I called in sick to work today. It is a very hard thing to do as a resident. I was thinking about it last night and I was kind of gearing myself up for it. I woke up early today just to do it. I had to rehearse what I was going to say: “Hi Marge, I’m not feeling well today and I am going to use one of my sick days. I was scheduled for clinic in the am and pm. Thanks.” It is hard to say! I literally am afraid I will be somehow rejected and they will make me come in. That is not grounded, but I feel it.

So anyways, I call at 7:30 and it goes to voicemail, she is out of town and I am supposed to call her assistant. Ok. Repeat the rehearsal and then make another call. Same thing. Another voice mail with a message to contact the chiefs. Well fudge. I go to my computer to look up their schedules and send a text message to one of them, and then anxiously await the reply as minutes pass by. It’s creeping towards 7:50 and I’m thinking that my patients are literally getting checked in right now and nothing has happened. I call the front desk and of course am put on hold for a long bit before I talk to somebody who transfers me to someone else, who then wants to transfer me to Marge “hold on,” I call out. “I’ve already called Marge and she is out of town. I’ve called her assistant and she is out. I know you’re not the right person to contact, but don’t just transfer me to her voicemail.” So she says she will look into it and hangs up. I don’t even get her name. I decide to text the other chief. Now I am just anxious, and it’s getting to be 8:10 and I haven’t heard back from either of the chiefs. I looked at their schedules and one is supposed to be on study time at the clinic, the other is in our urgent care clinic.

So much for going back to bed. I am anxious and feeling guilty and not sure what to do with myself. I am physically laying in bed and letting the minutes click away. Finally, about 8:30 I hear back from the 2^nd chief that it’s okay, she’ll contact a 2^nd back-up admin staff person to let them know and take care of it. About 5 min later the other chief gets back to me with a similar message. Fine. Woo. I finally feel somewhat relieved. Now on to my morning.

I alternately feel guilty and validated. I have been dragging this week and I just am in a bad mood. I had clinic yesterday and I was frustrated with my MA, and I really felt overextended to be doing the basics of my job for patients. Today I was scheduled to see 16 more people. I thought about, and felt guilty about those people each either being rescheduled, or cancelled or whatever. But also, the clinic is responsible for making decisions about who needs to be seen urgently and who is appropriate to reschedule. And more importantly, if people are taking time to see the doctor, they deserve the attention of someone who is feeling better than I do. If I am fried, I am prone to taking shortcuts or not providing the best care. I want to provide the best care. Taking responsibility for 16 patient visits today when I am feeling fried is inappropriate. That’s what sick days are for. I am caring for myself.

In this (medical) world, you’ve got to take care of yourself. No one is doing it for you. They are just pushing, pushing, pushing. I am more sensitive in ways that do not get seen by this environment. I have to advocate for myself. And in the end, people deal with it. Others have called in before. When I am in clinic, and I know someone else has called in, I might have 2 thoughts about it, but then I get on with my day. That’s it.

And I am moving on. I am thinking about the beyond residency time. And I am thinking about medicine from this philosophical place. I lean towards outright rejecting the system as a whole. I think that is an emotional reaction and that the truth is not so black and white. There is a lot of good that happens through the system with the bad. Some are in better position than I am to be working with that good. But I think about this whole RVU game that the system is playing. Decisions are constantly made consciously, and subconsciously to play the RVU game. Patients deserve better than that. The RVU game serves the medical industry’s interests. I as a primary care doctor am stripped of any power, any agency when I am tied up in the RVU game. What kind of patient relationships can I have playing that game? They don’t feel like much to me.

I am reading this book by Henry Emmons “The Chemistry of Joy.” Part of what he is describing is an empowering model of delivering care that is based on education and not relying on pharmaceutical power. And I am reminded, that in the role that is set out for me, I am designated to prescribe a lot of medications. I am to “screen people for depression so they don’t miss out on the profound benefits of miracle drugs.” Well, it’s actually so much more complicated than that. When the SSRIs give people a little boost, so they have this story that “this is what normal feels like”, it’s actually a little trick to make them a bit elevated in the short term. It’s a fucking gimmick. They don’t work well in the long-term. And here we go, peddling them freely, often because we believe we are doing some good. And so my reaction, which is maybe also unhelpful, is so antagonistic in the other direction that it’s sometimes just like a grinding brake. I just want to stop everyone from taking medicines when actually in truth, some situations and some people benefit and they are used successfully and it’s not so black and white. It’s so hard to articulate why it is hard.

Last night I was on the phone with a friend (Raven) in Oregon with a natural health clinic and Adderall came up. She said she doesn’t use it, and that then people thank her. She made a comment about how it fucks you up and makes you less heart centered. I believe that. It puts us a little bit on overdrive. Ego. Confidence. SSRIs do that too (artificial calm). People get inflated chemically. Our world is so filled with exaggeration.