By the way…

Oh. I forgot to tell you: I passed! It seems like old news now, especially with studying for the clinical well under way.

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Recovering

It only ever seems to be in retrospect that I can appreciate the load I was carrying. We’re just back from a short holiday – achieving the magical, feeling like we’ve been away forever, when it really was just over a week.  And I now see and feel the stress of the year that was.

Individually, none of this stuff is easy. Being a medical registrar, at the best of times. Studying for exams between on-calls, night-shifts, stupid rosters, etc. Returning to work from maternity leave with a child less than one. Breastfeeding, while working. A long, relentless succession of childcare illnesses – a febrile, miserable child, crying through the night; fretting parents; asking yourself – at what point do we seek medical attention? Estranging yourself from family.

But together… It adds up to a kind of self-neglect. where you forget yourself. You can deny so much – no ache, no pain, no need, no loneliness. You do what you must, because you must.

So now I’ve come to the end of that, for now. And because I’m old, everything about me aches. A year of not caring for myself is actually painful, to the point walking isn’t easy.

I went to the physiotherapist, and she took photos of me from various angles to show me my posture. Hunched over, turtle necked. Perhaps the antecedent form of a kyphotic old woman, sometime in the future, several centimetres shorter, unsteady on her feet.

We don’t have any full length mirrors in our house, and I was surprised to see the shape of me. This wasn’t the self of my mind’s eye, but it reflected how I feel. Weak, stiff, sore.

Change is beginning by trying my best to stand up straighter. Head up, shoulders back. And god, it feels weird. I feel like I’m falling backwards. I feel I must look ridiculous. And I ask my husband “do I look funny? Is my walk python-esque?” And he doesn’t know what I mean. But when I’m walking upstairs, I hold onto the rail because I feel I could fall backward.

How did this happen just over the course of just a year?

So this is my recovery. This week I find out the exam results. Whatever the outcome, there’s hard work ahead. And somehow, I have to work hard in a different way. I have to take care of myself. Right now I’m having trouble carrying my 13kg toddler. My body feels cumbersome trying to run after him. We talk about having another child, but I fear that stress on my body. I’ve never felt that I was getting older, but all of a sudden it’s hit me.

Where and how to get started is still a work in progress. Being part-time this year helps. We’ll see.

 

 

 

Homestretch

Just over a week out from The Exam.

Sort of feeling quite calm about everything now. The situation is as it is. There is no ‘ideal’ when managing life with a toddler and two full time jobs. I can only do what I can, and I have done that much.

Husband has hand, foot and mouth, which is the worst*. My little boy had a diarrhoeal illness about a week ago, which I think might be the source of HFM (HFM is usually caused by an enterovirus). So life’s been fun these last 10 days, but isn’t that just the new normal?

Fortunately, I’ve started work part-time this week. The promise of greater balance is really exciting, but I think it will take some time to get into the groove and understand how to best manage this different work arrangement. But till then, I am grateful I have this extra time to study.

Not long now.

*I have seen my husband cry for the 2nd time in ten years this last week – crying at the thought that our little boy had also experienced the pain he’s now suffering. On the plus side, looking inside his mouth, my mind went straight to toward the haematological malignancy end of the diagnostic spectrum. And this is why you should not ask your hospital doctor spouse for her medical opinion, and instead seek the trusted and sane advice of your GP (common things occur commonly, afterall).

Th obstacles in my way

Family is a group of disputed memories between a group of people over a lifetime.

Lemn Sissay

5 and a bit weeks out from the exam. It’s been a difficult time.

My rapist was admitted to my team last week.

I have been reported to my regulatory body following a patient complaint.

My family.

It feels like a joke, this sequence of events. The improbable.

And perhaps what keeps me up at night, is still my family.

I’m frequently given instruction by phone, text, whatsapp, email to “let it go”. They want me to let go of something that “happened 20 years ago”, but won’t clarify what that is. I say that my concern is the way we communicate now: how we listen and understand each other (or not). When I’ve shared my experience, I’m told that’s evidence of my mental illness (“Your’e mental”). The language I use shows I’m up myself, think I’m better than everyone else. They’re my “100% supporters”, but say they wouldn’t visit me because I’m “mental”, I’m difficult.

I imagine what it would be like to share with them some of the challenges I’m experiencing at the moment. Life with toddler. Managing two full time jobs around childcare logistics, illnesses, interrupted sleep. Preparing for a high stakes, expensive exam. Working my job plus rostered overtime, un-rostered overtime. A formal complaint. My rapist.

I anticipate the judgement. There’s no way I could. If I told them any of that, it would be held against me. My mum says I shouldn’t a be a doctor. I’m “mental”.

I don’t know why these people matter to me. While they tell me they’re “SO proud” of me, I feel they hate me. They way I speak. The words I use. That I want to talk things through, be heard and understood. That I feel hurt when I am dismissed, when my memories, thought and feelings are denied. That my efforts to connect, to find common ground can only ever succeed if we’re all blind drunk,.

I tell myself, I tell my husband: I am loveable. I am likeable. I AM a worthwhile person.

Slow lane

[Disclaimer: The following post was written by a very sleep deprived person.]

So, I’ve decided to go part-time. And that decision is on the verge of materialising into a part-time job. I’ve said ‘yes’, now just waiting to see it all in writing. This is happening.

Part-time. Being a mother. These are kind of controversial things in the hospital, I feel. When you mention to your consultant that you’ve just returned to work from maternity leave, you might observe their sharp inhale of breath. Because really, you just told them that you’re unreliable, a little bit demanding, definitely difficult.

Which is probably true.

I’ve taken more sick days this year than any other. Ever.

I have needed family meetings and MDTs to be scheduled around the times I needed to express milk.

I try my very best to leave on time.

I am permanently exhausted. I have word finding difficulties, and my memory is shot.

When I’m doing a double shift, it’s not hard to make me cry. It will be more than 24 hours till I see my little boy, and my heart is broken.

I never volunteer now to take other people’s shifts, stay back, or cover an absence unless it’s absolutely necessary. Sometimes even then, I still can’t say yes.

This little human, entrusted to my care, has non-negotiable needs (and I have legal responsibilities as his guardian). And besides, I love him.

The outcome of all this is a heavy burden of guilt. I’m a shit mother, a shit doctor, a shit wife. A barely functional human. (I write this, of course, after 3 hours sleep and 24 hours of gastro*).

Even when we’re all healthy and well, or at least mostly so, just the logistical challenge of toddler and two full time jobs is exhausting. Together with study, nothing I can do is enough. I feel like a failure.

Last night I dreamt about sitting the exam. I opened the paper and the words were a jumble. I spent my time drawing a picture of a person, until I ran out of time. I woke up in a panic. I’d only been asleep 45 minutes or so. The longest stretch of sleep I got last night – and I wasted it, stressing about an exam.

Someone posted a schedule of their morning on Facebook. It included exercise and a 9am start. My work roster is fairly kind at the moment. 10 hour days, Monday to Friday, no weekends. But a long commute out of the city. To my husband’s annoyance, I wake up our son early so I can spend 15 minutes with him before I leave. I get home to say good night. I cry in the car, often.

I’m getting fat. And it’s hard to sleep, even when I have the chance. I hate driving. I don’t have time to clear my thoughts after work, when my time is spent in the car. I come home to guilt.

I feel so sad to have missed my little boy. I think of the first 1000 days, and what harm I might be wielding. I worry that he’s not yet walking, that he doesn’t sleep through yet, that he’s due for his vaccinations, that I can’t get him to brush his teeth.

I feel guilty that my husband shoulders most of the domestic responsibilities at the moment.

I dread the nights, knowing scarce sleep awaits me. I hear my little boy crying, even when he’s not – my mind always vigilant to his needs.

I stress that I should be studying, I should be exercising. I should let my husband know how much I love him, how I appreciate everything he does. I should be there for my little boy more. I should be anything or anyone but what and who I am.

So, I’m going part-time. It seems like the only option.

I canvassed this idea a few months ago with colleagues I respected. Someone told me that would be a waste of resources, catering to my needs. He told me there is no such thing as a part-time doctor. I rolled my eyes, while quietly adding it to my list of things to feel guilty about. Other people responded with incredulity. Why would I do that? Get it over and done with. Push forward. Get past this. Which makes sense – except I can’t.

Even now as I type this, I feel so useless. I have one small child. The most delightful, lovely 18 month old little boy. He is healthy and normal and affectionate. And even with this good fortune, I struggle.  This much: job, family, study, THIS is too much for me. I don’t want to live like this. I can’t push through this, because my little boy is only a little boy once,  and I can’t ask him to wait a year or two for me to be his mother. I want to be there for him now. But I can’t study, parent, doctor and live all at the same time. I’m just not that good at any of those things.

Other women: stronger, better women, do more, achieve more, are more. But me, I’m going part-time.

*Childcare. In case you don’t know: childcare is an incubator of infectious diseases. Enjoy!

Special consideration

I’ve lost my study mojo. Somehow I’ve managed to wrangle a week’s study leave, and I hoped I’d reignite the fire. Alas, I’ve spent the last few days being vomited on by a toddler. Of course, that was always going to happen.

I’m hoping this is the chaos I’ll just become used to. It will become my normal. I remember when I first moved out of home, I felt this sense of injustice that I had to work, cook, clean, care for myself, have a social life AND go to university. I even developed a chip on my shoulder of sorts, comparing myself to wealthier peers who enjoyed all the perks of the home life, an allowance that afforded a better social life and cooler clothes than me AND time to study. How unfair!

Almost twenty years on (gah!), working, cooking, cleaning, and caring for myself don’t even make up the bare minimum. And I’d be embarrassed of myself if I thought being an adult was worthy of any special praise. But I guess my point is that at sometime between 18 and now, this just became normal. So maybe at some point the chaos and disruption of child just becomes something you take in your stride? You stop feeling guilty, inadequate, the imposter, the failure. This is just life.

Meanwhile, let’s study.

 

Stranger

So here we are. I’ve chosen to estrange myself from my family; the nuclear family, I’m no longer orbit to. I thought I might feel relief. Right now, I feel guilt and shame and self-doubt.

I won’t re-tell the circumstances that led up to it, because really this has been happening over a time that spans years, decades even. There’s no one particular event. It’s just me.

For all my words, I can’t explain this.

What I really want is to be able to say how I feel, and not be told that my feelings are wrong or untrue.

I want to share my experience or perspective with people who say they love me, and not be told that that never happened, that I’m mistaken.

Challenge me, yes. But don’t deny me – my memory, my feelings.

A few weeks ago, my brother showed my parents a series of messages I’d sent to him where I’d whinged about my parents. They had a discussion about me, and my brother came up with ‘a plan’ for me to make things right. He told me what was wrong with me, told me how things were. And this was all I had to do. Simple as that.

I’ve explained the challenges of doctoring and mothering, the constraints of time zones and geography that means making them my priority is almost impossible. You get home , we’re all tired and sleep deprived. There’s a toddler to be fed and nappies and pyjamas and bedtimes and crying and cuddling and soothing. And my husband and I, we’ve not yet sat down. We’ve not eaten our dinner. I’ve got study to do and things to get ready for the day ahead. Shower. Sleep. Something like that.

Making a call to people who don’t hear what I have to say, who don’t like me – but want something from me, I can’t give – this is not my priority. But they’re all asleep by then anyway. If I ever had that time, it wouldn’t be the right time,

But of course, they’re all excuses. I don’t want to speak to them.

My brother told me I am immature and selfish, amongst other things. It’s really hard to tell if he’s right or wrong. Who can be objective in this scenario? And if I am wrong, if I am unreasonable, immature and selfish, how does that help make things better? If tomorrow I received official documentation from some great authority that certifies my experience and feelings as untrue and invalid, and my behaviour selfish and immature, what could I do with that information?

I feel like there’s some vital core to my being under question.

This probably all sounds stupid and melodramatic. But this is where I am at.

 

Re-framing

I really hate my job right now, but I know I don’t hate medicine – all together, all the time – or forever. It’s a temporary state of affairs. A bad rotation. A punishing roster. Winter time. A congested ED. Everyone at the end of their tethers. Things will get better.

And I am making sure of it.

Did I already tell you: I’m re-thinking my job. Revising this path I am on. Not escaping the hospital, but setting some boundaries in this not always healthy relationship with work.

This is something that’s difficult to explain to ‘outside’ people: this complex relationship of the hospital versus you. The love is for those opportunities to engage your mind, your training (and sometimes your heart), in complex, life changing problems or crises in a symphony of teamwork and small miracles of modern medicine to treat, to help, to find solutions. Sometimes the job is deeply rewarding, invigorating, exciting. Sometimes.

But most often, it’s about processes, protocols and bed management. At least, that’s how it feels to me at the moment. Territorial disputes, big egos and internal politics, add in shift work fatigue, and battle hardened nurses who eat med regs for breakfast. And stir.

I’m not doing this anymore. I’m not playing this game. I’m not sacrificing my family or myself to be chewed up by this beast. It’s not worth it. What’s awaiting me at the end of my training? Un- or at best under-employment? Debt accumulated for the want of CV-padding? What?

It’s not that I am giving up all together. I’m not. I am just doing things differently. And with this decision, I already feel better. I have a plan. I have made the decision. Things will change. Things will be better. And it feels good. It feels like such a relief.  I can get through this bit, knowing this isn’t forever.

 

A plan

A few weeks ago, I barely kept someone alive overnight. I was only required to defer the inevitable for long enough to make death another team’s problem. But for the time being it was mine. At around 3am, the patient had arrived into my care. Family had already gone home – discussions with them about what was unfolding had taken place without me. Not for ICU. Not for CPR. But still for one thing – that would have to wait till morning. A consultant had proposed a plan, and according to the handover, this was what the family wanted.

I wasn’t winning. And at 6am, I called the boss who would be performing that one thing. I described what was happening, and said I needed a different plan. If something was going to be done, now might be the time…

“He’s first on the list”.

“Okay, but…”

“He’s first on the list”.

It was a horrible conversation where the consultant berated me for not knowing “my patient” well enough. He referred me to decisions documented in outpatient letters and the results of investigations that he assured me MUST have been done in the past*. What had I been doing with this patient for the last three hours?

I defended myself, for what it’s worth. I’d been focussed on the immediate task at hand – keeping this person alive, not to mention managing the many other patients under my care.

I wanted to tell him that being “first on the list” wasn’t an adequate plan for this patient. I didn’t have the guts.

But I did tellhim I’d contacted the family and asked them to come in. He was furious.

As handover was approaching I contacted anaesthetics . A Fellow arrived on the ward, and over-hearing me on the phone, interrupted to say ‘don’t bother’.

‘Really?’  I put down the pone. I was relieved. ‘I think that’s for the best’. I told him it had been difficult to manage this patient over the last few hours; I was surprised we made it this far. I said I had asked for the family to come in.

He looked irritated.

‘You know you’re a doctor too. YOU can make decisions, You could always decide to palliate’, he said to me.

‘But your boss…’ I started to say.

He thrust his hand toward my face, making a gesture to stop.

‘I don’t want to hear it. That’s nice for  you. You’re upset. That’s nice’.

My cheeks were flushed. I felt angry and frustrated, and holding back tears. This is what I looked like as I walked into handover.

Maybe this sounds like nothing. Maybe I am too sensitive. Maybe I am floundering.

This happened during my first run of nights since I had returned from maternity leave. The first time I had left my baby overnight in all his life. And this, THIS is the hospital life I’d forgotten about. This is what I sacrifice the needs of my family for? To prolong someone’s suffering and to endure the arrogance of dickheads.

There’s nothing good to say about my job right now, except that with every day and each shift, I get closer to finishing this term. And when I say ‘I hate this job’, I really do. I am filled with dread ahead of each shift. I am crying when I get home. The thought that I would most likely do this job again next year – at least once – brings panic.

By some good luck` I was doing a shift with a really lovely consultant the other day, and at the end of it I asked if I could get some advice about how to better manage scenarios like the one above. I explained how it had effected me – honestly. How I couldn’t sleep when I got home. How I feel coming to work here. How mothering and doctoring seem so incompatible right now. Just this outpouring of everything.

The consultant was great. And by the end of our conversation, I had a firm plan to leave. No pasture is greener, but there’s somewhere a better fit for me. There’s somewhere I might work where I don’t need to feel like this.

All of this I knew already, but change has felt too difficult – and with a baby involved now – too complicated. But with this consultant, we actually put together a fairly realistic and achievable plan -or at least the first few steps.

And like that, a weight has been lifted off my shoulders. The other night, I received 15 referrals in 3 hours, and was prisoner to my phone. How can I do anything in those circumstances? It was shit. But there’s an end to it. When I know there’s an exit path, I can manage. When I feel like I’m trapped, I am trapped.

Then, the I received an email from a consultant in another department complementing my work. The consultant wanted to let me know that I am the only medical registrar in my department that she consistently receives positive feedback about from staff at all levels, and she is going to pass that on to my head of department**.

And after that, the ED CN bought me a coffee at the end of my night shift.

The universe is messing with me.

—————–

*They hadn’t been.

** Secretly, I’m not sure if I take this as a complement? I look at my colleagues and suspect that the only reason people like it when I am on is because I am ‘nice’. I worry that I’m not tough enough. But then when I try to play tough it only makes a difficult job worse… Uh.

When does sleep happen?

Seriously. When?

If there was a date or rough estimate of when I will sleep again, it would be helpful. I’d be working toward something. There would be a light at the end of the tunnel.

In the last 3 weeks. The maximum number of consecutive hours slept is three. Three consecutive hours of sleep.


Approaching the last few weeks of my first term back at work.

It’s been hard, and I know I’ve probably had it easier: mostly working Monday to Friday, not too many weekends.

But it isn’t the work. I was able to get back into the rhythm of the ward fairly smoothly. It was everything else. It was – it IS the exhaustion.

I am so tired.

So tired.

So tired I want to cry.

I fell asleep in the car last night when I got home. I parked in our apartment underground carpark, and I suppose the quiet, dark warmth of the car was just to conducive to sleep. At least I made it home.

We’ve just got through Hand, Foot and Mouth disease, after a succession of other childcare illnesses. All routines and whatnot have long since been abandoned – and re-initiating the habits, more conducive to sleep and functioning, require effort and energy we just don’t have at hand. Instead, we just get through.

Babies sleep through the night eventually, right?

My next roster is all shift work. 13 hour shifts, most weekends.

I feel stressed, knowing my husband will be doing much of this alone. I feel sad knowing I’m leaving my little boy.

It’s hard not to feel like you’re doing something wrong. Everyone asks how your baby is sleeping, and the only right answer is a positive one. If you say that he still isn’t sleeping through the night, or confess any other problem, brace yourself for unwanted, often unhelpful advice +/- judgement.


But in all that: I am enjoying studying. At least I am right now. Maybe when dates loom closer, I’ll discover this is impossible – but for the moment, it’s just all so interesting and exciting. I love learning and knowing. It makes everything at work so much more interesting.