Fall is around the corner! After a hotter than average summer, I am ready for cooler, brisker temperatures. I think my favorite season, in retrospect, is fall. New beginning for school year kids. Time for new wardrobes and school supplies. Better weather for my hobby of running (cooler weather will be MUCH appreciated after the hotness I’ve been getting used to for the past couple of months). And most crucially for me… it is the return of the pumpkin spice flavor in all of my favorite treats!
I’m currently enjoying my pumpkin spice coffee. Delicious. Makes me think of fall leaves, cooler temperatures, wearing my light jacket on a brisk walk. Recollections of Halloween and dressing the kids up in costumes. Fall races. Hay rides. The cusp of the holidays, with Thanksgiving around the corner. Time to be with family and friends, and give thanks for another year almost completed.
So please excuse me as I finish up my cup of delicious fall memories. And if you like pumpkin spice, you are in luck! The store shelves are getting stocked with this classic fall flavor, and you will be in heaven on your next shopping trip!
We all have bad days, be it at work, at home, or in our extracurriculars. There are things we would rather not do. Sometimes I find my inner voice telling myself “I have to work.” When I get a bit down and out about this and “woe is me”, it helps me to force myself to repeat the statement and replace “have to” with “get to.” It’s totally true, I get to work. This is not a guarantee in life. No one is forcing me to do X or Y or Z in 99% of the cases in my life. A lot of my actions are a choice. And shifting my mind to think of things that way is totally eye opening and gives me more optimism.
Beyond simply repeating “I have to” statements with a counterpoint of “I get to,” I am starting to strive to then tell myself “I want to” to this, and as the going gets good and I am hopefully hitting a flow state, I realize that happily, “I love to” do this thing that initially I felt obligated and forced to do.
For example, if I have a tough run workout on the docket for the afternoon, and I am not really feeling it, be it from fatigue, heat, or worry about other things on my to-do list, I force myself to go through this mental sequence of restating the task I am going to do that day, going from “I have to do this tough run” to “I get to do this tough run”. Several months ago, I was injured, and I wasn’t able to run, and I remind myself how unhappy those times were. And now, I GET TO do this thing before me. As I step onto the road and start moving my body, I remind myself “I want to do this tough run” to give my mind and body a meditative break from my tough work day, to give myself an hour of time to myself to just be me, to get stronger and more able to tackle my upcoming planned marathon in 2 months, and to just be a healthier and happier version fo me. And, as the run sets in, and I hit my groove, I remind myself as the endorphins and runner’s high kicks in, that “I love to do this tough run” and this run is giving me great exercise, a way to enjoy the outdoors, and a way to get stronger and healthier.
Sure, all things in life are loaded with good qualities and bad. There are some great things to a job, for example, and yet there are several things we “have to do” that we would rather weren’t there, be it replying to mundane emails, filling out self evaluations or peer evaluations, attending a meeting, etc. However, I think shifting my mindset to a bigger picture and realizing how blessed I am to have this job, I realize that nothing in life is guaranteed. And it isn’t so much “I have to do this” but I am blessed and honored to do this. Having a tough day? Try reminding yourself that you are fortunate and breathing and alive, and that you get to take on this challenge called life. There are struggles and hardship in life, and there is a lot in life that we wish was better. However, we have freedom and autonomy as well. The job and career I have chosen was chosen by my own freewill. I get to do medicine each day, I get to be a wife and mother and I am blessed to have a strong, supportive family in my life. I get to enjoy the passions and fun things in life, be it cooking, eating, reading, running, or playing with my kids. Reminding myself when I am pessimistic that I get to do things in this life has helped me reframe my negative “have to” thoughts, and led me to be more thankful and mindful of all the things that I get to do, and want to do, and love to do.
I’ve begun reading the book, The Artist’s Way, by Julia Cameron. I’m just beginning, but I am planning to try some of the exercises the author proposes. One is called “Morning pages” where you simply freehand on 3 pages each morning. It can be anything and everything. I believe the author describes this as a “brain dump” and I can see why this is so appealing, particularly in our over stimulated digital society.
There is so much going on in our busy lives. So many things vying for our attention. I like this idea of getting all the thoughts strolling through our brains onto paper. The author proposes this removes some of the barriers we have to unleashing our creativity.
In my career as a physician, I see creativity is vital. Sure, medicine is dealing with the sciences. But crafting a plan for a patient is truly creative and personal. There is an art to gathering the story the patient is bringing before me into a coherent whole, giving them a story, a diagnosis, and a treatment plan. Sometimes, this goes smoothly and easily. Other times, it is surely a challenge. But I see that having my synaptic neurons firing on all cylinders often leads to better mental connections and a better day as a caregiver to my patients. And I hope removing some of these barriers and extraneous thoughts in my head each morning via “Morning Pages” will help me perform better.
In the first week of the 12 week course (where I am now), the author describes creating an environment of safety. As I strive to recreate this for myself, I hope I am also creating this environment for my children. It is so easy to simply tell children, “This is the way life is” or “Don’t do things that way, do them my way.” But, is this in a way extinguishing their creative spirit? Sure, it is good to be practical. But life with art and creativity is certainly more interesting. And as I described in my career, creativity in my life brings me better results in my interactions with my patients, and gives me greater joy and satisfaction.
The Artist’s Way course is 12 weeks total. A long commitment, surely. I am on week 1 now, quite some time still to go. I’ll plan to post an update later with any challenges or lessons I’ve learned along the way. So far, though, I find the book interesting and I’ll be interested to see how things go. I’ll let you know final thoughts once my 12 week journey has come to an end.
Student loan debt has been weighing on my financial mind for over the past decade, since the first day of medical school. It is hard to believe it has been 12 years since I started medical school and my debt balance began accruing. The largeness of my student loans has (fortunately) dwindled to a degree through hard work, discipline, and continued extra payments to them. But believe me: I will be incredibly elated when this debt monster is finally slayed. As things stand right now with my calculations and estimates, this should be in a little more than a year (October 2020 to be exact… I will need to celebrate grandly when that date hits).
Currently I am at around a 55k balance on my loans. It is hard to believe my debt balance was sitting over 200k at one point years ago. The “magic” of compound interest can really work against you when you borrow money and are working hard to payoff debt. And of course, on the flip side, its magic works wonders on your investments and retirement savings accounts, particularly if you take on the risk and invest in the stock market.
Will this battle with my student loan “debt monster” make me more risk averse in taking on new debt in the future? I am sure it will. I am already conservative with credit, and payoff my credit card bills monthly, live reasonably frugally, and try to spend mindfully. (This of course is getting better as I am getting older, and live and learn through past “silly purchases” here or there that never get used.) Also, as I get older, I am seeing that relationships, experiences, memories, time, and energy are incredibly more valuable than stuff and money. I suspect we all need to learn this lesson with time and trial and error in life.
If I could do things over again, would I do things differently? Most definitely. (Hindsight is always 20/20, right?) One key thing I would do differently is borrow the absolute minimum I could, continue to live as frugally as I could on borrowed money, and strive for side hustles while in medical school and residency. One other key thing I would do differently is analyze more job options after residency to maximize loan payoff packages and higher salary in a different location of living. I chose to stay in the Pittsburgh area where I am from, as this is comfortable, and my family is here, and I wanted to have family close by as I raised my family. I sacrificed a higher salary doing this, and was not offered any student loan help due to my priority of staying near home. But even a short 3-5 year hiatus in a different area with a greater need for medical care (and thus higher salary) would have helped me crush my debt, I think, a lot sooner. It would have been a sacrifice, but I think in the long run, this could have been well worth it.
Also, I think this student loan journey I have taken will change the way I view things as my children grow older and I offer them parenting advice as they advance through high school and future career options. Is an expensive school really worth it? Is the name of a school on a diploma really that valuable? I am learning that the school name on a degree and the fancy letters after my name don’t matter as much as I thought it would when I was a young adult. I hope I can impart some of my financial wisdom to my children as they chose their life paths. There may be a less expensive option that gives just as much joy, fulfillment, and happiness in life. And in the long run, avoiding debt will avoid the stress and heartache that come with being in the “red.” And more importantly, avoiding debt will get you started on building wealth a lot sooner, giving you the freedom to use your time and money on things truly bring you happiness and fulfillment.
Please see my testimonial in the ACMS July Bulletin about redefining identity to overcome burnout! I think burnout hits a lot of us throughout our busy lives, particularly those in the caring professions. It is very easy to lose sight of what matters I think, and taking a step back to redefine yourself and what means the most to you is a very powerful way to combat burnout.
“What do you do?” This is often the question used to spark a conversation in a new acquaintance, to get to know who they are. But aren’t you more than what you do for a job? And isn’t it more interesting to know what a person is passionate about, not necessarily what they spend their 9 to 5 doing? I think this common question highlights the fact that our identities often are interwoven into our job titles. But is this really healthy? Is it truly the whole story of who we are? And, more importantly, in our example as physicians, do our patients really want us to simply be a doctor? It is more interesting and more reassuring, I think, to know that the clinician in front of you is more than a man or woman in a white coat. He or she is a fellow human being, faced with varied challenges, passions and heartaches in life. The physician in front of you is human and truly “gets” you and what you are going through in this journey called life. If the physician in front of you did not really relate to you and your life struggles, how could you trust the advice they give?
One powerful tool that I have started using in my life has been to redefine my identity in the last several years. I am learning to define myself as more than simply a family physician. For example, I want to be strong, hardworking, caring and compassionate. And taking this journey of redefining myself has personally helped me to combat a foe that many physicians, I believe, know all too well: burnout. I think the reason so many clinicians face burnout is tied to our tendency to wrap our self-identities so tightly into “what we do” rather than who we truly are.
I believe physician burnout also stems from the fact that physicians work in a profession with such high and unforgiving stakes. We must make decisions that impact the health and sometimes survival of our patients, who look to us for guidance and support. An incorrect decision could be detrimental.
Many of us in the caring profession of being a doctor also are naturally prone to be “Type A.” It is hard to turn that “need for perfection” button off, even when we try. How many weekends or vacations have you spent worrying about a patient or decision? Or how many of you (gasp) are guilty of opening your computer or email client on your phone to work when you are supposed to be “off?” Are you ever truly off in such a demanding profession?
I recently read a children’s book with my children, “Little Miss Busy,” by Roger Hargreaves, that I think humorously paints a picture of a hardworking person. Miss Busy awakens at 3 a.m. each morning, and works tirelessly to clean her house, twice, before going to bed at midnight each evening. That is, until she unfortunately becomes ill. She is faced with advice from several friends. The advice ultimately boils down to the fact she needs to relax. How many of you out there have struggled with the skill of relaxing? I certainly have.
My own journey toward self-improvement has taken place over the last few years, as I have combated burnout. This journey has led me to embrace my outside interests with greater fervor. I am more than my job, and it is crucial that I make my outside interests a priority. This includes how I value my relationships, particularly with my family, and my hobbies. This is still a work in progress, but I am learning to reshape my identity and feelings of self-worth away from work, and instead have focused on how I can be a better version of me.
I think one powerful way to combat physician burnout is learning how to see yourself as more than a physician. Life is rich, varied and surprising. Sure, life is full of a lot of pain and disease (physicians can certainly attest to that). But there also is tremendous beauty as well, even in the hard things. Often, I find I am too focused on the wrong parts of life to see that – the daily task list in front of me, the eight-hour shift that I need to complete today, the huge pile of laundry I must complete, a workout for the day that I want to cross off of my training plan.
It is nice to see what you have done, and to get recognized for it, be it a medal, a certificate, or a diploma. But in the grand scheme of things, do these really matter? Instead, I have strived to shift my focus to building aspects of myself that I want (to be a supportive wife, to be a caring mother, to be strong, to be patient, to be kind). With this shift in focus, I feel I am able to steel myself against the aspects of physician burnout that can be so unhealthy – busy and long hours, a need for perfection, and not taking time to relax. I hope that any of you out there struggling with physician burnout can take something from my story that may help you, too. Redefining myself as more than a physician is an ongoing process, but one that I believe will lead to a healthier, happier and more complete me.
I think Independence Day naturally makes me think of the gifts I have. Sometimes, we can take the gift of independence and freedom for granted. But when this is threatened -e .g. our time or our resources or our health are taken from us, we start to realize the blessings we truly have.
Something I’ve strived for more and more is protecting my gift of time. When I have control and autonomy over my schedule, I feel so much more free. Of course, you cannot control everything in life. There are things I wish I had more control over, always. But at least having some semblance of control of more of my day brings me more joy and happiness. One way I have done that in the last year is changing jobs.
I am truly grateful for my new opportunity to practice telemedicine. This gives me an interesting new way to develop care to patients. And as an incredible bonus, I am able to work from home. This has freed up a bunch of my energy and time, and mental bandwidth, as it has eliminated a need for a commute.
My new job has also given me more autonomy in setting my schedule so I can juggle my other responsibilities as wife and mom, and so I can take care of me via my hobbies and self care. In turn, I think this has given me a greater sense of that elusive concept pf “Work Life Balance.” I think it is impossible to do multiple things all perfectly, but I think you learn to maximize as much as you can, to get all of your buckets “good enough” so you are happy and functioning.
As I reflect on Independence Day this weekend, I will work on keeping gratitude at the top of my mind. There are so many things we have to be thankful for in the United States. Sure, there are things that could be better – life is never perfect. But I feel we have come very far in the last couple of decades. And in the last 30-40 years, technology has brought many gifts to our society and to our nation. Would you have believed many of us would be carrying a smart phone around, with the power not only to call each other, but also to check the Internet, which contains such a huge wealth of knowledge it is difficult to fathom?
Again, Happy 4th of July and happy Independence weekend. I hope you too can find things to be grateful for. As the next few days go by, I would hope you find some time to reflect on our country’s gift of independence, and the great things our nation has to offer.
“I like playing. I like chores more. And I love my family the best.” Wow – the wisdom in those words really resounded within me.
At bedtime a few weeks ago, my daughter told me something very insightful. I forget how we got on the topic, but she explained to me, so succinctly but so beautifully: “I like playing. I like chores more. And I love my family the best.” Wow – the wisdom in those words really resounded within me.
My daughter’s life priorities: 3) Play. Indeed, play IS important. It is how kids learn about their world and their own abilities. It is often how I rest, rejuvenate, and get inspiration. 2) Work. She is still stepping into some roles around the house of chores. She is very eager to help and celebrate the fruits of her labor. And I see how proud she is also of the work she does each day during her school day. 1) Family and relationships. Without these connections and the people in our lives, I too would find life a bit less meaningful. Having the relationships I have with my husband, kids, and extended family adds richness and happiness to my life. There are of course times when those people I love drive me a little crazy. Is there really always a need for my two children to take out every single toy and then play with just one as the mess/clutter/post-tornado look surrounds my children? But I think my daughter has learned at a young age to see priorities.
Ranking things in life and recognizing their importance is crucial. It allows me personally to take a step back and see what I truly value. Like my daughter, I agree with the ranking she set forth: Relationships and Family, Work, and Play. As my life evolves, and as I and my family age, these rankings may change. But I think by taking a “big picture” view of life helps me attack each moment and each day with more vigor and meaning. How easy it is to get fixated on the mundane of life. The “to do” list checkboxes that feel good to cross off the list, but really, does it add to the things I value? Is it really that important to get my email box to zero each day? Or is it a little more important to spend 20 minutes with my daughter one on one, playing a board game, or playing outside and enjoying the sunshine together.
I think one thing that is hard but very insightful is to think how you want to be remembered in life. I believe I gained this idea after listening to Chip Gaines’ audiobook, Capital Gaines. He posed the idea of writing your own epithet or message on your tombstone. I think this really helped me to see my actions and how they could be viewed in the long term view of my life, as viewed through the eyes of my family and those around me. It is a helpful and eye opening exercise, one that I find difficult but insightful.
I want to be remembered as a caring mother and wife, a caring and competent clinician, and someone who knows how to enjoy life. I am still trying to figure out how to balance it all. Life is always so full of challenges and can get sometimes insanely busy. And I am still trying to figure out the right ratios of all of these things in my life to keep it balanced. But I am really impressed that my daughter, too, has a basic idea of what she values, and that her priorities mirror my own. I hope to keep my daughter’s example in mind as I live each day to its fullest. I also hope that I am able to keep this insightful perspective on what truly matters in life, and that my actions and choices each day reflect what I truly value.
And with that return to work, I gained a new burden that I struggle with now and probably for the rest of my days going forward, one that is shared I think by all moms out there: mom guilt. I think regardless of our choices after a birth of a child, moms have guilt no matter what path they choose, be it returning to work, working part time, or taking time off of work to pursue raising a family full time. With all of these choices, I think we moms feel a pang of guilt that we are not doing enough to fulfill all of our expected roles.
5 years ago, at the birth of my daughter, I gained a great gift: motherhood. With that, I learned all kinds of new challenges, not the least of which is having responsibility over another small human being. After a few short weeks of maternity leave, however, it was time to return to work. And with that return to work, I gained a new burden that I struggle with now and probably for the rest of my days going forward, one that is shared I think by all moms out there: mom guilt. I think regardless of our choices after a birth of a child, moms have guilt no matter what path they choose, be it returning to work, working part time, or taking time off of work to pursue raising a family full time. With all of these choices, I think we moms feel a pang of guilt that we are not doing enough to fulfill all of our expected roles.
Our society has changed, indeed, in the last several decades, with many women working outside of the home out of necessity at first, and now as a sense of a way to build an identity of our own. And in addition to this, the emotional needs, organizational needs, and household chore needs of a family unit still often fall to the mother. Getting the doctor’s appointments and dentist’s appointments scheduled, getting the kids to said appointments, keeping practices and activities straight on the calendar, paying bills to the school and activities, keeping the house in some semblance of clean, working order, and don’t forget the never ending mountains of laundry that accumulate each week. I think with this shift, however, moms, and in particular working moms, are not really cut enough slack. Being a mom is a “full time responsibility.” Being a working woman is a “full time responsibility.” And taking care of ourselves is a very time consuming responsibility in and of itself, one that often takes a back seat in our lives. There are only so many hours in a day, and we only have so much energy to expend each day. The quality of our work in each of these arenas sometimes suffers. Or at the least, if we do manage to fulfill our responsibilities to some semblance of acceptableness in our minds, we fail to take care of ourselves. And we get a pang of that dreaded guilt.
I think we all have limits. I am starting to gain awareness of my own limits – my emotions and my energy levels, and how these play into my ability to fulfill my work responsibilities and “mom” responsibilities. Guilt, I think, is sometimes not very helpful in this equation. (And of course, there is the whole idea of income divide in between men and women, a whole other challenge and topic of debate.) I am not able to be in two places at once, though sometimes I wish I could be. But that desire to “do it all” sometimes leads to an uneasy feeling in the pit of my stomach that I am not enough. Is this correct? Is this healthy? I am seeing that resoundingly the answer often is no: it is not a very helpful or healthy emotion. I am doing the best I can as a working woman, and as a mom and wife. I am starting to cut myself some “slack” so to speak, and take time for myself. I did this in the last few years by taking up running, and in the last couple of years with taking up writing in this blog. I think my children see this time I take for myself and I hope that they see that it is okay to take care of yourself. By doing so, I then have more emotional reserve and patience in the tank to focus on my family and my patients. And as any mother of young children knows, patience is always needed to deal with all of the little challenges the little ones can throw at you.
So my humble request today to all working moms out there: take care of yourself, so you can be the best version of you, for your families and for your workplace, and most importantly, for you and your own wellbeing. And in taking care of yourself intentionally and regularly, you are setting an important example for your family members and coworkers that can be inspiring to them to start taking better care of themselves. I am getting better at naming the emotion of guilt I feel, and more importantly, with practice, I am trying my best to let it go. This guilt often does not serve me positively or productively. Instead, mom guilt often raises feelings of self doubt and self criticism. I am practicing seeing the emotion of guilt, seeing if it helps me (often which it does not), and then letting it leave me as soon as I can, so I can move on to the next thing I need to do. I hope all moms out there can take on the task of learning to let go of that nagging guilt. Just like the rain of spring showers peppering my area now: Guilt, guilt, please do go away, and I’d rather you NOT come back another day. But, I if you are (inevitably) back another day, I vow to NOT let you stay.
I think it is easy to get fixated on the final end goal. However, I think I have learned in my running training, and in life in general, that it is so motivating to break down a big goal into smaller mini-goals. For example, with running, when I am feeling exhausted and over a tough hill, I push myself to a small goal in front of me, for example a mailbox, or a crack in the side walk. That way, instead of being overwhelmed with how much farther the top of the hill is, I am able to make it to the next goal post. And then, once a reach that, I feel motivated and move on to the next goal post. This has helped me during my training runs and on my race days.
My student loan payoff is a huge goal in my life. It is taking many years but as I get closer to the finish line, I am feeling more motivation. The huge balance at graduation was daunting and depressing. But I am now below the 75K mark! I am at the 71K to be exact. My next mini goal I will celebrate will be when I get below the 50K mark. This has been a long time goal, now at 8 years out from graduating from medical school, and just under 5 years from graduating from residency. But the end is in sight. I think again setting these short mini goals is helping keep me motivated.
I am trying to teach this idea of breaking down a big goal to smaller goals to my daughter. I told her about my mailbox method the other day when I took her for a mini run with me. I also try to teach her to celebrate small wins along her journey, when she is demotivated by how long something is taking to accomplish. It is easy to look forward all the time. But I see value in enjoying the present, living in the moment. It is also valuable to learn from the past – looking back on the past is a good exercise, teaching me to evaluate the progress I have made.
Money is a loaded topic. It carries a lot of emotional baggage for many. It is useful, but can also be destructive if utilized in harmful ways. It can be kept, spent, or given away. There are so many choices with what to do with it. I think one thing that has shifted within me in terms of my mindset on money is thinking of money as a tool to get what I want from life. Instead of seeing it as a roadblock, or as something to accumulate and collect, I see it now as something to earn, use, and trade for things I truly value.
Something that has helped me is learning to spend my money on what brings me utility and enjoyment in life. I am starting to more systemically strategize my own financial plan. Before, I would have a nebulous, and often frustrating goal of earn more, save more, spend less. Now, I am breaking this down and making it more concrete via online calculators and the old nerdy standby of Excel spreadsheets.
Seeing things laid out before me in my financial plan has helped me shift how I see my weekly and monthly expenditures. I am eager to create some breathing room between my necessary expenses and what I have accumulated in the bank. I get satisfaction from my job, but at the same point, I do not want to be forced into a working position where I have to work to pay the bills. I think this shift in mindset has helped me start to spend my money more meaningfully, and use money again as a tool to reach my life goals and my financial goals.
The book, Your Money or Your Life, by Vicki Robin and Joe Dominguez, highlights this in the idea of analyzing what you have spent. After you tally what you are spending in each category in your life (e.g. housing, groceries, restaurants, hobbies), you can then analyze each spending category by giving it a grade – whether it is right where you think it should be, whether you should be spending more in that category, or whether you should be spending less. I found this idea really helped me start to spend my money strategically, and feel less guilt in spending on what I think is important to me.
I hope to also teach good money habits to my children, via how I spend my own money and how I speak about money. As my children get older, I hope to show my children how money and wealth are a tool to be used, and also how this fits into the bigger picture of the economy of our neighborhood, our city, our nation, and our world. The book Silver Spoon Kids, by Eileen Gallo and Jon Gallo, had a very interesting chapter in it describing how a huge chunk of the nation’s wealth is concentrated in a very small percentage of the country. It offers the idea to do an exercise with your children dividing up 10 cookies among your children, to illustrate the distribution of wealth in the country. As described below in terms of the breakdown in wealth, what happens is one child gets several cookies, another few children get also a fair distribution of the cookies, and the majority of children are forced to break up and share a tiny portion of one cookie. This is astounding, heartbreaking, and eye opening. This book was published in 2000, so I suspect the statistics on the distribution of wealth in the United States have probably gotten even more lopsided.
But according to Silver Spoon Kids, around the time the book was published (2000), 40% of the wealth is in the upper 1% of the population, 30% of the wealth is owned by 2-10 percentiles, 29.8% is owned by the 11-60 percentiles. And the bottom 40 percentile of the population owned only 0.2% of the nation’s wealth. This is crazy to think about. And I am sure this trend may continue. I think that part of the book really gave me pause and think very differently about money, wealth, and how it is utilized as a society and an economy.
Money is valuable, but I see that it is simply a tool in life. As described in the book Your Money or Your Life, you are trading some of your time or life energy for your paycheck. You can then use this money from your paycheck to go to the stores and get other things you want in life (e.g. groceries, a roof over your head, a new set of headphones, a tank of gas). By using it more deliberately and carefully, I hope to be trading my time during my work for something I truly want. This is a work in progress, of course, but I hope to continue to get better at spending my money wisely. And I also hope that by leading by example, I can teach my children how to use money wisely, too.