Monday morning

It’s a Monday morning and I don’t have to drive my daughter to school — glorious professional development day; a little taste of freedom. She will be tucked away at home with her dad, and I can take my time, unencumbered by the drop-off deadline. This morning, the world of hematology/oncology can wait, and I decide to do something for myself. I have been a little low lately. Maybe I have broken my own cardinal rule and stretched that intention to take time off every three months. Maybe it’s the work politics that linger after a few long weeks. Maybe it’s too much time on the rectangle of existential crisis (my favourite recent description of my cellphone). Whatever it is, I decide this morning to start the week off right. First, grab a book and dig in (good for the mind: check). Sweet relief. With the sounds of the ocean playing in the background, I find peace and contentment, getting lost in someone else’s story.

My morning escape is punctuated by visits from my nine-year-old son — snuggly in his fuzzy “daytime PJs” for today’s PJ and movie day at school. He just wants to cuddle, like he does every morning, and every night, and every afternoon. His love is sweet and occasionally suffocating, but ultimately precious. I check the time — still only 7:45. My husband has the morning routine under control and my body is feeling jittery. The morning coffee worked a little too well. What the hell — it’s still early and I don’t have anything scheduled; let’s do some yoga.

I head upstairs and pop my hair into a ponytail. I look forward to feeling those aches ease as my muscles stretch, warm up, and revitalize. My body starts to hum, and my mind calms. What a great morning. This is the best I have felt in weeks. Today I’m just going to take my time at work and focus on me. I’m going to try and find this moment of joy more often, I’m —

Buzz

My watch vibrates. Even as I am coming out of downward-facing dog, I look and see the text message. “______ is in the ICU.”

I curse out loud — swearing is therapy for me. I remind myself that I’m not on call. This notification is just for my information, a well-meaning teammate assuming that I want to know what is happening with one of my toughest patients. I do not have to jump into action right now.

I try and finish the last breathing meditation of my yoga workout, but the moment has passed. A heaviness begins to settle into the pit of my stomach. I have been doing this work long enough that interruptions by themselves don’t necessarily pull me out of the moment, but as I see this message, my first thought is, “I should have admitted him.” It passes through my mind as naturally as taking a breath. It was one of the hundred decisions I made last week, but now I question it. Then I question my efforts to find balance in my work. Did I spend enough time making that decision?

Anxiety has been my life companion, though I often didn’t recognize it. It masqueraded as that internalized need to control. It hid in plain sight, as my desire to go above and beyond to achieve perfection. Ironically, these were qualities that I and others often viewed as strengths — even keys to my success. I used to joke that if I treated my anxiety, I wouldn’t be as good a doctor. I was so young and arrogant. In retrospect, these exaggerated tendencies, fuelled by anxiety, held me back and contributed to my burnout. Ironically, I will be forever grateful to the anxiety triggered by the COVID-19 pandemic. This extreme discomfort finally broke through my denial and forced me to seek treatment. Before starting my blessed SSRI, I would ruminate over decisions. I would weigh every possible outcome, trying to make a perfect decision. In the business of medicine, perfect decisions, perfect outcomes, are not possible. Control is an illusion, a truth that tortured me as I desperately tried to make a perfect decision in those pre-SSRI days. Now decisions come faster and with more certainty. The anxiety takes the back burner and allows my clinical judgment the freedom to do its job. I trust myself more, and with that freedom has come a concerted effort to put myself ahead of the work.

But this morning’s interruption has unleashed a wave of self-doubt about my journey as a practitioner. In my attempts to protect myself, my time, and my life, have I become too clinical and detached? Has the pendulum swung too far? Is it a good thing that I can experience the news of a negative outcome for a patient and not assume that I did something wrong? My chest begins to tighten.

I go to the computer to see if I can find out what happened to my patient. Details are sketchy. I try to call the ICU but the nurse is busy. So, I take my inner monologue and head out the door, determined to fix the error of my ways. It’s time to get back to some of that hyperfixation.

I chat with my mom on the way in. The tightness eases as we talk about normal, everyday things, allowing a little perspective to sneak its way into my ruminations. Suddenly everything feels a little less weighty. On the walk from the parking lot, a funny podcast keeps me company. The distraction is effective, and a little more balance finds the back door into my thoughts. But as the hospital looms, my mind shifts back to self-doubt. It’s time to go to the ICU and start my new resolution to be all in, all the time, again.

Providentially, I arrive to a ray of hope. My co-worker is already there and, as the on-call physician, this patient is her responsibility. As usual, she is competently and confidently handling everything. I realize that no one needs me desperately. I can feel the weight lift off my shoulders as I watch her bustle about and hustle me off. She knows this one was hard for me and, somehow, she knows my secret intention of giving a piece of myself again. She is having none of it. She updates me on what happened overnight and reviews the plan for the day. She has the torch right now and is running with it. I don’t need to worry. Message received — almost.

I still have a niggling thought that I could have prevented this. Our nurse practitioner stops by. She was directly caring for our patient last week. He was fine. There was no reason to admit him at that time. Everything that could be in control was under control. Another competent and confident woman with whom I share this burden.

I sit in my office and wonder why I keep doing this to myself. Why can’t I trust my instincts? Why do I inhabit a space where I consistently look for fault in myself? These questions do not have easy answers, and they won’t be resolved today, or perhaps ever. But at least for today, I can let go and return to enjoying my life.

For months, I have stared at these words, looking for answers. Finally, today I had an epiphany. There is no final resolution — only progress. For me, reflecting on this experience has concretely exposed substantial barriers to my wellness. I identified my perfectionism as a manifestation of my anxiety. I saw with clarity how my own thoughts and beliefs were toxic to my wellness. I identified the supports and realities around me that challenged my false beliefs. Now I had something specific — and, even more importantly, within my power — to work on. We live and work in a world where so much that affects our life is out of our control. For me, seeking wellness must focus on the things that I can change, and self-reflection is the tool I can use to identify them.