One of the toughest things throughout residency for me has been transitioning to living alone, where a lot of the external cues/regulation I had to do certain things are no longer there. A big way this comes up is mindless eating as a means of soothing myself, and naturally I have seen the result of some weight gain. I have worked through this a lot and fortunately been able to get back intro my pre-residency gym routine which has made me much happier and has been much more fulfilling! Still I am noticing I have hardwired the habit of eating to self-soothe/numb when I come home, and so today I decided I'd do a thought model surrounding this and curious to get some feedback on it. A lot of this comes up when I have these thoughts of needing to be in control of my time and "recharge" for the next day, but inevitably eating past the point of comfort drains me and sets me up for an even less pleasant following day.

Unintentional model:
C: I come home from work
T: I don't have much time left to myself before I have to run right back to work tomorrow
F: Agentless/powerless/out-of-control --> anger/frustration
A: Seek something that I tell myself will bring me pleasure/relaxation, most often eating in front of the TV, and eating way more than I would like
R: I end up not really focusing on the food nor TV/being mindful of either as much as I would like, and then I overeat and feel even more out of control in anticipation for the coming day

Had some trouble figuring out the exact feeling the thought caused, so I came up with a few but they don't quite capture it, and the feeling of not being able to choose how I HAVE to spend my time, or control the long hours leads to anger

Intentional model:
C: I come home from work
T: I wonder what would bring me the most pleasure/relaxation/fulfillment this evening
F: Curious
A: Start brainstorming/trying different activities
R: Potentially find something I enjoy way more that actually adds value to my life, and may ultimately break the cycle of the overeating habit that has been tied to the thought I have every time I come home

One other question I had was which part of the intentional model should we be trying to choose? Most often the thought or is it really any line other than the circumstance that we can play around with?

Thanks so much in advance!

ANSWER:
Hello Friend,

I am so glad you brought this here. You have such wonderful awareness in your thought download and in both your UM and IM. Really nice work!

You are describing the action of eating food as a way to diffuse the uncomfortable emotions of feeling powerless/out-of-control/without agency.

We call this "BUFFERING" and buffering can be any number of actions---- eating when you aren't hungry or the food isn't nourishing (overeating), over-drinking, scrolling on social media, buying things you don't need, numbing out with Netflix. On their own, these actions are neutral, actually. But what makes them "buffering" is when you use them to avoid/diffuse an uncomfortable/unpleasant emotion AND they lead to a NET NEGATIVE result for you.

The interesting thing in this case (as you point out) is that you (and me, and many other people), might eat (or shop, or drink, or scroll) to avoid feeling out of control, but then after the eating/drinking/scrolling/spending is done and that dopamine we get fades....... we feel....... out of control and powerless... right?

I love how you are working towards an emotion of curious in your intentional model right now, and that it absolutely the way forward.

Here are the circumstances:
You are a human with a human brain and a human body
You go to work and you come home from work
You have practiced, over many years, using the action of eating food to diffuse/buffer uncomfortable/unpleasant emotions.
Sometimes you eat food in excess of what your body needs

Before you start practicing a new model, I think it wold be really helpful to get curious and non-judgmental after the over-eating happens.

I call these questions "write it down and move on", and these are a great place to start once you've realized that you were operating in your UM. And remember, we don't use these questions to beat ourselves up, only to understand ourselves and love ourselves more. OK?

What did you eat or drink that was not in service to your mind/body?
Why did you eat it?
What did you notice?
What did you learn?
How can you let this go now?
How do you want to feel moving forward?
Would you like to do something differently next time? What?

You can ask yourself these questions any time you do something that you want to get curious about.

I invite you to bring this back for more (and more...)

<3

Feeling a bit overwhelmed while trying to people please in the hospital. I'm an intern and rotating on a high-turnover service. One of my patients has a lot of consultants on board and many moving parts because we're not totally sure what's going on. The patient and family are pretty nervous about not knowing what's going on, and have their mychart open refreshing throughout the day, and ask us for the reasoning why med doses are changing, why a subspecialist note doesn't comment on said medication change, why we ordered a lab that a consultant asked for if it didn't say it in the note, etc. While I would love to update them, I don't have enough time to update them this frequently while also taking care of my other to-dos for all my patients.

C: Patient/family are checking mychart and asked for 4-5 updates today based on what has changed in mychart
T: It's not possible to update them, and they're going to be mad and think they're getting bad patient care
F: guilty
A: Ruminate about not checking in more often, complain about it to my team, spend extra time with this patient/family to update them and end up spending less energy on my other patients
R: spend more time on one patient than others, giving worse patient care to my other patients? and patient/family are still expressing unhappiness with the level of updates.

I know in theory that I can't control what this patient/family think, and I know that I can't sustain checking in with the family so many times per day. I feel frustrated and burnt out with this amount of work. I also feel like if this were my family member in the hospital, I would also want frequent updates. I wish our system was built differently so that we did have the bandwidth to give clear and helpful updates as much or as little as patients and their families would like. But I also feel like it's not fair to give special consideration to this patient/family and not others. Today I stayed late trying to finish up all my tasks and spent less time updating other patients/families than I wanted to. I'm struggling to be OK with having this patient/family be upset with me. Yet, I think it's important that I don't burnt myself out trying to please this one patient/family and thus end up providing worse care to my other patients.

ANSWER:
Hi Friend,
I'm SO glad you brought this here.

This is the perfect example and PROOF of how we are never in charge of what other people think/feel/do.

I see how you have accessed empathy for them in your download above. You can imagine what they must be going through and I commend you for that.

As you point out, There is likely no amount of updating/checking in that would allow this family to feel informed and at ease about the care their loved one was getting. You could call them every hour on the hour and they may STILL have thoughts that lead to them feeling distrustful or anxious about their loved one's care. The only result of you bending over backwards to try and make them satisfied is you having a sore back.

Expectation vs. reality mismatch is fertile ground for frustration. Both for you and for them.

The good news for you here is that YOU are in control over your expectations for yourself as it pertains to how you engage with your patients' families. Let's get really clear on what you want to be able to do for all of your patients. Make a list here of what is reasonable and possible (i.e. not perfectionistic or impossible) to expect of yourself when it comes to communicating with your patients and their families:

Example: " I can expect myself to call my patients' families "x" times per day (or week?), and will do my best to honor their request for ______. On days when I can't call everyone, I will _________. I can expect myself to provide "x" minutes for each call. If families have more questions than I can answer in that time, I will say say__________. If I need help, I will ___________. "

What else would you add to this?

The reason to do this exercise is to define for yourself what "good enough" is, and to free yourself from defining your success or worth as a doctor by what a stressed/anxious/worried/scared loved one is thinking/saying/doing.

What you are doing matters.

<3

I think the answer is -- "yes, I was doing the best I could with what I had." That answer saddens me a bit because what I had felt like so much less than everyone else. I'm a bit mad/ embarrassed because I think my poor mental health set me back. I keep on thinking about how much more I could have learned and achieved if I had more grit and resilience. I know that wallowing in these feelings and dwelling in the past will not help moving forward, though.

ANSWER:
I'm so glad you brought this back. Consider these questions and if one resonates with you, I invite you to bring it back here.

Is it OK to be sad about the idea that you did the best you could with what you had? Why or why not?

Why should one be embarrassed that they struggled to do an 80+hr/week job when dealing with grief and/or depression following the unexpected loss of a parent?

What would it have looked like to have "enough" grit or resilience during that time? Does that seem like a reasonable expectation that you would have of someone else?

Keep it coming, friend.

<3

Thank you so much for your dedication to coaching us in this program! I really wish I had access to this program earlier on in residency.

I wanted to ask for coaching on some of my thoughts surrounding my skill and progress during residency. I am graduating this year (eek!) and feel like I have not learned enough. I'm afraid I will be expected to be a totally independent practitioner without the requisite skills and competence. As some background, I had a parent pass away very unexpectedly about 1 year before starting residency. I started my program feeling depressed and raw and without much emotional reserve. Being back in the hospital was really hard. I had a lot of questions about what might have been done differently for my dad to prevent his death, and I think it fueled a lot of anxiety for me in my clinical practice. I was constantly afraid of making a mistake and causing harm. And this led me to avoid pushing myself to act independently, avoid pushing myself to accept new learning opportunities. I did not want to mess up and hurt someone. And that of course led to a vicious cycle of me feeling like I was falling behind. To make a perfect storm, my program is one that does not tend to offer much direct feedback, though there's a lot of hero worship among peers (i.e. people talk about each other as being "really good" or "really strong" in a way that I find detrimental). I am not one of the people that others talk about as being particularly good or strong. Now I feel like it's too late in residency to turn things around, and I may just graduate as a subpar doctor.

ANSWER:
Hello! Oh, Thank you for those kind words, and we are SO GLAD you are here now <3

Friend, oh goodness, I can imagine how hard it would have been to start residency shortly after losing a parent, to question what could have been done differently, and to be afraid of making mistakes. I can imagine you as an intern, doing the best you could, feeling depressed, and like you didn't have the emotional reserve. I can also imagine that your brain was doing its' best to incorporate new medical knowledge and clinical reasoning during that time. Finally, I can understand why your brain is convinced that you don't know enough. It's trying to protect you, AND it is misguided in its' approach.

It's OK. Let's walk through it together. It might take a few back-and-forths, if you're up for it.

I suspect these thoughts feels VERY TRUE to you:

"I have not learned enough"
"It's too late to turn things around"
"I may graduate as a subpar doctor"

Notice these thoughts assume as FACTS that
a) there is a time when you will reach "enough" knowledge and skills to stop worrying
b) you are headed the wrong way
c) that there is a time after which one can't change their heading

Those are not facts.

Here are facts:
You are a human being.
You are a resident.
You lost a parent the year before residency.
You have advanced in your training year after year and are on track to graduate this year

OK sister, I think you brought this for coaching because you can tell that your beliefs about yourself are keeping you stuck and aren't serving you. That if you keep them, you are signing yourself up for more self-flagellation and less actual learning and growth, right?

If that is true, then let's explore the following:

Do you believe that during that first year of residency that you were doing the best you could with the cognitive and emotional reserve you had available to you?

If the answer to that is "no, I wasn't doing the best I could with what I had", who/what is it serving to judge yourself in that way?

if the answer is "yes, I was doing the best I could with what I had", what else could be true?

Bring it on back here.

<3

Sorry for the slow response! The transitions have now become a reality, where I have a beautiful son who is the cutest in my humble, totally unbiased opinion, and my family is in the process of moving. It's hard to think much about internal transitions while we're learning to understand our son and his needs, not to mention becoming new homeowners, but here are a couple of thoughts...

Academia: I have felt that many of the faculty I have worked with in academia don't have the best boundaries. That being said though, many of those are people I did not personally look up to, whereas those who had stronger boundaries were those that I did.

Leadership: I can't say that I'm certain, but I know deep down the emotion/thoughts are that I wouldn't be able to be successful at being able to be present with my family and pursue a traditional leadership position. That said though, before getting married and starting our family, I used to define my worth by achievement and I believed that becoming a leader was the ultimate goal. I can't say the same now, and lately (before maternity leave) I see myself wanting to be more present with the people I care about.

Flexible Academia Job: I think I'm having a hard time defining a flexible academic job because it seems like a lot of those who are in academia are constantly busy, publishing, having meetings (this is probably perceptions, but not the actual reality). I think it doesn't help that I live in a competitive region, where there is an external perception that this place is a rat race.

Community Practice: The "settling" perception comes from feeling like the community is less involved with the hubbub of an academic center where there's more resources and specialists to speak to one on one. Interestingly enough, my residency training was in a semi-academic, but really more of a community practice setting - and working with community partners felt more rewarding to me than publishing/doing research.

Dream Job: This is a good question, because lately I've been wondering if I made the mistake of going into medicine. I enjoy working with patients and families, but do find myself drained at the end of the day (but this may be the burnout speaking). What I have been able to piece together is that I do like the bread and butter medicine of my field. I like working with ancillary staff/consultants. I like teaching medical students and mentoring residents - and I want to make the art of medicine fun. With that all said, I am also an introvert, so I also want to have a healthy balance of residing in my little alcove and read pediatric articles and think about how best to translate for my learners/patients. Most importantly, I want to do all those things above, and be able to go home and spend time with my family (which these days include being driven crazy by colic and frequent feedings, but also adoring my baby and hoping he's gaining enough weight for the next weight check...)

ANSWER:

Welcome back! You're right on time 😉

I love reading those reflections and I especially love reading about your dream job! Here's what I'm hearing that a "dream job" means to you.

- working with patients and families
- working in a multidisciplinary team
- Teaching and mentoring learners
- making the art of medicine fun
- taking time to read/learn and translate that knowledge for your learners and patients.
- time to connect with your family

Im noticing in some of the other sections some "all or nothing" beliefs popping up. Here are some I'm picking up:
- In academics, "successful" people don't have good boundaries
- Can't be a leader AND be present with your family
- Academics has to be a rat race

Let's see if we can choose ONE of those beliefs to explore a bit more.
Which of those feels the most true to you?

Can you make a list of 5 examples of how that might NOT be true?

Bring it on back!

This past weekend I finished a one month off-service rotation that I had been dreading since this year's academic schedule was released last spring. Every time I looked at the schedule I squinted my eyes when they gazed over this block because I was dreading it so much. It was a rotation I hated in residency and it was absolutely the last rotation in the world I wanted to do as a fellow; it was going to be awful, I was going to do horrible, I had never independently managed sick liver transplant patients before, and everyone at my fellowship institution was going to find out really for sure that I wasn't meant to be here. To pile additional dread on top of months of pre-meditated anxiety, our nanny quit the Sunday night before the rotation started and I was concurrently studying for my oral board exam (which I took yesterday).

I can tell you now that it was one of the best rotations that I've had as a fellow. On my first day presenting 25 patients on Zoom to 20+ team members with ICU-style presentations for every patient I joked- "THIS, I PROMISE, is going to be the WORST patient presentations you'll see from me all month. I can't remember which faces match with with patients and I'm going to get some of these plans wrong but I'm promising you that I'm gonna get better each day." I normally fall into myself when I'm not sure if I'm getting the details of the plan correct etc etc and instead of getting so worried and self-conscious about it all I just made it so lighthearted and almost funny. They loved it. I came across confident, even if I didn't get all the details right I didn't worry about it because I had disclosed that I was going to make a few mistakes, and the "confidence" was totally a redirected nervous front but it carried me through the difficult parts of starting a new rotation until I really did learn each patient and was able to make plans on the fly. Because I had set a lighthearted "improvement-oriented" tone I wasn't as hard on myself and unexpectedly and ultimately ended up having more confidence than I have even on my home services. I got a lot of good feedback at the end of the month with more than one attending telling me did I really great job and that when I start my job as an attending someone will be lucky to have me as a partner.

If this had been written by someone else I would have said "that's you, that won't happen for me" and I staunchly maintain that I don't have imposter syndrome, I AM AM IMPOSTER-- if you could just let me tell you ALL the ways that I REALLY shouldn't be allowed to be here I could MAKE you see that for me, it's not a syndrome, it's the #truth. But this rotation... it was good. It was great. The quiet suffering and worry and all the other stuff-- it wasn't there. Now I need to take this back to my remaining home-rotations and figure out how to bring the authenticity of "I'm still figuring this out" when I always feel like I should already know the answers within my primary specialty. But... I feel like I'm getting closer to figuring this out. R?

You blow me away!
<3

Hi there!

I've put on 15+ lbs since starting residency 1.5 years ago and it feels bad to be a health professional who feels overweight (although by BMI I'm just barely not there yet).

I attribute this to working a lot of nights/24 hour call shifts, having dysregulated cortisol and appetite as a result, and having limited ability to exercise due to an injury that is worsened with night shifts. In the injury, I take two steps forward on dayshift months, and then take 1.5 steps back during night shifts/call shifts. I've tried working with my program multiple times to reduce the number of night shifts that I'll be working in the future, but the best I've been able to negotiate for is stacking my remaining three months at the beginning of the year (July-September).

I'm a person who really really enjoys being physically active (dozens of previous half marathons, mountain climbing, rock climbing, biking, swimming) and residency fucks it all up. Exercising is dangerous for me physically post-nights when all I want to do is some sort of physical activity mood stabilizer. I want to be someone who coaches others on how to be more physically active and eat better but I feel like I'm not even doing that myself because I had to be a glory-seeking idiot and go to a "high powered highly ranked" program that does a shit job of teaching primary care and abuses residents bodies. I came here for the sticker on my resume and I'm paying for it.

I've thought about transferring, but fear that it would be worse at other places - working under the assumption that programs that have lost residents and have spots they need to fill likely have similar problems with resident work hours. And uprooting my life away from a care team that seems to improve the health issue seems counterproductive.

It's hard to feel at home in a program when you don't feel at home in your body or at home in your values (eating right and exercising) and I constantly find myself traveling. Ejecting from the gun violence fraught city, this bible-beating state, from the culture warring country.

I just want to be free of my loans and grow a flower garden somewhere, heal from my injury.

C: I'm approaching overweight and my clothes don't fit
T: It's my fault for picking a program that doesn't support me physically or my primary care goals
F: frustrated, hopeless, angry, tired
A: negotiating with my program re: nights, escalating to HR (I have the number for the right person to call if my program does not schedule as promised), constantly pursuing new PT/strengthening exercises/all available therapies, working on my home exercise program, walking when I can but sometimes ending up in pain, but some how eating like a ravenous raccoon and you can't outrun your fork when it comes to weight. and not looking for love because I feel inadequate. Also because I don't want to love someone here and have to come back to this state ever again.
R: Hopefully some improvement in my condition come October, prior to losing my insurance next July because fuck all if I stay here in this godforsaken system any longer than I have to. And approaching overweightness.

I just would like to feel like I do when I'm out on the road, free and interested in what I"m doing, not wanting to always eat.

ANSWER:
There is so much good insight here! I'm going to clean up your model for clarity sake:
C: 15+ lbs since starting residency 1.5 years ago. Clothes starting to not fit how you would like them to.
T: This is my program's fault (and also mine for picking it)
F: frustrated
A: Overeat. Look outward for blame, try to negotiate with my program re: nights, escalating to HR, constantly pursuing new weight loss programs (PT/strengthening exercises/all available therapies, refine home exercise program, walking), continue to overeat. Close yourself off to relationships. Consider transferring (but don/t). Consider a different career path. Blame, blame, blame.
R: Your blame game only sabotages you.

Ok sister- here your brain is desperately looking for a solution. It wants this to be "because of" something or someone (here it's made it because of your program, your state, your county, and a little bit because of you), because then you could maybe fix it. BUT, first of all, it's not fixing it. The program isn't changed, no one is as mad as you, and the issues continue. So let's see if there is a different way that feels lighter to you and moves you where you want to go. Here's a radical thought: What if it's not the 'fault' of anyone or anything, but instead just something very human that is phasing through your life right now?

Can you see that your program is not making you overeat (yes, there are obviously triggering things here for your brain, but at the end of the day, the program doesn't care if you do or don't overeat)? Can you also accept that YOU are not to blame? (you are a human being who's brain is programmed to seek sugar and food whenever it is stressed or the food is available)?

What if you look at this through a lens of *responsibility* rather than blame? We can all agree that it's not your FAULT that you have overeaten. It's not your fault that residency is flawed in the ways it is. It's not your fault that the country has gone haywire. However, it is your responsibility to decide what to do next. You can choose to do any number of things now, and all are legitimate and not right or wrong. But when you are looking for who's or what's fault it is, you are only stopping yourself from progress toward your ultimate goal of staying present and free.

I give you permission to stop trying to figure out who or what's fault this is and just release that blame/resistance all together. What happens if you drop it? What is left?

You mention at the end that you just want to feel free and present. I wonder how much your RESISTANCE to not wanting to think about food is actually driving you away from this. Another radical idea: what if your desire for food is totally aligned with freedom and presence? Can you use your desire to bring you to presence instead of away from it?

I give you permission to stop RESISTING your over-desire for food.
I do NOT mean to react to it (i.e. overeat)- but can you welcome the fact that, right now, you have a lot of cravings for food that are not strictly hunger related?

Can you stop the next time that you notice one and just look at that pure emotion (F= "urge" or 'craving" or "desire") and allow it to be in your body without either acting on it or fixing it (with blame and anger)? What if you just let it be there? How long does it last? How frequently does it come to you on the average day? What triggers it? Get really curious here:

This model is ALWAYS available to you. You can choose it on nights, at home, at work, wherever you are:

C: ??? Some trigger
T: I want to eat
F: UGRE
A: -----> here is the work: allow the urge. Watch your brain try to go to anger or try to get you to eat. Just watch it, don't think too much about it.
Process the feeling (go do a worksheet from month 1 week 2!)
R: You are present and working towards freedom.

What's coming up?

Hello,

I'm joining a bit late but just finished the video on the Impossible Goals in month 1. I feel like intuitively it makes sense, but what happens when someone keeps trying and trying to get to their goal and it just leads to them feeling more upset because nothing budges? How would this help us live in our values?

I have a specific example. I entered my residency program thinking it would be very open to resident feedback and wellness (advertised during interviews). However, once I've gotten here it's clear it is the opposite - admin never listens to the residents' feedback and nothing changes, despite our feedback. It can be very disheartening to keep working to change the culture of a program and not seeing any changes. How is this helping us to live in our values if nothing changes? I'll give a specific example

C - Our residents asked for ability for residents to decide where our float resident goes for coverage because some services were getting slammed with patients. Program agreed but nothing has changed.
T - My program never listens to me.
F - Frustration
A - Disengage from the program, complain about the program to other residents, not volunteer to help with things when asked by the program
R - learned helplessness, cycle continues of hating the program

Thanks so much for your help.

ANSWER:
Hello, and welcome! So glad you are here.

OK friend. I totally get your question, and your frustration!

You are asking powerful questions and your model is very powerful too.

Here's what I've learned in the past several years of doing this work:

When we make how we feel contingent on what other people do/say, whether something outside of us changes or not, we give away all our power.

I think what is adding to your pain here is that you are giving what your program does/doesn't do the power to make you happy/well/frustrated/disengaged/unhappy/helpless.

We use the Model to bring awareness to the layers of pain and suffering we are adding by resisting the reality of what is.

The thought "my program never listens to me" feels VERY TRUE to you. Maybe it is true, maybe they don't care at all! But it's expensive for you. The price of believing this thought is that you spend your time cultivating and rehearsing your frustration and as you say, continuing the cycle. That adds salt to the wound because it leads you AWAY from your values of agency, advocacy, and promotion of healthy culture and wellbeing.

It's OK to feel disappointed that the program you thought you were getting is not the program you got
It's OK to wish they responded differently
It's OK to feel frustrated when things aren't changing the way you think they should.
It's OK to grieve the loss of the experience you thought you were going to have.

Here are a few questions to explore
1. If nothing changes- what do you want to take away from your experience in training?
2. What is at risk if you stay in the cycle of hating-disengaging-blaming your program?

This will take a few back-and-forths, I suspect, so bring your model 2.0 back for more!

<3

Lately, I've been really struggling as a geriatrics fellow at what I thought was my favorite program. I've wanted to be a geriatrician since high school (influenced by growing up with my grandparents) and finally getting to geriatrics fellowship at one of my top programs was a dream come true.

I like to describe my experience in fellowship so far this year in terms of my love of DisneyWorld - at first, all the rides were brand new, I was so excited, I wanted to go on it multiple times. Then, the initial sparkle went away but I was still at Disney, and who doesn't love Disney? Now I'm on Thunder mountain and I'm stuck because the ride is broken - I'm seeing everything that's wrong with the program and I'm still stuck on the ride for 4 more months. But it's such a confusing feeling, because I love Disney! (aka I love geriatrics). Why do I feel this way??! It's very frustrating because I'm usually a very enthusiastic person and I love this field so much. I've got tears in my eyes typing this.

I'll try the model:
C: Fellowship has a lot of ups and downs, sometimes more downs then ups.
T: Fellowship is supposed to be fun, I really love this field of geriatrics and I don't understand why this feeling is here.
F: boredom, lack of control, lack of motivation, frustration, dissatisfaction
A: I keep looking for things to do outside of my "boring" rotation, I've reached out to people for things that I'm interested in, and my program director is being as accommodating as possible in the constraints of funding for our program.
R: Feeling regret that I ended up at this fellowship even though there are so many things that I have learned this year and it was important that I was here. The grass is always greener on the other side, and I have not felt fully happy for the last few months.

A lot of my conflicting feelings surround feeling like I was falsely advertised to regarding the fellowship (didn't know I would be spending 6 months at the VERY slow VA), yet I have a super amazing program director who has heard me out and is allowing me to do a lot to try to address my feelings, but it still doesn't feel like enough. Talking to my close friends about this hasn't even really helped.

Appreciate any thoughts you have and for this community.

ANSWER:

Oh Friend. I'm so glad you brought this here tonight.

Oooof! Its really stinks when our real-life experience (Disney, or fellowship) doesn't match our expectations.
You thought it was going to be one way (love it all the time, busy service, complex patients), and part of it hasn't been what you were expecting. It makes sense that you might feel disappointed or frustrated.

You are going through an important realization, here. The realization that professions/jobs aren't always shiny and happy 100% of the time. That sometimes there are ups and downs. That there is gritty stuff and boring stuff, and stuff that's outside of your control, and that life isn't always like we thought it was going to be like (Disney), even when we LOVE what it is we are doing.

A few points about your model. We always want to keep it to ONE thought and ONE feeling per model. You certainly are operating from more than one at a time, but for our purposes we like to get curious about them individually.

C- You are a geriatrics fellow.
T- "Fellowship is supposed to be fun"
F- How do you feel when you think that? (I'm going to guess frustrated?)
A- What do you do or not do from that emotion?
- look for all the things that aren't fun
- judge yourself for not having fun because you "should be having fun, after all you should LOVE THIS"
- look for evidence that the program isn't meeting your expectations,
R- The result for you is you double down on the un-fun experience by then punishing yourself for feeling that way! And this really hurts because it is not aligned with the image you have of yourself, someone who is enthusiastic and who loves her work.

Do you remember being a senior in high school? remember being OVER IT, and picking fights with your parents, and just being ready to get out of the house? (was this just me?)

Turns out, feeling "over it", and thinking things are "boring" and a waste of your time, was probably a totally developmentally appropriate thing for a 17-18 year old to be feeling. This helped us launch into college and be successful independent adults. But we sure were frustrated and miserable at the time, right?

What if feeling bored and frustrated and dissatisfied in training are signs that you're getting ready to be done? Could that also be developmentally appropriate? Could it be a sign that you're shaking your wings out and getting ready to launch?

I don't know, but I wonder.

All this to say, it's OK to be disappointed that this wasn't the experience you thought you were going to have.
It's OK that you're not feeling motivated right now.

neither of those two things means that you will never feel satisfied, enthusiastic or motivated again.

In times like this, I like to look for ways to align your work with your values.
What things brought you to a career in geriatrics?

I'm picking up values of Service, Compassion, Connection. What else?

In what ways can you lean towards those values even if the service is slow?

You have 4 months left. What do you want to make of that time? Why? How?

I'd love if you brought what comes up for you back for more coaching,

<3

Shoot! Someone asked a beautiful question about rude people in my coaching call tonight, and I tried to copy it from the chat to put an answer here (since we ran out of time!)- but I failed at copy/paste. Can you come post your question here? Ok to keep the prompt de-identified <3
Tyra

This is not directly related to work-life, but I know that the feelings and reactions I have are similar in work life and personal life and I can grow both places! I am newly in a relationship that I am very excited about, after not being in one for all of med school and most of residency and definitely using work as an excuse. My last relationship ended when my partner said they were no longer happy in the relationship, but it came out of nowhere as they had been working through some personal things and had been reassuring me it was not about us. So now, in this new relationship, every little thing is scaring me and I don't trust anything.

Here's my current model;
C; I am in a new relationship with someone who says they are excited about a future with me
T; This happened before, and that time my partner didn't open up and tell me the truth about how they really felt, so that's probably what is going on now too
F; Anxiety, fear
A; Asking constantly for reassurance, assuming they are only reassuring me because they know I'm anxious, and not trusting them. Letting their moods and feelings dictate mine. Reading into things to try and convince myself that they must be feeling differently than they say.
R; Convincing myself that if I have anxiety then it must be a sign that something in this is wrong.

I know this model all too well--I have a similar model if I think about my imposter syndrome at work (people must be telling me I'm doing a good job because they know I am extra anxious about it, not because I am actually doing well!). I don't want to be someone who needs constant reassurance and then doesn't even trust it. In my relationship this makes me oscillate between being honest about how anxious I feel and apologizing for everything, not wanting to seem "dramatic". I think in medicine it has been easier to work through this because I have had feedback and reassurance from more than one person (and with whom my personal relationship felt less meaningful or important), and I can see the growth I've made over residency. I am not sure how to break past this with another person I care so deeply about.

ANSWER
Look at you being onto yourself so quickly! Congratulations on your spot on insight!

I want to point out how you have a thought: "I don't want to be someone who needs constant reassurance" but then you use reassurance as a reason that you believe you have "worked through this" in medicine ("it has been easier to work through this because I have had feedback and reassurance from more than one person").
So- here you are not wanting to be dependent on reassurance, but still framing it to yourself as a must-have to be ok. This is probably the part to dig into. The great thing is that the truth is that the "reassurance and feedback" you have gotten in medicine is actually NOT why you feel better. The reason you feel better is because you have a different set of THOUGHTS about yourself. Yes, probably those thoughts came easier to you with the Circumstance of "reassurance and feedback" that you have received, but it's an important distinction because this is where your power lies.

You said that you can see the growth you have made over residency and *this* helps you feel more grounded and less imposter-y.

So I wonder, where can you see growth in yourself in relationships?

I want you to free write on these prompts to see if you can illuminate your growth in a similar way:
What were you like 15 years ago in relationships? How did you grow from there?
What were you like 10 years ago?
What were you like 5 years ago?
What were you like just before this current relationship (what thoughts did you have about yourself that you no longer have, or still have?)?

In fact, I bet you are a completely different person now than you were in any of your prior relationships- the human brain naturally evolves and changes so much without us noticing -
I bet it's true that you have "grown" magnitudes in both dimensions (medicine AND relationally).but if you only let yourself believe it's in the former, you will be stuck in the latter.

What comes up for you here?

First off, I wanted to thank all of the people who've submitted messages and the coaches and participants I've listened to on calls. It has been so helpful.

Unintentional Model
C: there is a set amount of work per day on a rotation. There are two residents (including me) on the team.
T: "I am doing more work than my co-resident."
F: Betrayal? [the coach mentioned Harry Potter on the last call - this is the "I trusted you!" moment from the HP 3 movie]
A: gather evidence that proves my thought (ie, make a list of all of the work I've done that is longer than theirs); stay late; compare every action I do to theirs; avoid talking to them; get angry at myself that I'm not speaking up about this; "armor up" for the next day; don't say what I'm thinking because maybe it's incorrect and I'm seeing the situation differently (or incorrectly) than my co-resident is
R: don't trust other people and don't trust myself and my skills.

Intentional Model
C: there is a set amount of work per day on a rotation. There are two residents (including me) on the team.
T: "I am doing my best and that is enough."
F: Encouraged/Invigorated
A: focus on the task at hand; visualize things going well; allow myself to say and use my boundaries; enjoy my interactions with people more.
R: I have greater confidence in myself. And don't rely on other people for how my day will go and accept them with compassion where they are.

I still have some exploring to do with other thoughts, but I am getting stuck on 1) why the concept of "fairness" is so important to me; 2) how to separate expectations or goals for myself from the inner critic; 3) remembering that I am enough (#3 has gotten better). Would love to hear your thoughts on the models, Thank you so much!

ANSWER:
Oh, thank you so much for those wonderful words, and YES thank you to EVERYONE who is sharing this work. <3

OK let's check in on your models.
GREAT awareness in your UM. You nailed it.

How does your IM feel to you? Does that thought/feeling feel available in the moment? Sometimes it's good to "try it on in the wild", if it doesn't quite feel believable yet to think "I"m doing my best and that's enough", that's OK.

Let's go to your questions. The cool thing about them is that I suspect you have the answers if you give yourself time and space to discover them.

Why do you think the concept of "fairness" is so important to you?

How could you tell if a goal was set from a place of healthy striving (part of you that is curious and brave), or from perfectionism (the part of you that is the inner critic and wants everything just so)?

Bring it on back!

I am going back to a rotation as a senior that I hated as an intern. This is a unit that is notorious at our institution for undermining and not trusting residents. Worst of all, blatant bias toward certain patient populations is omnipresent across the unit. There has been extensive work between our residency program and unit leadership to improve conditions including implicit bias and microagression training for the staff. I was back there a few weeks ago to cross cover a shift and did not feel that much progress has been made in the past 2 years in terms of how residents are treated or comments that are made. I want to show up as a supportive senior for the interns and not fall into the trap of complaining about everything. I did not do a good job of that when I was cross covering. I know it is important to call out bias and have space to process it, as well as report issues of safety. However, I feel because of my negative experiences, my brain is constantly on the look out for how terrible things are or how comments that are made is impacting patient care. Please help me reframe my thinking!

C: I am senioring a rotation that I did as an intern
T: This is going to be a terrible month
F: dread
A: rehash all of the terrible things that happened when I was an intern, look for evidence that things have not changed and people are still assholes in this unit, complain to co-residents, tell interns that this was my most hated rotation of intern year
R: I’m setting myself up for a terrible month

ANSWER:
Hello!

I want to acknowledge how HUGE it is that you are aware and anticipating what your brain might do when met with this particular location/rotation. This is meta-cognition in action. You are doing it!

You have great awareness in your model here. I like how you have just ONE sentence on your T line and one F. You're spot-on with your R line. Not only do you set yourself up for a terrible month, you are experiencing the negative stuff NOW!

I want to practice an idea called DECISIONS AHEAD OF TIME. That means that you can make a decision NOW for what you want to do when your brain does the thing you are predicting it is going to do.

What would be most helpful to you and your team when your brain goes on the hunt for how terrible things are? Is there a way that you could nudge your brain in a direction that is aligned with your goals?

NOTE: this does NOT mean that you say "Everything is fine here! Rainbows! Unicorns!". We are not going to try and gaslight ourselves into thinking something we don't believe. It won't work.

Let's try this:

You said you wanted to show up as a "supportive senior". What does that mean to you?

Make a REALISTIC (not perfectionistic) list of all the things a "supportive senior" does or doesn't do. Get as specific as you can.
Some things you might want to include...
"When a macro/microaggression happens to someone on the team, a supportive senior______"
"When she is frustrated with how something is going, a supportive senior ___________"
"When her brain is on the lookout for how terrible things are and she has the urge to rehash all the terrible things that have happened in the past, a supportive senior______"
"when she has good intentions, but sometimes slips into an old habit, a supportive senior_________"

What feeling would drive those actions? (Courage? Commitment? Pride?)

Let us know what comes up!

I was in the fall cohort and over the next few months I want to work on re-writing my origin story. I was thinking to go back and forth with it on AFC instead of on the live calls because it seems that it requires some extra thought/deliberation. How do you think it would be best to engage in this work using the AFC platform? Should I write out my original origin story followed by a bit of a thought download and go from there?

ANSWER:
What a great idea! Yes of course you can bring it here and we can go back and forth. Another idea would be to write it out yourself and then bring what comes up for you here for coaching. Do whatever feels right, friend!

What a powerful process this will be for you. <3

Ha! Re: "childcare is still a requirement for our lives to function" -- totally a F*ing thought, and it's a thought I don't even believe! LOL., Truthfully I think that we could get along fine without childcare if my husband could just embrace having more bandwidth or tolerance or whatever else it is that in my manual for him, which, alas, isn't my circumstance. I think for me, accepting this as a "circumstance" [when I certainly don't feel like it is one] has been a process of slow acceptance/acknowledgement of the boundaries that my husband has decided to set for himself. If the tables were turned I would be handling all of the childcare without complaining. I digress...

C: My husband and I work full time. We have kids.
T: why can't he just handle it; why do we even have to deal with this nanny bullshit; if the tables were turned I would be able to manage all of this without help
F: annoyed at him even though I know he is doing the best he can
A: nothing helpful comes from this thought
R: The results are not helpful either.

ANSWER:
Look at that funny little manual you have for your husband emerging. I will summarize your T here as "he should handle all of this, and he's not." In your "user manual" for him, where he should deal with all things childcare, it seems so "right" to expect him to handle nanny issues.... BUUUTTT in this internal space, only you are suffering ill effects.

So what if you "would be able to handle it"? First of all, we can't be sure how you would show up or who you would be if the tables were turned. But even if we pretend that you would do it differently and "better" according to you, that imaginary land where the tables are turned is not reality (because you have chosen to not make it reality, you have chosen the work you are in and therefore to not turn the tables) and now you are using it to make yourself feel bad.

Now listen, I also want my husband to do more childcare. I want the world to have more equality, for this not to fall on me, and for men everywhere to have their eyes opened to the invisible load that mothers carry (yes, I'm generalizing like crazy here). But when I live in this space, only *I* suffer more. And I don't get my husband any closer to seeing my load, taking on childcare, or connecting to me at all - all of those things get worse.

So.... the big courageous questions becomes: Can we drop it? What happens if we drop the manual?

You still get to have requests, expectations, and asks of your husband, but if he says no, (or nothing), then what are you going to do with that? Right now, you are handing him control of your emotions. What does it look like to take them back?

Result: You step into emotional adulthood
Actions: (what happens here? How do you ensure that you get your needs met? Your childcare desires met? Your emotions held? what else?)
F: ???
T: ??????????
C: Husband and I both work and I have decided to hire childcare

HI friends,

Thank you all for holding such a beautiful space for each other tonight.
You are incredible.

I wanted to share a few things that we talked about on the call.

1, Check out Tyra's articles on cognitive bias in assessment here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527954/ and Here https://onlinelibrary.wiley.com/doi/10.1111/tct.13351

2. How to learn to like/love(!)/appreciate yourself? I shared a little bit about my recent journey on this topic during the call. Here are a few of the questions I asked myself weekly during a 4 month period last year when I set out to become my own best friend. During that time, I completed each of these "worksheets" once per week.

Hint: It was NOT comfortable, It's is still a work in progress, and I'm OK with that 🙂

"Appreciation for my mind"
To appreciate something means to recognize its full worth. Appreciation= Gratitude + attribution
Today, I appreciate that my mind………..
This week, I appreciate that my mind……

"Appreciation for my body"
Today, I appreciate that my body………..
This week, I appreciate that my body……

"Savoring Time with Myself"
I’m becoming a person who treats herself with love and respect. Part of this work is the way I interact with my self. Some ways I can do this are by luxuriating through the steps of the care for my skin, hair, and body (not rushing through face routine, brushing hair gently, using a fresh razor in the shower), and having fun while I am alone (reading for pleasure, laughing, dancing etc)
In what ways did I savor time with myself today?
In what ways did I savor time over the past week?
What did I learn about myself through this process?

"A NO for a YES"
I’m developing a practice of generous honesty, appreciation, compassion, respect and love for myself. Part of this work is the way I interact with others, their expectations of me, and my expectations of myself. One ways I’m learning to honoring myself is by right-sizing my expectations of what I can do for other people, and saying no once per week so I can YES to honoring a commitment to myself.

In the past week, when did I say NO so I could say YES to honoring my commitment to myself?
What did it feel like to say no?
What happened once I said no?
Was it worth it? Why or why not?
How do I want to handle this next time?
What did I learn about myself through this process?

I'd love to hear how YOU would answer these questions.

Take care, friends,
Adrienne

I've been continuing to notice that anger is a frequent and exhausting emotion for me, so I want to try and work through another situation that brought up anger for me.

C: The program director emailed us during afternoon didactics, "[Only three of us are it didactics.] Some of you have the power to change this."
T: That is so unprofessional and passive-aggressive! I HATE being bossed around. Why would somebody to talk to me and the other fellows like this? This program is the worst, our leadership sucks, how do these people get into leadership positions!?
F: Angry? or perhaps indignant is more specific?
A: Stewing, venting in the group thread, definitely NOT going to conference
R: Wasting emotional energy, not present with my team, missing out on didactics that I might have enjoyed

I'll try an intentional model:

C: The program director emailed us during afternoon didactics, "[Only three of us are it didactics.] Some of you have the power to change this."
T: The APD sounds frustrated that folks aren't in conference. I had sort of forgotten about conference, but actually I could make it if I went now.
F: Aware
A: Make a grounded decision in whether attending conference fit with my goals for the day.
R: Make a decision in line with my values, not get caught up in somebody else's emotional roller coaster, not waste energy with negative emotions that have no value.

I like the feeling "aware" because it doesn't try and turn the situation into a positive one, but does bring down the frequency of the whole experience....

ANSWER:
Great awareness here!.

Your R line in your unintentional model is spot on. You can see that anger, by itself, is not positive or negative. As we talked about in tonights call, sometimes we may WANT to be angry about things. You are 100% right, though, that in this model it creates the result of you spending your emotional energy and missing out on something that might have been educational.

I want to check in with you about your intentional model.

Does this feel accessible for you?

If so, great! Try it on in the wild.
What thought do you want to practice on purpose that brings you to the feeling of "awareness"?

Bring it on back 🙂

Thank you for your answer! I love that pearl about how strong moods are usually signals about values. To answer your follow up questions, here goes:

When I feel like I am spiraling into a strong emotion that I can't control, how do I want to relate to myself?
I think I want to learn how to self-soothe. I don't think I've ever learned how to do this. My first instinct is to call a friend or sister and sob to them until they say something that makes me feel better. But I want to learn how to make myself feel better. And I know we shouldn't try to just change or get out of our strong emotions, but maybe I can just stop adding judgment to my strong emotions?
For example, saying something like "It's okay to be a hot mess sometimes.". Or "You're a beautiful hot mess right now and that's okay". Or "You've felt like a hot mess before, and you've always come out of it". "You may not feel like you're handling it well right now, but that's okay. You're working on it. You'll get better."

Then when I do have a strong emotion, how do I want to react in a "healthier way"?
Hmmm I'm trying to imagine what someone else might do if they have a very strong emotion... maybe go on a run? Distract themselves some way? Meditate? Journal?
The thing is that I tried to do some of these things and I still felt awful... I tried to journal, I posted on here, and maybe I felt a little better because I was telling myself "this is good, it's forced you to seek out coaching and forced you to do self work". But then I immediately thought about how I just spent the entire afternoon of my day off sitting inside journaling and being in a bad mood when I should have been out enjoying a beautiful sunny day with my husband.
Idk, maybe bad moods and bad days are just supposed to happen sometimes? That thought makes me feel a little better.
Or maybe I will try to ask myself what the values are that seem to be in conflict to cause these emotions?

Thanks for bearing with my stream of consciousness <3

ANSWER:
Beautiful work here, friend.

I love seeing what opens up for you when you made the shift from trying to "control" (to me this is a tense, heavy thing) to allowing and understanding your emotions (which to me feels much more gentle, and open). What a beautiful realization that, in fact, you have a 100% success rate of making it through messes before!

OK. I want you to check out the week 2 video "how to feel better" (and the accompanying pages in the month 1 workbook) where we introduce the 4 ways to respond to emotions. The first three most of us are well practiced at:

1. Resist- This is what you are used to doing. This looks like trying to "control" them by pushing them down. It's like holding on to a steering wheel so tight that your knuckles are white. You know what I mean? This is an ENERGY SUCKER

2. Avoid- This is when you try and distract yourself with food/drink you don't need, instagram (!), Overworking (!!), impulse purchases (!!!). We call this "Buffering". It alleviates the discomfort of the emotion in the short term, but has a net-negative result for you.

3. React- Snap at your partner (!), blame someone else (!!), Give in to whatever that uncomfortable emotion is urging you to do.

the 4th way is the one you get to start practicing now, and YES you are on the right track.

4. ALLOW the emotion- This might mean noticing and naming it when you feel it. Identifying where it is in your body. This feels uncomfortable until you have practiced it enough to build trust in the belief that that emotion, in and of itself, can not hurt you. You might journal about it, what it feels like, you might take it with you on a walk or a run.

Notice how in the times you tried to allow an emotion, you immediately judged yourself for not making better use of your time ("go outside!" "do something fun!").

What if the BEST use of your time was to learn how to allow your emotions?

What is at risk if you don't?

If you're up for the challenge, I wonder if you can complete the "feeling now" worksheet once a week for the next 4 weeks. Try it with pleasant emotions, unpleasant ones, "good" ones, and "bad" ones.

What could you learn?

You're absolutely right that the T- "Making mistakes about the type of person that I let take care of my children is something that doesn't have a lot of wiggle room" is not helping me at all. It makes me feel overwhelmed and highly at risk for "failure." Another simultaneous T is- "I’m definitely going to mess this up again so I better be prepared for failure" and this T is also not serving me. I think you’re right that the best T is somewhere between these- acknowledging that irreparable damage is unlikely, that I really don’t have much control over other people actions (and I can handle whatever comes up in the future even if it’s painful again), and that I’m nonetheless faced with a situation where childcare is still a requirement for our lives to function.

ANSWER:
Yay for noticing unhelpful thoughts!
Also - the only way to find the most helpful T sometimes is to try a bunch on, which is what you are doing.
Remember - you don't actually have ANY control over other people's actions. Only yours. And "trusting others" goes in the A line... you get to decide when, who and how you use this one.

Interesting that you phrase your thought as a circumstance: "childcare is still a requirement for our lives to function" is NOT a C, my friend. This is a solid T.

The problem with phrasing it as a C is that you lose autonomy and choice here. It feels like you "have" to find childcare (I know, that seems true!) but really you don't. You could leave your kids at home unattended (yes, you'd probably go to jail, but you could technically choose this). Or you could find a different job. Or you could find a totally new situation to do your same job in that makes childcare easy (hello, most of England!). But you are *choosing* to find childcare, because it's available to you and you prefer this option out of the alternatives. Subtle difference, but a powerful one.

C: you and your husband work full time. You have kids
T: I choose to find childcare for them so that I can continue like I have been
F: ??
A: ??
R:??

Anything you want to tweak here?

Ok, so, YES! definitely hit the nail in the head there, I had completely ignored the option of being upset at change but still manage to somehow enjoy the situation. I was ready to take on and practice the proposed model, when I got stuck again at the part where I could potentially name my disappointment out loud... The more I thought about it, the more it became clear that I am not giving myself the space to be disappointed (or feel much of the negative emotions other than anger, really) because I (or my very strong inner critic) have associated it to being childish, petty and selfish. When changes happen, particularly through a third party's opinion, I feel unheard. I don't think that people forget that I had good reasons for my choice or preference, I give little time to analyze whether they are trying to be helpful, I just assume they are actively and knowingly choosing to ignore or dismiss my choice. My response is then to give it right back, I ignore and dismiss them, I don't communicate my discomfort, I throw a tantrum and now I'm really being selfish and childish. Wouldn't it be easier to allow myself that space to be disappointed? To name that uncomfortable feeling for myself and to others? I think this is really where my mental block is: feeling an emotion is not what is childish, reacting to them is. I am allowed to voice my feelings and show them in a grown up way and maybe then I will be able to have more transparent relationships and even more enjoyable experiences.
Now, since the original post, plans have continued to change and I have to say, I was not successful in sitting with the disappointment at the moment. It takes me a couple of minutes to realize the path my brain is taking me down and even when I see what is happening, my brain goes again towards logic and avoids emotion. This time I did not say I was disappointed, but at least I did reiterate what I actually wanted to do (? better? Still kinda gaslighting maybe?). This sitting with my feelings thing is harder than it sounds. Any tips to help me work through this emotional/mental block?

Oh, and for the bubble tea, I cheat: Option 1: Premade Costco packages, mix it all up in a cup of hot water and voila! Option 2: Make your own tea and add milk of your choice, ice and a pack of microwavable tapioca balls from any Asian grocery store. Option 3; Make your own bubbles from tapioca flour and add to tea as in option 2. There are many videos out there to teach you how, but I have heard it takes a good amount of skill and trial and error so I have not yet tried this fully DIY method.

ANSWER:
Alright, sister, great work here!

Listen, If you grew up in an environment where it wasn't allowed or encouraged to feel all of the feelings, then it makes sense that this is the habit your brain learned and has practiced over and over again for many years. One caveat here to say that you aren't alone in this! Many of us, even when we had caring adults who were doing their best, developed a similar thinking pattern.

It took many years to learn this habit and it will take a bit of time, and practice, and patience to learn a new habit. Nothing has gone wrong here and you have just taken a HUGE leap just by noticing that this pattern exists. you don't have an emotional or mental block, you are learning a new skill and you are a beginner at it!

The way out? Create awareness of when this happens. Even if you don't notice it in the moment, start to bring attention to when you DO notice that you are entering your old thinking pattern. Then, WITHOUT JUDGEMENT for yourself (this is key), ask yourself to check in. "What is happening here?" "Oh, I noticed I'm going down that old pattern, isn't that interesting", and then you might find "Oh look! I'm noticing it sooner now!", "I'm building the muscle of identifying an emotion", "Now that I am building the skill of naming my emotion, I'm starting to practice allowing the emotion to exist in my body", "I'm getting better at allowing emotions", "Look at me rewiring my thinking patterns!"

Developing awareness will help you notice and change your thinking and reduce your resistance/reactions when you ARE feeling those new emotions.

What if you challenged yourself to FEEL one emotion per week. Put it on your calendar.
During that time, work through the "Feeling now" worksheet, or "the 50/50" worksheet all in the month 1 workbook.

Bring what comes up back here form more 🙂

I am reaching the end of my training and have a number of job offers. I have prioritized training/work heavily over the last 10 years and have excelled in a number ways but have been grappling with arrival fallacy. While I have "good' opportunities (ie, programs offering to build a position for me with whatever aspects I want - research time/clinical time, etc) in academic medicine now as a result of my hard work, other aspects of my life (relationships/life outside of work) have felt the squeeze because I've prioritized work so much. I worry that if I continue in academic medicine, I will stay on the hamster wheel of achievement out of habit, and even if I break my habits, will still have a job with high expectations/lots of demands and that will make it challenging to build the relationships/life that I want outside of work. In light of this, I started looking for opportunities outside of academic medicine and found an option at the fda that I think will challenge me, let me utilize my expertise/training, and fit with my core value/purpose of helping others. It also has much more flexibility and seems much less stressful than any path I have seen in academic medicine and I would still take care of patients one day a week. Rationally, I think this could be a positive change of circumstance for me and my family. However, I worry that I am doing something wrong by trying to change my circumstance rather than sticking with what I have been doing (academic medicine) and trying to change my thoughts.

C: I have an offer for a job outside of academic medicine and am considering it.
T: I am trying to change my circumstances instead of changing my thought patterns and will end up feeling unfulfilled/unhappy regardless as a result, I am making this choice for the wrong reason. (this is the most exaggerated version of this thought, not the one I have most of the time)
F: worry
A: post this here
R: hopefully get some good advice

Alt thought: This a potentially positive change of circumstances and I can still work on my thought patterns not matter what my circumstances are. There is no inherent value in sticking to something for the sake of stick-to-it-iveness.

ANSWER:
Hello! Wow, how exciting!

T- "If I stay in academic medicine....I will miss out on the relationships and life that I want outside of work."

That's a really expensive thought, because it is convincing you that there is no way to win!

Can you name the emotion/feeling you have when that sentence runs through your head?

C- Graduating from training summer 2023, jobs exist
T- If I stay in academic medicine I will miss out on the relationships and life I want outside of work"
F- ?
A-???
R- You miss out on dreaming of and creating the life you want regardless of if it's in academics or not!

There is great news here.
You can live aligned with your values and purpose of helping others NO MATTER WHAT. Sure, priorities of your leadership and work environment may be different in academics vs community practice, but I promise you, it's your THOUGHTS about your work that create your experience of the work.

I invite you to imagine your life 10 years from now. Maybe you are in the first job you chose after training, or maybe you've tried one thing and then changed your mind and are in a different type of practice.

Tell me what a DREAM life is like for you?
What kind of patients are you seeing?
What brings you the most joy in your work?
How much of your time do you wish to be in direct patient care?
What is family/personal life like?
Paint a picture as vivid as you can.

How could all of those things be possible in an academic career?
How could all of those things be possible in a community practice career?

Let's see how much overlap we can get in the Venn diagram 😉

Thanks for the BT 2.0 questions! Such good revelations, I just had to share. Progress!

As maybe expected, I don't really feel guilty about taking care of myself, I feel guilty about NOT taking care of my friend

From the time I was a toddler and my sister was born, my mother reports I was always a "good helper" and that's been my guiding principle since. And taking care of others has so often come before taking care of myself, often at my own expense. And I have relied heavily on the fact that I help other people for validation

During my life as a student, I gained validation from my academic successes, mostly by grades and award recognition etc.
And then when grading wasn't a part of my day to day, I think I subconsciously started to rely on peoples words of affirmation for validation, whether it was family, friends, patients etc. In truth I probably did before too, but then it became my "main" source of validation. Which isn't serving me. If I'm relying on other people's happiness for validation, but I really can't control other people's happiness, then my self-worth is at the mercy of other peoples thoughts. And that is SUCH a slippery slope

SO, I'm exploring the ideas of self-validation and self-compassion. I'm making my way through Kristin Neff's book to start
Just wanted to say how grateful I am for this program and the support
hugs!

ANSWER:
This is so powerful! Thank you for sharing your wins here! Keep them coming, friend.

<3

Oof, having a day--no week where I've felt like I'm at my emotional limit. Like I'm a teapot that's ready to give a high pitched squeal if the temperature is turned up any more. Or like a precarious tower of Jenga blocks that is about to tip over if you take one more block out. I HATE feeling this way. Not only because it just sucks, but mainly because I see how it affects my relationship with my husband. When I am at this point I just can't show up for him in the way I want to as a wife/partner.

It's hard to know where to start in unpacking this because I've noticed that my negative (or unpleasant) thoughts and feelings tend to trigger a spiral of more unpleasant thoughts and feeling. But I'll try to summarize:

C: I'm a newly elected Chief Resident. (We're elected as R2's and do most of the work R2, but then we're "chiefs" in R3). The Chief residents (R2s) have to make all the schedules for next year. There are a lot of new ACGME changes and things up in the air. The schedules would ideally be done by March/April. I'm also starting a two month stretch of Medicine and ICU in March/April.
T: I have so much to do before medicine and ICU starts. I don't think I can get it all done. But if I don't get it done then I will be even more stressed out on these hard rotations and my co-chief will have to pick up my slack.
F: Anxious, stressed
A: I can't relax, I'm thinking about work all the time. Just generally in a bad mood. Many times when I'm in a bad mood I tend to take it out on my husband (even if he's done nothing wrong!). I'm cold and quiet. In some sick way I think I want him to be unhappy too... so we can be unhappy together???
R: Spiral of more unpleasant thoughts and feelings: I feel guilty and full of shame for treating my husband this way. Triggers thoughts like "he doesn't deserve to be treated like this". Or "he deserves someone who can control their emotions better than I can". Or "He doesn't seem to be as moody as I am... he must be better at controlling and responding to his emotions. I don't deserve him"

Oof that last one hurts. It hurts so bad.
I know he loves me and I know that I should love myself even when I'm an emotional mess. I know I am a good partner in a lot of other ways. I know a "perfect" partner doesn't exist and I know I need to work on my perfectionist tendencies.
But I would also love to know how to not react in this way. How do I choose a healthier way to respond when my emotions feel sooo strong??

ANSWER:
Oh friend, You're totally IN IT right now, and that's OK. Look at you bringing this for coaching! Future you will appreciate that move 😉

I TOTALLY have played the "If I'm going to be miserable, then you are too" move in my relationship. Ooof. Never quite works out the way we hope it will, huh? And now you are turning that on yourself as proof that you're not a good wife/partner etc. Of course this feels awful.

When we have strong emotions, they are usually signals about our values. Here's what I can pick up from your TD:

In your work you value accountability, commitment, dependability, integrity (you want to make sure you get your job as a chief done because other people depend on you)

In your partnership, you value caring, compassion, kindness, connection (with your husband), Self-Control (you want to not spin out).

Of course these values aren't mutually exclusive, you can value accoutability etc. in your personal relationship and caring/compassion etc. in your professional realms, but right now you seem to have them pitted against each other.

What is extra painful for you here is applying judgement on yourself for acting in ways that are not aligned with your values.

OK friend. You are not alone here. You are not wrong for feeling anxious/stress, you are not bad for reacting to anxiety or stress differently than your husband, or anyone else for that matter.

You want to "choose a healthier way to respond to strong emotions". What do you think that would look like ? If you can't imagine it for yourself, imagine it for someone else. What is a "healthier way"?

How do you want to talk to/ relate to yourself when you are anxious or stressed? or when sometimes your brain spins out?

<3

I have a lot of trouble with changes, especially last minute ones, because I like to rely on plans, heavily.
I like structure and control, and change takes that away. I'm getting better at accepting change but I haven't mastered it yet. Here is a recent example:
I made weekend plans for dinner and a comedy show since my husband and I have a friend staying over this weekend; and I was looking forward to that particular food, but I received news that I had potentially been exposed to COVID. I told my house guest and husband that I felt good, would test before leaving and wear my mask but I was still good to come out. I showered, got ready and sat down to watch TV while I waited for dinner time when my friend decided she was no longer sure if going out was a good idea. For reasons that escape me (people pleasing kneejerk reaction) I said I would be fine staying in if they did not feel comfortable going out. And so we did, but here my emotional child came out to play: I started pouting and stomping, changed into my PJ, ate whatever snacks I could find around the kitchen counter and made myself some bubble tea. I sat down to watch tv and waited for them to join, when they finally did they both asked what the plan was and casually mentioned they were hungry. Needless to say I reacted to my emotions and became irritable and short fused with them. And, I guess here is where the model comes in:

C: House guest decided to change plans on me last minute while I was looking forward to going out. Now they wanna discuss new options for the night
T: Plans should not change last minute, this sucks! How dare you ask me what I want now? What I wanted was the plans we made! Now I don't care what we do or eat, I'm not hungry, nothing is gonna be as good as as those original plans I was so looking forward to.
F: Sour
A; Pout, snap, be short, say I didn't care while actively opposing every other option and opinion, getting even more irritated that the choice was not mine.
R: Did not enjoy my night

So now, I got in my own way and fulfilled the initial negative thought. Not a great place to be, so going to give an intentional model a try:

C: House guest decided to change plans on me last minute while I was looking forward to going out. Now they wanna discuss new options for the night
T: Dang, plans changed again! But wait, she's right, going out while potentially COVID positive is maybe not the smartest idea, let's try to bring the night out to us, we can still have fun
F: Optimistic
A: take part in the discussions of new choices, maybe even get the food I wanted delivered
R: Enjoy a night in

This intentional thought sounds as believable to me as the unintentional one but to jump from that to a positive feeling is the part where I am getting stuck, maybe I am trying to change into an intentional model too quick and should just learn to sit with my negative feelings first? Fitting for feelings week.
I guess this is a 2 for one as well, I also want help practicing the naming my feelings exercise. While working through this situation, I used the feelings list in the workbook and realized that there are many nuances that I can't discern. My feelings vocabulary is limited to happy, sad, mad, frustrated, tired, defeated, lonely, excited, calm overwhelmed and proud. For the unintentional model above I debated using irritated, mad, retaliatory and sour and I think I either don't know the exact meaning of all the words or again, I need to sit down and start feeling my emotions, get to know them so I can hopefully deal with them better? I vote for the second option, would appreciate your help in the matter.

Thanks!

ANSWER:
Hello! So glad you brought this here 🙂

We can ALL practice expanding our emotional vocabulary. This is SO IMPORTANT. The more we can be in touch with and identify our emotions, the easier it is to build agility in navigating between them.

I have the book "The Dictionary of Emotions" by Patrick Michael Ryan, and it's helpful to flip through when I'm having trouble putting my finger on what I'm feeling.

Let's look at your model.

Remember, we only want ONE sentence in the T line per model, so let me help you clean this up a bit.
C- Covid exposure, houseguest, you said "you'd be fine staying in", houseguest accepted that offer.
T- "Nothing is going to be as good as our original plans.... (and it's their fault)" (does that resonate with you?)
F- Sour (that's such a good feeling to identify, great job).
A- pout, stomp around, obstruct/shoot down other options,
R- you make sure you don't enjoy your night.

The reason you're having trouble with your new intentional model is because you're kind of gaslighting yourself into feeling good about something that you were honestly disappointed in, right?

You're basically saying to yourself "stop being like this, she was right, stop pouting about it, you can still have fun!". Imagine being a kid and you were disappointed that you didn't get to do something you were looking forward to, and an adult said "she's right, going out now is not the smartest idea, stop pouting about it, you can still have fun!". Odds are LOW that that's going to change a kids mind, right?

Here's where two things can be true.
1. You can be disappointed that your plans changed AND
2. You can find new ways to have fun.

What would it look like to allow yourself to be disappointed when plans change?

Here's an example of a model that might come between your first one and your intentional one:

C- COVID exposure, houseguest, you decide not to go out
T- Shoot, I was hoping to go out, this is a bummer"
F- Disappointed
A- Give yourself permission to feel disappointed, maybe even say out loud "I'm disappointed, and that's OK, I was really looking forward to that", what else could you do?
R- You allow yourself to process the disappointment without launching into emotional childhood.

Here's my challenge for you.
Next time you notice an uncomfortable emotion, I want you to get really curious about it. What value is it signaling to you that is not being met?
Instead of trying to swap into a better feeling emotion right away, what would it be like to allow that emotion to stay with you for one minute, maybe two.
When you find yourself in that uncomfortable emotion, ask yourself "what else is true here?".

OK bring this back for more, friend!

PS- how do you make bubble tea? Would love the recipe <3

This week I am finding myself feeling absolutely overwhelmed with being a parent and a physician.

To set the stage, I am a second year fellow and my program is very research-heavy the second and third years. My husband, on the other hand, is also a second year fellow but in an INCREDIBLY time consuming fellowship. As first years, we both were pretty equally busy (and I may even have been the busier one) but this year I am finding myself the "less busy" parent and because of this a lot of childcare has been put on me. My son is two and is also going through a huge "mommy" phase where he wants me ALL the time and wants me to do everything for him. You would think this would be flattering but when a 2 year old wants YOU to pick them up so they can scream directly in your ear for 2 hours it really isn't, In general, I find myself feeling resentful, not towards my child, but towards my spouse. I find myself wanting things to be "fair," thinking I am a fellow too, I am busy too! I know this is just a season of life but we have been talking about having another child and all I can think is that if we do that, I'm going to have 2 children to watch alone for all of the nights and weekends he is working.

Things were particularly bad this week because my two year old has been sick which has made the fussiness, clinginess, and tantrums MUCh worse. Simultaneously, my husband has been on nights and my son has been febrile so needed to stay home from daycare. So I find myself in a situation where my husband is sleeping all day (I understand he should be, he is working in an ICU at night and needs sleep) while i am carrying around a screaming toddler, unable to get any of my work done, feeling frustrated being stuck in the house and absolutely overwhelmed. At one point I hid from my son under a bed for 5 minutes so I could get a moment of peace and just listened to him walking around saying "where mommy go?" I feel like I'm at my wit's end. Then I'm up all night trying to get the work done I didn't get done during the day when my son was awake, he is waking up every few hours crying because he is sick, my husband is gone. It's just so much. My husband and I have no family support in the area so any time my son gets sick it becomes a catastrophe in terms of getting work done.

C - My husband had long hours. My child is sick.
F - Overwhelmed by the crying, Bitter that the child care responsibility is falling on me. Scared of the future and if will only get worse when my son is 3 (a "threenager") or once we have two children.
T - "This isn't fair. This sucks. I can't do this. How much worse are things going to be when we have another kid? When will this ever get better?"
A - I've become short-tempered with my husband and feel furious any time he leaves a dish out or does anything I perceive as "more work for me." I feel withdrawn and like I can't even talk to him when he gets home from work because I've used every ounce of patience and compassion that I have for my crying toddler.
R - I feel miserable and disconnected.

ANSWER:
Hello! You are not alone here, friend.

I could absolutely jump "into the pool" and splash around with you by agreeing about how hard and unfair it all is (I've been there, sometimes I AM there). But if I did, then we would both be wet, and you would have made no progress in moving yourself towards how you want to relate to your husband, your child, and yourself during this time where you are both fellows and your child is 2. (those are your circumstances). I could also offer you a bunch of actions ("try this!", "read this book", etc.), but before we get to different ACTIONS, we need to take a look at your thoughts and feelings.

There is ONE sentence up there that is causing a lot of your pain.

"A lot of the childcare has been put on me... and that's not fair"

When you are thinking that the burden of childcare is "put" on you, and you have no agency/control over this right now, it's easy to understand how you could feel resentful. Right?

Here's how your model looks:
C- You are both 2nd year fellows. His schedule is "X", your schedule is "Y". You have a 2 year old. 2 year olds do 2 year old things (want mom, cry, get fevers)
T- "A lot of the childcare has been put on me... and that's not fair"
F- Resentful
A- You rehearse your argument for why it's not fair, you have a short temper with your spouse (what else does this mean exactly? pick fights? pout? can you flush this out a bit?), look for evidence that he's not doing enough (dishes in the sink, other things that make "more work for you"), you close yourself off/withdraw
R- You put the onus on your emotional state OUTSIDE of you and allow that to disconnect you from your spouse, your child, and also yourself.

Now, This is not the kind of model where you can jump from this one (feels bad) to a new one (that feels good) in one swoop. The first step is really to see that it's the THOUGHT that you are powerless/have no choice in this, and that it should be FAIR that is adding to your load right now.

What comes up for you when you sit with this model?

You said above that you have run out of patience and compassion at the end of the day. I suspect that means you have run out of those things for yourself too.

If nothing changes in the next day, week, month. What would it look like to have patience and compassion for YOURSELF?

What needs do you have that you can meet for yourself?
What needs do you have that you can ask to be met by your spouse?

Finally, how would you know what was "fair" when it came to parenting? Is this fixed day-to-day? month-to-month? Year-to-year?

Bring this back for more coaching, friend.