Heartbeats and Rainstorms

Family Medicine / F / new attending Blogging about military medicine and general nonsense Obligatory disclaimers: Talk to your own doctor for medical advice, not a stranger on the internet. This blog reflects my personal opinions and experiences and by virtue of that does not necessarily reflect the views of the military or DoD.

[heardatmedschool]

Medical Intern: Actually Medical Technology was my first choice when I graduated high school.

MT: Why? Did you think your grades were too low for medical school?

Intern: No, I was just scared of people.

what is a medical technologist?

[pharmdup]

I love medical students, I love physicians, and it’s also genuinely funny to me how often they’re perplexed by people who work in health sciences are like, “why didn’t you go to medical school? You’re so smart and driven!” I do know it’s a compliment. It never makes me mad.

Honestly the thought never crossed my mind. Why ask me why I didn’t go to veterinary school or like idk podiatry? It never crossed my mind.

Actually, I just now decided I’m going to ask them why they didn’t go to pharmacy school. “You’re so good at chemistry! Why didn’t you go to pharmacy school? Save yourself a year or two of residency!”

[heartbeatsandrainstorms]

Yeah, I did my undergrad at a school where most of the students were in the pharmacy program. I took a large portion of my classes with the pharmacy students. I can confirm that even under these circumstances, the notion of me pursuing a pharmacy degree would've been a foreign concept. I just...wasn't interested.

[heartbeatsandrainstorms]

I feel compelled to share this quote from a podcast I was listening to earlier today, which so delightfully describes life with ADHD for those of us who compensated and went undiagnosed and untreated for much of our lives:

"If we are not on top of things, then everything will fall on top of us."

[heartbeatsandrainstorms]

In the most recent episode of "Everything Keeps Going To Shit", after talking to someone about the latest shitty thing, I came to a kind of relevation that felt weirdly groundbreaking:

Self-worth and self-love are two vastly different things.

Things have been shitty in so many ways, and I often feel like I'm to blame for my problems. That I just need to Do Better, to be better at All The Things, and the fact that I can't just do that makes all of my problems all my fault. This is...obviously not a recipe for self-love. As a general rule, I neither like nor love myself...most of the time. In fact, I may fucking hate myself 98% of the time. But I realized...despite that, I know my worth. And because of that, other people's opinions really only can matter so much. Even so, there are a hell of a lot more people out there who do value me, and that also means something.

I'm fairly certain that at various points in the past I neither loved myself nor had any sense of self-worth. So I'm not sure where this came from, or when it came to exist, but I'm fairly certain that this is the biggest reason that I'm still managing to power through life these past several months without completely breaking

[heartbeatsandrainstorms]

My nonstandard med regimen continues to be a positive thing. I don't trust that my brain will continue to respond well, but apparently my psychiatrist does. Either that or he's happy to take every win in my case and run with it.

[heartbeatsandrainstorms]

After I got diagnosed with ADHD in residency, I had a brief but glorious period of time were I was on meds that were incredible and made it seem like life was on easy mode. And then they stopped working.

It's been a struggle since, and I've trialed so many medications and combinations of medications. And nothing has made me feel like a functional human again. But I was started on something new, and for the last three days, things have been improving.

I'm so afraid that this won't last, that it's just a coincidence, that I just happen to have had a couple good brain days and that before I know it, I'll be right back where I started. Or worse, that it'll only work for a short while the way the first med did, and then I'll be back on a downward spiral of not functioning.

But for now, my kitchen is the cleanest it's been in months, I've cooked myself actual meals today, I've almost cleared off my table so maybe I'll be able to eat at a table like a normal person, and there are a few other things I could do tonight that could make additional improvements, and I both know that they're easy and think they'll actually feel easy.

[heartbeatsandrainstorms]

Long time, no tumbl.

2023 has been a trip, and not in a even sort of positive way, and I don't think I've ever had a year that has been as bad for my mental and physical health. And it's been professionally shit too. I'm not one to wish time away, but at this point all I can do is push through the last couple weeks of this year and hope that 2024 might be an improvement.

[heartbeatsandrainstorms]

Sometimes- even as an adult- you just gotta make yourself a sticker chart to get things done

[heartbeatsandrainstorms]

PSA as a follow up to the last post:

if you show up in the ER saying you've had multiple episodes of an arrhythmia for at least 8 years, have correctly identified it yourself, and saying that no, you have not ever had it worked up or sought any kind of medical attention for it, most of the people taking care of you will NOT want to believe you.

[heartbeatsandrainstorms]

Work has been hard. My job is designed to make me fail. As a result, I've been doing a shit job taking care of myself.

Not taking good care of myself apparently exacerbates a cardiac issue that I've been deliberately ignoring/self-treating/pretending doesn't exist for the past many years. I've been increasingly concerned about potential failure of my usual mitigation strategies over the past 1.5 years or so. Well, that happened recently, earning me an ambulance ride to the hospital, an overnight stay, and a lot of shade being thrown at me pretty much every other doctor taking care of me. Cannot blame them for the shade, though. I absolutely earned that shade and probably would have done the same in their position.

[heartbeatsandrainstorms]

Guess who's got two thumbs and a single digit ferritin?

So uh... that is probably part of the fatigue issue.

[heartbeatsandrainstorms]

Last week I finally got in to see my new doctor after moving several months ago.

The poor guy got hit with the mess that is my chronic exhaustion/burnout/ADHD that seems mostly resistant to treatment and therefore makes me question the diagnosis even though I clearly meet DSM criteria.

I kind of went in with an agenda of wanting at least some lab workup even though I'm pretty damn sure most of my problem is garbage sleep, garbage diet, inadequate exercise, and burnout/moral injury. All of which obviously can exacerbate ADHD. He agreed on getting some labs and also readdressing meds.

I think I caught a flash of relief on his face when I told him I'd already made a separate appointment for a week later so we could talk meds/plans after we have more info.

It was like...dude, we work in the same broken system, I'm just doing what I wish everyone would do and making separate appointments for separate discussions

[depsidase]

[heartbeatsandrainstorms]

I hate to break it to you all, but it's far worse than 23 birds.

The additive nature of the gifts with each subsequent day means there's 1 day with 1 bird, 1 day with 3 birds, 1 day with 6, 2 days with 10 birds, 1 day with 16, and then 6 days where 23 birds are gifted.

If I've done my math right, that means a total of 184 birds were given over the 12 day holiday.

[heartbeatsandrainstorms]

The burnout has been real. I've been dropped into a job where I do not feel that I have the skills or abilities to do all the things that I need to do all at once. I could do any/all of the things individually, but I'm either being asked to do the impossible with all the things I'm being asked to do all at once, I do not have the requisite experience to do all the things, or I do not have the executive function to do all the things at the same time. Or I could theoretically do it, but I'm too burned out to be able to.

Or some combination of the above.

Trying to figure out how to recover from the burnout to even begin to be able to sort out the rest.

[heartbeatsandrainstorms]

Pretty sure I'm establishing myself as a giant weirdo with my new coworkers due to preferring to bike everywhere rather than get a rental car while I'm working out the logistics of car acquisition with relocating.

I'm using a borrowed bike, which is mostly fine, but holy shit do I miss my bike. Also the standover height is too tall for me, so it's a good thing I'm not AMAB, because it's hard enough not to accidentally hurt myself without external gonads). But I also keep landing in decision paralysis territory regarding acquisition of a new bike.

Do I need a second bike? I've decided that answer is yes. Do I want a full on commuter bike (fenders, not built to be particularly speedy so more upright positioning/more of a stepthrough frame, rack/basket/panniers for transporting stuff), or a road bike that I retrofit the standard commuter things onto? Or do I keep searching the online listings for what I think would be the perfect solution (i.e. an older road bike which has had the retrofitting done already). Really hoping option 3 falls into my lap, but bikes go fast, and most of them seem to be too big for me anyway.

[heartbeatsandrainstorms]

Cell phone carriers holding use of one's phone hostage to an arduous unlock process is theft and should be made a legitimately criminal activity.

Change my mind.

[heartbeatsandrainstorms]

Today, self control looked like: refraining from sending the first draft of an email reply, rewriting after cooling down, then editing some more to change the tone from very spicy to more savory.

I think the recipient still caught on that I had Opinions.

[heartbeatsandrainstorms]

Hello self doubt my old friend

I know it's not a bad thing to send someone for specialty evaluation or other testing that is outside the bounds of what I can offer a patient at our facility

I also know that them arriving at a different diagnosis or eventually ruling out all the things I was worried about does not mean I'm a bad doctor

But shit...when they arrive at a diagnosis that doesn't even begin to make sense to me based on the history I got or that wasn't on my radar, it makes me feel like I must be an idiot or losing my damn mind