Birthday Month

So I’ve been struggling a bit this month. Which is ironic almost, because Year Twenty Eight has been the movie-like coming of age year for me in so many ways, and I expected nothing but spring to end my year. But we all know how that goes.

I’ve been working nights this month, almost the last time I would likely have to do that in my life – there aren’t many emergencies typically in Infectious Diseases, my chosen fellowship field starting this summer. Despite the havoc on one’s circadian rhythm, I have almost enjoyed every one of my night rotations previously. You’re on your own, taking care of everyone else’s patients in the hospital while they are gone for the night, and admitting any new ones that come in. You attend to any Rapid Response Team calls or Code Blues that arise. There is a lot of autonomy involved for a resident, and the kind of exhilarating scary that promises a feeling of  ‘who da bad-ass who survived that mofos’ at the end of one’s shift. But this one has been unexpectedly hard for me.

I’ve been stressed out, snappy, easy to anger. And that is uncharacteristic of me.  At least the grown up me.  My teenage years were in fact spent as an angry young woman staring down men abusing power and parenting women who were being bitchy. I cringe. It was not my place.

And those edges had been painstakingly smoothed out over the last three years. I remember one particular evaluation from an intern that said “S is super kind and understanding when mistakes are made”. That was one I was particularly proud of. But it feels like I haven’t been deserving of that for the past three weeks. I could say I wonder why. But fact is I definitely know why.

So I have mentioned the depression before. I have mentioned my triumph over it.  While I credit writing, working out and volunteering to my recovery,  I cannot deny the role the right antidepressant has played.  The one that has become second nature now – that single pill I pop right before I dash out the door every morning without a second thought. Well, we all can agree I haven’t needed it for a long time now.  It was like a reasurrance for the powers that be that things were under control, a security blanket of sorts. Needless to say my Psychiatrist and I agreed that it was time I left the blanket behind. Side effects are an inevitable reality for every medication, but they are justified only as long as the benefits outweigh the risks.  Long story short, it was time.

The weaning process has been careful, methodical.  From taking 300 mg daily I was to reduce the dose to 220 mg for 10 days,  then 150 mg for 10 days, then 75 mg daily for 10 days before stopping. But what has been erratic has been the irritability, the snappiness and the pangs of anxiety that made an unwelcome comeback after two years of supreme confidence. It was like I was a teenager again, insecure, unsure of my worth, with a bitch of an imposter syndrome causing a nagging feeling that something, somehow was going to go wrong any minute now. I pondered going back on the meds, every day.  Was the freedom and the ability to feel like myself and the avoidance of further side effects worth the risk of my work suffering? WAS my work suffering? Is this something I should just take all my life? Is the ‘angry young woman’ an illness, or just my personality? If it was, did I want to be that person?

S always said I was a bad judge of people. And by default,  that makes me consider myself a bad judge of me. Am I acting like a crazy person? Would someone tell me if I were?  My dear friend M insisted that I seemed completely fine, amazing in fact. “You are your incredibly kind and good self, as always”, she said. But she hasn’t seen me at work,  which is where all my anxieties manifest.  I decided to take my night co-resident into confidence. She was someone I thought was trustworthy and a decent human. It was not a pleasant conversation to have, but a necessary one. I explained my ‘Past Medical History’ to her,  so to speak, and requested her help. Would she tell me if I were acting, say,  not like a normal person? ‘Of course’, she said.  Besides, she’s always thought I have been so much calmer than her during stressful situations on nights at work this month.  I heaved a sigh of relief,  and thanked her.

I read more about the process of weaning. It was not supposed to be easy.  “Discontinuation Syndrome” was common.  The key was to replace the drug-induced Serotonin in your brain in more natural ways. I started making sure my workouts were consistent.  I started doing yoga almost every day. Bought myself more flowers than usual. Organized my closet and my finances.  Went for long walks. Did my first run outside, that I was training a long time for since being impaired by shin splints.  Slowly but surely,  I found my footing.

Sure, it’s all not perfect. I’m still snappy sometimes, but I have not been beating myself up about it. I just decide it was a mistake and resolve to do better next time. And now, on day 6/10 of 75 mg, I feel like I can see the light at the end of the tunnel. I feel like I can do this. I hope I can. I sure am scared.  But I have to try. I have to do this for my teenage self – I feel for her so much. She had all the talent and intelligence in the world, but was crippled by her anxiety and insecurities. And taken advantage of, for them,  with the loss of many an opportunity which otherwise would have been a piece of cake for her. I have to do this for my sweetheart of a Dad – he has all the talent and intelligence in the world , but is crippled by his anxiety and insecurities. I see how good kind people like him are taken advantage of by the bad guys in life all the time for their insecurities. And I want it to stop. The question is do I achieve that with the aid of drugs that I take for the rest of my life, or do I utilize the infinite power of the human mind to change my detrimental defaults?

I could take the easy, safe, former route and just go back on the pills. But if I succeed with the latter, this will be among my top personal achievements.

I have to try.

Playlist: Women of Pop

One of my favorite things is long car rides listening to music, on earphones if alone, blasting on the stereo and singing along if with friends.

J is away for a bit. He had to go back home to LA for a family emergency. I decided to give him some time and space away. It would do us both good I think. He can come back whenever he’s ready. Part of me wants to be there for him, support him through this. But I get the sense that my current stance is preferable. I told him I’m here for him if he needs anything at all. Besides, it’s given me some time to focus on me a little, indulge in some reflection on long car rides over music.

Content and peaceful. Those are the words that come to mind thinking about my mental state these days. I’m okay, after 28 somewhat tumultuous years. I’ve found my footing, it feels like. Of course, it took a lot of hard and painful life lessons to get here, but they’re what got me here, so I’m okay.  I’ve made peace with the past and the future. I’m truly living in the moment, as cliched as that sounds. There’s no dream I’m trying to achieve, for the first time.  I’m exactly where I want to be, personally and professionally.  Anything good that comes along would of course be appreciated, but in a natural course of things way. Anything bad will be seen as life being life. Humblebrag is the only way to say, I really like who I’ve become. I only wish I had gotten here sooner. Lots of cringeworthy moments with S especially come to mind.  I’m not really surprised he did not propose all those years anymore – for the first time, I get my past imperfections. But I’m definitely not beating myself up about it – I was just working with the life experience I had until then. It would have been nice to have someone just teach me all the hard lessons as an eight year old.  But I guess that’s not how it works.  Well, I’m gonna try anyway when my kids are eight,  if I have any that is.  Until then, I hope to continue to work, read, write, sing, dance, go to spin class, do yoga and be kind. There’s no white picket fence I want anymore.  There’s no academic laurels I want to earn anymore. I just want to live and love the best I can.

I guess that’s a good note to go back to Spotify on.

Until next time,

S

Love story

So yeah I really don’t know where to start. Its been a while I know, and obviously that is because stuff happened. Stuff I am trying to process. Its been so emotionally exhausting that I don’t even have the energy to write this. I wish I could just say random words and be comprehensible enough. Random words like…..

Boyfriend. Yes. Long story. Short story – great kisser. Me – vary. Me – way out of boy’s league. Me – give him a chance. Red flags. Sex. Third date. He – I love you. He – wants forever. He – you are going to be my wife, I promise, you’ll see. He – has kid. Kid – adorable. Me – let’s guard down. Me – falls hard. He – cancels dates. Promises more. Cancels again. Excuses legit. Or are they? Me – sweet. He – rude. Kid priority. Me – tries to understand. Friends – break up with him. Me – got the feels. Me – confused. Mixed signals. Why. Did not need this. Fuck.

Sigh.

Today

Today was a day I will not forget for a long time. It was one of those days when you really want to go into a storage room at work and cry alone but cannot afford the luxury because you just don’t have the time.

It began like any other call day. I woke up with a jolt at 4 am realizing I had completely forgotten to finish my clinic notes from yesterday – was supposed to do them after the gym last night but had a long hot shower and crashed instead – it had completely skipped my mind! Well, good thing I had my laptop near my bed from last night’s The Office binge. I stayed under the covers and finished all three notes within the next hour and a half. My mind was surprisingly fresh. I remembered all the details from the previous day – I gave Ms A her Flu shot but Mr B refused to get his Shingles vaccine. Ms C was due for her colonoscopy – but she wanted to think about it. I put in a little reminder note for when she comes in next. It was great. I finished by around 5:40 am, and then snuggled back under the covers for twenty more minutes. Then it was the hustle of the morning – a blur of eggs over easy, coffee, trying to use concealer on my bruised upper lip in vain (don’t even ask) and searching for my ID in frustration while Alexa played Honest by The Chainsmokers in the background. Ahh, my life was so hot and perfect.

Walking into the ICU sign-out room at 6:55 am with my usual ‘hey guys’ I plopped myself down, a little giddy.  This had been my favorite rotation in my entire residency. I find myself actually looking forward to the uncertainity of my days in the ICU. Soon, the night team walked in, a little too solemn for having just finished their shift. Before we could ask, J said, ” I have bad news… Bed 12 passed away last night”. I was briefly disoriented. For a moment I wondered if he was talking about someone else. Wait, what?! Bed 12, who had just last evening laughed and joked with me? Bed 12, with the amazing girlfriend of 20 years I had bonded with – ‘I’m gonna marry him now, she had said..I had cold feet the last time he asked me..but now I know for sure..I have to marry him the minute he gets discharged’. I had been delighted at their story – they had met in Kindergarten and reconnected many years later (yes, like V and I). I remember thinking she was so lucky – he had coded twice in the cath lab, and had been succesfully resuscitated, and had improved so much in two days that he was  sitting up in a chair and joking around, eager to go home. Only he never got to. And she never got to marry him. He possibly had another clot in his LAD, they said. I couldn’t believe how fucked up this was. I sat through sign-out trying to focus, but my mind was already numb.

Well, I couldn’t afford to stay that way much longer – it was barely 8 am and my pager was going off incessantly.  The ER attending was calling ICU consults with a vengeance. I wasn’t rattled though. I shrugged and got to work. I downgraded the less sick patients to a regular floor/Telemetry, and worked in earnest stabilizing the others. As I went through my day I marveled at how much my efficiency and confidence in my clinical decisions had improved over the last three years. I could almost do this in my sleep now.

Around 1 pm, I had finally almost caught up. The anion gap had closed and sugars were under control for the young newly diagnosed Diabetic patient with Ketoacidosis. The 91 year old with COPD exacerbation was now off BIPAP, saturating well on nasal cannula at 5 L. Labs were cooking for my post op patient in Room 13. He had had a hernia surgery, with small bowel resection, developed a post op anastomotic leak, had that repaired, and then developed a retroperitoneal bleed , with wound dehiscence, and was taken to the OR again today. I had started him on some sedation and pain management as my attending had advised. He was hemodynamically stable. Maybe I have a minute to finally start working on my consult notes, I thought, ignoring my pangs of hunger. I had barely sat down when my pager went off again. CODE BLUE IN 32 SOUTH, the overhead announcement repeated. I ran, 32 South was the ICU. I burst in through the doors when R directed me to the back of the unit. ‘It’s 13′, he said. Fuck.

We coded him for 20 minutes, and then finally got a pulse. Barely. He had become hypotensive and acidotic once he got on the unit while I was down in the ED, and my attending had been working on keeping him afloat, putting him on three pressors and pushing bicarb. His systolic blood pressure was still in the 70s. He was bound to code again. We called the family, asking them to come in as soon as they can. They wished for us to try all we can until they got there. We obliged. He coded again. We resuscitated him again. He held on until the family got there. My intern had his first go at the difficult conversation. Would they want us to continue to try and resuscitate him, when that may just prolong his suffering? I did not expect them to know the answer. And they did not. We decided to give them time. Meanwhile, we called the Chaplain for them so he could get his last rites.

But time is elusive. It slips by before you know it. CODE BLUE IN 32 SOUTH was called again. We ran over, to find 13’s lovely nurse N waving her arms indicating NO. They did NOT want us to pound his chest anymore. He was DNR now – Do Not Resuscitate. We let him go.

N was hugging everyone in the family tight. Tears were rolling down all of their faces. I blinked back mine. He was a good man, the wife said. We got them a bereavement tray  – I truly do not know what that entails – some food and other things to provide comfort, I was told. I hope it helped.”I have to get the fuck out of here’, the son said in anguish before walking out of the room where his father lay cold. I called my intern over. ‘Have you ever done a death exam before? Come, let’s do it together’  I told her the steps. He was not responding to verbal or tactile stimuli. His pupils were dilated and fixed.  We each listened to his heart and lungs and checked his pulses. We flashed a light in his eyes. We checked his reflexes. Time of death: 16:30.

ER paged again. My second COPD patient who had his blood CO2 level so high it was unmeasurable, was having second thoughts about his code status. He wanted a tube now. The Catholic in me secretly rejoiced – it has been a constant struggle for me to be the one who has these conversations with patients – I wanted them all to want to live! ‘Protect life from conception till death – my Catholic medical school had taught me. This whole DNR business was new for me. I explained his options to him again. I am always careful to start these conversations reiterating that this is something I am required to ask every patient in the hospital – asking them their code status does not imply that they are going to die the next minute. But in this case it could go either way. He was alert and awake at that CO2 level. COPD patients sometimes live at these higher levels of CO2. I truly could not predict his prognosis in the next 24 hours. But naturally, that is what the family wanted to know. What do you think his chances are? I tried to explain the facts while trying to not make the decision for them. The daughter tried to get her father with mild dementia understand the question again. She began to repeat my explanation to him, and then broke down unable to continue. I got her a tissue and rubbed her back pathetically.

The rest of the day was a blur of similar emotions. I know I did good today. I actually played doctor. I helped some people through their worst nightmares. I was efficient, effective. I got the job done. “You guys were terrific today’, the ICU ACLS coordinator said to my intern and I. ‘Thanks’, I smiled feebly.

It is 8:30 pm. I opened the door to my apartment, switched the lights on, took my coat off. Then I crumbled to the floor, sobbing.

 

Thanksgiving

I know I haven’t written in a while. No, I haven’t given up on yet another blog. I just wanted to make sure I had something quality to say every time I wrote. Something that wouldn’t make an older me cringe a few years down the line. Also, I use this as a platform to work things out in my head and I have been fortunate enough to not have any pressing concerns in the past couple of weeks.

Yes, it has been an unusual period of bliss-ed out contentment for me. One that I am very thankful for. I figured it would be appropriate to take a few minutes out of a day off that happened to fall on the eve of Thanksgiving Day to log my gratitude.

A lot of things have factored into this joy. I am doing well at work. I love my patients. I have found enjoyment in studying Medicine again. I am excited about my future. I have learnt to appreciate my family for how absolutely wonderful they are, and not take them for granted. I may have finally found my clan in Chicago – a group of smart, funny, decent Malayalees around my age who I met at a Meetup event, almost all of them having lived in Bangalore at some point in their lives! – can you sense my excitement? Now it may all fizzle out but I am OK with that possibility. I have learnt not to have lofty expectations of people. I have spent lot of time in the past dwelling on being disappointed by friends. Now I realize that is probably because I hold them to very high standards.  Most importantly, for the first time in my life, I am not looking for love. I really really like myself and seem to not mind not having constant validation of my worthiness.

Now this may seem to be contradictory to that statement but I recently went to a Dabble class on “How to attract with allure and approachability”. Yes you are allowed to laugh at me now. It was something I had signed up for before this whole I don’t-need-a-boy emancipation came about. I decided to go anyway, and boy, am I glad I did! It was a small intimate gathering of of five single women sharing their stories of love over wine at the host’s apartment. All the while our wonderful coach gave us eye-opening tips on things that must be holding us back in love. It was as delightful as it sounded. What I liked best was how honest everyone was with their vulnerabilities. It was interesting how even though we all might have our individual hurdles, the common theme was self- doubt. It was yet another instance where it was evident that we as women, tend to put ourselves down so much in our heads, that we might be really really far from our truths. I came out realizing a lot of my mindsets that must have been holding me back for years in situations that I could have taken to my advantage. Oh and guess what? We enjoyed each others company so much that we ended up exchanging numbers and making plans to catch up again this Christmas.

Don’t get me wrong. I am terrified that this will all come crashing down come December 6th on Fellowship Match Day. I like to think this time around I have enough maturity and wisdom to approach this period of uncertainty with balance and grace. I hope I can manage to keep my sense of hope and purpose in case things turn out unfavorably for me. I really struggled the last time during Residency Match two and a half years ago. In hindsight, things really did work out for the best. But I was young and naive and used to winning all the time at the time. I have learnt to forgive myself and others for my perceived failures. The fact that I said “perceived” in itself is a revelation to me of a change in mindset. I now have a mindset of acceptance and pride in myself and all that I have achieved. And I am finally happy to just live in the moment, doing the best I can each day, not agonizing about what people think of me, or what the future may look like for me. I am paying my bills on time. I have a 401k. Going to the gym daily has become a habit. I am reading, listening to podcasts, watching the news, making conversations with strangers, going out of my comfort zone. I am also making time to hang out by myself in my living room that I so lovingly decorated two years ago but never used much as a result of being too high-strung all the time to just relax on my couch. Thank you, Whoever is making all this happen. Please make it so that I am this happy come what may for the rest of my life. And please help me keep my feet on the ground while I am at it.

Note to self: How to get over a breakup.  

I was reading Anna Faris’ new memoir Unqualified today.  It was something I had picked up on a whim at the airport. I wasn’t engaged in her life in any way before I bought the book. But for the past two days, I haven’t been able to put it down. It was heartfelt, honest and personal. I have always loved memoirs. I am glad I found another good one. One of the chapters was on how to get over a breakup. It was a collection of advice from different people who had responded to a Facebook survey by her. And boy, it was good. It got me reflecting on how universal this experience is.  Everyone goes through heartbreak at one time or the other. That puts a different perspective on my predicament. It helps to know I am not alone in my loneliness. That chapter got me searching for similar advice on the Internet.  Here is what I found:

Note: None of this is mine.  This is simply a consolidation of things that I found particularly helpful from Anna’s book and elsewhere, so that I have a reference to go to at times of weakness.

1. There is no timeline. It may take three weeks or three years depending on what that relationship meant to you or how invested you were. So don’t beat yourself up for your inability to move on.

2. Fill your life and mind with other things that you love.

3. Don’t be in a hurry to date again. It is not fair to whoever you are dating if you are still hung up on your ex.  Give yourself time.

4. Make as many friends as possible.

5. The no contact rule. This is one I particularly struggle with.  It does not mean you can never talk again. It does not have to be a set number of days. It is for however long you need to heal. And it is essential to healing.  So do it.

6. Again, there is no timeline. You don’t have to get married by the time you are 30 and have 2.5 kids by 35. It may still happen. Even if it doesn’t, you’ll be just fine. Don’t sweat it.

7. Go on hikes.

8. Tidy up things in your life.  Your apartment, computer screen, closet. It requires just enough focus to give your mind a rest.

9. Volunteer. Focus on things bigger than yourself.

10. Write about your feelings.

Well, check on that last one.

After rock bottom.  

It was another Sunday alone. She could go on about that but she was not going to. Instead she reflected on her journey through these tough times. She had come so far. One year ago she struggled to get out of bed every morning. Now, for the first time in a long time,  she could say she was genuinely somewhat happy.

She never thought she’d be one of those people who said this, but her healing had begun through Yoga. It was December last year, when a friend asked her to go with her to the Yoga studio that was just a few steps from her place. She did not think much of it. Her mother practiced every day, but she herself was definitely never a smoothie-drinking, yoga pant-wearing kinda chick. But her friend wanted company and she had a hard time saying no to people so she agreed to go. But it turned out to be her first step towards the self-care that she desperately needed. It was a slow progress, with definite setbacks. But now, finally, she was at a place where she could look forward to her days. Days that she had filled with art, culture, learning and self-growth. And accomplishments.

She decided to make a list of her accomplishments in the past year.

1. Pased Step 3 USMLE boards with a good score.

2. Earned laurels at work.

3. Learned to dream about the future again.

4. Decided on a future career path.

5. Managed to complete the fellowship application procedure in a timely and effective manner.

6. Managed to bag over 80 interviews across the country.

6. Found the drive to travel and attend interviews at her top choices.

7. To the best of her knowledge, did well in those interviews.

8. Developed the grace to accept the outcome of the application come what may.

9. Read four books in the last month.

10. Started listening to music again.

11. Became interested in her work again.

12. Attended church regularly, without expecting anything in return from God.

13. Started following the news.

14. Learned to switch the TV on to a news channel when she found herself lonely or brooding at home – focusing on things larger than herself.

15. Went to her first meetup group and decided to return.

16. Started a skincare regimen. And stuck to it.

17. Started getting monthly massages.

18. Started getting monthly facials.

19. Paid every single bill on time.

20. Improved her credit score.

21. Signed up for a Volleyball game.

22. Developed restraint in her social media postings.

23. Bought herself flowers regularly.

24. Started having breakfast daily.

25. Stopped beating herself up for her mistakes.

26. Started really loving herself, for the person she was, and not for her achievements. Stopped caring about what other people thought of her, like completely.  She knew she was kind and good and special. That’s all that mattered.

27. Started listening to podcasts on long journeys, on her walks.

28. Stopped feeling sorry or self-conscious about going to places by herself.

29. Finally found not one, but three perfect shades of lipstick for her skin (Sephora ColorIQ is an amazing tool ladies)

30. Learned to curl her hair, for the first time in her life.

31. Learned to contour (Sorry boys, this is another girl thing. You don’t wanna know).

32. Started developing female friendships, for the first time in her life.

33.  Discovered who her real friends were. Forgave the rest for abandoning her in her time of need.

34. Started this blog, to turn her grief into art.

35. Accepted that S was the love of her life. And that she would be happy with having had the chance to spend seven beautiful years with him.  Accepted that she would never find it in herself to love anyone else, and that that was ok. She would love him unconditionally from a distance, without ever expecting anything in return.

She smiles in relief. She still had a long way to go,  but her heart was already full.