Boundaries, or lack thereof

Confession: I surf, scroll and check. It’s a compulsion and applies to my social media, work and personal email, and even the EMR because I have an Epic app on my phone. I get secure chat alerts on days off asking me to do things for my patients. I oblige more than I should. It doesn’t seem like much in the moment, but I can’t deny that the thousand micro-crossings of my personal boundaries and well-being must take a toll over time. People talk about not checking email on nights and weekends and while in theory I support it and secretly aspire for it, I simply haven’t been able to imagine an existence where that’s possible. 

But I think it’s time. 

I logged onto the EMR from my phone just to see if there were any new results that popped in (in retrospect, why?? Am I really going to act on them on a Sunday?), and remembered one of my medically complex patients was hospitalized. I figured I’d hop on her chart to see how she’s doing as I know it had been a bit of a tenuous course for her but I thought she was on the mend. As I was opening the chart, I got an alert that said,

You are about to open the chart of a deceased patient.

My heart dropped. I closed the EMR. My day was suddenly shrouded with grief over this longtime patient of mine, as well as sadness for her surviving family members who are also under my care. I regretted the thoughtless choice to open Epic on a day off when I was home with my family. And suddenly I realized how desperately I’m in need of some clear boundary settings to protect my heart and stay present rather than worry about my patients when I’m with family. 

This is one of many #EmpathProblems that I expect I’ll write more about in the future. To feel so deeply about the folks I care for can be incredibly fulfilling and make the job even that much more of a calling, but it can also be incredibly draining. It’s important to compartmentalize deep emotions I have about my patients when necessary to go on living non-doctor parts of my life. But I also recognize the need to feel and process hard things my patients go through. To set some clear boundaries like avoiding compulsive EMR and email checking, silencing push notifications on my phone, and setting away messages when I’m “off” can be important steps in creating a bit more healthy separation. 

I can’t undo the heaviness of the loss of my patient today, as much as I wish I had learned of this when I was in clinic and able to process it more effectively in my workplace. For now, I will accept that this grieving day I’m spending with my family was a hard lesson that I finally allowed myself to learn. I will never shed my doctor self fully no matter where I am, but I’m hopeful that small steps in setting boundaries can help me nurture the other parts of my identity that help me live the full life I dream of.

You're in charge of you

Some people turn to alcohol, recreational drugs, or overconsumption of food as a way to fire their dopamine reward pathways. My issue? I'm a recovering workaholic. 

Well, let's be honest - I still work way too hard, but I can't deny how much my work gives me joy. To be there for people during some of the most vulnerable parts of their lives - from welcoming a baby into the world to holding space for someone thinking about leaving this world - it is an incredible privilege. It's truly rewarding to be this anchor for folks - but it's a double-edged sword, as we can take on so much and not see ourselves buckling under the pressure.

It's easy to make yourself last when everyone/everything else is consuming your attention. Caregivers, I see you! I am on a constant journey of figuring out boundary setting and recognizing my limitations as a human being. It wasn't until I started treating my self-care like work - with scheduled exercise, recuperation time, and healthy lifestyle goal-setting that I started feeling like I had some efficacy in my own life and wellness. Weirdly, I think I kept waiting around for someone/something to hold me accountable to get myself in gear. Who/what was I waiting for? 

At the end of the day, you have to remember that you are in charge of you. No one else can make you decide to give yourself rest, nourish yourself, heal from trauma, or optimize your well-being in general. I think so often we de-emphasize it in this work-obsessed world we live in because there aren't deadlines around our lives. I mean, one day we do die, but we all assume it is far away, that we have all the time in the world. But that's never a guarantee. Sometimes horrible things have to happen to us to really reorient - whether it's losing a loved one, going through a major personal health issue, or having our lives upended in some major way. We can't fall prey to the assumption that there will somehow be time in the future. Because what if there isn't?

We don't have to let a morbid obsession with our mortality guide us, but I do feel that if we are able to wrap our minds around the inherent impermanence that is our lives, sometimes this can help us stay in better alignment with what truly matters. Mindfulness and meditation can keep us more grounded, humble and grateful, and I am striving to make that more a part of my life. By conscientiously plugging into our existence more and taking time to reflect on what matters, we can be true to our north star and also have just a little more impetus to take steps to ensure we are doing what we can to stick around in this life.

Here's to continually learning and growing on our own wellness journeys!