Structured Program

[Forest]

Recently on the wetpaint forum, Phil posted the following thread:

I have posted on the Wiki in the recent past but not lately, although I've still been lurking in the shadows, reading other's posts and trying to heal.

I was officially diagnosed with TMS by Dr. David Schechter in 12/11. I have since completed his MindBody Workbook and resumed some physical activities which still scare me and continue to cause pain, but I've stuck with it (lifting weights to challenge my shoulder pains, which haven't entirely gone away...still have a "tendonitis"-type feeling and the same feeling simultaneously appeared in the left shoulder too).

Day # 1 asks me my level of belief in TMS. I would say about 90% but doubt pops in regularly. That, and fear. Despite this, I broke with medical convention in my own patient care today and proceeded in a TMS-like direction for one of my severe neck pain/TMJ patients.

You mention that you are about 90% convinced that this is the right diagnosis for you. IMO this really isn't a terrible thing, and shouldn't really prevent you from recovering. When I first started with this approach I too had my doubts, and was probably at 90% convidence level for quite some time. I think people can have doubts has long as they are committed to the approach, and are willing to do the work.

With that said, I do think it would be a good idea to think about and journal about why those doubts pop up. I think it is only natural to have the occasional doubt. When I had these doubts I always tried to investigate why I had them. One of my favorite things about this question of your level of believe in the diagnosis, is that it helps us start the introspection process. Remember, there is nothing wrong with having doubts, as long as you investigate why you have those doubts.

Best,

Forest

 

[Shanshu Vampyr]

My doubts are based on my slow progress. To wit: Even before I bit the bullet and flew to Dr. Schechter's office, halfway around the country in CA, in 12/11, I had been lurking on forums/journalling for MONTHS. I've completed his workbook working through it at a slow, wholehearted attention (100% obsessive) pace. Now it's 3/2012 which marks one calendar year since I "injured" my shoulder joints and I still have this "tendonitis" feeling and slight fear although I can lift weights now without a lot of conscious fears (just did tonight, in fact). And yet large strides are not yet to be had; in fact; symptoms add onto each other (symptom imperative?) so that I'll have low level aches and pains in various areas at the same time. It's incredibly frustrating, and not a little bit scary.

I do realize I'm in it for the long haul, and I've become better at approaching my life with an eye to making some positive holistic changes. I do have an extremely stressful job (residency after one catastrophic failure in the past). I've become better at asserting myself and (slightly) better at daily mindfulness. I've become conscious of my tendencies to people-please in real time and somewhat better at learning how to say "No" to people instead of always going with the flow.

Schechter has suggested that I 1. "move on" with my life instead of it all being about TMS/job worries 100% of the time, and also 2. TMS therapy (despite I am quite attached to my "conventional" therapist--who introduced the Sarno concept in the first place). Obviously I'm worried that this, too, will fail. I know LA Kevin ultimately achieved peace by accepting his lot. I'm trying to do the same but it's not an easy process.

Thoughts, comments, as always, appreciated. Thank you and good luck and take care all.

 

[Beach-Girl]

I do have an extremely stressful job (residency after one catastrophic failure in the past).

Hi Phil:

I read your both your posts and see a couple things. First is your job. I'm in a really stressful period right now as well. It's really hard to work the program (which ever one you're working) then turn to your daily world of stress. I think this is the hardest piece for me to recovery. How can we "relax" and "not worry about the pain", when stress is all around us? It's a tough time in general right now for many. And I think it takes a lot of bravery to attempt these programs in order to get better with stress as your constant companion.

I had to stop my program for awhile because I am overwhelmed with stress and trying to get better at the same time. It's kind of like trying to push a tiny raindrop up a hill. So small to look at, yet spreads all over the place as we try and move it. Perhaps it might help to take a breather and reflect on all you've learned. I'll bet you're really much further along than you are giving yourself credit for. And a "catastrophic failure" sounds like you're being really hard on yourself.

I just started (with 120% enthusiasm and ten years of back pain) and did 2 Structured Programs for TMS. I'm finding now that I have learned so much that some of the lessons are kinda coming automatically in my daily thinking. I think it's important that (for me) I note/celebrate it . I'm not out of pain in fact have had several odd new symptoms. But I know this is TMS, so I'm not worrying too much. And I'm really good at worrying. At this I excel!

I've become better at asserting myself and (slightly) better at daily mindfulness. I've become conscious of my tendencies to people-please in real time and somewhat better at learning how to say "No" to people instead of always going with the flow.

This reminds me of me. Before learning about TMS, I would have inserted the word "slightly" as well instead of "I'm so much better at this than I was before I learned some of my actions are TMS traits." - I see in myself that these changes are subtle, but they're life long reactions or actions that until recently, I'd always done. So in my personal monologue - I'm learning to take out the word "slightly" and stating it to myself as a full and powerful statement. "I'm becoming more assertive each day, and I say 'no' even though I feel guilt pangs afterwards. Only now I feel them for under an hour vs the better part of a day.

Schechter has suggested that I 1. "move on" with my life instead of it all being about TMS/job worries 100% of the time, and also 2. TMS therapy (despite I am quite attached to my "conventional" therapist--who introduced the Sarno concept in the first place). Obviously I'm worried that this, too, will fail. I know LA Kevin ultimately achieved peace by accepting his lot. I'm trying to do the same but it's not an easy process.

I'm not familiar (yet) with Dr. Schechter's work. But if you aren't ready to "move on" - then maybe finding out why would help. Journal about what this and see if this doesn't work for you. Ultimately, the practitioners, therapists, authors, et al - are making suggestions they've had successes with in their work for people with TMS. But ultimately we know ourselves better than anyone else. Moving on may mean to you: moving inward and taking another look. Maybe sit on a different side of the bleachers this time as you cheer yourself on.

And lastly (I will say because I live it too) I see the word "fear" a few times in your post. I have a lot of fear, have fear with my coffee, have fear as I'm going over what I'm afraid of, and am afraid to make even tiny steps that would aid my TMS. Fear is a powerful block. But you also mentioned lifting weights! This is awesome. Are you giving yourself credit for this huge hurdle?

Perhaps some writing about the progress you've made in the past year would help you. Even if it's one small thing that is different about now vs when you first learned about TMS - then that in itself is a victory.

Do some writing and find out what YOU want to do and see, "pause and reflect" as a friend used to say, and maybe just spend some days writing about this past year and your journey. Maybe some things will come up that will help you to make your next move. And also how far you've truly come.


BG

 

[Enrique]

Hi,

To just add a comment about job-related stress. My RSI pain was mostly caused by inability to deal with the stress related my job. It was during my introspection, meditation, journaling that I uncovered the insecurities, fear of failure, inability to please my boss, lack of self-confidence, etc. that were all veiled in my unconscious/subconscious mind.

I've become better at asserting myself and (slightly) better at daily mindfulness. I've become conscious of my tendencies to people-please in real time and somewhat better at learning how to say "No" to people instead of always going with the flow

This is great... I did the same thing and it has made a HUGE difference. Keep it up!!

 

[Shanshu Vampyr]

To all who replied, thank you, thank you.

I'm struggling with a particularly dark period right now. I have practiced holistic methods of self-improvement such as yoga and mindfulness meditation since shortly after this all started last year, even before I really had much knowledge about Sarno, although my conventional therapist had introduced the concept. Yet even now, my subconscious runs the show with every physical symptom that I have (my neck and upper back are killing me and have been for months), and it comes out to play every night while I'm asleep with horrible fear and doubt so that I may wake up in the middle of the night drenched in sweat. While on the one hand, I'm grateful to TMS for opening up my eyes to how dysfunctional my coping style is, I keep thinking that I've gotten the message over and over again on a conscious level and why won't it cross the chasm to my subconscious? I don't mean to diminish anyone else's work stress or job suffering, either, but my job is one hell of a crucible for my emotions and my mindbody (Few things compare to the unpredictable mindf*ck of having really sick people code and die on you with no warning). I simply feel that all of my insights and progress can't keep pace with the frenetic stress that I'm under right now.

Worse off, after the emotional roller coaster of losing my first residency, I don't think I've ever forgiven myself for the simple act of being human and failing at one endeavor and taking the lumps of life. I remember reading another TMSer's therapist telling them, "So you finally figured out that you're human?" and that really resonated with me; and yet I don't know how to be anything other than a perfectionist. What sucks is that I'm a genuinely good person and a joy to get along with, doing my work pretty capably, I must say; and have quickly built up massive amounts of goodwill among my co-residents and bosses--not that they know about what's going on inside the maelstrom--and I sense that they'd be incredibly accommodating if only I could learn how to trust people again--so to knuckle under and quit would be a total WTF moment? I hate the massive amount of stress in my job, and yet I really enjoy the people I work with...what options do I have?

I may need that TMS therapist. And yet, I'm petrified that it, like everything else, will fall short.

 

[Beach-Girl]

and it comes out to play every night while I'm asleep with horrible fear and doubt so that I may wake up in the middle of the night drenched in sweat.

Wow. I have this issue too Phil! I wake up sometimes 3-4 times in the night, drenched and have to change my pajamas. These times seem to come out of nowhere, and happen infrequently. But I see through your experience, it's TMS for me too. Our minds must be very busy at night!

One thing I do is to listen to meditation music on an MP3 player and headphones as I fall asleep. This makes for a peaceful sendoff into the dream world. You might want to try this for awhile. A really good CD is "The Sounds of Source - Volume 4". Really relaxing and my brain knows the music so well now, that it really makes me feel good as I drift off. I'm also surrounded by my cats. Their little energy cuddled next to me - helps ME a lot. Not telling you to get a cat, but do you have an animal that you could snuggle with? Very healing.

While on the one hand, I'm grateful to TMS for opening up my eyes to how dysfunctional my coping style is, I keep thinking that I've gotten the message over and over again on a conscious level and why won't it cross the chasm to my subconscious?

You mentioned it yourself Phil - you're a perfectionist. And we Who Must Be Perfect think we're going to get TMS techniques to work for us as if we're still in a college course. But I'm finding it doesn't work that way. Here is some food for thought: surrender. Just tell yourself - "I know what this is, I know why it's constantly on the mind and you know what? I surrender. I am going to go with the flow of where you are now." And surrender doesn't mean "give up" - it means you stop fighting it. You stop struggling to get it right. I did this recently and am having some interesting results. I surrender to where I am in my life, what all it entails, and will just live today for today.

I don't mean to diminish anyone else's work stress or job suffering, either, but my job is one hell of a crucible for my emotions and my mindbody (Few things compare to the unpredictable mindf*ck of having really sick people code and die on you with no warning).

Wow. No, you are kind when you say you don't mean to diminish others and their line of work. This can produce a recurring tape of PTSD. No wonder your struggles are mighty. Not many have the courage you do to be in this line of work.

I understand this. I really do. My work is with animals. I'm not a vet, but I work with animals and their humans. And losing them is simply too hard to handle sometimes. I have learned to not attach myself to this part of my work. I couldn't help the next one if I took each to heart. And it sounds like you have a big heart - full of compassion - doing the best you can. But if you walk into work each day and have this possibility in the back of your mind, then that will produce stress that will bring on TMS symptoms regardless if you lose someone or not. I admire you Phil for being one of the few humans walking the planet who can do this kind of work.

I simply feel that all of my insights and progress can't keep pace with the frenetic stress that I'm under right now.

No S***! I've noticed also in my work with fellow TMS'ers that we tend to be people who have a lot of empathy and a lot of emotion we bury. Like in your neck? Or your back?

I don't think I've ever forgiven myself for the simple act of being human

You've hit on a big one here. Only you can do this for you - and writing about all of it, leaving nothing out, might really help you.

What sucks is that I'm a genuinely good person and a joy to get along with, doing my work pretty capably, I must say; and have quickly built up massive amounts of goodwill among my co-residents and bosses

And it really comes through in your writing. You had one word in there that *I* try and find everyday: Joy. You can see it in my sig line. There IS joy in everyday, we simply (and it's simple after awhile) need to recognize and celebrate it.

if only I could learn how to trust people again

Yep - this is another big roadblock. And you appear to have built a few for yourself.

To me, you sound like your a hard worker, empathetic, and trying to rebuild yourself while working in a very difficult situation. Since there is so much, perhaps a TMS therapist is the answer for you.

And in the meantime, learn to be kind to yourself. I see no one here beating you up - but you. You talk of failure. I don't see a failure. I see someone who is trying to work through issues that are happening on a daily basis.

Our situations are apples and oranges. But I too struggle daily with stress. And for me, taking a break, surrendering to that which I couldn't control, and being nice to myself each day are really helping to let the information I've learned through the TMS program to really sink in. I felt like a failure for having to stop the program, but ultimately saw no way to continue either. Since then, through some meditation, surrender, and the Serenity Prayer - I'm getting a little better simply by giving myself a break and most importantly: being nice to myself.

I know that you will find your way through this maze. I see my recovery as a slow journey that will succeed. I know you'll find the tools for yourself. Some simple changes will work best for you, so that you can get rid of your pain.

BG

 

[Shanshu Vampyr]

Dear BG,

A profound thank you. I know to you I'm just words on a computer screen, but truly I'm sitting here with shaking sobs and tears streaming down my face for the simple act of validation that you've given me (something that I haven't learned to do for myself).

I am not brave. I am very much the opposite, in fact. But thank you for saying it. :'(

Phil.

 

[Shanshu Vampyr]

PS: What you wrote about losing animals made me bawl. I don't have an animal (not allowed in my apartment), but I have a teddy. Does that count?

 

[Beach-Girl]

PS: What you wrote about losing animals made me bawl. I don't have an animal (not allowed in my apartment), but I have a teddy. Does that count?

Yes. Of course a teddy works. I know you must have a really hectic schedule with the work you do. But you need some "Phil Time". One thing that is becoming popular (wherever you live) is walking dogs at your local animal shelter. Not only does the dog get some much needed "sniff time" and fresh air, but YOU get to spend some time with a dog.

Animals are very healing. They understand our thoughts, our emotions, and can literally read our minds. It would be a win/win for you both. I propose that you work with as many different dogs as possible vs walking just one dog each time. This way you won't get too attached, and if the dog should get adopted, you won't feel abandoned. And talk with the dog. Tell him everything you think and feel. He'll understand and be there for you - even if it's just one walk.

I know to you I'm just words on a computer screen, but truly I'm sitting here with shaking sobs and tears streaming down my face for the simple act of validation that you've given me (something that I haven't learned to do for myself).

You're wrong Phil. You aren't just "words to me on a computer screen". Someday I'll share more of my story with you, but today is "Phil Day". I have chronic back pain and to come here and work with others, truly helps me to feel just a little bit better. You are very unique and special in what you do. (I still think you're brave) But you also seem to be really hard on yourself. I can say this because I excel at this.

It's part of the whole picture we learn the pattern of growing up. Page One TMS: "we feel we need to be perfect and good". This has been the hardest part for me to let go of. I was told as a child by my mother in front of everyone - that I was perfect. Then we'd go home and behind closed doors I'd hear each and every way in which this wasn't true at all. So I tried harder to be perfect. And good. I always wanted people to like me. It was a horrible mixed message for a child.

But I've only recently discovered this through working daily in my journal. I've had so many people reach out to me here, that it makes my pain just a little better. So - remember - we're all in this together in one way or another.

You may be in the slow lane with me in terms of getting to where we'd like to be: pain free. But most days I have confidence that I will get there. And perhaps if you are as kind to yourself as you are to others: you will get there soon too. When you write in your journal are you nice to yourself? Or do you beat yourself up? Maybe you could practice a little of both. Journal most of the time on being nice to you - and only allow 5 minutes to flog yourself.

You could walk your Teddy Bear I suppose, but why don't you see if you can carve out some time for yourself one afternoon a week. Spend it with a special dog who will heal some of your pain, while you show him some love. And a simple walk is showing love to a dog.

BG

 

[Shanshu Vampyr]

I need a cute li'l doggie now. *hugs Bear*

Day # 3's Question to Ponder Response:

"Exercised the other day--weights. Did so more out of a sense of obligation than anything else, an obligation to myself. Felt like I'd lose the psychological progress I'd made if I didn't. Still have 'tendonitis' type pain when I do. I don't know if I'm making any progress on this TMS journey."

 

[Shanshu Vampyr]

PS Beyonce's song "Listen" and Jennifer Hudson's "And I Am Telling You I'm Not Going" (I'm on a Dreamgirls kick right now) really resonating with me these days.

 

[Beach-Girl]

Still have 'tendonitis' type pain when I do. I don't know if I'm making any progress on this TMS journey."

Phil: If you had it inside you to do weights - you're getting somewhere. Keep going. And I am not familiar with those tunes, but I do know that music and lyrics have meaning for us. Listen to the lyrics and see if you can find "the message".

Keep going. I think for me it's all going to fall into place one day - maybe the same is true for you too. But only you know this.

BG

 

[Shanshu Vampyr]

Thanks again Beach-Girl.

I owe you a perspective on your own ongoing neck pain. It doesn't feel right to "draw" comfort from others in Cyberspace who are also fellow TMS'ers without providing something in return.

Day # 4's Question to Ponder Response:

"When I first 'injured' my shoulders in 3/2011, I went to see an orthopedist after waiting about 4.5 agonizing weeks for the pain to subside and go. Mind you, the day the 'injury' happened I was ALREADY locked into a TMS cycle of worrying, although I did not know it at the time. I did a stretch with my hands clasped behind my back, my elbows locked, and bending forward as hard as I could while thrusting my arms towards the ceiling. I mistakenly thought, for some reason, that this would relieve my new onset neck stiffness/pain. It never responded fully to heating pads and OTC analgesics taken for extended period of time.

I asked the orthopedist if he had heard about a Dr. John Sarno (By then my therapist had introduced the good Dr.'s name to me). He said he had but the tone in his voice made me veer away from asking if he believed in such a concept. Now, I know that's not something he actually SAID about my diagnosis, but upon finding pain out of proportion to an essentially normal exam--except now with cracking and snapping and popping shoulder joints, which still persist--he was pretty quick to label me with "shoulder impingement" and send me off to physical therapy, which I endured three times a week for the next 2.5 months to no avail."

 

[Beach-Girl]

Thanks again Beach-Girl.
I owe you a perspective on your own ongoing neck pain. It doesn't feel right to "draw" comfort from others in Cyberspace who are also fellow TMS'ers without providing something in return.

Ah but it does Phil. I see others getting better. Passing me by as I creep towards health. I'm learning a lot simply by being a part of this entire process of the forum and myself. I'm definitely going to win, but it is taking awhile. Many issues to sort through, and I'm working on them daily. I took a break from the Dr. Schubiner's program and will go back and work with certain aspects some more. But in the meantime, oddly this helps me. And I see my neck pain as progress. I simply put up with it rather than dwell on it.

And I feel a community here, not just faceless posts in cyber-space. I guess that would be the difference between us.

BG

 

[Shanshu Vampyr]

Thank you Beach-Girl.

This afternoon I found out by way of the online system that my last rotation is unsure of whether to pass me or fail me (this from a medical Department in which much protest has been raised over the nature of the evaluation system--catty nurses gossiping and evaluating residents? I mean, WHAT THE FUCK??!?!?!?!?! and has been the proximate cause of one upper level resident not having her contract renewed after remediating the rotation twice, and another currently remediating the rotation). It was like a dam burst inside of me. It was like a caged animal being let loose. After all the work I've done, after all the psychological progress I've made, WHAT THE FUCK!?!?!?!??!?! I'm pretty sure I snapped psychologically. I'm pretty sure I raised the dead with the sheer volume of my screaming and shouting. I'm pretty sure feral animals would have been cowed by the guttural, animalistic growling and gnashing of teeth that I felt unable to control. I'm pretty sure I pounded a permanent dent into my apartment floor in spite of the pillow that I was pummelling.
I am so fucking tired of trying to please everyone, including catty bitchy nurses and asshole attendings, at my own expense. There's only one person that never gets pleased, and that is MYSELF.

Ironic that half an hour before, my journalling had been about just this topic:

Day # 8 (Unsent Letter Technique)

"Dear People-Pleasing,

I feel like you're always in the way. Naturally I expect you to be most prominent when I'm at work, because I lack basic self-esteem and am always worried that I'ma screw up (and that screwing up has had nasty consequences in the past). I'm working on acknowledging your presence as a part of my personality and even more importantly, working on acknowledging your drive when I'm doing my job, because quite honestly you're getting in the way of my learning and GROWING. The next time I'm presenting to an attending a patient on Rounds, I'ma look for your presence. Once identified, you should be easier to manage. (I've already made definite progress identifying your presence).

But it's not just WORK ME that is a victim to you. Hell, even something as mundane as eating at a restaurant, your presence rears its ugly head. To the point where (sometimes) I'm almost embarrassed to ask for a utensil or an extra breadstick or something, just because I might irritate the server! And even more so when I'm trying to calculate a fair tip...

People-pleasing. I wonder where you come from. I'm tempted to say that you originate from my childhood when I was made to feel like I never measured up. I know my parents are pretty emotionally distant most of the time, but I can't recall a single incident where I would have started to doubt that I had Mom's love and that I would need to "overcompensate."

People-pleasing, you are difficult to overcome. I hate you."

I'm having another crisis of hope and faith. The only difference is, that now I've identified TMS attributes that have served me in poor stead all throughout my life, and even if I lose this job, at least I'll have made giant strides towards mental health and happiness. Whatever happens happens in the residency (and it's not like I haven't gotten "excellent" ratings in other rotations despite the crushing existential loneliness and serious pains I've been contending with since July). At least my eyes are now open more fully.

Fuck them.

 

[Shanshu Vampyr]

Day # 8 Question To Ponder (Are you having success in recognizing the emotions connected to your pain?)

"Yes, I am. Today's experience may be the worst emotional experience I've had since starting this godforsaken job. The painful reality is that I took the path of least resistance, in going to medical school @ 18 straight out of high school as per the misguided hopes of my parents. Well, I'm 31 now and have endured SOOOOO much hardship. And the sad truth of it is, it still hurts. Having my life path dictated to me by others still hurts. And showing no real hope of getting better anytime soon."

 

[Beach-Girl]

"Yes, I am. Today's experience may be the worst emotional experience I've had since starting this godforsaken job.

Wondered where you'd been Phil. Well now I know. Do you love this job? I mean the work? Do you get satisfaction out of working with the patients? Office politics will be the same in whatever field you choose, so I am wondering whether you enjoy the work or not. Because you're making some headway in your journal. You are angry. But are you really angry at your people-pleasing? Or are you angry you find yourself in a gossipy little place where you are the last to know?

The painful reality is that I took the path of least resistance, in going to medical school @ 18 straight out of high school as per the misguided hopes of my parents.

THIS is the path of least resistance? Med school? My understanding is it's really hard! And you went straight out of high school? Phil! You must have a great brain there. I'm serious. No one does that! So on top of brave, I'm learning you're incredibly smart.

Well, I'm 31 now and have endured SOOOOO much hardship. And the sad truth of it is, it still hurts. Having my life path dictated to me by others still hurts. And showing no real hope of getting better anytime soon."

Why? Why are you letting others dictate your path? Are you afraid you won't please someone if you don't do what they want instead of what you want.

I've never once heard you mention that you enjoy being a doctor. Only the competition and petty things said by nurses and "The Big Screw-Up" that happened way back when. You haven't let that go.

If you could have any job (since you seem to be very in intelligent and need a break) on the planet. Anything at all. No matter what anybody else thought....what would it be?

Thirty one is very young. You could have that job and leave the pain of all of this behind you. When you get another decade under your belt it will all make sense because everything - everything happens for a reason. We never see it in the moment because we're busy being in it. But all things good and bad to happen to us for a reason.

And you seem at a really good point in your life where you could start again, star in your own life, please yourself which in turn....whether you like it or not....always pleases others. The plain truth is: you can't please anybody else, until you learn to please yourself.

So what would that job be?

BG

 

[Shanshu Vampyr]

Thank you Beach-Girl. My own mother betrayed me today (she lives with me) by taking the side of some arrogant nurses who deigned to wave their fingers in my face. I don't care whether you're the President or the Prime Freakin' Minister of England, you don't disrespect someone by waving your finger in front of them. And I may not be her superior, but I DAMN well am not her fucking subordinate. Insult to injury is Mom's attempt to deflect anger by saying, "Well, that's probably why you screwed up the rotation." Maybe, but I don't see a failure on the books, just a question mark.

I occasionally enjoy the patient care milieu. It's why I'm training for Family Medicine instead of something like Radiology. And just this week, I got a heartfelt letter from the daughter of a dying woman who was not even my patient, yet I was able to offer solace. That letter is scotch taped to the wall of my office to remind myself why I put up with 16 hour shifts, ungrateful patients, and surly staff. Yet on the whole, 15 years of my entire professional life has been all about being kicked around, being forced to do scut, menial jobs, and the sheer LACK OF RECOGNITION and appreciation pisses the hell out of me. So, on the whole? Being a nice guy with a big heart who occasionally sees that he's doing some good does not make up for the other 99.9% of the time when I am de-valued and underappreciated by everyone. Especially these particular nurses, who have a ken to make interns' lives miserable.

I've wanted to be an actor since I was in high school. I imagine the road is quite tough but you asked. I would do ANYTHING rather than be an underappreciated scut monkey.

 

[Beach-Girl]

My own mother betrayed me today (she lives with me) by taking the side of some arrogant nurses who deigned to wave their fingers in my face. I don't care whether you're the President or the Prime Freakin' Minister of England, you don't disrespect someone by waving your finger in front of them.

Totally agreed. That was rude. And being the nice guy you are, I'm sure you won't confront your mother. Perhaps you should send her an unsent letter? (Or send it to her) That is uncalled for especially in front of your co-workers. Not good. And does she live with you? Or do you live with her?

And I may not be her superior, but I DAMN well am not her fucking subordinate. Insult to injury is Mom's attempt to deflect anger by saying, "Well, that's probably why you screwed up the rotation." Maybe, but I don't see a failure on the books, just a question mark.

You are showing some doubt here. And I DOUBT you did anything wrong. You already eluded to the fact that these nurses are "gossipy". You are already sending yourself to a bad place when you don't know what is really going on. Or if you do, I'm not real clear on it. Sounds like you're falling into the B.S. of office politics. Am I right?

I occasionally enjoy the patient care milieu. It's why I'm training for Family Medicine instead of something like Radiology. And just this week, I got a heartfelt letter from the daughter of a dying woman who was not even my patient, yet I was able to offer solace. That letter is scotch taped to the wall of my office to remind myself why I put up with 16 hour shifts, ungrateful patients, and surly staff.

How lovely. Seriously, not even your patient yet you offered comfort and the woman took the time to write to you? You must have done something really nice or that wouldn't have happened.

It sounds like it's your co-workers who get to you. And maybe you need to ignore them, quit trying to be liked, and just do your job. Focus on the patients and their needs rather than the staff. And nobody in a hospital is ever happy. They're in pain, they're sick, and they're scared. That IS where a good doctor like yourself could be really great. But it's the thing you mentioned yourself: people pleasing - that isn't working for you - that is never going to be easy in that environment. None of it sounds like much fun and dare I guess that you're exhausted? Could this be part of the source of your anger? I know when I'm wiped out I have a very short fuse. And maybe some rest (do you ever get any?) could change your perspective and how you view this field.

Yet on the whole, 15 years of my entire professional life has been all about being kicked around, being forced to do scut, menial jobs, and the sheer LACK OF RECOGNITION and appreciation pisses the hell out of me.

So why do you do it? Have you asked yourself this in your program? You don't feel like you have respect from your co-workers or your patients, you're working a 35 hour day, and the lack of recognition is painful to read. I am recognizing how hard you try and work. I am seeing that you have a meaningful place there. And you are angry. This is a good time to write because you don't or won't hold back. Perhaps in the end, this will help your TMS. (Upside?)

So, on the whole? Being a nice guy with a big heart who occasionally sees that he's doing some good does not make up for the other 99.9% of the time when I am de-valued and underappreciated by everyone. Especially these particular nurses, who have a ken to make interns' lives miserable.

And they think they're in charge? Or do you let them be "in charge"? Not fair. They must have no lives so they're going after you. I pity them really. And you ARE a nice guy with a big heart. That has been obvious throughout our visit here.

I've wanted to be an actor since I was in high school. I imagine the road is quite tough but you asked. I would do ANYTHING rather than be an underappreciated scut monkey.

Well - we have another member who is an actor. You could ask him what it's like through pm's. Perhaps that is where your heart is truly wanting to be. You are acting now Phil. You are really angry with these people yet I bet you go in every shift with a smile on your face willing to do anything asked of you.

The "Phil's" of this world are a rare breed. Anything you choose to do, whether it's stick it out in this job, or a try at acting - will be lucky to have you on board. And I'm not trying for a minute to placate you out of your rage. Truly I'm not. That you are venting is really good and you should write more if you feel like it. Either here, or in your journal. In the end you'll find some answers to your TMS.

Gonna take a dinner break, but will check back soon.

BG

 

[Shanshu Vampyr]

Dear Beach-Girl,

I am still here, still lurking, still working, as you say, a 35 hour day (how apt!) and then going home and doing the only work that is meaningful to me at this particular point in my life, the TMS journey/work. Thank you as always for reaching out. (I am trying to become that one person in my life to give myself unconditional acceptance and love but I'm breaking sharply with ingrained habits of self-loathing and unworthiness as I do so, so it's hard).

I do get satisfaction out of working with patients. But only when it's on my own terms, and I'm able to offer them bits and pieces of the humanity I've acquired throughout the years, and when it's in particular about me reaching out to someone in their hour of need, when they need a hand to hold or a shoulder to cry on (I started out as a Psych resident initially before being terminated and finding my way back into Family Medicine after a three year hiatus, which is an eternity in the medical world) and not just a sterile figure in a white coat standing above their bed. But 99.9% of the time it's about executing the team's decisions, executing the attending's particular brand of medicine and not my own, and therefore being a bit player in someone else's show rather than the showrunner. To that end, always being the low man and the scut monkey, I hate medicine with a fiery passion and I hate the rote and staid way everything has to be done on Rounds. Acting indeed, as you said! How funny I never thought of it that way before.

"It sounds like it's your co-workers who get to you. And maybe you need to ignore them, quit trying to be liked, and just do your job. Focus on the patients and their needs rather than the staff. And nobody in a hospital is ever happy. They're in pain, they're sick, and they're scared. That IS where a good doctor like yourself could be really great. But it's the thing you mentioned yourself: people pleasing - that isn't working for you - that is never going to be easy in that environment. None of it sounds like much fun and dare I guess that you're exhausted? Could this be part of the source of your anger? I know when I'm wiped out I have a very short fuse. And maybe some rest (do you ever get any?) could change your perspective and how you view this field."

I am exhausted. I am bitter from the years of psychological work I have put into rebranding myself, obsessively sniffing out anything in my character that might be considered a weakness and trying to change it into a strength, and not necessarily being validated for that very hard inner work at all. Right now, I am the one who is "in pain, sick and scared." Right now, I am the vulnerable one. And yet my very role, my purpose (???) in life, prohibits me from being the vulnerable one--because there are others that are vulnerable that are my charges.

But maybe I'm in a place where I'm too jaded to recognize that I DO have support. My Training Director had scheduled a meeting with me today a couple of days ago and brought the faculty Behaviorist/therapist with him to gently probe to see if there's any support the program could offer--because my overall trajectory has drastically improved throughout this first training year, and my patient care skills pretty laudable, yet I clearly flip back and forth between sad/demotivated periods and periods of what they see as normal. Naturally, given this recent online evaluation business, my hackles were raised as soon as he scheduled the meeting a few days ago, with shades from the past making me think, "Oh no! I'm going to be called to task." Turns out, he hadn't even yet heard of this evaluation, and when I broached it, opined, "Take it as constructive criticism. If you'd failed, I would have heard about it already. I'm not worried about it." He also agreed that I seemingly have coped with a lot from surly staff.

Restoring my ability to trust in other people--does it show through that I have trust issues?--and yes, in myself, is going to take a lot of inner work.