2.20.2023
Physician Wellbeing
I wore my blue physician wellbeing shirt today, a reminder to rest and take things easy. It was a 3-day weekend in America, not a holiday here in Malawi, but I wanted to take some time to release some stress and relax and work less anyway. Work has been going well, patients are recovering or at least progressing, and the work I am helping with in America has some incredible opportunities and projects coming up. But I wasn’t doing well with boundaries. I tried to take last Monday easy but I ended up working just over 8 hours. By Wednesday I was pulling almost 10 hour days and by Friday I had logged 13 hours, starting at 9 am and not finishing until after 10 pm, with barely a break in between. I was loving my work, it really rejuvenates and motivates me. Well, at least until the end of the day when it was time to sleep and I still just can’t let go, always trying to do one more thing. And the work had also extended into the weekend; I found myself sitting in the office checking just one more email, planning one more thing. Greg had to come looking for me, I had left to go to the kitchen for dessert but found myself in front of the computer.
So now I sit on the couch and listen to a meditation about trusting God, while cuddling with my dog. People think I have good boundaries, probably because I only check my emails at certain times, I tend to leave my phone on silent in a corner of the house when I don’t want to be disturbed, and I’m only going into clinic to see patients in-person a couple days a week these days. Yet somehow I’m busy with emails and phone calls and projects all day most days. I try to take a day of rest at least once a week. Sunday was pretty good yesterday, with no official work, but I was trying for another restful day today, partly to make up for the 55 hour workweek last week.
So I wear my blue shirt and after cuddling with my dog I drink tea. Greg schedules a massage. That’s right, a massage. At $15 per hour I try to book one every month. Even at that frequency, I can feel the muscles on my back like a rope made of knots, slipping and sliding as the muscles try to give way. Today, I spent a little extra on a hot stone massage, and the combination of pressure and warmth finally get through some of the tension. For once my masseuse doesn’t chide me for having so many knots, maybe she feels like she has told me enough that I should come in more often, and I never do. Sometimes I wonder if my back would be better if I knew how to relax my muscles – I think I learned to exercise them and stretch them, but never really how to release. I do leave the parlor feeling relaxed, more so than I have in a long time.
Greg and I grab some food on the way home, some ready-made chicken from the supermarket. I read a book on the couch and later, in the garden. The weather is so nice today and I notice how the birdsong changes to crickets as the sun starts to set. Then I move into the screened porch because neither my dog nor I like the mosquitos that start coming out at twilight. I reflect, I plan, I read some more, I meditate on scripture, I listen to praise songs. I cave in and work a little bit. Just a little – reading through some things so that I can start thinking about big-picture ways to write articles and send in reports and take next steps. I drink lots of water and tea and eat lots of veggies.
I need days like this, I think I might be even more productive this week because of the rest today. We shall see. Step one will probably be getting to bed on time, that will be a first in a while.
2.22.2023
Out of Balance?
You would think a doctor would understand her body more. I mean, that’s definitely what I would think, what I want my patients to think. And yet I sit here, trying to rest, and I notice that my right bicep is twitching, and I don’t know why. It started a couple days ago, and it usually calms down if I touch it gently. But today the left bicep started twitching too. I stretch, walk, exercise, eat healthy, I’ve even been sleeping like I should, mostly, I just can’t understand why my body would do this. I rationalize: well, this is some of the first time that I’ve tried to be intentional about rest. Sure, I’m still working 8 hours a day, well, not yesterday or last week, when I had zoom meetings and didn’t finish until after 10 pm, but I have taken extra days off to compensate. One of my friends laughed at me when I announced that I would be trying to stick to 40 hours of work a week in honor of this being my seventh, my sabbatical year. I thought she was laughing because she, a surgeon, thought that 40 hours a week was unrealistically low for any doctor. I realize now that maybe she was laughing because 40 hours a week isn’t much of a break.
I worked closer to 60 hours last week. But I took Monday off to compensate. Maybe that’s the reason, I rationalize, my mind and body just don’t know what to do with rest after intensity. I think about it intellectually, too. I have a patient booked tomorrow, a middle aged women with a condition where she can’t control the impulses in her brain. She says words she doesn’t want to and can’t stand on her own feet, and all the tests show that it is coming from her brain, not her muscles. Instead of controlling her nerves, her nerves are controlling her. So I think, maybe this will help me to better understand my patient. Then I wonder, is this part of the restless leg syndrome and Parkisonian traits that run in my family? A friend messaged me recently and asked, with as much as I’ve been sick lately, if I’ve seen a doctor. What should I do if I’m reasonably convinced that another doctor wouldn’t have a solution any more than I do?
Then I think it could all be emotional. This morning a dear friend of mine told me that she was being summoned to the medical council next month after an adverse event in the hospital. I know the hospital, and I know this doctor, and I am certain that there were other factors which led to the death. If anything, my friend was the one trying to hold everything together and sound the alarm. And now I’m afraid she would be a scape goat for an institution that she has been trying to help hold together for years. Maybe my feelings of dread for her and helplessness are part of what is making my brain feel fuzzy. And it’s not just that, Cholera is killing people in this country and it shouldn’t be. It’s so easy to prevent and easy enough to treat, if people come in on time. But some churches say that Christians shouldn’t worry about infectious disease and culturally some people don’t like drinking treated water and economically they can’t afford to boil or filter all their water, so people get sick, and people die. Then sometimes villagers come and attach the cholera units where their family member died. They riot and burn tires and threaten the hospital staff, a reminder why usually only certified government hospitals and foreign volunteers from the outside are the ones working in cholera units. I wish I could do more, but I don’t know where to start.
So maybe that’s why I stay up late helping my friends in the US with their training programs and their public health initiatives. Things are making progress there, and I’m the one who gets to tally up the results and show how smoothly things are running. Residents and students want to join us and people barely notice that I’m working remotely from sub-Saharan Africa. So maybe that’s why I stay up late, because there is a rush of satisfaction from the work I do at nights. That’s also why I try to work less and put up more boundaries, so that there is more of me left at the end. So that I can think about long term goals here and not just the path of least resistance there. It still doesn’t explain why my biceps are twitching, but at least it’s not constant like the right eye twitch I lived with for 10 months last year. Maybe I’ll stretch and go for a walk in the beautiful weather outside. Maybe I’ll sit and reflect a bit more before jumping back into work.
2.28.23
Striving to work less.
I’ve never tried so hard to be intentional about taking days off, taking breaks during the day, and getting rest. Well, I’ve never tried for so long to set boundaries on myself and make up for overworking. Yet somehow I still overwork – a call from a friend means I need to go in and see a sick old lady in the morning, and then meetings about maternal health and wellbeing research in Loma Linda extend late into the night, past 10:00 night after night. My holidays and intentional days off seem to evaporate when balanced with 11, 12, and 13 hour days. I work through dinner, I work through lunch, I try to get a few more emails in during the morning before Greg wakes up. Work is exciting right now, rewarding, definitely, but also demanding.
Last week I got sick again. A GI bug this time. I felt nauseous one day and was completely emptying my stomach the next. It wasn’t cholera, thank goodness (we haven’t had a chance to update our vaccines because the country ran out of vaccinations, but praise God we have been OK for now). But I was tired and couldn’t eat. I was impressed at what I could drink, though. Before lunch I had taken down 3 liters of Oral rehydration solution – a fancy name for mixing salt and sugar in my water. I was tired, for sure. Thoko and Nixon came to visit and talk about next steps in village outreaches, and by the time they left I ended up taking a 3 hour nap – it’s been a long time since I slept that much during the day and still had time to rest at night. And within another day I was feeling better – back to running, back to eating, back to drinking regular water without sugar and salt.
But I continue to ask myself, how is it that I have had so much sickness in these few weeks which I’ve tried so hard to be intentional about resting? I joked with my sister that maybe my body is a lump of tension held together by stress, and attempts to release stress do a bit to unravel me. On the other hand, perhaps this is the first time I’ve tried to have intentionality about rest in 20 years. Never since high school, maybe even junior high, have I tried to find rhythms of rest week after week, month after month. I can’t say how well it is going. I did go on a vacation and I did take some days off this month. But then I worked more than 10 hours a day on the remaining workdays. Sometimes I wonder whether it’s good that I’m aware and trying hard to fix my workaholic habits. Other times I worry if keeping track of everything and trying so hard is adding to my stress.
Friday is a national holiday this week. I don’t think I can take it off from work, I have a meeting at 7 pm. I was still trying to decide whether or not to attend the meeting at 11pm. Now I see that there is one