This evening I was walking around my house naked, prepping a bath for my little one, and vibing to the sound of James Bay on my speakers. At that moment my quality of life was 10/10. And I realized that quality of life isn’t just for the dying, it’s for all of us. Even doctors.
As the music echoed through my home, I reflected on the dinner I’d just prepared, a few fish fillets from the freezer that flaked just right on my cast iron pan. A side of kale and risotto, chopped and prepped by someone else as a side dish. Feeding myself the healthy fare, I relished watching my little man eating mushrooms, marveling at the sight. I sipped sauvignon blanc as we grazed on a picnic-style dinner consisting not only of fish and veggies but the toddler snacks he’d already strewn across the table. The remnants of cheesy popcorn, hummus, and pretzels.
After dinner, we ate the Ben & Jerry’s I’d grabbed from the hospital cafeteria before I left. It was the half-baked kind, and it was half-melted, yum. I divided it into two dishes, as my four-year-old melted down, whining that he wanted to eat it right from the container. Don’t we all, little buddy… don’t we all. I chose creativity over a battle of wills, setting most of it aside in the freezer, while allowing him to eat the rest right out of the carton, delighting his little face. That’s quality of life right there. A moment of pure joy.
I’m actually going through a hard time personally, for reasons I might explain some other time. Suffice it to say I’ve been mourning. I actually hired a life coach who specializes in intentional living, with a background in palliative care. I want to live this life fully and intentionally, without regrets at the end. And I like the idea of being guided by 80-something-year-old Barbara– she’s crinkly, joyful, and still a bit sarcastic. She knows what’s best for me, and I can ask her for guidance. Some call this, “living with the end in mind.” Old future Barbara knows what really matters. She knows what quality of life is all about. It’s about those small, beautiful moments like tonight.
The thing about valuing your quality of life, and allowing yourself to be guided by it– before any devastating diagnosis occurs– is that it requires accountability. Sometimes something in your life isn’t quite right. A situation or person is not right for you. You need to make a change, but that isn’t always easy. It can be heartwrenching. But think of that wise old lady inside. Love her, and take care of her. She knows what’s up.
The thing about doctors, medical students, aspiring docs, is that we learn to hyperfunction. We learn about the ECOG performance status scale, which tells us a lot about a patient’s ability to care for themselves, and therefore, about how they might respond to treatment and their overall quality of life. Zero is the best score, meaning a patient is able to carry out all daily activities one would need or like to do. ECOG five is dead, and one through four are in between. For example, an ECOG 2 patient can perform activities of daily living like bathing, but they can’t work.
Imagine if we evaluated ourselves on this scale as medical people. We’d be below zero, in the negative range. Because often, we are HYPERfunctioning. We aren’t just doing all our own activities of daily living, we are picking up those of the people around us. We’re an ECOG negative 2. And that’s not anything to brag about.
In our world, full-time work means something different than it does for other people. We are just special that way, in a sort of overworking martyr-y kind of way. An FTE or “full-time equivalent” physician can work 80-100 hours. Yet some are ashamed to scale back to a 0.8 or a 0.6 FTE. I dream of it regularly. But it took me a while to get there, since we are indoctrinated to think that full time work is standard, no matter how many hours that entails, and that part time work is inferior.
Hyperfunctioning is a defense mechanism, and it’s one I’m looking to drop. It’s not our fault that we’re this way. This behavior gets us through school, and helps us achieve our dreams. We get results from this accomplishing and overdoing (hello, memorizing one book for a month, 10 hours a day in a gray cubicle over burnt coffee!).
We get results by planning our days and measuring our worth in how much hyperfunctioning we can fit in. And in school, in clerkships, heck, even in relationships, hyperfunctioning can seem to garner some great results. Maybe. At first. Then later, not so much. You see, hyperfunctioning can be maladaptive. It’s tiring. It’s not healthy. And it can degrade your quality of life if you’re not mindful of it.
It’s part of our medical culture, so we’re swimming in it. But the thing is, while it may get you the results you want, it won’t lead to a great quality of life. Often, it can sabotage it. Why?
Because when things are rough, the answer in medicine, and for people like us is to grit it out. To try harder. If you’re trying to ace organic chemistry, it works. If you’re trying to run your social life that way? Not so much.
Your quality of life matters, even if you’re not dying. I mean, technically, we are all headed in that direction, but you don’t need to wait until someone hands you a dismal diagnosis to value and choose the highest quality of life for yourself.
No one else can do this for you. Not your advisor, your mentor, not your parents. Your quality of life matters, even as a doctor. Especially as a doctor. Because if you don’t care about your QOL, it can fall off the list.
You’re not a machine, no matter how gritty you’ve proven yourself to be.
And your enjoying the shit out of that avocado toast doesn’t take away an ounce of your grittiness. I’m just saying.
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.