The Green Me

Today is the last time I will post the end of year musing as a resident.  Next year this time I will be 6 months into my new job.  Not a resident anymore.  This is like growing up all over again and it is exciting and scary.  Last two months of my absence have been pretty eventful.  I finally achieved Nirvana and by that I mean that my 4th year has set into lower gear and cruise control.  Of course PRITE is over forever and from this despair that started this blog, to this less desperate slightly happier mention of scores, to a complete absence of any update on scores this year, things have certainly changed for the better.  In honor of my original post, let me just say that, I did really well this year.  I have moved from the lower ranks to top 5 scores in the program.  I think that is enough said about the dearly departed.

I can finally read, have time to see patients as often as I need to and have taken more therapy cases.  It's actually really fun to be a 4th year.  I completely agree with myself about what I said here regarding transition pattern in my posts.  Clearly I know myself, Yippee!!!

This gives me perspective about my anxiety with change.  When I get anxious and feel pressed for space and time, it means I will eventually get over it and on top of it.  This shall pass too, never sounded more relevant than in the past 3.5 years.  I look at the new interns and nostalgically remember my green, struggling self as an intern.  It seemed like it will never end but it did.  I remember the weekend calls and pager beeping, inpatient grind and off campus rotations with early am rounding with coffee in hand.  Part of me misses that intern because of how protected I really was and never realized it, until after the fact.

Then came second year and being the chief.  Again another green year because I was the "chosen one", the one with the invisible cloak etc., etc., etc.  I had to grow up faster than others and at times had to do it alone.  Being the oldest in my family, it just felt natural to me; until I wasn't the chief anymore this year and actually got to have less responsibility.  It is nice.  Part of me misses that green chief as well because of how she reshaped the more pedantic parts of herself/me and I never realized it, again until after the fact.

My 3rd year came and yet I was green once again, out patient!!  "I got this." I told myself when I started 3rd year, even though I had no idea what I was doing.  I knew I loved therapy and boy did I push myself.  At one point, I had 15 regular therapy patients and I was pressed for time in supervision to get consultation on all of them.  The best part of having a heavy therapy load was the decision to have my own therapy done.  I went through ups and downs of 3rd year, hanging on to my soft place to land namely, my therapy and my supervision plus my own office because let's just face it, frame matters.  I sat through sessions, my own and my patient's.  My emotions ranging from confusion to clarity, annoyance to enjoyment, sadness to happiness, anger to delight, scared to bold and then there were times when there used to be nothing.  At times, I miss that brand new 3rd year resident trying to be a therapist, because of how she pushed herself despite her doubts and stuck with it.  I just didn't realize it, until she wasn't there anymore.

So here I am, only 6 months left to graduate and knowing what I will be doing after graduation.  As I look back at years in my training, at every point, I see a part of me that had doubts, frustrations, anxiety, joys and changes, yet I was unaware of those at the time.  Sometimes things seemed impossible and sometimes it felt like an uphill battle that wouldn't let up.  But now I know that underneath it all, there always was a soft warmth of assurance and a sense of belief in what I did everyday; otherwise residency can be quite a jading experience.  Those of us who can hang on to that warmth and belief in our capacity to go beyond just "what is needed", tend to come out of this experience changed for the good.

We enter as interns but in order for us to be able to be on our own, grow up and do the job we signed up for; we have to accept the residency as a privilege and not a right.  Rights make people entitled, privileges make us humble.  Rights can be taken forgranted, privileges keep us on our toes.  Those of us who can admire that privilege in it's entirety, eventually come out better on the other side and that is my firm belief.

So as I say good bye to 2015 and wave in 2016, I hope to remember to be kind to my next green self in 6 months and take lessons from every past green part of me through these years.  I always come out better on the other side as long as I can keep my feet on the ground and head in the job.

So I will close with this,

“Drink from the well of yourself and begin again” — Charles Bukowski, (Author)

Happy new year everyone!!!

Final Chapter

I just completed the seemingly mundane task of updating my signature for my work email on my iPhone.  For many this may be an unnecessary task or a head scratcher as in "what?" or "you have a signature in your email?"  For me however, it's not.  My email always has a proper intro and a formal ending with of course what else but my always up to date signature.

Today is the last day of my 3rd year of residency training.  End of so far the fastest year of my residency.  I am slightly shocked by how fast this year has gone by and now as of tomorrow I am a PGY-4.  Next year on this day I will finally be done with my training.  So many emotions go through my head when I think of where this year is headed.  I think I don't want to think about it for a few months.

My signature update included changing my PGY-3 designation to PGY-4 and most importantly removing the "Psychiatry Chief Resident" title from the body.  It was a mix of nostalgia, sadness and slight sense of relief.  I am not the chief anymore.

I won't be getting dozens of emails about millions of different little things that I used to do from schedules (until I did them) to class schedules, to putting out little fires here and there, to big things that happen in every group that has 20 different adults of various ages and personalities, to many emails that I had to write to ask for this or that to be done.  I am not doing the orientation this year nor am I responsible for anything else chief residents have to do.  I mean there is no set job description as is and yup still no magic wand.  While I feel like I will miss the daily churn and the feeling of being needed that came with the job, it is probably going to be pretty nice to have a relaxing final year of training and being back in the middle of the group in the meetings rather than at the front of the room.

It is going to be a big adjustment because at this point I have more time as a chief in the program than just being a resident.  I am fully aware of this transition and that it will be a bit of struggle for me because I have a tendency to try to handle things when they present or take upon myself projects to handle things I think need handling.  My title gave me enough autonomy to do so while I was in the role, like figuring out patient hand off between incoming and out going residents or taking on updating our website or changing the ER rotation structure when I felt like it needed changing.  That is a place from where I have to mindfully step back and let the newbies get their feet wet and make their own mistakes and take up their own projects.

If I had a chance to do it all over again, I would probably do it despite of the frustrations and stresses and extra work it gave me.  These past two years also gave me a lot of experience to look back on and learn from my mistakes.  I am sure because of these two years I really want to think about what do I want from my life after this year is over.

I am finally ready to let the responsibility go and enjoy what is left of my residency training.  In the end as I edited my signature today to take my place back in the middle of the group, I realized that sometimes the seemingly little or mundane acts like hitting the backspace and delete keys are all it takes to take a load off and put up your feet.  Of course, it helps that now I am officially allowed to do so.
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As some one once said "Don't close the book, just turn the page."  so here I am and I think the final chapter is going to be the most exciting.  

What's In A Job?

T minus 19 days to APA MEETING - HELLO NYC !!  It is going to be a busy week starting with 75 years after Freud and then leading into APA conference plus the chief meeting, before I come back home.  Last year when I was about to start my chief year, I had the opportunity to go to TARRYTOWN for the chief retreat.  As I think about wrapping up one year of this job leading into year two, I cannot help but realize how I have changed in this job from one year to the next.  The natural progression from a newbie to a more confident chief has come on it's own terms and in it's own time.  It has pains and gains and moans and groans.  Well more groans and pains at times, but nonetheless there it is.  Part of this also comes from the fact that transitioning to a 3rd year is terrifying at so many levels that I can't help but be aware of the need to expand my vision, not only as a chief but also as a resident who in 2 more years; is going to be an independent physician and may be also an attending physician to work with new residents.

When I started last year and went to Tarrytown as a spring chicken, I had no idea how over the span of the year with all the experiences and events; I will have a totally different view of what my job actually is.  Rewind to this post and I see how much I have grown up in just four months as well.
While for the most part the post I referred to above still holds true, esp the part where I talked about my amazing residents and how much I love being around these people.  But I have also learned that I do have a role besides being a liaison between residents and the program.  I do play a role in decision making with my boss and I do have a role in working with him to ensure program integrity.  There are times when I worry about the lines of authority i.e. should it come from him or me?  At times it is a fine line but at other times I know what to do.  I do believe that managing physicians is a very hard task.  

By nature we are annoyingly narcissistic with the added necessary devil of the learned and mostly productive autonomy needed for our jobs.  I am sure I do not need to elaborate.  If I have to choose the hardest part of my job, I would choose schedules any day, closely followed by the every day resident issues specific to our setting.  But many of those issues are beyond my scope and fan my own frustration as well.  I have learned to pick my battles carefully just so I can keep myself sane.

Back to the oh so lovely schedules.  I have lost count of how many hours I have spent on creating, recreating and tallying call hours and numbers.  Sometimes I look at the folder on my desktop at home and I become nauseous because I remember nights when I have mixed up master tally with master master tally and DONOT ALTER tally and still have altered the tally even though it was named specifically "DONOT ALTER" in ALL CAPS.  I have it all corrected now but I have had close calls bad enough to give me a heart attack.  Part of me is very proud that I have kept the Tuesdays, Thursdays and Fridays, fair and square between all of us because for our call purposes those days really do matter a lot for every one.  I have anxiety regarding giving up the call schedule duties in a few months but I will get over it because I have to.

I have also learned that I have gotten better at having a thicker skin to criticism and have learned to really choose my words wisely.  I advice everyone who wants to be a chief in any residency training program, work on being careful about what you say.  You are under a microscope and you will need to be able to absorb a lot of anger directed towards you directly or indirectly.  You cannot make everyone happy, not as a resident and certainly not as a chief.  What I can do is, be fair and approachable.  People for the most are aware of your fairness and availability even when a few won't acknowledge it.  At the end of the day that is all that matters.

If you plan to hold the chief's office start to expand your vision from a perspective 2-3 years beyond your current training year.  I have been guilty of tunnel vision and not seeing the bigger picture because residency is tough, tough, tough but these years no matter how tough, are still protected by the shield the program provides compared to when you are out and about on your own and have to be responsible for all and everything.  I do realize now that people are positioned from the beginning mostly unconsciously but at time consciously to hold positions of responsibility, either by themselves or by their superiors.  So if you have inclinations of doing the hard job of managing your peers, position yourself maturely.  It helps.

What's in a job you ask?  The maturity, ability and willingness to go above and beyond what is needed to get things done and understanding that your role; should you pursue this path, is vital for your program whether you realize this or not.  It's not as much as being a good or bad doctor in this role but really about being able to be a manager/leader.  Being effective without being insensitive and being available without being a push over.  What I have really learned is to finally realize that I am not a union leader but rather a resource for both sides to work through issues and concerns.  What I am is really a position that is able to voice frustration, concerns, at times anger from my peers to my program with the intention to resolve that frustration, with handling issues that need to be addressed to diffuse the frustration.  But I do see now that a big part of this job will be to present better vision and goals to better the program and consequently ourselves as physicians and role models for the next generation of residents.

Here is a great piece to read regarding what other chiefs found out and learned about their jobs.  What chiefs learned!

Until next time I leave you with this thought:

A genuine leader is not a searcher for consensus but a molder of consensus.

Martin Luther King, Jr.

WWW.Brainyquotes.com

To Chief Or To Not?

I was reading a personal statement yesterday during the residency interviews.

"You don't choose Psychiatry; it chooses you."  Pretty deep right? 

Now this is exactly how I feel about being the chief resident.  It literally chose me while I was at my daughter's morning assembly one April in 2013, instead of being at the weekly Friday AM meeting.  Here I was taking adorable shots of my 1st grader singing and making videos because that is what moms do.  And then I got the text inquiring would I be interested in being the chief?  

This had to be a joke because the last thing I expected was to be handed the magic wand that I had imagined every chief had hidden under their invisible cloak.  If anything I was sure it was going to be the smart and fun AT to be named as the first ever PGY-2 chief for our group of croods, if we even succeeded having a chief from the 2s.    

Turns out my emails about wanting to do that and do this landed me in a hot pickle.  I used to think about, what my peers thought about my emails and I knew at least at some level they had to think "She has way too much time on her hands."  I admit that I am intense and as of yesterday I know for a fact people know that I am. Okay now if you know Dr. T, (No relation to Dr.T and the women, though Richard Gere has nothing on Dr.T in looks) you would know why I wanted to fall out of my chair, when he said that a particular applicant who we all liked reminded him of me because she was intense.  He is a man of a few words around residents for the most part.  I was kind of confused that he thought that.  Now I am hoping he meant it in a good way but I cannot be sure.  Darn you over thinking.   

Which brings me to the great part of being in this pickle.  The in between status of not faculty not resident, the Chief has it's own marination status.  Too tart to be a faculty and a bit more chewy to be a resident. Either way I want to assure everyone there is no magic wand and there certainly is no invisible cloak because if there was one, I would be unavailable at times for sure.  

Being a chief is like being a child who was suddenly allowed to stay up past bedtime from now on after the younger siblings have gone to bed.  It has it's perks when you get to find out John Stewart is really mad about the Pizza in Chicago and the reality shows on Bravo are really so good for one's self esteem but it also makes you at times miss the early bedtime and lullabies with the soft blue light in your room.  The great part of interacting with your faculty in a different capacity and finding out that they are not really that scary along with the painful knowledge of the fact that some people really are very hard to work with and there is no magic wand to make them disappear, it is an experience in it's own.  

Match season has it's own pains and gains.  It's the behind the scenes look that makes it all so incredible and sometimes I can't believe I am a part of that elusive scene whose mysteries haunted 3 years of my residency search.  I have found that there are no mysteries just pure cut throat competition.  I was told that "Chief year is the loneliest year of one's residency" or "No matter what, all chiefs are A--h*les."  It had made me somewhat weary of being one before starting.  I don't like being isolated and I certainly do not like failing.  

More doubt came as a spring chicken at the Chief Retreat back in May where I was met with a lot of skepticism (in a nice way) and sympathy because of being the only rising PGY-2.  I learned to make my year of training "a need to know" fact pretty fast just to avoid other chiefs trying to find horns sticking up my head.  I came back home quite defeated and literally considered walking up to the PD and telling him sorry I won't be able to do this.  But then I heard Phil Dunphy in my head "There is no Done in Dunphy" and I am not a Dunphy but I still listened to that voice in my head.  Yes I knew it was an imaginary voice, just so we are clear.  

Now at midpoint in my chieftain year, I do admit that it has been a stressful half year and I have fleeting thoughts of quitting next year but I have a Dunphy at home too.  I know he won't let me quit if the early bedtime group won't decide to harness my late bedtime.  I have no idea what they will decide but my half year has been anything but isolating and I don't think my peers think that I am that other thing I was told all chiefs are.  But then again I work with an insanely wonderful group of residents.  I think angels sing when we are all together or at least they want to sing.  I think the envy gods of chief town get green in the faces when I feel anything but isolated, well for the most part.  Okay well I do feel isolated when I make the call schedule and when I have to ponder for hours on the tally sheets just to keep track of all the call numbers but that comes with my territory.  If I get to wear the big girl pants, I have to keep the spiky itchy belt attached to the pants with superglue.  

To chief or not to chief is not merely because it is a feather in one's cap because it definitely is a feather and very colorful one from a distance.  But it also is at times a difficult task of being a reliable human bridge between the program and residents and no matter how many times it is crossed there will always be some people left on the either side who won't like the bounce or distance the bridge had to spread.  Nonetheless at the end of the day if you are able to make them believe that the construction is sound and the bridge won't fold when the either side needs it to be there, they will walk you and walk you with camaraderie and care.  

That is the essence of being the chief and that is what should drive the decision to be or not to be.