Adulting and Growth

Reevaluation of different aspects of life has me overall feeling pretty good.

This is the aspect I did a lot of work in recently. I finally girded my loins and looked up my credit score, to find out that it is really good. I also finally tackled the Pink Elephant of figuring out my loans, and to use public service loan forgiveness. I wish I had figured it out before residency started, because I've essentially wasted the past three years in that aspect, as well as $80K. But ultimately, I should be able to save almost $220K but doing this. There are a few concerns I have, but given that this puts me on a repayment schedule that I would have been okay with anyway, it works out. Financial stuff is the one (okay maybe there are two) aspect of my life that I have the most mental resistance in, so I'm proud of working through some of it.

Contract has been signed and sent in. Credentialing has been signed and sent in, and is under review. I have also had several opportunities to walk my talk regarding trying to promote sexual health in primary care, so I feel pretty good about this.

Okay, maybe slacking off on this one. Gained about five pounds recently. Trying to work it back off. And may have found something physical that I may like, and have dropped money into it, so I've at least committed myself to try it for a couple of sessions.

Okay, this one is too long to go into. But finally spoke up about something that has been bothering me, which is always a difficult issue for me, and I feel heard and understood, and that feels good.

It makes sense to me to put this under the same category. Either way, it is a category that I have been slacking in. I've got a few creative projects that have fallen by the wayside, even those that I have made obligations in. No bueno. That one at least needs to worked on soon. I also want to design a pretty cloth holder for my Oracle Cards, as that may make me reach for them more easily, instead of being under several crystals and my faerie tree.

I feel pretty damn good about this. So the role of chief resident has been handed off to the new ones, and I've trained them as much as I think I can, since most of the job is on-the-fly decisions and figuring shit out. But I had changed a lot of things in the past year. I've clarified a lot of roles that were sort of nebulous before. I also created the office schedule, and straightened out several issues that had caused so many of the issues from last year. I also negotiated a pay raise for the chiefs (though sadly, too late for me).

Another thing happened recently that I file under leadership. A car accident happened in front of me on the highway the other day, sending all the traffic to a screeching halt. I did sit in the car for a couple of minutes, confused at what was going on, and wondering if it would be pretentious if I walked up. Then figured, screw it, I'd rather risk being pretentious than sitting on my ass while someone needed help. As it turns out, someone did. It was beyond what I could do in the moment (the person for sure needed an ER visit and a head scan), but I was able to evaluate the driver for injuries, call 911 and give signout, and keep the other passengers and kids calm until the police showed up. I don't do well with in-the-moment emergencies (or heck, possibly even most situations) and was pretty shaken up afterwards, and questioned the legality of it, but felt like I did the right thing. The ensuing debates and conversations with friends and family were also interesting and fun, but also taught me a fair bit about myself and what my motivations are. Hint: it involves quoting a famous Spider-man phrase.

Obligatory new year's post

I can't really figure out what 2015 was. Things kind of blur together. I'm sure there were bad parts. But there were also some good parts, just in the last few months: I went to two medical conferences (crossing those off my bucket list), I went on a cruise for the first time, I set up several awesome new crystal grids and completed several art projects, and spent some good time connecting with friends and family.

I ended the last day of 2015 by clearing out some old things:
Tidied the apartment and cleared out fridge/freezer/pantry, and took out the trash
Set aside a pile of clothes/shoes to donate
Set up the new version of my presentation on sexual health
Sat and focused on some of the old feelings and guilt and bad thoughts that I want to leave behind, then tried to breathe out and let them go
And most importantly, I PAID OFF ONE OF MY LOANS. Granted, it was my smallest one, at the lowest interest rate, but it was to a friend of mine, and I didn't have to dip far into savings to do so.

Things I want 2016 to bring:
New friends, new passions, new awesome experiences, new love of all sorts, new perspectives, new job, new sustainable methods and experiences of joy and squee.
In sabrinamari's pattern, I am choosing a word for the new year, and that word is EXPAND. I thought about the word GROWTH, but I don't necessarily think that that encompasses it all, and perhaps downplays the starting point and growth I have already done. I want to expand on the growing I am doing, expand on the amount of new people and connections and experiences, and expand on things currently in my life and bring in new things as well, almost like the universe expanding and changing galaxies.
(On a silly and superstitious side note, I'd like to note that one thing I would NOT like to expand would be my waistline/body habitus, but I suppose a more positive way to put it would be that I would like to expand on healthy life choices and physical activity)

Maybe this is why it only lasts three years

I've been getting angrier and angrier over the past several months. Part of this is because you can only burn so much before you start destroying the core of yourself. Part of this is because I've done a lot of emotional digging and have figured out how much has been repressed under all the guilt and feeling the need to be a good girl. Some of this has come out, inevitably, with work. I genuinely don't think, however, that I'm being a bitch at work. I think I'm just finally not being miss nice girl sure I'll take on all the extra work thanks for thinking of me! I have started speaking out more about what I think, and I have started taking less shit from patients.

There's only so long I can be overworked and underappreciated before I start to burn the fuck out. And then when I finally develop enough emotional backbone to stand up and say no to the extra work they got used to me taking, suddenly I'm not a team player and I don't step up.

Go. Fuck. Yourself.

Resident salaries

Bits that stand out to me:
"This year, in fact, first-year residents are paid a bit less than they were in 1974, even as the costs of housing, child care, and medical school debt have skyrocketed."
"Unless you no longer want to be a physician, there is no other choice but to sign." + "law exempting teaching hospitals from antitrust litigation"
"Resident physicians working in the same emergency department, sometimes asked to treat far more serious issues-—from hemorrhagic shock after a major car accident to cardiac arrest-—are paid an hourly rate about a third of [what an ER NP is offered]."

This is an industry-wide unspoken standard that quietly and persistently takes advantage of residents.

Don't get me wrong: we aren't at the level of full-fledged doctors. We are going to make mistakes. We aren't autonomous and need preceptors to oversee us. But I don't see that being different from any other apprenticeship, and has a significantly higher amount of responsibility and risk. (Some studies say that as high as one in three residents will be named in a lawsuit due to something that occurs during their training) We work crazy hours with an insane amount of stress, our personal lives---both interactive and solo---suffer greatly for it, and it is nigh impossible to sustain our sense of self (personal, mental, spiritual, etc.) I don't necessarily think this part needs to change (at least for the purposes of the discussion today. If we open this can of worms, then we look into extending the length of training in order to meet the necessary time to get the experience) but we barely make enough to stay afloat, much less pay off the loans that just keep stacking higher and higher, as our salaries stay the same as they have been for decades, despite inflation.

In certain ways, I am very lucky. I am not married with children. This means I don't get the tax breaks that some of my fellow residents get, but it also means I am not responsible for feeding, clothing, and taking care of a tiny helpless human being, both physically and emotionally. I have fellow residents that slog through 12-hour days for the privilege to interact with their baby daughter for half an hour before she has to go to sleep. I don't have to pay ridiculous amounts for day care and child care needs. I don't have a spouse that depends on my salary to keep the household afloat. I have never in the past two and a half years worked a 40-hour workweek without vacation or holiday time being involved, but I am not leaving behind a spouse and child at home either. I am able to sock away a certain amount to take vacations from time to time, and I am able to buy things for fun and do things with friends. I am able to put 2% toward retirement, and still get by. At the same time, even with forebearance, my debt has only continued to skyrocket. I had a full scholarship through college (including a stipend for textbooks), and I still owe almost a quarter of a million dollars.

I don't know if this initiative for a resident collective is going to go anywhere. Like the author said, this is just something that we (residents, hospitals, and the system) have accepted is part of the training, and part of what we need to go through, sort of like a very expensive, very soul-draining hazing that lasts 3+ years instead of one week. But that mindset is probably part of the problem. So whoo hoo, good luck, and I look forward to seeing how it plays out.

Old writing

I'm lucky enough to be doing a lot of traveling over this two month period (vacations and conferences), which means I have the dubious pleasure of being on a plane or airport a lot, which means a lot of time to read.

One of the things I picked up was a long fictional piece of writing I worked on throughout my teenage years. It was titled Bloodlust (because my younger self was VERY emo), and at its peak, it was nearly 800 pages typed up, and was a fanfiction-cum-urban fantasy sort of story. It had gone through several hard drive crashes, rewrites, new ideas that turned out to be false starts, and remains "unfinished." Indeed, the concept of 'finishing' this story was completely anathema to my younger self, and still continues to be a highly counterintuitive process to my current self, since it was an outlet for emotions and venting, and it didn't seem right to have a finite stop to that.

There are a lot of things I am noticing about it, and myself. The first being that holy shit, I was way more passionate when I was younger. The technique and finesse of the writing was awful, but it had a helluva lot of feeling, of emotional immersion, of passion. I had flashbacks to how I felt when I wrote those pieces, and they still elicit certain powerful emotional responses. I used to write A LOT when I was younger. Approximately half the time in class, my clipboard would not be for taking notes, but for working on new ideas. I could literally go into trance states when I was writing, and come back to myself two hours later to find pages and pages of story that I had no memory of writing. In fact, I used to yell at my brother for messing with my stories. That's how much I used to be able to completely fall into something and have it sweep me away.

Along the same vein, I was way more creative, or at least, way more prolific. Not only did I find the actual Bloodlust manuscript itself, but I found several snippets. These snippets were little five-page stories told from a different character's point of view, or to explore a "what if" scenario. So not only did I create the original story, but I was so into it, I had written other stories in the same universe.

The story was also fucking dark sometimes and I'm talking holy shit this is making me vomit in my mouth and I would have put my younger self on antipsychotics kind of fucked up. I figure that at that age, a large part of writing is as a catharsis, but it scares the ever loving fuck out of me that that kind of fucked up shit was coming out of me.

Most interestingly, it is also giving me a look into aspects of my deeper self that I hadn't realized were there, even when I was younger. The main character is a fairly badass woman, but now that I can look at her with emotionally healthier eyes, I can see some major scary flaws: she is submissive in certain relationships to the point of unhealthiness, codependent as hell, and severely anxious. I look back on her/me now, and I kind of wonder why this was the epitome of badass for me, because now I can look back and think "honey bunny, you need to get yourself some therapy and self-respect." Except she probably would have killed me in defiance.

It is also interesting to look at it and see aspects I hadn't thought were there when I was younger. In fact, I was shocked to discover that my main character was in a somewhat poly relationship. My younger self did not recognize it as such, and tried to explain it away, but no, she was definitely poly, even if I hadn't known that term then. Curious that this was a concept to me that had been present and emotionally reconciled even at that young an age. The story also later unfolds in an area that I have always been curious about medically: heteropaternal superfecundation. I can assure you my younger self DEFINITELY did not know that term, but just as definitely, it's there.

Strange how much emotion reading that old story stirs in me. There's aspects that embarrass me, and aspects I can't believe were a part of me. But at the same time, it is also showing me aspects that have ALWAYS been a part of me, including the vicarious belief of being a magical, fierce, beautiful, badass creature. And that feels pretty good.

I'm Okay

Welp, fuck retrograde.

September is turning into a fairly expensive month. I'm finally getting my shit together and applying for licenses and whatnot. And it is turning into a friggin fortune.

For New Jersey so far: $325 application fee, $805 processing fee (WHY THE FUCK IS THIS DIFFERENT FROM THE ALREADY RIDICULOUS APPLICATION FEE), $55 for my board transcript, $10 for my school transcript, $20.25 to check my fingerprints (I ALREADY PAID TO GET MY FINGERPRINTS ON FILE A YEAR AGO, WHY DO YOU GET TO CHARGE TO CHECK MY FILE), allegedly $750 for a DEA fee, and I don't know if the CDS requires another fee.
For New York so far: $735 application fee, $350 to use their required information-gathering service, they thankfully don't need a CDS, but I don't know if there is a processing fee or a separate DEA fee.

So just applying for these two states is already costing me about three grand so far.

I also took my car to the mechanic today and found that my brakes are shot (which would explain the shuddering I've been feeling when I slow down) and will cost almost $750 to fix.

So September is already costing me about four grand. Fuuuuuuuuuuck.

It is impossible to tweak my budget around the next couple of months to pull that. I also have several vacations coming up that have already been planned/registered/deposited, so I won't be able to pull from there. I will need to pull it from the pocket universe savings account to pay for it, and then spend the next few months replenishing it, and hoping there are no emergencies in that meantime.

I also noticed my clothes being much tighter and uncomfortable, so I stepped on the scale (ugh) and found that I am heavier than I've been for the past couple of years. So yesterday, I came up with a plan to cut back on certain things and move more. Today when I did all the math, my instinctive reaction is to reach for a bag of Kit Kats. Dammit. And I tried to sublimate some rage by going for a Zombie Run, but the app has deleted my completed missions, won't let me download new ones, and messed up my playlist.

Essentially, the straw is THISCLOSE to breaking the chocobo's back.


On the flip side, I can actually pay for this. It isn't going to bankrupt me. Yes, this is dipping into my don't-touch-this savings account, but I can actually afford it and still have some buffer. It is only bothering me because I finally felt like a responsible adult getting my finances in order, and on track to pay off at least one of my debts by the end of 2015, and now that accomplishment is being taken away. But that's okay. That isn't traumatic.

And while the next few months may have money going out more often for vacations and conferences, in December I get a minor raise (which has been promised for two years, but will not be backdated, on which I call bullshit) and the first three months of 2016 will be very work-heavy rotations. That part is boo, but I don't spend a lot of money during those months/rotations because I don't have time to. Thankfully, sleep is free. So I should be able to rebuild that buffer in those months.

In essence, this is temporary. And it isn't going to hurt me in that temporary time. I have resources (family and friends) if I really do get into a financial bind. That's more than a lot of people have. So maybe I should stop freaking out and just breathe.

Also, one thing I have been doing fairly well lately is working on communication. My initial reaction to things that make me uncomfortable is always to run away from it, and there are few things that make me more uncomfortable than having to speak up in the moment when I'm feeling upset. But I've been doing it on three occasions (okay fine, two and a half)

The first was when hanging out with friends and the conversation in the room suddenly brought up a lot of old memories and feelings that I hadn't really known were still THAT unresolved. That's the weird thing about anger. Each time I think that I've hit the bottom of the anger and that I'm okay, there's a whole new angry underground garage I discover. I spent a few minutes stewing and slamming things around, and the conversation petered out. It would have been really easy to just rest in that silence, wait a bit, and then turn and start talking about something else---which is what my inherent programming tells me to do. This time I forced myself to turn around and say that I was upset. I couldn't really explain why I was upset, and honestly, it took me the rest of the night to figure it out even to myself, but it was important to speak up in the moment. It was the healthier option rather than my usual repression, and probably made me look a little less crazy crying lady for no reason.

The next was in trying to figure out what to do with a vacation I had planned in October for many months. The person I was going to visit suddenly remembered another plan he had made, and everything had to be shifted around and I was going to get dragged to do something I didn't really want to do. Initially, I went with it, even though it was making me uncomfortable and annoyed. But after a while, I decided to tell him that I was upset. I didn't expect him to change anything, but it was important that I speak up rather than squish it down and maybe unconsciously hold it against him. And strangely, once I expressed my anger to him, I stopped being so angry, and began to be okay with the new plans he was making. It felt good.

Ironically, his plans/preferences have changed yet again, and now we're back to doing what we were originally going to do---still a change for me, and again, slightly annoying to adapt to something new, but I expressed that easily as well, and we are okay.

The third was when I had a friend staying the night and we chatted until quite late in the morning about all sorts of things. It was uncomfortable to air dirty laundry, but I brought up the episode earlier when I had gotten so angry, and now that I had a lot more time to understand why, I vomited everything at her feet. And she essentially completely agreed with and empathized with me, and that felt SO VALIDATING. We spoke a lot about upset and closure, and we talked about how closure is an illusion. She told me, "You will never be okay, and that's okay."

So... I've still got a lot of anger and upset and fear, and that's okay.
I'm not great at understanding why I may be upset, and that's okay (as long as I can speak up about it).
I have to spend a lot more money than I expected to, and that's okay.
I'm okay.

This reminds me of a beautiful poem I came across, written by a 14 year old (if anyone knows who, let me know for credit)

(no subject)

This is shockingly accurate for me as an INTJ. It praises the INTJ virtues, but it also nails the flaws in how we can come off and in what our fundamental issues can be. The major thing it discusses is our "exoskeleton", and how it both protects our squishy squishy insides, but can also become the thing that traps us.

It also reminds me of this picture

which is the card "Sanctuary" from the New Tarot deck (Art by Leslie Minnis. Deck design by Warren Tusk.)

Deja vu

Full of grump today. Started work at 6am, and didn't walk out of the hospital until 9pm. Coded the same person three times for a total of almost two hours. When I got home, starving, with aching feet, and ready to cry, I couldn't muster up the energy to heat up a can of soup and just ate potato chips and pastrami for dinner.

Sigh. S told me in our session yesterday that she is leaving the practice, making this the second therapist that I've really bonded with in a year that is leaving. I really like her. She has a medical background, so she understands the medicine and hospital stuff I talk about. She is a witch, so she and I talk frequently about crystal grids and energy and the universe and manifestation. She both accepts and understands my aspects of poly, kink, guilt, and sexual freedom. She lets me vent and get out what I need to get out, but she also pushes me a little more than my previous therapist did. It really sucks that she is leaving.

I think I reacted in a pretty healthy way. I cried. I told her that I understood her reason, and that it wasn't her fault, but that I did feel a little hurt and betrayed because I really grooved with her. She told me feelings are feelings, and I don't need to feel bad about them, which is something we've been working on for a while.

I know that I am not actually being abandoned. She is leaving for family medical reasons, and I KNOW that has nothing to do with me. I also know that she has been cutting down her patient load for a couple of months now, and that she stood her ground with management to keep me as a client, which was difficult because I am a floater (due to my schedule, I have a different day and time for therapy every week, and it would have been easier to assign me to a full-timer who is always there) She fought for me. She has also said that I'm one of the few clients that she would have wanted as a friend if we hadn't met in this context. It fills me with love and gratitude to know that I am cared for. And I know that I will be okay. It does, however, still suck.

She also was very honest with me in terms of finding a new therapist, and then brought up the question: do I feel like I still need therapy?

It was a strange question, and difficult to answer. Sometimes it is just another appointment to keep in the week, a place to go and I just end up venting about work or whatnot. Sometimes when things flare up at work/home/relationships/self, I very much look forward to therapy as a place to cry it out. And more often than either, it is a safe space of Me Time, time when I don't have to be a dutiful daughter, or a competent physician, or an understanding lover, or a considerate friend. I just get to be me, and spend the time trying to figure out who that is.

Ultimately is it something I need now? I don't know. It is nice to have someone hold the mirror up for me, but I am pretty good at self-reflection, and the vast majority of my therapy is me talking things out loud. I feel like I am strong enough now that I won't fall apart without validation. I would say that two years ago when I started therapy, I Needed it. A year ago when my previous therapist left, I had this same conundrum, but in hindsight, still probably needed it, at least for a while. I've done a tremendous amount of growth with S. But do I need it anymore? Maybe not. And it really sucks to completely bare my underbelly and bond with someone on a completely unique level, only to be given another three week notice and have to pull myself back in. The other issue is that because therapy needs to be a safe space, and my situation is somewhat odd, we both agreed that it would be detrimental for me to be assigned to a therapist I didn't genuinely groove with. So I think I will complete my last three sessions with S, and then maybe take a break from therapy for a while.

It is also possible that I just need something else that is structured me time.

When talking with A later, I said that I was looking for other things to do, fun things that might give me some joy and excitement and new experiences.
A: "I think that would be good. You might not need therapy at all if you do that, and you get to do something that gets you out of the apartment."
Me: "Well, I was thinking about it earlier, and I want to find a shooting range nearby."
A: "...Okay. Well, I was thinking of something a little more social and a little less...Unabomber."

I still want to go shooting. It is something I have done a few times and like. It does not require a particular structure or schedule, which is a HUGE plus given my ever-fluctuating schedule. I can just go whenever I want to, and stay however long I want to. But it would also be nice to do something that requires human interaction, even if it is an instruction class.

Some possible thoughts:
There has to be a gaming night at the local gaming store. Maybe I can do that.
A hands-on art class like a pottery-making or crafting class. I like crafts and it is social without triggering my social phobia of direct interaction (I hope)
A static trapeze or Lyra class. This was Ames' idea, but it is usually a small class, you're only a foot off the ground, it isn't cardio (which I hate), you don't have to commit to a whole course. She and I came to the agreement that if she can find a beginner class---and I mean a freaking lazy sloth deconditioned chunky monkey kind of beginner class---then I promised I would sign up and go for at least the first class.

So I leave that option open. If you can find and set up something for me that I can fit into my crazy schedule without commitment, doesn't cost an arm and a leg, and I'm not vehemently against, I will do it.

For now though, after a couple of epic shitty days and 15-hour work shifts, I am going to finish eating this bag of potato chips, rest my feet on an ice pack, watch some youtube clips, and go to bed.


I know what movie I'm gonna be watching tonight!

My co-chief and I were talking about a problem we have noticed in the program. Specifically, between the residents and one of the faculty who seems to abuse her power in selfish and hypocritical ways. We were griping about it, and inspired by righteous rage, I decided that I was going to do something about it, dammit. I vowed to take her down.

He immediately tried to calm me down and talk me down from what is likely to be political suicide and lots of agida. We're only here for another year, all we have to do is keep our heads down and we'll be done. Pick and choose your battles. We can change other things, but don't mess with faculty. Stronger and ballsier people than us have gone up against her before, and nothing has changed.

I argued that what other people did or didn't do wasn't relevant. The only relevant thing was what I---or we---do right now. Yes, we're only here for a year, but we can DO something in this year. My goal is to leave this place in a better status than it was when I came in. We can change something for this year and maybe for the years that come in after we are gone.

He started laughing and said, "Okay. You've inspired me. I'm in. Now I want to fight against impossible odds for the little people. I hear orchestral music swelling in the background. We will not go quietly into the night!"

Without missing a beat, I joined in quoting, "We will not vanish without a fight! Today we celebrate our independence day!"

Laughter aside, this is a potentially sticky situation. If we don't handle this VERY carefully, we will piss off someone with enough power to try to retaliate.

Yet, my recent level up in confidence, self-respect, and anger retorts to me, "So what?" And after thinking about it for a bit, it's right. I'm damn good at what I do. I honestly dare any of the faculty to do as good a job as I'm doing with the scheduling. And...I have multicolored hair. I brought a guy who wore a kilt to a work function. Obviously, I'm not particularly afraid anymore. And I think I'm in good enough standing with the rest of the faculty that she can't retaliate against me as a group.

I'll gird my loins and see how it goes.

one down!


So I've been chipping away pretty hard at the integrative medicine curriculum I'm doing. I have a three day weekend this week and spent a lot of it recuperating, cleaning, doing geeky things, doing artsy things---my usual neurotic geek routine. But because I had the extra time for me, it also gave me the motivation to do some of the bigger projects I've been putting off. Namely, a few air-dry clay and paint crafts that have been on my list forever, and to hammer at the integrative medicine. I did four modules this weekend, which put me well over the amount necessary to take the exam.

I've been dreading the exam because I've been doing this module all year and I can't remember half of the stuff I learned. I also didn't know much about it other than it is multiple choice and timed. I also get three attempts at it. But after completing about 85% of the modules, I had an impulsive moment of "fuck this, I can do it! Let's use the first attempt and see where I stand."

I finished it in less than half of the allotted time, and passed it on the first try with 88%.


The awesome thing about this---aside from finishing a big responsibility---is that I still have access to the material for the next year. Which means I get to continue reading through the modules and learning new things, not because I have to study for an exam, but for the purposes of actually learning. Holy shit! I'm not sure how much time I'll have between being chief, studying for boards, and thinking about a job, but hey at least the option is there.