Guest Post by Monisha Vasa: Red Lipstick and the Quest for Perfection

I am excited to bring another guest post to Balance, written by Doctor Monisha Vasa! Monisha is a psychiatrist, mother and writer, currently living in Orange County, California, but has strong ties to Chicago growing up in the southwest suburbs. I have had the opportunity to read through much of her writings and poetry on her website and appreciate the emotional honesty of her voice as she shares her own journey.

There were a quite a few posts that I could relate with. When I shared with Monisha the three or four I was thinking about using, she told me one of them was a favorite.  I find her words captures my thoughts as well…

“Taking small and big detours and not knowing and figuring it out as we go isn’t necessarily the life plan…But that is the truth of how we all unfold.  That is how we all grow towards whatever light we are each uniquely designed to find.  Whether we like it or not, and whether we share it or not, that is the reality of how most of us navigate our days”

RED LIPSTICK AND THE QUEST FOR PERFECTION

by Monisha Vasa

 

“You awake? :)))”

“Yes!”

“Do you have the energy for me to unload some of my crazy on you? :)))”

“Yes!”

And so our text exchange began, the type of long drawn out texting that unfolds late at night, when there is so much to release, and kids’ perky ears still awake and within earshot.  The types of text conversations that you can only have with dear friends who will respond to the 11 pm pings and whistles, happily and without hesitation.

On this particular night, my neurosis was indeed just that–neurosis.  I went on to share a certain pressure that I had been feeling.  A few blog posts ago, I had received some wonderful feedback about how my words had been especially meaningful to one of my readers.  I was so touched that they had found some wisdom in what I had written, and that, in a sense, my words had helped them.

After all, that is why I write.

But since then, I found myself chasing the high, if you will.  Trying to “knock it out of the ballpark” with another sage post.  Trying to say something important and unique and memorable.

To make matters worse, what wanted to be written lately was poetry, an art form that was entirely new to me.  I don’t know how to write poems.  In fact I know nothing at all about poetry.  But I love the chance to play and stretch and yes, suck at it too.  I love the vulnerability of expressing myself in an unfamiliar way.

What I didn’t love was the feeling of somehow falling short of my readers’ expectations.  What if my poems were not as meaningful as my other blog posts?  Where was the wisdom?  Was I disappointing my supporters?  In my poetry-playing, was I somehow depriving my readers of something they had come to look forward to, a post to learn from every week?

If you want to kill your creative spirit (and over-inflate your ego), try engaging in an entirely self imposed pressure to write a perfect, life altering, mind blowing blog post every week.

My phone lit up:  “Why are you doubting yourself and your work?  Your readers don’t want perfect. If anything, your readers want more of YOU.”

And yet another ding:  “You are putting too much pressure on yourself.  Remember why you started your blog.  For your children to read one day.  Remember them.  Remember your intention.”

Yes.  Thank you dear friend.

My intention from the beginning was to be real, true, and most of all myself, as I show up on the page.  I don’t want to be perfect.  I don’t want to save anybody.  My readers don’t need my “help.”

My readers need my honesty and transparency and my humanity most of all.  They need to feel my love, one shaky, uncertain word at a time.  The last thing they need is shiny wisdom, which inadvertently has left us all feeling inadequate and needy at one time or another.

We were texting about my blog, but as always, it was a reminder that writing mirrors life and vice versa.  My desire to get it “just right” has often paralyzed me from taking risks big and small.  I didn’t go for the English major because it wasn’t part of the pre-med plan.  I struggle with letting my kids be free to have a do-nothing summer because I fear a blank college application.  I wanted to take a couple of years off to travel but never found the right time or opportunity.

I don’t wear the red lipstick because I simply don’t trust that I can pull it off.

Letting it all hang out while we seek and screw up and struggle for answers in the dark isn’t how it’s supposed to go.  Taking small and big detours and not knowing and figuring it out as we go isn’t necessarily the life plan.  The unfortunate lipstick choices and dead ends aren’t the parts we are comfortable showing to the world.

But that is the truth of how we all unfold.  That is how we all grow towards whatever light we are each uniquely designed to find.  Whether we like it or not, and whether we share it or not, that is the reality of how most of us navigate our days.

I am grateful for the mid-night soothing of my (entirely unrealistic) anxiety to change the world one blog post at a time.  Because in some ways, we actually all need to be a little less perfect.  What if we could simply show up as we are, and share our stories as a way to let ourselves out and let others in? What if these words represented what we most long for–a relationship between you and me?

So today and in the week ahead, I invite you to join me in noticing where you might be imposing perfection upon yourself.  How does perfection paralyze you?  Are there small ways for you to show up just as you are?

With gratitude, Monisha

A Journey From Burnout to Balance

I wanted to share a sincere thank you to Elizabeth Metraux at Primary Care Progress, for the opportunity to be interviewed on her Podcast, Relational Rounds. Becky and I were able to share our story from medical school and residency training to fellowship and private practice, navigating challenges along the way.  Elizabeth has a strong interest on the topic of physician burnout and has written about it at STAT:  I experienced trauma working in Iraq. I see it now among America’s doctors

After reading my post on How Do You Know When Someone Is Broken?  Elizabeth reached out to talk. She then asked to interview both Becky and I for what turned out to be a pretty interesting experience.  Attached below is a player linked to the podcast for those interested in hearing a little of what has gone into almost twenty five years of medical training and practice while trying to balance the needs of work, family and myself.

 

From Flowers to Dostoyevsky and the Road In-between

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I am sitting in the parking lot, waiting for the local bookstore, The Book Bin, to open. I am here because of a flower. And a pear tree turned maple. And a sense of time and space. And the writer Dostoyevsky.

Sipping my morning coffee, with the Jeep’s soft top down, I feel the heat and humidity of the day gaining momentum. I have ten minutes to kill, but there is no rush. I am in no hurry.

I am not a particular admirer of flowers or plants, nor fond of gardening. You will find no green in my thumb. I struggle to tell the difference between tulips and roses or what qualifies as a annual versus a perennial. Becky is both president and vice-president of landscaping and curb appeal for our home. But every year, after Chicago thaws out from another nasty winter, there is one pink plant I notice from July to the frost.

The routine is one I have done a thousand times. A long day of work followed by a quick drive home. I turn into my driveway, stopping short of the messy garage. I grab my evening Starbucks and step out of the car, making a bee-line for the front door. Just to the left of the brick paver walkway, pink flowers bloom on the tall arching hibiscus plant. Ten year ago, Madison and Maya won an Earth day contest resulting in a hibiscus plant in the front yard and a Pear tree in the back. Now, every time I see the pink flowers, a Pavlovian response follows. See hibiscus; think of Madison. The pink flowers stand out as the summer days get longer. But the reflexive thought is usually fleeting. I have a narrow two-hour window to play catch-up with the family, eat some food, and take care of some odds and ends before getting ready for evening water polo practice.

But this has been a year of change. More weeks off of work than on. Days slower, pressure lower. Options greater. Headspace clearer.

Yesterday, I got out of the car and looked just to the left of the brick paver walkway; pink flowers bloom on the tall arching Hibiscus plant.

I paused.

I deviated from pattern and routine. I literally stepped off the brick pavers and walked through the dirt. I kneeled, and for the first time in ten years, I looked. Not rushed and fatigued, but with the unassuming eyes of a child.

Was it the way the day’s light caught the blooming flower? Or its movement, as it swayed back and forth in the afternoon breeze? I stopped. I looked. Differently. Not with an expectation of confirming what I knew to be true. Not reflexive with a programmed response. But with eyes and mind open in a way they often are not.

Not a simple single color, but pink and dynamic, with pattern and texture. Not just petals, but a flower with a complex architecture that I forgot existed. I am mesmerized. I focus. I take pictures, trying to capture or preserve what my eyes see. There literally is a world of things present that I have not noticed previously, all backlit by light emanating from small slits in the petals left open at the base.

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I have written, in the abstract, about increased time and space since going part-time. But it’s concrete and tangible right here in this flower. My mind is unencumbered by the weight of a twelve-hour work day or a week’s accumulation of fatigue. There is no pressure of a two-hour window closing in on me as I stop to smell the roses; or in this case, the Hibiscus. I walk around to the backyard. A few years ago, we identified the pear tree correctly as a maple. I look up at what was once a six-foot tree which, to my surprise, towers overs me by at least thirty feet. Thick branches, once thin and pliable, have weathered quite a few storms over the years. Despite viewing the tree daily through the kitchen window, I have missed this transformation.

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Patterns and behaviors. Expectations and assumptions. Tools often necessary to get thru challenging days. They consume less energy, tapping less into one’s reserve, to operate more on auto-pilot or cruise control. But that path foreword is limited and constricted. One where the hibiscus remains just a pretty pink flower, and the maple six feet tall.

Time and space. Look left and right. Stop assuming. Be more curious, and have fewer expectations. Break patterns and rethink behaviors.

I didn’t read Crime and Punishment in high school or college. Over the years, when I came across references to the book and its protagonist Raskolnikov, I made mental notes to buy and read the book, but never followed thru. Too little time. Never made it high enough on the to do list. In a few minutes that will change. I am waiting for Book Bin to open and I am going to buy that book.

Time and space. Break Patterns. Rethink behaviors.

Madison comes home soon to visit for a week. He’s about to move into his own apartment in Oregon. Maya’s about to start her senior year, with quite of few colleges on her mind. Becky is gearing up to offer tutoring services in a more formal fashion. We are a family with quite a bit of transformation ahead. But despite the potential and promise of the upcoming year, I am in no hurry to launch myself forward.

Days slower. Headspace clearer.

I drive away from the Book Bin, Crime and Punishment in hand. I am ready to read it. With more time and space. With more curiosity and fewer expectations. And with unassuming eyes and a mind wide open.

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Top 5 Lessons Learned for the New Interns

Welcome new PG-1’s! One day you wake up a medical student. Then by the afternoon you are a MD. A few short days later, you are now in the hospital no longer looking for someone to co-sign your orders in the EMR.

It’s a crazy time, full of excitement as well as an inordinate amount of stress.

My list is not for your first day of the first week. But maybe bookmark it for after you get your sea legs under you. After you know where to park the car and where to get that much needed cup of coffee. This is for after you figured out how to login to the EMR and PACs system and know the pattern (or lack thereof) to your days on your first rotation. Then, come back here and re-read. When you have the bandwidth to actually process. There are many pearls out there for new interns. There are handbooks, pocket guides along with Twitter full of words of wisdom. The five I have written about here I think will serve you well as interns and beyond.

  1. Don’t forget the chief complaint.

My closest calls and near misses over the years have been when I neglected to pay adequate attention to the patient’s chief complaint. They may be in florid heart failure with a pulse ox of 70% and not making any urine. But all they care about is the pain in their calf. While I am placing them on non-invasive positive pressure ventilation, nitro drip and Lasix, two hours later I find them in the OR for compartment syndrome. Their chief complaint may not be at the top of YOUR problem list, but it is at the top of THEIRS. It may not always end up being a life or limb threatening process, but then again, how do you know if you don’t check it out. Always respect the patient’s chief complaint.  If you do not bother to pay attention and address it, what else is your patient telling you that you are not hearing!

2. Ask that question!

If you are uncomfortable asking as an intern, how will you do it when you are an attending? I will let you in on a little secret. We (the attending’s) do not know what’s going on all the time. But I do know where to go to get help. What resources I have in the form of other colleagues, partners, consultants, etc. You are not expected to know everything. Definitely not as an intern. But we doctors can be an interesting bunch. We often feel like imposters, especially early in our training. That we do not belong. Yet we have pride and ego that compete with our feelings of insecurity.  This is an awful construct to have in your head.  Break it. Ask the question. I am willing to bet someone else on rounds has the same one. By asking, you encourage the next person to speak up. By sharing what you do not know, you foster an environment that encourages learning and is better for patient care. More importantly, you will recognize that this doesn’t stop after intern year. Welcome to being a life-long learner

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3. Approach with caution the patient with psychiatric illness.

It’s hard when the patient’s history of mental illness gets put up front during sign-out from the ED or on your chart review. Our biases often kick in whether we intend to or not. Often the patients ability to give a good history and report symptoms accurately gets called into question and their voice gets tuned out in the shadow of their mental illness.  Patients with mental health issues can just as easily develop physical illness. Which often in turn leads to exacerbation or decompensation of their underlying psychiatric diagnosis. Too often we dismiss out of hand their complaints or the “pan positive review of systems”. It is hard when someone’s psychosis or mania or anxiety is raging to discern what is the truth. But be disciplined and approach all patients with same level of concern.  Don’t stop listening and tune the patient out. That abdominal pain, even though it is the 5th time they have been to the ED, can still be an appendicitis. 

4. Don’t fear the family.

I remember dreading walking into rooms with family members. They were more able in body and mind to ask questions and were not so easily dissuaded by my quick in and out of the rooms trying to get thru my morning pre-rounds. I feared them. Not just because of the time they took that I did not have, but also, I felt they would expose me for what I was. An imposter. Unable to answer their questions, I feared more what they made me think and feel about myself.

They fear too. They worry about their loved ones. They are confused, out of place, disoriented and are trying to advocate in the best way they know how. Don’t fear them. Lean into them. Sit down. Answer questions even if it means saying you do not know. Start getting comfortable with diagnostic uncertainty and being able to talk about that with patients and families. Honesty combined with empathy goes a long way towards building trust and confidence.

5.   Recognize wins.

I have written about this before in  another post  10 Tips For New Interns For Surviving and Thriving in the Intensive Care Unit  but I think its important enough to include here as well. Learn to retrain your brain. As physicians, we tend to focus and dwell on what went wrong. The challenging patients and families. Frustration over missing labs or delays in imaging. The complications of our interventions. The bad outcomes. The deaths. This is where our brains go when we are most tired and beaten down after an exhausting and non-stop twenty-four hours. But in doing so, we miss out on celebrating our wins. We successfully shepherd so many patients through the treacherous and complex world of medical illness.  Treating a “routine” COPD exacerbation and managing them through their hospital stay to discharge without any drama or significant adverse event is no easy task. But we fail to value our role in this as a win. It is viewed as a baseline expectation. We need to learn that there is nothing given about a patient’s course. If we blame ourselves for the bad, then we must take credit for the good. We focus so much on what goes wrong or in our perceived failures to help or heal our patients we end up ignoring all the positive around us.

Best to all the new interns on the start of a new journey. Exciting times lie just ahead. If you enjoyed this post and want to hear more thoughts on medicine and work-life balance, please sign up to follow this blog!