Sunday, November 13, 2016


A few years ago I had the (crazy, surreal, amazing) fortunate experience of spending some time with Abraham Verghese.

You know how people say you shouldn't meet your hero because they will inevitably disappoint?

That is not always true, turns out. He is actually precisely what I thought he would be; articulate, measured, polite, engaging, interesting, and a good cook. We talked a lot about books, and writing, and medicine. He even said he read my blog (!!!) which was flattering and intimidating at the same time. But he said one thing which still rings in my head, something to the effect of "I couldn't write a blog, it would take me so long to feel like something was ready to post. I'd want to edit it and rework it and I just know it would take me so long to feel like it was good enough to publish, ready to be put out there".


Well, I hadn't thought of blog postings that way before. I mean, sure, I hope that there are no glaring spelling mistakes or complete violations of the rules of grammar, but I had always just written something and then posted it. I also know he is a world renowned, famous author so he can't just throw a random GIF up there with "Happy Saturday" and expect his readers to appreciate it, but still.

So I currently lie awake at night thinking of things I want to write about on the blog. And then I wonder if I should write a draft then send it to my mom (retired English teacher and editor) then rework it, marinate in it for a while, rewrite, send back to mom, then post. The rumination makes me tired and by the end of this thought cycle I am asleep. Which I suppose is a good thing, since I am usually an insomniac. But it paralyses me from writing at all.

October whizzed by in a September-like fashion. I pulled a 21 day straight stint which had some ups and a few big downs. So much for "taking time for myself" etc. Why is it that when you start as an attending you're cursed? I've said, "Well I never saw THIS as a resident" more often in the past couple of months than I'd ever admit. The other new attending and I often pass each other at the hospital with mummified expressions that betray our lack of sleep muttering "curse of the new attending" between us. We tried to have wine together one night to commiserate but didn't even finish the bottle before our yawning took over the conversation completely.

Most of the time, I am just terrified. I woke up one night with a start, my heart was racing and I felt this rush of panic, "shit, I'm on call" check my phone, no missed calls, there was nothing to panic about. My breathing was fast and I couldn't seem to get myself to calm down. I thought, "Am I having a panic attack? WTF? This is awful!" My stomach was in an unrelenting knot for days and I had the worst flare up of eczema I've experienced in my life. I was actually considering blood work because I was scratching my legs so forcefully in my sleep that I developed these multicolored blooming bruises everywhere, giving the appearance of scabies AND a clotting disorder. Apthous ulcers made eating and drinking so painful I was trying to chew/slurp on one side of my mouth. Coupled with the near compulsive hand scratching (oh, the joys of dyshidrotic eczema) I am quite sure I looked like a spectacle to my new colleagues most days.

I texted one of my surgical attendings from last year. "Did you have resting tachycardia the year you were a new attending?" Her reply, "the first two years".

Great. Well, I have certainly reached the promised land of being an attending.

A nurse recently asked me (after I had scoped all day, scurried home to eat and then returned for my 12hr ER night shift), "Are you glad you went back and did medicine? I am thinking of doing that".

Cue deep intake of breath.

I remember vividly all the negative input I received from people when I told them I was thinking of going back to school to become a physician. I remember it so clearly because it occurred with monotonous regularity. I don't want to be one of those people to someone else.

"Oh you don't want to have a life?" "I wanted to do medicine but I chose a life and a family instead" "Why would you ever want to ruin your life and get that much in debt?" "Getting in is basically impossible" "Have you written the MCAT? You'll never get a high enough mark to get in". Etc. Etc. Etc. Those are just a handful of my favorites.

But looking back now, these comments weren't completely off base. I take a look at what I've gone through in the last 8 years on this tumultuous journey. I see where I am and what my life is now. I am not sure that I am glad about becoming a physician. When asked about my decision to go back and study medicine, I genuinely answer, "Ask me in 10 years" because I feel that by then I can more accurately assess the pros and cons. Right now the "cons" list is pretty heavy.

I wanted to be a doctor because my Grandad was a doctor, and he was my hero. But now that I am older and can take a wider lens to my perception of him I realize he was also a farmer, a voracious reader, a world traveller, a philosopher.

Abraham Verghese, Atul Gawande, Jerome Groopman, Walt Lillehei, and Kevin Patterson, Brian Goldman are a few more of my heroes, not because they are doctors but because they inspire me by what they've done in addition to (or despite) being doctors.

I can't ask most of my heroes how they came to find the time and energy and inspiration to do the things they've accomplished in their lives. I'm still in survival mode right now but things will hopefully settle in the next few months and I can re-calibrate and re-introduce myself to the things I enjoyed doing. If medicine remains the only thing in my now-one-dimensional life I know I'll burn out fast.  I'll find those things that inspire me again and start putting my energies into those things as well. And keep the betaderm handy.


nurse 8 said...

For me, the NP route seemed to make the most sense; lots of clinical knowledge and better quality of life than the MD route (certainly for the first decade or so). But, everything has its drawbacks. I'm finding there are not as many positions available as I'd hoped (I specialized in pediatrics), and there is a fair amount of push-back front he medical community - NPs not being used to their full scope of practice, being passed over in favor of PAs (thanks, nursing union and sexism), MDs not wanting NPs in their primary care practices... it's challenging for sure, and makes me wonder if my time would've been better spent in medical school.

I also hugely adore Abraham Verghese. I'm pretty sure I "found" him because of your blog.

Please keep writing; I hardly ever comment, but always enjoy hearing from you.

Albinoblackbear said...

@Nurse8 you're totally right. There are pluses and minuses to all the different paths. In Canada we don't really have PA's and NP's are much more widely implemented now that many health regions are pushing for Primary Health Care I think it is more of a feasible option. That said, I have friends who are NP's who faced similar struggles with finding employment and where they could "fit in" once they were done.

I think I would have always wondered "what if" had I not gone back, and maybe that would have made me crazy(er). Maybe I would have then blamed all my woes on not doing medicine, hard to know.

Thanks for your thoughts, and glad you enjoy the blog!

Unknown said...

If what you put on your blog so far hasn't been edited twice by your mom, then I'd say, just keep doing that. I tell my perfectionist 5-year old (and myself) this: there is a continuum between bad and perfect. 'Good' lies up there close to perfect, and if you make a mistake or two, and something is no longer perfect, it is usually still better than 'good'. Your blog is better than good, so please keep writing and posting. Any blog posting of yours that is actually posted is a lot better than a pile of un-posted, or un-written imperfect entries. Especially since I those imperfect entries are likely very, very good.
Miss you! And gah! That eczema sounds brutal! Hugs.

Sarah said...

I think that your blog posts have always seemed thoughtful and well-written. It would be sad for your readers if you felt self-conscious and throttled their output.

The balance is tough, and in medicine you quickly reach a point where you can't sleep or eat any less often to give yourself the margin you need to be a complete, balanced human. Several physicians I know negotiated for a 70% full-time job to bridge the time gap and make their job sustainable for the next few decades.

Anne said...

You provide a fascinating glimpse into a world a long way from mine, and I don't believe that more editing, revising, or re-writing would improve on that.

Albinoblackbear said...

@VB Miss you too!! Thank you for that!! <3

@Sarah Yes, in fact I talked to the VP's of our health region yesterday about revisiting my FTE in a few months (once the other GP-Surg comes back from mat leave). They seemed surprisingly open to it.

@Anne Thank you, I'll keep that in mind. :)

Zed said...

I agree your posts are well written
When I write I comfort myself in the knowledge that not many people are reading
I'm just starting out my medical career and the whole work life balance is one of the things I'm struggling with. Medicine dominates a huge part to the point where I'm too tired to do the things I used to enjoy and even when I try, I find I can't do them as well as I used to.
But it's worth trying! The Medic Mind

skyjockbill said...

What they all said. Write as you speak, eloquently, passionately, readily; you have your own voice and style, and it is so engaging.
We would all be sad if you got tongue-tied through comparing, which, as we know, is always invidious. And anyway, "A work is never completed except by some accident such as weariness, satisfaction, the need to deliver, or death: for, in relation to who or what is making it, it can only be one stage in a series of inner transformations." - Paul Valery