Treva Fights for Herself

[Treva]

*Emerges from the hole that is intern year*
Ermergerd guys.  Er.  Mer.  Gerd.  I don't even remember what happened the last month and a half.  I was on hospital floors, got a very bad cold and have been recovering ever since.  I have a few days coming up to breathe, so I can finally catch up here.

Today's post I'm going to reflect on what worked and what hasn't worked in the last 6 months, and update my Gainz

 

Happy body: 

Diet: Eat healthy foods most of the time

This is good.  I have expanded my definition of "healthy" to include complex carbs again, and to scale back on animal proteins.  I make healthy ramen when I need comfort food, and keep healthy quick snacks.  Also, I HAVE AN EGG COOKER!  I also bought an icing gun and I love making frosting roses.  

My new diet looks like:

Breakfast and midmorning snack: Tea with almond milk, banana with peanut butter.

Lunch and afternoon snacks: whatever the program serves us, roasted chickpeas for afternoon snack, trail mix with chocolate, and jerky as backup before workout

Dinner: boiled tofu with frozen veggies, peanut butter/ketchup/siracha sauce.

Dessert: frozen fruit with coconut yogurt.

 

Exercise: Do a form of exercise every day.

I think this good, although lately I have been counting sleep as exercise.  I think the one thing I want to change is adding more rest/recovery time.  I have been working myself to the bone, and sometimes I can't sleep because of that.

Where I am with all my exercises:

Lags: squatting 110 lbs, box jumps 27"/3 steps.

Arms: benching 65 lbs, 3 sets of 4 bodyweight tricep dips, 5x10 pushups, 5 sets of supported full extension pull ups (using resistance band)

Core: 5x5 of hanging leg lifts with my usual pilates.  

 

Happy brain: 

Intellect: do a form of studying every day

This is hard, but rewarding when I can get it done.  I have adjusted to doing practice questions during the week, review them on my days off.  I'm averaging 50-70% correct, which for a first pass is pretty good.  

I have also had to add in research time.  It's a different form of learning.  I would also like to add in reading more papers.  I haven't done this yet because I am not sure I know enough to apply it to my practice.  That said, I have to be a doctor sometime, might as well start now.  

Mental health: Spend some time on myself in some way, every day.

I am making sure I acknowledge that sleeping and eating healthy count, because sometimes those are the hardest choices to make.  I am also taking time alone in my own space to be alone with myself and remind myself of the positive qualities I have.  One thing I want to get better at is calming my sympathetic drive quickly so I can go to bed anywhere, any time, and not just when conditions are perfect.  

I have made lists of what I should do when I am different levels of not functional.  I wish I could have an app on my phone where I could press "I am feeling this" and have it feed me the thing on my list I need to do.

 

Happy heart:

Spiritual health: Meditate every day.  

I have been so so bad at this.  so bad.  But other things I have been doing include reading, tuning into radio or televised services when I can, and keeping Spiritual Stuff at the center of what I do.

Relationship health: Be better at sticking up for myself.

Things came to a head with my family and I stopped being able to hide and compensate for my roommate.  I care about my roommate, but I am not covering for them anymore.  I have also developed a few more relationships in my life, and I have been more forthcoming with expressing my needs and being honest with myself about how I am feeling.  

One area of growth for me will be to stop judging myself based on antiquated or unhealthy rules, regulations, and opinions taught to me by unhealthy people.  

 

Tomorrow I am going to think on and post about things I want to change based on my review of how things have been going. 

Good Consistent things to keep going

Diet: Is very good.

Exercise: is very good

Study: finally found a rhythm I can use

Mental health: improved self compassion

Spiritual health: being patient and taking what I can is good.

Relationship health: Good progress.  Work to do here. 

 

[Treva]

OK! So today I promised myself I would think about what changes I wanted to make to my routines to help me decide on main quest missions tomorrow.  

Diet: 

I promised myself I would try to keep off the four pounds I lost while being sick.  Which doesn't sound as healthy as I think it probably is.  I think my biggest enemy is cortisol and stress and not sleeping, which really is not a diet issue at all.  I don't have any real changes I want to make here.  I am totally comfortable eating the same thing every day.

 

Exercise:

I think I have already started making the changes I want to make (adding in parkour, doing more running).  If I have the time, I might go back to my light cardio of biking, since running and my body don't always agree.  

I do want to be more intentional about stretching at the ends of my workout.  And maybe adding in some roller time stuff?  My legs are really tight sometimes and it can be hard to get some rest when they hurt.

 

Study: I think it's just sticking to the practice questions, especially when the going gets tough, and taking some of my free time on my days off to review them.  I have been using my free time for Other Activities With A Human, which has been great!  But also not study conducive.

I want to read more papers and stay more up to date on the literature.  I don't know how to do this yet.  A paper every night would be awesome, but unlikely.  I should probably keep a journal of all the papers I've read and the main points, like I do for the books I read.

 

Mental Health: this is the area where I want to do the most work.  I am getting better at sleeping on command, and I am learning when I am good at sleeping (11P-7A, or 10A-2P), and when I am not good at sleeping (3P-8P).  So normal hours, exhausted from post call, but not when I need to sleep to be ready for night shifts.  Which means I have to learn how to do night shifts for a few more years before I can be an attending and sleep like a regular human.  

I am recognizing that my baseline level of anxiety is the biggest contributor to my not sleeping.  Also, not being tired.  I would love to be able to snap my fingers and have my body be in REM like that.  I might return to Nidra yoga again while I'm on vacation and rebuild that habit, in addition to building a meditation "base".  I'm going to use it like a chronic antihypertensive, instead of a labetalol push.  You know what I mean.  Yeah.  Doctor words. I'll keep looking for other deep sleep techniques.  the other thing I need to do is play music more in public and at home.  I did less of this, and then my brain went to pieces . There is a pattern.  It's called I am Musician Brain and It Need To Do.

I am also recognizing that I need to take steps to reduce my stress that isn't at work, because that is one of the only areas I still can control.  I am going to get a cleaning service, schedule a "check in" appointment with our mental health people if only to have it there for me if things go to hell in a month, do some decluttering and donating both at home and at my apartment, actually go see a doctor (I know, ironic).  I am recognizing that in most normal circumstances I am an emotionally healthy, perky, happy individual who is currently dealing with two stressful environments, and something Has To Give.

Right now the thing giving is Aggressive Decluttering and cleaning and Owning My Space Goddamit.

 

Spiritual health: meditation as above.  More practicing.  Always moar practicing.  And meditating.  That.

 

Relationship health: Not covering for anyone anymore is really important to me now.  My room at home and my apartment have gotten cluttered with Other People's Stuff and at some point, that is not my fault, not my problem, and needs to not be my responsibility.  At home, anything that doesn't belong to me is getting dumped in the respective individual's room.  My closet is half full of other people's stuff, and I'm happy to defend that clutter to my parents as that being what it be.

At the apartment, well, I'm doing the cleaning service.  I'm gonna.  

I think the most important thing I want to make progress on is not judging myself based on other people's opinions.  I get obsessed with am I pacing things right, have I gone too far, and I am forgetting that the person who should tell me that is me, and not my grad school friends or professors.  I want to be able to stop fighting myself, and that starts with not judging myself.  I want to strip out the bad brain worms that might still be around so I can enjoy the nice things that I have right now, for as long as they last.  

[Treva]

A few days behind, as always, but here I am.  Trying to figure out my main quests.  Yup.

I have been off my game since December.  I haven't been my usual calm, collected self in a while and I'm finally getting back in touch with that.  

 

Diet:  no main quests to change my diet itself, but I want to rearrange my kitchen, throw things out, and ensure I have lots of counterspace to do more baking.  I love baking, I hate that I don't do it more, and I discovered my limiting factors are proper equipment and proper space.  

Exercise: I've completely done away with ballet exercises, so an ABC model doesn't make sense.  So I'm going with an ULC-P model (upper, lower, core, parkour),  the main quest is to do Warmup-Weights-Cardio-Stretch every day.  Yup.  As many days as I can.  Because my off days have gotten filled with Other Things.

 

Study: Main quest is to complete the following 3 parts weekly.: 4 sets of 10 practice questions, read 3 papers and write them up in a journal to keep track of what I've learned.  

Mental Health: this is going to get a few side quests and 2 main quests

Side quest 1: make doctors appointments.

Side quest 2: make a cleaning appointment

Side quest 3: declutter and donate stuff from my apartment

Main quest 1: re-learn nidra yoga.  This week will be a bootcamp on sleep meditation.

Main quest 2: Channel my anxious thoughts into Active Relaxation, such as--yoga, journaling, swordwork, practice, beer and pizza with friends, videogaming.

 

Spiritual health: Main quest--just uber to church when I need to, ok

 

Relationship health: 

Main quest 1: spend time every day knocking down a self-judgement.  Meditation will be good for this.

Main quest 2: Practice the art of Letting Go by using the Active Relaxation in mental health main quest.

[Mistr]

Good plan on food, exercise and studying. You have a solid base in all these areas. Just minor adjustments to fit your current work schedule.

 

On 2/19/2020 at 8:11 PM, Treva said:

Mental Health: this is the area where I want to do the most work.  I am getting better at sleeping on command, and I am learning when I am good at sleeping (11P-7A, or 10A-2P), and when I am not good at sleeping (3P-8P).  So normal hours, exhausted from post call, but not when I need to sleep to be ready for night shifts.  Which means I have to learn how to do night shifts for a few more years before I can be an attending and sleep like a regular human.  

I am recognizing that my baseline level of anxiety is the biggest contributor to my not sleeping.  Also, not being tired.  I would love to be able to snap my fingers and have my body be in REM like that.  I might return to Nidra yoga again while I'm on vacation and rebuild that habit, in addition to building a meditation "base".  I'm going to use it like a chronic antihypertensive, instead of a labetalol push.  You know what I mean.  Yeah.  Doctor words. I'll keep looking for other deep sleep techniques.  the other thing I need to do is play music more in public and at home.  I did less of this, and then my brain went to pieces . There is a pattern.  It's called I am Musician Brain and It Need To Do.

I am also recognizing that I need to take steps to reduce my stress that isn't at work, because that is one of the only areas I still can control.  I am going to get a cleaning service, schedule a "check in" appointment with our mental health people if only to have it there for me if things go to hell in a month, do some decluttering and donating both at home and at my apartment, actually go see a doctor (I know, ironic). 

 

Stress and rotating sleep hours is a terrible combination. Practicing Nidra yoga is a good idea. Does melatonin work for you? That might help convince your body to sleep at non-ideal times. Playing music is a great way to deal with stress and make a happier Treva. Setting up people to reduce stress in your home and talk to for support are also excellent steps.

 

On 2/19/2020 at 8:11 PM, Treva said:

I am recognizing that in most normal circumstances I am an emotionally healthy, perky, happy individual who is currently dealing with two stressful environments, and something Has To Give.

Right now the thing giving is Aggressive Decluttering and cleaning and Owning My Space Goddamit.

 

Relationship health: Not covering for anyone anymore is really important to me now.  My room at home and my apartment have gotten cluttered with Other People's Stuff and at some point, that is not my fault, not my problem, and needs to not be my responsibility.  At home, anything that doesn't belong to me is getting dumped in the respective individual's room.  My closet is half full of other people's stuff, and I'm happy to defend that clutter to my parents as that being what it be.

At the apartment, well, I'm doing the cleaning service.  I'm gonna.  

 

Good for you owning your own space and standing up for it. I had a cleaning service with my roommates when I got my first real job. It was the Best Thing Ever. And I was just working a 40-hour-a-week job, not the insane hours you work. You are training valuable doctor skills. It makes sense to pay someone else to clean so you have more time and mental space to devote to your main goal.

 

On 2/19/2020 at 8:11 PM, Treva said:

I think the most important thing I want to make progress on is not judging myself based on other people's opinions.  I get obsessed with am I pacing things right, have I gone too far, and I am forgetting that the person who should tell me that is me, and not my grad school friends or professors.  I want to be able to stop fighting myself, and that starts with not judging myself.  I want to strip out the bad brain worms that might still be around so I can enjoy the nice things that I have right now, for as long as they last.  

 

You are an adult and a professional. You have proven that you have good judgement to get to the point where you are now. You have the skills to research areas of concern and make up your own mind. You do not need to rely on anyone's opinions. You can find out the facts for yourself. Go Treva!

[Mistr]

How are things going?

 

We last you checked in, you were working on keeping your sanity with your crazy work schedule. That was before the pandemic hit.

 

I'm betting you are working on the front line of the crisis. I understand you are probably too busy to do anything but eat and sleep during your time off. Just know that I am sending you positive wishes.

[Mistr]

Hi Treva!

 

I hope you are still hanging in there through all this craziness. You deserve a nice long vacation when things calm down.

[Treva]

On 4/1/2020 at 3:53 PM, Mistr said:

How are things going?

 

We last you checked in, you were working on keeping your sanity with your crazy work schedule. That was before the pandemic hit.

 

I'm betting you are working on the front line of the crisis. I understand you are probably too busy to do anything but eat and sleep during your time off. Just know that I am sending you positive wishes.

 

On 5/6/2020 at 10:14 AM, Mistr said:

Hi Treva!

 

I hope you are still hanging in there through all this craziness. You deserve a nice long vacation when things calm down.

Thank you so so much for checking in.  It means a lot to me.  I needed the positive wishes. I am sorry for being so unresponsive.

 

Swears and a Very Deranged Treva to Follow.

 

I was doing the challenges and then the pandemic hit.  I went from working in the ICU to working in our emergency department, hospital floors, and now I am back in the emergency department again.  So...front lines.   I am not in NYC.  I am still in a moderately to heavily affected area.  I am working in a tertiary/quaternary care center where we are taking care of the sickest of the sick.  

So.  typical day is get up, get my mask and ppe, go to the ED, swim in the air with god only knows how much COVID, walk into rooms where I have no idea if the patient's been properly triaged so you bet your butt I'm wearing my N95 to high heaven with ALL my bells and whistles I take NOTHING with me into the drift, and pray to god no one codes that shift because codes are a nightmare now.  

I am in a fortunate area where we have enough protective equipment that we can all do our jobs safely.  Right now, there is no risk of us running out of masks, gowns, gloves, or cleaning supplies.   We are all social distancing from our colleagues.  Instead of talking about the weather, we talk about how we decontaminate.

Doctors are living away from their families still.  Infectious Disease, Emergency Medicine, Internal Medicine (me), Critical Care Medicine, and Anesthesiology are the hardest hit specialties. 

It is both an incredible learning experience and a fucking terrifying apocalypse at the same time, so most of us are just trying to beat back our ongoing existential terror with the free food the hospital offers us sometimes.  Free stuff!  Totally makes the mortal terror of going to work every day go away!  

 

The biggest help is that I trust my PPE, and the people who manage it tell me I'm one of the steadiest and best educated about how to use it and how to clean it.  I'm doing the best I can, and that's all I can do.

 

Anyways, back to our regularly scheduled fitness programming.  I don't even remember what the fuck I was doing before, so here's the new plan.  

 

Food and Water: Groceries services have been down for weeks.  My hospital has started selling some produce, so I've been mixing up my extra free money for veggie based lunches and dinners with whatever frozen food I have left for dinners.  Eggs are a fucking staple.  Eggggssssss.  And fruits!  I've learned to get creative with my pantry, but I'm running out of veggies.  Mostly I've been "Whatever the fuck is going to get me through a pandemic". 

I have embraced grubhub.  I have no choice.

Still baking!  Made homemade marshmallows, apricot tarts so far.  Looking forward to making pokemon poffins today!  Took me a month to get yeast

Trying not to eat too much chocolate or candy.  Is hard.  

 

Exercise: Early on I invested in a bike and a set of bars.  I miss the barbell racks.  

S&S only with the 25, could not get a 30lb bell. May try to order one now, since it will be a long time before I feel like I want to go to the gym much.  Maybe I should get a scale too.

Arm:  5x10 pushups, 5x5 inverted body rows, 5x5 tricep dips

Leg: 3x5 one legged squats each leg, 3x5 skiers?  with resistance bands, 8 laps weighted squats 10lb KB

Core: pilates, combat.

I've started exercising before work, because when I come home from work I decon.  After that I don't really want to work out.  I like sitting on my couch with cooking shows and pretending the world isn't exploding.

 

Study: Basically, I've been researching COVID as things happen.  I try to read 1-2 papers every day, keep up with the numbers, and I'm on the chat with the crit care fellows trying to absorb the knowledge and get a sense of what they're seeing in patients.  I'll get back to studying at some point.  Like all I do is read the literature and try to keep the misinformation from entering my brainspace.

 

Spiritual Health: livestreaming services when I can.  I just got back into practicing.  It helps.  Just anything to get me away from work helps.

 

Relationship health: my human and I are still together.  It's nice.  I didn't expect it.  I have no idea how to tell my human how I feel.  I still overreact.  The pandemic is hard.  I don't do nights well.  I can't words.

Also going to stop going to therapy.  I don't need it.  My parents are spoiling me and supporting me.  I have a human.  I am reconnecting with friends.  The ones that text back are the ones that understand.  The therapist was not helpful and I actually feel better not talking to her. Maybe I'm ignoring my problems.  Maybe I don't care.  Or MAYBE I'm getting more confident as the year goes on and I make more of my own decisions, and it turns out they're the right ones.   It's started to happen.  It's cool.  I just needed to let myself take risks.

The human helps with that too.

I am having trouble being on the front lines, and being isolated from everyone I care about.  It is hard.  Going to work every day, facing something we know little about, and going home to decontaminate and prep for the next shift. 

 

tl;dr your local hospital doctors ARE KIND OF A MESS RIGHT NOW but we're fine, everything's fine, we're totally good, totally.  It's good.  We are the new plague doctors. That's not a scary statement or anything.  Nope.

[Mistr]

Wow. Just wow. So much wow in your post.

 

I am SO GLAD to hear that you are okay. I understand that the value of okay is shifted a long way from normal. You are hanging in there and taking care of yourself. That is awesome.

 

Thank goodness you have PPE and are using it like your life depends on it.

 

That sucks that grocery delivery is not happening in your area. Your hospital feeding your and selling produce some of the time is great. All the time would be better, but you take what you can get. With that in mind, no one is going to criticize anything you eat or don't eat. I'm eating way too much chocolate because of my pretty mild stress. I admire you not overdoing it on the candy and chocolate with your work on the front line.

 

Congratulations on finding a human to have a close relationship with! When things calm down I want to hear more.

 

You are doing awesome taking care of yourself, your patients and your relationships in a ongoing crisis. I am tremendously proud of you.

 

GO TREVA!

[Treva]

On 5/11/2020 at 5:05 PM, Mistr said:

Wow. Just wow. So much wow in your post.

 

I am SO GLAD to hear that you are okay. I understand that the value of okay is shifted a long way from normal. You are hanging in there and taking care of yourself. That is awesome.

 

Thank goodness you have PPE and are using it like your life depends on it.

 

That sucks that grocery delivery is not happening in your area. Your hospital feeding your and selling produce some of the time is great. All the time would be better, but you take what you can get. With that in mind, no one is going to criticize anything you eat or don't eat. I'm eating way too much chocolate because of my pretty mild stress. I admire you not overdoing it on the candy and chocolate with your work on the front line.

 

Congratulations on finding a human to have a close relationship with! When things calm down I want to hear more.

 

You are doing awesome taking care of yourself, your patients and your relationships in a ongoing crisis. I am tremendously proud of you.

 

GO TREVA!

I DO NOT DESERVE THIS.   

THANK YOU VERY MUCHLIES.

 

THANK YOU THANK YOU.

DOES NOT COMPUTE THANK YOU.

 

Okay has shifted.  Okay has definitely shifted.  I now have to live with baseline level of anxiety.  It is really, really hard not to overdo it with chocolate and candy.  I am very nervous all the time now.  It seems so silly to focus on my weight and diet, but I know my body will not be healthy if I do not take care of it.

 

I am also going to see a doctor for the first time in years for a check up.  Is it weird that I'm nervous?  It's weird.  I get white coat syndrome just like everybody else.  I just don't want to get shamed for not coming in sooner.  It's weird.  I'll tell myself it's fine, right?  It's fine.  It's totally fine.  Taking ownership of my body took a minute, and it's not like I wasn't ever going in to see a doctor and I didn't have vitals taken in the last never, it just wasn't for a straight up physical.  I am fortunate enough to have health insurance that I can use.

 

The human is great.  I am very fortunate.  I can talk to them about anything, and I should probably just PM you or something like a proper human.  

 

Today I am tired and torn between I need to do All the Work and also I am So Stressed I need to Not be a Huge Fehkin Ball of Anxiety and Inflict my Horribleness on All Other Humans.  I will try to address both tasks.  But for now, temp check and try to get myself to breathe a little bit.

[Mistr]

You totally deserve all the credit for the work you are doing.

 

Here, have some fluffy bunnies:

 

I took some time earlier this week to read about angora rabbit color genetics to destress. They are cute, calm and fluffy.

 

Good for you for going and getting a physical. Baseline data is good to know. I do a Know Your Numbers health assessment every year through work. The first couple times weren't that helpful. After a few years I could see trends. Those are good to catch before they become problems.

 

I hope you get some rest and destress so that you can do what you need to do. Give yourself a break on the rest of it. There are lots of things that don't need your personal attention right now.

[Treva]

Thank you for the bunnies!!!! I should make something fluffy as my background picture on my phone.  It will keep me from being stressed.  That is such a good idea.

 

On 5/15/2020 at 12:45 PM, Mistr said:

Good for you for going and getting a physical. Baseline data is good to know. I do a Know Your Numbers health assessment every year through work. The first couple times weren't that helpful. After a few years I could see trends. Those are good to catch before they become problems.

 

I hope you get some rest and destress so that you can do what you need to do. Give yourself a break on the rest of it. There are lots of things that don't need your personal attention right now.

IT was a good idea to get the physical.  Nothing is wrong, but now we can get a baseline for everything and make sure I can stay healthy.  

 

I have been doing a lot of resting.  A lot of sleeping.  I even made myself a cocktail the other night.    I am still trying to be on top of things, like I have a presentation tomorrow and still have some days in clinic, but I really needed to slow down and find things that calm me down again.  Apparently it's interior design and parkour thoughts.

 

Training: Looking into buying a 30 pound kettlebell and some training gloves that protect my fingers.  The bars I have at home are ok, but they don't substitute the pull up bar at the gym.  I am thinking I should try pulling myself up onto other things.  I realized that I am losing my motivation to work out, especially since I have been so tired.

I invested in getting a 30lb kb eventually, and some gloves that cover my fingers.

Parkour Stuff: I have reviewed the parkour for beginners, and I think I am ready to try again.  I can practice landing properly and step jumps in my apartment.  When my gloves come, I can go outside and find somewhere to practice safety vaults and muscle ups..  I will also practice going out running in my cheaper glasses, so if they break it is not a problem.   Parkour and combat incentivize me to work out, and I need to make time for those things.

 

Eating: I was able to get out and get more fresh fruit, and I had a lot of veggies delivered.  Is it boring right now?  Maybe.  Can I make it less boring later?  Absolutely.  

Sleeping: Going remarkably well.  Warm milk and melatonin all the way.

Music: I have not done as much intensely of this as I am used to.  I have been doing some fun stuff to keep me sane.

Spiritual: going to mass virtually every week.   

Studying: I have been working on some things for work, but other times I am too tired to do much of anything.  I have wanted to start my pharmacology review for a week now, and perhaps today I will finally have time.

Mental health: still seeing a therapist twice a month to make sure my anxiety is not badonkabonkers.  I think the relationship I am in currently has a bit of extra stress.  I do not know how to make it less stressful.  It has been very hard to be motivated at home to do things.  I have been extra sad more days of the week than usual.  I do not know why.

I have been watching movies I have wanted to see but never got the chance to, and trying to play a different video game every day.  

[Mistr]

I'm glad that you were able to get fresh fruit and veggies. Boring is not the worst thing if you are eating food you like. I can eat strawberries with yogurt and granola for breakfast every day in the spring and not get tired of it. (Or I could until yogurt started to give me gas  ). 

 

Figuring out alternative exercise that you will really do is challenging. Yes, there are lots of things one can do at home. That does not necessarily make them appealing to do. I have been struggling with this too. I'm impressed that you are using a 30# kettlebell. I just did my NF beginner's circuits with a 10# kettlebell this morning. I can do it with the 15# bell, but that was more than I could face at the crack of dawn.

 

Which exercises do you do? Or I should say, how did you start, since I am new to kettlebells?

 

Having an outside person to talk to about things in your life is really valuable. Your work situation would be stressful under normal circumstances. What we have now is the definition of abnormal. Plus you are in a fairly new relationship. There are always things to figure out, and that is stressful. I'm guessing here, but I wonder if you maintain a professional demeanor at work, so your emotions about the things you observed have to wait until later to come out. Somehow I don't think everything has been happy with your patients.

 

You are doing reasonable things. Hang in there, this will pass. I hope you get to take a nice vacation when we get to that point.

[Treva]

On 5/19/2020 at 2:10 PM, Mistr said:

I'm glad that you were able to get fresh fruit and veggies. Boring is not the worst thing if you are eating food you like. I can eat strawberries with yogurt and granola for breakfast every day in the spring and not get tired of it.

It's funny you should mention that, I have been doing a strawberries and cream oatmeal for the last several weeks, and it is never not delicious.  I love doing stir fry, so maybe I should work on upping my peanut sauce game.  

 

On 5/19/2020 at 2:10 PM, Mistr said:

Figuring out alternative exercise that you will really do is challenging. Yes, there are lots of things one can do at home. That does not necessarily make them appealing to do. I have been struggling with this too. I'm impressed that you are using a 30# kettlebell. I just did my NF beginner's circuits with a 10# kettlebell this morning. I can do it with the 15# bell, but that was more than I could face at the crack of dawn.

I absolutely noticed that this morning when I decided to lay in bed for an hour instead of doing my core exercises--which I love--but also my body is so tired.  I am glad I am not the only one struggling.  I will need to work on motivating myself, because I will always be tired and always need more time in bed.

That circuit still looks intense,  I would not want to try it out of the gate with my 25 (which is more than I can face in the morning a lot of the time too).

 

On 5/19/2020 at 2:10 PM, Mistr said:

Which exercises do you do? Or I should say, how did you start, since I am new to kettlebells?

So @Kishi is responsible for my picking up the kettlebells, and I started (and still do) Pavel's Simple and Sinister.  I have yet to meet the weight goals he suggests, but I still continue to do them.  It consists of 5 sets of 10 kettlebell swings per arm, and 5 turkish getups on each side.  I do it as a warm up before I do my other strength training and cardio . 

 

On 5/19/2020 at 2:10 PM, Mistr said:

Having an outside person to talk to about things in your life is really valuable. Your work situation would be stressful under normal circumstances. What we have now is the definition of abnormal. Plus you are in a fairly new relationship. There are always things to figure out, and that is stressful. I'm guessing here, but I wonder if you maintain a professional demeanor at work, so your emotions about the things you observed have to wait until later to come out. Somehow I don't think everything has been happy with your patients.

 

You are doing reasonable things. Hang in there, this will pass. I hope you get to take a nice vacation when we get to that point.

Yeah.  It has been the right thing to do to have one, just to have an outside perspective on when things are crazy...which is all the time now.

I do have to stay very professional at work, and my emotions do have to wait until later.  Thank you for the reassurances.  Things are changing.  They are kaleidoscoping, if that is a word I can use here.  The outward trappings are mostly the same, but I have a different perspective on them, and feel empowered to make changes if I want to.  

I took yesterday completely off, outside of the meeting I had to attend.  I did things I enjoyed, went for a walk, did not focus on the relationship, and found things to make me happy.  It was very healthy for me.  I will try to continue to do those things.

 

Thank you for the reassurances.  They help.  I would love a nice vacation.  

 

 

 

Diet: Back on track with some meal prepping.  And slightly off track with baking.  I am hydrating, eating fruits and vegetables and lean protein.  

Exercise: I am using habit bull again.  I have now gotten myself to KB+Cardio+Stretches+ pick one of the following: Arms, Legs, Core, Parkour, Combat, Yoga.  I know I cannot keep this up on floors, so I am making sure I meet a minimum of KB 4x/week, and cardio 4x/week.  It allows me to skip some mornings if I can't wake up that early, and components of Core and Yoga can be done in the afternoon after work.  I found a good video about how to start doing vaults, and I am practicing at home for now.

The reason I am changing all this is because I now have to shower immediately when I come home from work for decon reasons.  I kinda don't want to get sweaty after that.

Sleep is good.  Emotional well being is improving.  I am making my own decisions, for myself, and this is causing me a little angst but overall less stress

Studying: I started my pharmacology review, and I've worked on question banks.  I have been less great about keeping up with the covid literature.  

Mental Health:  I have been much better over the last few days.  I had a success at work, and my end of year review went well.  I took a long walk today, and have been doing lots of resting.  I am realizing how important rest is for my mental health, and not just for intellectual functioning.  I knew I got cranky, but I get very mopey, I start to split on people, and I interpret things much more darkly than they are intended.  I'm glad I've learned that about myself right now.  I have taken time to cry and be with myself, which has cooled off my brain.

 

[Kishi]

17 hours ago, Treva said:

So @Kishi is responsible for my picking up the kettlebells, and I started (and still do) Pavel's Simple and Sinister.  I have yet to meet the weight goals he suggests, but I still continue to do them.  It consists of 5 sets of 10 kettlebell swings per arm, and 5 turkish getups on each side.  I do it as a warm up before I do my other strength training and cardio .

 

So, to go ahead and give it some more context: there are weight goals and a time goal that are attached, but the system as Pavel designed it has been revised somewhat.

• The volume is 100 swings and 10 Turkish Get Ups a day, day in and day out.
• Swings are generally one arm, so 5x10 on one, and 5x10 on the other.
• Every 3rd day, you switch to doing 10x10 two arm swings to give your grip a break.
• Pursuit of the time goal is prohibited until you master the weight goal, meaning that even though you're hitting this volume day in and day out, you do so at a relaxed, easy pace. Easy pace is defined as passing the talk test - can you carry on a conversation easily? Then you are cleared to fire again.
• Weights are not allowed to go up until you hit 28 sessions/4 weeks and you've mastered the weight you're on. At that point, you add only a little - 2 sets of swings at the next half-pood up, one set of TGUs at the next half-pood up. (pood being the old term for the unit of measure before kgs; one pood = ~16kg). So if you're swinging 10x10x16 for the first month, the second month you switch to 8x10x16 and 2x10x24. The order goes 16, 16, 24, 24, 16... until completed.
• Rinse and repeat. Pavel allows for faster progression but generally advises slower and I bias the same.
• Once every 2-4 weeks, do something that tests your spirit without breaking your body (ie, run a 5K, help a friend move, run the Century Test, etc).

It's totally doable to hit this on a day by day basis, but truthfully if life is a little much, you could do this as little as twice a week and still get benefits. That's why I list 28 sessions as the total - you could technically start adding weight after 4 weeks at 2x/week, but that would be a comparatively faster progression which may be more than you're ready for, and it would fly in the face of the spirit of this kind of training.

 

It also can work as a precursor to other training, but be mindful that if you dedicate yourself to it and get your weights up, you might find yourself letting the other stuff go for a time.

 

Anyway, hi! Glad to hear that you're rolling with your situation and continuing to take care of yourself on top of taking care of others. That is Very Good. I can definitely respect needing to take some time to cry and let the storm come through. I'm glad it doesn't seem to last.

[Treva]

On 5/22/2020 at 2:19 PM, Kishi said:

 

So, to go ahead and give it some more context: there are weight goals and a time goal that are attached, but the system as Pavel designed it has been revised somewhat.

Thank you for the revised goals!!  These help a lot; I kept worrying about meeting the time goal before increasing the weights.  And the way he has weights progression makes sense; I had been doing something similar, but it's nice to have the formal structure.  And something to give my grip a break with!  I can use those on days when I don't have much time to get through all my reps.  

I have been doing it as my warm up for other training, since I am still at low weights and may never even reach the simple goal.  

I had never heard of the century test!  I will attempt it at some point.  

 

On 5/22/2020 at 2:19 PM, Kishi said:

Anyway, hi! Glad to hear that you're rolling with your situation and continuing to take care of yourself on top of taking care of others. That is Very Good. I can definitely respect needing to take some time to cry and let the storm come through. I'm glad it doesn't seem to last.

Hi!  Thank you for the validation!  I am trying my best.  It is very stressful, and there is a lot of messaging from our administration to put our own emotional and physical oxygen masks on first.  

The storms have not lasted.  I am one of those people who needs to let her emotions happen, sometimes in a Big Way, privately before they are over.  Acknowledge the feeling, know that I am not the feeling, but it has to happen, and then it will pass and the feeling is gone.

 

Happy Body: Diet and Exercise

Diet: I have been doing ok.  I have been indulging more in pizza (once a week) and dessert (every night), and should probably get back on the bandwagon and cut back.  I'm going to make english muffins and Minecraft Mushroom Stew before I start back on the units.  I don't have a fabulous lunch plan; I will need to see what free food is being offered, and if not where I can acquire healthy meals.  

Exercise: I have turned into a Morning Person, with early walks in the fabulous post apocalyptic landscape.  No mutant sightings yet.  Here is the schedule for this week

Monday: Legs (took a walk, then S&S, one legged squats, donkey kick/leg raises, weighted walking lunges, cardio)

Tuesday: Parkour (S&S, Run, step jumps, safety up/down legwork without vaults)

Wednesday: Core (S&S, cardio, hanging leg raises, side planks, pilates)

Thursday: Yoga (S&S, cardio, stretches)

Friday: Arms (S&S, cardio, push ups, arm rows, tricep dips)

Saturday: Combat (longsword drills only)

Sunday: REST

I'm setting a minimum of 4x/week cardio and S&S, knowing that these will be difficult goals to meet and that there will be no getting up early on postcall days.

 

Happy Brain

Intellect: I am actually through all the nitty gritty extras my program has assigned for us.  I'm back to question banks, pharmacopeia building, and following up on research.  I did an end of year review with my program director that was very positive, and I am looking forward to using that momentum to be a good team leader next year.

Mental Health: I'm asking myself to work on self-judgements every other day.  I should make a list of them, so I know what to work on.  I have also been practicing more, and I realized that the work of music is very similar to the work of meditation, where one is bringing one's attention back to the task at hand, and remaining in the present at all times.  This is a strength I did not realize could be applied to other contexts. 

 

Happy Heart

Spiritual health: I need to remember to meditate every day.  I think taking ten minutes before bed to stretch and meditate would be wise.  This also gets at mental health too.  I can set a timer at night so I remember to do this.

Relationship health: I have been alone in my space for a most of quarantine, and I realized how much certain things about living with my roommate really bothered me, so much that I don't want to go back to that way of living.  In the future, I think it will be easier to fight for what I want, because I now have what I want.

I am still in a relationship that in a big picture view is fairly new.  I still like it, and want to be in it, and will be spending some time working on how to be a better partner.   My reviews at work say I am an excellent communicator, so perhaps that is a place of strength I can begin working from.

 

Thank you everyone for reading and chiming in.  I like hearing from you.

 

 

[Kishi]

5 hours ago, Treva said:

Thank you everyone for reading and chiming in.  I like hearing from you.

 

We like hearing from you too.  Glad to hear that even on the front lines of this thing you're still carving out time to care for yourself. That life is still happening.

 

5 hours ago, Treva said:

I had never heard of the century test!  I will attempt it at some point.

 

Ooh, let us know how it goes if/when you do. It's a fun little 8 minute jaunt. Also, bear in mind, calisthenics folk love to set up arbitrary things like this, so if you should fail, bear in mind that it doesn't really mean anything.

 

5 hours ago, Treva said:

I'm setting a minimum of 4x/week cardio and S&S, knowing that these will be difficult goals to meet and that there will be no getting up early on postcall days.

 

That sounds wise. I would humbly submit that if you have to choose one thing to do on those days that it be S&S, just because it functions so well for general physical prep and if done in the prescribed manner it will still leave you with a lot of energy in the tank to get after what you gotta get after. Don't be afraid to let that be the only thing you do. Very often, it's enough.

 

It's your call of course and you know your situation better than us. Just wanna present options in case the days try to get away from you.

[Treva]

22 hours ago, Kishi said:

Ooh, let us know how it goes if/when you do. It's a fun little 8 minute jaunt. Also, bear in mind, calisthenics folk love to set up arbitrary things like this, so if you should fail, bear in mind that it doesn't really mean anything.

 

I certainly will!  I think I would feel bad if I couldn't do it, so thanks for telling me it doesn't matter.

 

22 hours ago, Kishi said:

That sounds wise. I would humbly submit that if you have to choose one thing to do on those days that it be S&S, just because it functions so well for general physical prep and if done in the prescribed manner it will still leave you with a lot of energy in the tank to get after what you gotta get after. Don't be afraid to let that be the only thing you do. Very often, it's enough.

 

It's your call of course and you know your situation better than us. Just wanna present options in case the days try to get away from you.

Thank you for the suggestion.  I actually always start my day with S&S, so if I do absolutely nothing else, I have done the one thing that helped me the most to get in shape.  

Today's accomplishment: I did my first moderate speed safety vault!!  I don't even need a supporting foot some of the time.   I felt so empowered.  It was awesome.  The gloves I got to protect my hands work great.  I may go through a few pairs of them, but I came back without any injuries.  I'm still working on my form, but I'm proud of myself.

[Treva]

Hoo boy.  It has been some time.

As always, want to thank anyone who has taken the time to stop by and read.  I appreciate you looking in on my journey.  I'm hoping to get back to looking in on everyone else's soon.

 

After my last challenge, I felt close to my baseline fitness level again.  I have been realizing that non-hospital months are good for returning to baseline or making progress.  Hospital months are for not losing ground.  

I have been working on cooking and baking more.  Specifically cooking.  I want to do more healthy meals for myself that don't just involve roasting vegetables.  

 

I have been using my anti-anxiety journal, which helps, and been doing a new thing where I post weekly goals for myself on the fridge.  I pick an internal and an external change each week, and try to meet them, instead of making big monthly goals for myself that can feel daunting and get overly involved and complicated.

 

External goal: tomorrow can take care of itself better if I prepare the night before: make espresso and moisturize.  

Internal goal: My talent is only as good as my last practice session.  I am worth it, therefore I practice.  And if anyone bothers me, my excuse is still "I can't, I have to practice."  

 

Other big changes include having gotten some confidence at work after surviving the literal actual worst calls of anyone in my year, realizing what I want in my relationships, and doing well on my last step exam!  My highest score yet!  So that was nice.  

 

 

[Treva]

So I have decided this is the only way I am living my life right now

 

 

I guess a check in to where I am

 

Physically: I am back on the fitness ball.  My weight is my usual stable.  I don't know if I am going to be able to lose more; my scale seems really erratic (I am +/- 5 pounds or more every day, which seems weird), and I might get a different one.  I am doing a lot more self care than I used to.  I am still doing mini vacations at night which have helped with sleep.  I haven't had a "sleepless night" since January.  Or maybe december.   Investing in my physical health and picking shut off times has been really good for me.

 

Mentally/Intellectually: I am practicing more.  I am also just stealing time on the piano at work after hours to do slow practice work.   I am not meditating as much as I used to.  I am also finding that working on my research projects counts as studying.  That said, I need to work on more physiology knowledge.  As soon as I crank through one last research project....

 

Emotionally: I have gotten through some challenging mental spaces surrounding my relationships.  I know what I want now.  Human and I need to talk, but human may not be ready for it yet.  I think I am as ready as I will ever be.  

The vaccination stuff was emotionally taxing because I felt judged for getting the vaccine earliest (1a as essential healthcare worker aka doc with covid patients) because I am young and healthy.  However, as things have opened up and more people are able to get their shots, I feel less judged.  

I also opened up to some colleagues and students about how we all don't have confidence in our work and how to combat that in a way that isn't "fake it till you make it".  We agreed that supporting each other and looking for ways to build on our experiences would make us feel the best and helped with our confidence the most.

Lately I have come across some of the most clinically challenging scenarios since my time on a critical care unit.  I had to trust my instincts much more than I expected to; and I was right more often than I expected to be.  I also faced my own "kobayashi moru" of medicine and did everything I was supposed to do; a little haphazard, but the fellow let me run the whole thing start to finish.  That helped my confidence.  I had to remember though that no battle plan survives first contact with the enemy; and yes, it was ok for me to be really terrified the first time doing this by myself.  But I still did it, and I know the next time and the next time I will be less and less scared. 

[Treva]

Gettin back on the scale and still being at goal weight like wooooo.  It's really nice to  see some progress.

 

Physical:   I am still pretty tired in the afternoons which has made working out challenging.  I'm always trying to keep my 30 minutes of cardio, even if I am too exhausted to do weights.  I finally broke out my 30lb KB the other day for some swings, and it wasn't as horrible as I was expecting.  I went for a run today   Running still makes me want to die.  I also tried my hand at bechemel to make a mac and cheese; not the healthiest thing, but it was fun and I offset it with some roasted brussel sprouts.  

 

Mental: I have been getting up before clinic to work on my research projects, which has really helped me get ahead.  I am most productive in the mornings--after 9-10 hours of sleep.  I am finally starting to get caught up on the tsunami of work I had hit in feb.   Papers are either submitted or getting submitted, projects are either done or almost done.  I have been able to control my time more (amazing) so I can actually do the things I want to do outside of work (insanity).

 

Emotional: I really like my antianxiety journal and my goal setting for the week.  It helps me stay focused and keep "moving forward" even when I am tired.  Like last night, still got on the bench and felt better after practicing, even though I was bone tired.  

I'm actually with a really nice crew of residents for this block and have really enjoyed the time just because my coworkers are fun. 

[Treva]

ook time for the standard weekend navel gazing and deciding what to do next week.  

Flexibility is going to be the name of the game.  I am going to aim to structure my blocks of Workout, Relaxation, Practice, and Homework around worktime.

Lessons I learned this week

Workout: I still hate running.  It only makes sense as a mode of transportation.  

Relaxation: I sleep better if I schedule this before bed. 

Practice: I need to have different levels of difficulty in my music so I can do easier stuff on more taxing days, and harder stuff on easier work days.

Homework: I cannot exceed my limit of 2 research projects, 1 QI project, and 1 case report.   I learn better when there is a project involved.

 

 

How to apply things next week - not too many new changes!!!

Homework goals: Pick a topic to make a talk about.  

Relaxation goals: Declutter each space in the apartment this week.

Internal Change: Respect my own strength by not diminishing my own capabilities. 

External Change: stay off facebook newsfeed this week.

[Treva]

Midweek checking in.  

I got my book for my homework goals.  Gonna start on LDAs.  

I decluttered when I got back after vising home.

Internal change: this has been hard.  I feel like a bad doctor, and let's be honest, it can be really hard to do my job when patients yell at me.  Trying to de-escalate them or find a way out has been hard.

External change: this was way easier than I expected.  I only skim it occasionally and can stop myself pretty quickly- I stop scrolling any time I get annoyed by a post, so I don't get very far at all.

 

Workout Adjustments: Today I am really tired.  It's been hard when I'm really tired.  one think I want to look in to is dry land training for swimming.  I miss swimming and want to go back when the pools open up.    Things I've found and will keep here are

- medicine ball slams

- box jumps

- burpees

- planks

- russian twists

- dips

- jump lunges

I think my set size and repetitions are pretty typical.  I might switch up my strength training exercises to include more of these.

 

I'm gonna nap for 20 and then try to work out.

[Treva]

Recap of the week

Internal change: I have been doing better with jut presenting my plans and having attendings tell me whether or not they like it.  I've stopped caring a little bit about whether or not I sound smart, or if it works out.   I'm just trying to take care of patients.

External change: It has been a very good idea to step away from facebook.  I am going to continue that this week.  I just don't want to see what's on there.  I've logged out of every device except the browser where I've replaced newsfeed.  This feels good.

Did not get started on the LDA lecture

Workout goal: I started adding on burpees, russian twists, and dips.  I'm excited to add more things.  I can't box jump, but I can step jump in our stairwell.

Decluttering: was good for me.  I rearranged some furniture and now everything is more conducive to work and my lifestyle.  

 

To do This Week

Internal Change: Name the things and behaviors from other people that make me angry.  Find 5 minutes to meditate on one to let it go.

External Change: Find one day this week to practice for an hour

Homework goal: read 2 papers on the recent variant and surge in India

Relaxation Goal: Play video games 1-2 times this week.

[Treva]

I don't think I got to any of my goals this week.  I am going to reset and try them again for this upcoming week.  For some reason things were busier than expected.  

 

[Treva]

I bit off more than I could chew today.  A lot of laundry, had planned to mop, all that kinda fell by the wayside.  Was too late at work as well, everything just seemed to take too long.

 

I'm still waiting for my laundry to dry so I can go to bed, but even if I pass out at 10 PM, that's still 9 hours of sleep I can log.  easily.  

I'm writing this instead of doomscrolling.  I still think stopping looking at facebook feeds has been healthy.  I realized I wanted to post things in response to other people, because I couldn't stand their feeds.  No feeds, no posting.  

I think I feel a little defeated too because I'm behind on doing the things I normally do, like homemade jam.  I am also realizing it is completely bonkers to expect myself, a resident in an apocalyptic style pandemic, to still have the time to make homemade jam and ciabatta every two weeks.  Everything I expected of myself was bonkers.  Seven research projects, work, and studying for step, AND practicing.  God.  Crazy.  

I still need to fold laundry.  I guess I can do that.

I had a really nice talk with one of my attendings today about toxic body positivity and how we are supposed to talk to patients about their weight when they want to fire us for bringing it up, and we riffed on motivational interviewing.  I need to look more into that.

Anyways, I realized I can change if I feel brave enough.  So Tl;dr I got some B12 and Vitamin D because we talked about how bad my SAD can get and how much better it is with aggressive lighting.  

 

 

Maybe I'll feel a little more energetic in a few weeks.  For now, no more doom scrolling, do laundry instead.