, right?  When I meet him in real life, there's just...nothing.  I'm not sure I feel attracted to him physically and the conversation is overly animated witty repartee on my side to make up for the lack of emotion and utter seriousness on his side.  I've tried to pass it off to nerves on his end...but you'd think that after three dates that maybe things would loosen up a bit.

Tonight I'm going to tell him that we should just be friends.

Aside from Grad Stud #2, there have been a couple other dates since the last post way back in August, but these were also lackluster.  I went out with one really weird dude who still sends me short little email snippets (i.e. "Hope things are well with you!").  I guess it's amusing.  The other guy...we just didn't mesh.

Honestly, though I occasionally have moments where I want to meet someone and do the whole "settling down" thing, I am more frequently terrified by that idea. 

I see the majority of my high school, college, and med school classmates on Facebook with their S.O.'s and pictures of children growing by leaps and bounds.  I feel like I'm supposed to want all of that. 

But instead, I really really love my job.  If I have learned anything in the last couple months, it's that I missed clinical medicine last year while I was on research.  I love being able to spend time on my job and not be pulled in a million directions.  I love having an active and drama-free social life.  I love being available to help out my family when they need it.  And most of all...I love having my freedom.  Some of my settled friends might call these feelings "delayed adulthood" brought on by extra years of training.  Another word I have heard is "selfishness."  Or maybe this is just the way I am built.

Though I may be single, I am not alone in my sentiments.  There are more and more single women out there who are single by choice or by the reality of a lack of suitable partners.  This article from The Atlantic ("All the Single Ladies") poignantly and eloquently states the case.  

One of my mentors told me that in order to be a good surgeon and researcher, I might have to find a path all my own and that my professional future may look different than I expect.  Perhaps the same is true for the personal futures of us single ladies.  Maybe the future of relationships isn't the nuclear family with 2.5 children.  Maybe we will create new realities, relationships, and families that are unique to each individual.

Physician, Heal Thyself...Financially

For those of you in the Eastern Time Zone being pummeled by Hurricane Irene as I am, here's a little bit of educational leisure reading from the NY Times about the mistakes physicians make in their financial lives.

I noticed over the course of my residency, that many of my colleagues sank themselves in credit card debt.  As the article mentions, ours is a profession of delayed gratification.  Once we finally start making even a little bit of money as residents, it's tempting to go out and indulge a bit after a tough day at work.  Unfortunately, in addition to massive amounts of student loan debt, many also end up with massive credit card debt and little savings.  We basically mortgage our future income.  I think this hit is doubly hard on those who have children during residency.  From what I've seen, many live paycheck to paycheck, relying on credit cards to make up the difference.

It's not hard to see that this is a bad idea, especially in today's economy and litigious environment.

Some ideas: make a budget, read up on financial issues, put some money away in a Roth IRA during residency.  My residency program had a yearly retreat and brought in a financial planner to talk to us about all those practical things that we otherwise don't have time to think about during our training.  If your program has a didactic series, lobby for a session on financial planning.

We should approach the financial aspect of our lives in the same way we approach medicine--careful study and planning for the best possible outcome with the least amount of damage. 

More on the (Student) Debt Ceiling

As a follow-up to my earlier post on the effect of the debt deal on student loans, here's a timely article from The Huffington Post on how to deal with the new regulations on Stafford loans for graduate and professional school.  Timely topic for the new first years and those going through the application process.

Welcome Freshmen!

I was walking to the gym yesterday when I spotted some bright-eyed and bushy-tailed young twenty-somethings in shiny, new short white coats.  It's that time of year again--the matriculation of medical students. 

As I bustled by, I couldn't help but feel a bit nostalgic.  I started medical school exactly a decade ago. 

As I watched the new medical students take pictures with their families, I felt a lot of mixed emotions.  On one hand, I am so excited for these newbies.  I can honestly say that they are entering one of the most intriguing jobs a person can have.  As physicians, we have such wonderful opportunities in so many arenas.  We get to meet interesting and incredible people, including our patients and colleagues.  We get to see and do things that most everyone doesn't.  We get to learn, research, teach, travel.  We have great job security.

However, with those great benefits come incredible risks.  When non-medical people ask me about my medical education and residency, I quote Dickens:

"It was the best of times, it was the worst of times."

The best of times for all of the reasons I stated above, but also the worst of times for the many sacrifices we make to do this--personally, mentally, physically, financially.  We get to push ourselves to the limits of our beings in order to do what we do.  I don't need to go into the gory details, we all know them.

Though it sounds cheesy, the emotion that overtook all of the others when I saw those medical students was an incredible sense of pride.  Pride that I made it through, and pride that there are still people who want to do this despite the risks and benefits.

The (Student) Debt Ceiling

How many of you are carrying student debt that is the equivalent of a mortgage on a modest new home in the Central Time Zone?  According to recent data, American medical students graduate with an average of $158,000 in student loans.  Check out this item from The New York Times Well blog for more terrifying med student loan stats.

On Sunday, our Congressional leaders arrived at a deal to raise the debt ceiling, but students in professional schools and graduate programs are going to suffer as a result of this.  The deal cut the subsidy on Stafford loans (so all Stafford loans will be unsubsidized and will accumulate interest while you're in school) and the interest rate cuts for people who make timely loan payments when the loans go into repayment.  Check out this story from CNN Money.
 
Though student loans seem like an issue focused on individuals, it is increasingly becoming a major health policy problem  that is finally garnering the press it deserves. For example, the blog post above from NY Times, The Huffington Post, and a recent article in Academic Medicine which chronicles the history of student loans amongst medical professionals.  This article makes for interesting reading--do we really know how much it costs to educate a medical student?  Is it really to the tune of $60,000 per year?

The prohibitive costs and debt associated with medical schools are affecting the practice of medicine throughout the physician workforce pipeline.  High potential debt and the lack of support for medical students affects the applicant pool for medical school, increasingly making medical school a luxury for the more well-off.  This leads to a lack of diversity amongst the applicant pool and medical professionals in general.

Additionally, I think medical student debt is one of the many causes for the primary care physician shortage.  Students choose higher paying, procedural-based specialties because they pay better and allow physicians to pay off massive amounts of debt more comfortably and in a quicker timeline.  In the Well blog post I mentioned earlier, the author talks about how it took her attending 15 years to pay off his debt.  Do I really want to be paying off my own student debt into my 50's, while trying to save or pay for my own kids' educations?

I recently took a health policy class that has opened my eyes to many of these issues.  Ladies, and you brave gents who read this blog, let's all get educated on these issues.  Big changes are coming for American physicians, and we need to have a voice.