Wednesday, December 17, 2014

2014 In Review

This post will be nothing like those year-end holiday cards from acquaintances you may or may not have seen for a while that include a long list of accomplishments and highlights from the year. For me, 2014 was not a year of big travel, notable changes at work, or major fitness successes in climbing, etc.

Instead, 2014 was a year of learning about myself. And this learning predominantly stemmed from my focus on a basic human function, something that many people take for granted: fertility. I didn't intend it to be the theme of my 40th year, but knowing what I know now, my shot at starting a family has appropriately filled a vast span of time. I knew that my hypopituitism would slow things down, but I had no idea how difficult getting and staying pregnant at 40 would actually be.

I'd like to share with you some of the things I have learned this year:

We are all zebras. There is a saying in medicine: "Common things are common." As medical students, we are urged to "avoid the zebra chase" when it comes to diagnosis. But zebras are not unicorns; they do exist, and in a way we are all like the zebra - unique and special. When I embarked on my infertility treatment journey, I searched the medical literature for studies about people like me. What protocols work best? What are my chances? My search was quite short because there ARE no studies on people that have my exact constellation of medical problems. Likewise, I realized that I could not easily apply any outcome statistics or advice to my own situation when it is based on the experience of women with completely different reasons for having infertility.

This concept is discussed ad nauseum in health and fitness articles about weight loss. The formula for success for one person may not apply or may even be detrimental to achieiving results for another person. The answer to the question, "Will this apply to me?" is almost always, "It depends." What this means is that during your pursuit there will inevitably be trial and error. Which requires patience, and waiting....

Waiting is difficult but essential. I blogged about this a few months ago during the height of my frustration as a person who does not normally have to wait long for things to happen at work or in life. We are all conditioned to want quick and clean solutions to complicated problems, but they rarely exist. This fixation is evident in makeover shows such as The Biggest Loser and the myriad advertisements for medications that promise to erase all of our uncomfortable symptoms and feelings with the swallow of a pill.

I don't pretend to know the perfect remedy to aleviate waiting, other than trying to be mindful, grateful, and concentrate on the present moment. I journaled and journaled and talked and talked... and somehow, I finally accepted the waiting. Ironically, part of what helped was actually seeing an endpoint to the madness of fertility treatments. One that is starting to peak its head around the corner but is not quite in full view yet....

Progress is not usually not linear. Have you ever seen this graphic?

It describes what I'd like to say here perfectly: we all experience plateaus and dips in our pursuit of goals. In this post, I talked about how I saw some sort of improvement during every previous round of fertility treatment I had undergone. Eventually, that line stopped climbing upward, but I (and my fertility team) have continued to move forward. Avoiding trial and error, turning a blind eye to learning from failures, and not implementing small changes are what kill progress. In the face of a difficult goal (obscured by a plateau or a regression), we must recognize these small improvements even when tangible progress is difficult to see. This is the essence of one of my other favorite things to do: project climbing....

Working toward a goal is all about priorities. There are some things that I enjoy doing which happen to directly impede my fertility quest, and it has been a challenge to put them on the back burner. One of these is intense exercise and strength training. During the active part of treatment cycles, it is not recommended to do high intensity or impact exercise anyway, and as you can imagine, significant stress on the body from an exercise program or a rigorous diet/calorie deficit could seriously impede a woman's fertility.

Another thing I have reprioritized this year is rock climbing. While I have still enjoyed the movement of climbing (mainly in the gym between fertility treatment cycles), I have pretty much ignored my love of projecting, training and improving at climbing, including traveling for climbing. Initially, this change was brought on by a period of burnout following a long climbing trip which happened to precede my first IVF cycle, but the persistence of my climbing apathy is a difficult thing to describe. While climbing can be intense and can involve impact in the case of bouldering or controlled falls (thus something I was forced to cut out of my life at times), it can also be relaxing and mellow and thus I could have done more of it if I wanted to. But normally, the climbing style and settings that I prefer involve a tremendous amount of mental as well as physical energy.

It might be somewhat hormonal, but I have not felt enough mental energy to "try hard" at these goal-oriented things that I normally care about and are a big part of my life and social culture. I wrestle with this inner conflict frequently, but I always come back to the idea that climbing and the weight room and travel and projects will always be there. It may be a while until I get serious about them again (especially if I do eventually have a child). Yet this is my only time to try for a pregnancy. It has to be done now. So I need to let go of feeling guilty and conflicted and identity-less....

Loving yourself is a constant and necessary process. I have had to work at this every day: letting go of the shame, the feeling of being inhuman or unwomanly, the feeling of being in limbo and not being myself, all the while accepting my current situation. No matter what steps you take to reach your goals, guilt, shame, and frustration ("Why is it taking me so long?", "I'm not worth of success.", etc.) will stand in the way.
Enough said... except for this great quote:
"I have an everyday religion that works for me.
Love yourself first, and everything else falls into line."
- Lucille Ball

(Source: Start with the Heart,
Happy holidays to you and best wishes for 2015!

Monday, November 24, 2014

Checks and Balances

I haven't done one of these posts in a while, so I figured I'd share with you a few things that have interested me lately:

(In the interest of self-care, I've been trying to put the electronics away at night)

  • I've been into walking recently. I started out wanting to walk an hour every day this month, but the weather and work schedule haven't always obliged. Nevertheless, I have managed to fit in at least 30 minutes of low-level walking most days. Just as sleep forms the base of the self-care triage pyramid, simple walking should be the cornerstone of physical activity for most people. Furthermore, this Mark's Daily Apple article makes the case for walking as therapy and stress-reliever.

  • This great interview with Elizabeth Dunn, the co-author of the book Happy Money, reminded me to continue my practice of simplicity. Her five core principles of spending for happiness (buy experiences, make it a treat, buy time, pay now/consume later, and invest in others) are good advice for all of us this holiday season.

  • Are you taking some vacation days this winter? For many people, days off are not accrued and will reset in just a little more than a month! See the sobering statistics of why Americans don't take all their vacation and try to find a way to take the rest of yours!

  • And just for laughs, check out this very funny spoof on the DIY "hacks" articles you see all over FB and Pinterest. #1 is my favorite. Enjoy, and happy Thanksgiving!

Monday, November 10, 2014

A Month for Gratitude

Pumpkins on one of the last days at the farmer's market

It's November, and Thanksgiving is almost here. November is always a good month to reflect on the things we are grateful for, and frankly, I need the "gratitude practice"...

I recently underwent yet another IVF procedure - a multi-egg stimulation and retrieval - because all of my banked embryos from that previous egg retrieval last winter when I briefly ended up pregnant have now been used up. Without success. To be honest, it's been a hard several months of disappointments, for which I was NOT mentally prepared. After undergoing this more involved and invasive type of IVF procedure again (the frozen embryo transfers are easier), I maintain what I've said before here and to everyone that has asked me about it: the physical experience of IVF is seriously nothing compared to the psychological experience of IVF.

Not the most fun way to spend a day off. At least it's only a 22 gauge.

Sparing lots of details, the point is that I have been feeling a little bit lost. But I'm finding my way back through gratitude. I plan on doing a "gratitude challenge" by journaling about at least one thing that I am thankful for each day this month. This practice has been discussed extensively on the internet, in books, and on social media. Although I had never done this before, I imagined that it will provide a great reminder of what matters most.

I began my exercise of gratitude awareness this month by focusing inward, and I wanted to share with you the first two items in my gratitude journal:

I'm grateful for my mind. Sure, it may have a hole in the bottom of it that was plugged up with a bubblegum-sized piece of fat from my belly 3 years ago, but I must admit that despite its current pituitary deficiencies, my brain has served me quite well. I recently had to write a mini-bio about myself for a chapter submission to a book, and as I was writing it I realized all that my brain has accomplished for me. It solved many engineering problems, in school and on the job. It completed research projects and a Master's thesis. It got me into medical school, through medical school, through residency, and to the point of being a board certified medical specialist. That is pretty amazing, undisputed stuff. And it's helped me make good decisions in my life, about lots of things... too many things to list here.

I'm grateful for my body. I recently heard an interview with movement specialist Katy Bowman in which she made a distinction between "exercise" and "movement". Exercise is one little piece of what is movement, which is one of the elements that constitutes optimal body functioning. This also includes, she pointed out, very basic and overlooked but important things: the ability to eat, to digest, to sleep, to eliminate waste, to have sex, to get pregnant, to stay pregnant, etc. Yes, I know those last couple of things in that list are currently missing for me, but I'm doing pretty well otherwise. And I am reminded (if I allow myself to be) of these gifts every workday as I see patients struggling with one or another of these vital elements.

Thank you for reading today about my thanks. Have you ever done a "gratitude challenge"? Was it helpful? What are you thankful for right now? Share it here or on Facebook!

Thursday, October 30, 2014

Introvert or extrovert? Recognize when you're "out of your element."

Me traveling upstream

Are you an introvert or an extrovert? This question has been discussed in books, articles, and social media recently, as the answer can affect big factors in our lives: how we conduct business, the success of our relationships, parenting style, and what kind of job we would be most happy doing.

The conventional thinking of an introvert as "shy" and an extrovert as "outgoing" is too superficial. It is actually more appropriate to describe an introvert as one that gains energy from solitary activities, while an extrovert is one that gains energy from being around others. The opposite on both sides is true; introverts tend to lose energy from being in crowds, while extroverts lose energy from being by themselves. Of course, none of us exhibits traits on entirely one end of the spectrum between introvert and extrovert. Sometimes introverts do "extroverted" things like go to parties or give speeches, and vice versa.

But are you one of those people who regularly does something (for work or otherwise) that's "out of your element"? Are you an introvert working in sales, are you an extrovert who programs computers, etc.? I definitely lean toward the introvert side of things, but I am not always out of my element at work. Because the workdays are so varied, being an anesthesiologist requires a balance between introversion and extroversion. Sometimes I care for only one patient in a long case, quietly monitoring and administering anesthesia for the entire workday. A true extrovert could find that type of day particularly draining. Conversely, on a day with six quick cases, I have to be constantly "on" when interacting with multiple patients, nurses, surgeons, etc. I go home feeling a bit more fatigued on those days, and the last thing I want to do is go to a dinner party or a meeting. These opportunities sometimes arise, but often I end up saying no to them. (Having an introvert for a husband helps!)

In the book Quiet: The Power of Introverts in a World That Can't Stop Talking, Susan Cain gives an example of a beloved professor. Despite being a classic introvert, he is well known for his engaging lectures. He gives these lectures in the mornings and the afternoons, but in between, he must retreat to a silent place to "recover". At one point, he was asked by a superior to spend his lunch hour in a recurring meeting, but he declined, citing some sort of made-up need to research ships in the harbor (i.e., go sit in the park alone).
That's good self-care! He knew himself well enough to realize that he required silent time to recharge and thus should not sandwich in another activity that was clearly out of his element. This would cause both undue stress and degeneration of the quality of his lectures. If you lean toward one personality type and you are frequently performing activities that are on the other side of the spectrum, then you are going to need extra self-care and de-stress opportunities during those times. How this is achieved is up to you. What's in your black bag?

Don't know which type you lean toward in the first place? Check out Cain's 12-question quiz on her website. There are others out there in a similar vain, and you can always take a Myers Briggs test (as I discussed here) as well. This excellent Fast Company article summarizes the differences between the types and gives advice on how to care for introverts vs. extroverts (more from a management perspective, but could be applied outside of work situations).

Does this change how you think about something important that you regularly do or participate in - your work, a hobby, etc.? How do you recover when these pastimes are out of your element? Share your thoughts here!