Etc Follow Up

February 17, 2022

As always, thank you for the caring and insightful comments yesterday. I feel very lucky to have you.

I woke up feeling a bit better today, maybe because I have a plan to obtain some support.

Things I Will Work On:

1- Prioritizing exercise. I know I have ‘permission’ to dial down in this area, but I have always felt that exercise is a positive thing for my mental health. I am giving myself permission to do what feels good, but I want to prioritize getting in daily movement, whether it is a run or a yoga session. 6:00 am is my sacred window for this.

2- Saying no when I need to, or figuring out how to say yes but on my terms. I also love the suggestion of not responding immediately to things that are non-urgent. It is very true that instant responses a) just invite more (*&#$ emails and b) create a (false) expectation that I will be able to answer every question immediately. One idea might be a weekly “call back” block, and one of the medical assistants could alert patients that I will be calling them during that time to answer questions. I think with clinical questions, it would put people at ease to know their questions will be answered, even if the time frame is not immediate.

3- Getting some things on the calendar that are truly FUN for me. I have a 3 day retreat planned with Laura next month that I am really looking forward to, and Josh and I just added an impromptu date night this Saturday.

4- NOT stress over things not worth stressing over, to the extent possible. Example: finances. A reader (wisely) pointed out that it might be time to just . . . stop worrying so much right now. We did not purchase a house that is above our means, and thus we are not going to broke from expenses related to said house. It is true we might not save as much this year as last year. It’s not a race, and a year in which you purchase a house might be a year requiring more financial outlay. I am better of accepting this.

Another example, which I will begrudgingly note: screen time totals. YES, staying off of social media is largely good for me. YES, limiting scrolling as escape mechanism is good for me. NO, worrying about “minutes accumulating” as I take a walk during a Webex meeting or use google maps is not a productive use of brain energy. This can be filed under #uphholderproblems that aren’t actually even problems and I will just work on getting over myself.

5- Finding a therapist, as I mentioned yesterday. Because I can only vent into the blogosphere so much . . . and I think having that dedicated time carved out for processing will be valuable. Plus, this is what I would encourage any friend (or trainee) to do in these circumstances! I have one call set up and another possible lead, so that is good.

That seems like a good start.

Started this book this morning after a reading drought:

Seems like it might feel comforting right now.

On an unrelated (sort of) note: this pic from this Sunday’s Superbowl brings me joy, as did the halftime show itself (which I have since read means I am due for a preventative cancer screening, which is true – mammogram #2 soon, ha). G was rocking out with a dance accompaniment and C lying there is fast asleep.


  • Reply CBS February 17, 2022 at 6:22 am

    It is good to hear you have a plan. I was feeling pretty anxious and hopeless a few years back and went to the GP who prescribed a low dose of anti anxiety meds, which made me feel better within 24 hours. Not because they were working but because I had taken a step forward. It was a shortish course and let me recover enough to figure out what was bothering me and how I could fix it.

  • Reply lawandcreative February 17, 2022 at 6:55 am

    This plan is excellent. The call back slot made me think of the idea of office hours that Cal talks about a lot.

    And I agree so much that the immediate reply sending only trains people to expect immediate replies. Would it be possible for you to have a permanent out of office reply that sets out handy FAQ info and shares your email checking times? I’ve done this before at times and it was handy because it confirmed receipt of an email where a response wasn’t actually needed, allowed me to remind clients that if they’re checking in on XYZ, those updates go out at point ABC, and in my case to say I’ll reply within 2 working days. I ALWAYS reply quicker… but I wanted to set expectations that an email wouldn’t be responded to within minutes all the time. Could you do something similar?

    Good luck finding a therapist! I love how openly you’re talking about this.

  • Reply KDR February 17, 2022 at 10:03 am


    An hour after I posted yesterday I received a text from my husband saying we finally got the bill for our driveway snow removal 😱 that plus Con-Ed tripling energy supply costs really tested my sage advice yesterday hahaha.

    • Reply Sarah Hart-Unger February 17, 2022 at 10:28 am

      Well, at least I know with confidence that I will NEVER receive a snow removal bill 😂

  • Reply Amy February 17, 2022 at 10:04 am

    Sarah, I think this is a great plan and it’s no surprise that you feel a little better already.

    I love that you are going to stick with exercise, and I think that’s important. So many people are conditioned to see exercise as a chore or an unpleasant / unnecessary-when-in-the-trenches task they need to check off a list, but shifting your perspective to seeing it as an important component in mental wellness is crucial. It is when you are in the trenches that exercise becomes even more critical. I’m glad that despite the chorus of “take it easy!” you’re choosing to prioritize this. I would just caution you (in light of your #4) to try not to quantify it or make it an additional source of stress. Leave the watch at home and force yourself to run without knowing your pace, for instance.

    I do think your #4 in general is going to be really important for you in a long term way. I think you have fallen into a trap of overanalyzing and overquantifying pretty much everything in your life (so much time tracking!!) and it is NOT serving you. Are you really stressing about screen time minutes at that level of detail?? Stop that! While you’ve gotten advice from multiple people about the benefits of psychotropic meds (and those benefits can be real and important! I say this as a Zoloft graduate), I would really encourage you to focus on this first before concluding that you simply have a chemical imbalance that needs to be addressed medically. This is where therapy can be really helpful, especially therapy that will help you to understand and challenge where these impulses come from. (“I’m an upholder” is an incomplete understanding.)

    It may also be time to just assess your life in general, your family’s lifestyle, and determine whether what the 5 of you are doing is working for all 5 of you. Just as you switched C’s school because he wasn’t thriving (and I remember some angst around that — you did not need to angst or feel guilty for doing what was right for your child!) you may need to make some lifestyle changes so that everyone in your family — INCLUDING YOU — is thriving. Throwing money or more babysitters or Zoloft or me-time at the problems you face does not solve them at their root. That’s just treating symptoms. Don’t be afraid to explore that.

  • Reply omdg February 17, 2022 at 10:06 am

    My 2 cents is that you have a lot going on right now. Moving takes way more out of a person than one generally anticipates, as does buying a house, especially when one has to DO things to the house before one moves in, while hopefully keeping one’s job in the process! One way to get through these times is to cut yourself some slack. But also, you have to remember that this is a marathon, not a sprint, and new challenges are sure to come up in the future, so you best take care of yourself now.

    I found all the suggestions to seek therapy really interesting because the overwhelm you describe to me sounds so familiar to me, but I honestly have started to just accept that it’s part of life. What drive me crazy (and I do need to get better at this) is when I experience a piling up of tasks right as I’m trying to finish something else, or when something I thought I finished comes back as a new task. These are the times that I can grow short with people, and feel overwhelmed and hopeless. If you learn strategies for dealing with this — currently I am learning to resist the urge to address the new task immediately — I would love to hear them.

    (Also, I vote for skipping the DC trip — but YMMV since vacation planning and spending lots of money both stress me out.)

  • Reply Lisa of Lisa’s Yarns February 17, 2022 at 10:10 am

    I am glad you have a plan. That always helps! I think letting go of worrying about expenses is key when you are going through an expensive stage, like buying a house. The FIRE movement is inspiring but if you don’t plan to retire early (which I don’t think you plan to do) then the saving behavior of people in that movement just doesn’t really apply. We don’t plan to retire early either. So we save and are naturally frugal but I firmly believe in enjoying the fruits of our labor and trying not to stress too much about spending. But I also recognize the privilege we have in being able to have this mindset. I listened to a marriage kids and money podcast episode about paying off a mortgage early (which we did) and the host asked about why they chose to pay it off instead of investing and the guest basically said that there is a limit to how much you need to have for retirement. Like maximizing investing is great but how much do you really need and what are you giving up in pursuit of that goal? I am not paraphrasing this great but hopefully you get the point.

    I just tried to read wintering but ended up abandoning it at the 20% mark. It didn’t resonate with me but I think I am in the minority!

  • Reply KGC February 17, 2022 at 10:17 am

    I love that you have a plan and are openly talking about how you’re navigating this situation. But what I really came here to say is how much I loved the book Wintering and I hope you like it, too! (though my mom did not love it, so – different strokes for different folks)

    I’ve also heard Katherine May interviewed at least twice – one of which was on the What Fresh Hell podcast, which also recently re-aired her interview (and I highly recommend their podcast in general – great mix of commiseration, snark, and good advice). If you haven’t heard her speak about the book, I recommend it – if for no other reason than she has a lovely British accent! But it’s nice to hear her talk about her experiences and processes and gives permission to not always be go-go-going.

  • Reply Grateful Kae February 17, 2022 at 11:09 am

    I was listening to the latest Deep Questions podcast episode this morning, and I liked some kind of obvious yet very true advice he gave to a listener around minute 43:50: “If you’re struggling juggling lots of balls, the best solution is to take out a bunch of the balls. It’s much easier than trying to learn how to juggle 5 balls, which is hard to do.” The listener’s situation wasn’t identical to yours at all, but I still liked that good old visual of “balls in the air”. It is a true fact, that juggling, say, 2 balls would be a lot easier than 5. Of course, as a working parent, that’s always easier said than done…but maybe not impossible.

    Personally, I feel like if I were this constantly stressed out managing work/life/motherhood, and I had a surgeon husband and could likely easily afford it, I would probably go very part time on my work somehow (like 2 days a week) and free up a bunch of time until my kids graduated. But I am not overly defined by my career, in my case. I like it, and I wouldn’t want to not work at all, but I would be fine doing less of it, too, if I felt it was the best option for my sanity. Obviously this might not be something you’d even consider, but I was just pondering your situation and wondering what I would do if I felt that way. Glad you’re looking at some options to work through it all. It does seem like an ongoing problem, so it’s smart to take some real action toward fixing it. As you said, venting is great and all, but that doesn’t necessarily CHANGE anything- so you seem like you’re on the right track with some actionable steps!

    • Reply omdg February 17, 2022 at 11:36 am

      I agree with this, but also (speaking from personal experience) it can be really difficult to disconnect one’s identity from achievement at work and switch to… something else, even if scaling back may ultimately lead to greater happiness and fulfillment and minimal reductions in financial security. Particularly in doctors, who tend to be highly achievement oriented and motivated by external validation. I personally have a great deal of difficulty with this, anyway.

      • Reply Amy February 17, 2022 at 12:59 pm

        These are both great points and are worth exploring. For instance, suppose the idea of reducing time at work resonates with Sarah but she finds it terrifying to really consider. Why is that? What’s behind that? Or she finds she really values the work that she does — how can she then make everything “flow” better than it is now and feel less anxious and overwhelmed? (To answer your bemusement upthread, omdg, this is where therapy can be really helpful.)

        • Reply omdg February 17, 2022 at 2:01 pm

          Yeah yeah yeah I know. 🙂

          My historical approach has been to let things build until breaking point, at which point I’m forced to make a decision. It has not escaped me that perhaps a more deliberate approach where I actively decide what I want to do might serve me better. 🙂

          • Amy February 17, 2022 at 3:39 pm

            Lol. You are not alone there!

  • Reply Jessica February 17, 2022 at 4:26 pm

    This is a super minor detail, but can you remove Maps and WebEx from tracking on your screen time app? I use the app Quality Time, and I have maps and the phone app removed from it. They’re not the type of screen time that I want to limit!

    • Reply Hilary February 18, 2022 at 1:00 am

      I have been looking for an app exactly like this!! But I’m not seeing the app within the iPhone App Store…. there’s a “My Quality Time” but looks like that’s just a phone locking mechanism.

  • Reply Marie February 17, 2022 at 7:07 pm

    Sarah — some of what you’re talking about sounds like collaborative overload. There are many projects, stakeholders, and people putting demands on your time, and it’s overwhelming. You might find it useful to check out a new book, Beyond Collaborative Overload, on this topic… it covers this from both an organizational and personal perspective.

  • Reply Elizabeth February 17, 2022 at 10:15 pm

    I’m also glad you have a plan! I support therapy and have personally benefited from an SSRI but I know not everyone may need that. I do think you’re experiencing upholder tightening and you sound mildly anxious/depressed and it’s a great idea to try to sort out where those feelings are coming from. I agree with omdg that to a degree this is life with school aged children, but I also love the idea of juggling fewer balls. It may be that you decide to look at your hobbies and decide to split them in two groups and alternate months (or weeks) or focusing on them, rather than trying to do all of them all the time. Or, maybe some are seasonal. Or, perhaps you really don’t love both haves of your job? Would you want to explore going back to just clinical (but perhaps at the same amount you are clinical now, so going part time). No more call time than you’re already doing, but no administrative frustrations. Or, would you want to drop the clinical work and save yourself ever doing a call week again? Or, since your practice is hiring, can you go back to 80% or 90% time? Or maybe even better, don’t change your hours BUT with a new hire completely eliminate call from your workload? So maybe you’re paid 90% for full time work but never doing call again.

    Just wanted to join others in pointing out you have options. Being overwhelmed and perpetually snippy and anxious and exhausted is not sustainable nor is it the life you’ve worked hard to have.

    And as an aside, when I look at my screen time each morning for the prior day, I always subtract out time spent in maps, on podcasts or audiobooks, or in the peloton app. Those aren’t things I’m trying to reduce. Maybe you could do that too?

    Also, I really loved Wintering and hope you will too!

  • Reply Elisabeth February 18, 2022 at 5:55 am

    I know exactly what you mean about hating to see the screentime minutes add up for things that are “necessities”. It was so bad I would refuse to let my husband have the screen on if we were navigating using my GPS (and his phone wasn’t available) and then we’d be relying on voice commands…and it was not pretty.

    I’ve actually done a major overhaul of my screen time (very highly recommend the book How To Break Up With Your Phone by Catherine Price, especially because it’s VERY short!). I was tracking screen time in my planner, but lately, I just spend a few minutes reviewing it at the end of the week and I subtract all the time I spend: texting friends (I curate this, so my texting is generally just with close friends/family now OR it’s important notices from school or making arrangements for playmates or related to work – the latter all via WhatsApp), taking/editing photos (so any time in Photos or my Camera app), and time spent on my AnyList app. I subtract every minute from those and am left with a tally of my “scrolling” time. It makes me feel very liberated to take the extra step to break this down and see that on the day I spent 2 hours on my phone, an hour was actually being spent taking pictures, for example, which is an activity that brings me a lot of happiness. I still scroll more than I’d like, but giving myself permission to use my phone for the activities that are important to me has been a big relief.

    Regarding the ball dropping suggestion of @GratefulKae, I think this is bang on. I’d also add – and I can’t remember where I heard this – there are two types of balls. Glass balls and rubber balls. The glass ones break if you drop them; the rubber ones bounce and you can eventually catch them again. We need to identify what things in our lives are glass versus rubber and triage accordingly. Dropping the ball about responding to a child’s class birthday party invite, to me at least, is very much in the rubber ball category. But I think sometimes, when we have too many balls in the air, we get the frantic sense that EVERY SINGLE ONE IS A GLASS BALL. Balls are coming at us from all directions and we don’t have time to think at what level we need to prioritize the catching of said ball.

    So, yes: if it was me, I’d look long and hard at getting rid of some balls. And then when the dust settles think long and hard about what balls are glass and which are rubber. Chances are, a lot of things can be dropped without anything bad happening.

    Re @Elizabeth above: “Being overwhelmed and perpetually snippy and anxious and exhausted is not sustainable nor is it the life you’ve worked hard to have.” This is so true. Recently I’ve looked at some of the things that are playing out in our family work/life balance and we decided to make some radical shifts. Is it scary, yes? But with only a few more weeks to go until we’re all going to have (some temporary; a 6-month sabbatical for my husband) extra breathing room, it’s also VERY exciting.

    What’s the priority? Having a big career and saving for retirement and investing in kids extracurriculars and producing great content via podcasts is all great, but is it really the answer now? I get the sense you feel like you’re on a hamster wheel and while I’m a HUGE advocate of therapy, I think the underlying stressors are just too great in number to be managed by one person. You’re doing great, Sarah. I wish you all the best in the next steps. And hope you get some rest this weekend?!

  • Reply Sara B. February 18, 2022 at 12:49 pm

    A lot of what you struggle with resonates with me too. I don’t have as many of the “upholder issues” you describe, although I do sometimes have a hard time re-questioning things that I’ve decided are a certain way. However, I’m a physician who has similarly voluntarily taken on leadership/administrative loads and felt torn between feeling very fulfilled and happy with my (multiple) jobs, and also constantly feeling like I’m overfunctioning and teetering on the edge of my capacity. I also don’t think its as simple as holding on to a role-based identity or just deciding to do somewhat less. For example, I could give up one of my administrative positions and do a similar amount of clinical work, which I don’t find stressful. We’d be fine financially. The lifestyle is actually MORE flexible. But I am a fixer. Even if I wasn’t doing this job, I wouldn’t be able to keep my brain from seeing opportunities for this improvement or that better way of doing things. I’d be frustrated that the only people in leadership were people committed to perpetuating the very same lifestyle I’d prefer to get away from myself and that harms the people in our profession. I’d feel both drawn to filling my newfound space and also pushed to do so with other things anyway. I like to be a part of change. Would I be happier if I went to therapy in an attempt to find peace in not being that way? I don’t know. It doesn’t feel that way, but I guess that’s what therapy could be for. There is a lot of stress in trying to do a big hard job while putting up boundaries and guardrails when that isn’t “what is done.” There are many physicians in many institutions trying to change (or at least override) their institution’s culture of overwork from inside it, and it seems like that’s the position you are in. Yes, finding more ways to put up and support those boundaries will be helpful. So will looking for more grace for yourself and learning to let some things go that maybe you care about less. More realization and support of the load you are carrying by choosing to do this would be great. But I guess I’m just saying that I get the sense that making some sweeping change in your job description or cutting back by slicing away time doesn’t feel like a good answer. Its understandable that it would be incredibly difficult to be a part time PD. Even a job share might not reduce your workload as much as one would think – there would be a good deal of duplication of effort. I wish I had more answers – I don’t – but you’re not alone if this is how you’re feeling.

  • Reply Erin February 18, 2022 at 8:13 pm

    Late to the comments here but I agree with another commenter about the tracking perhaps not serving you, and that might be something worth addressing in therapy. Candidly, I find the over quantification of time/goals/activity/phone use almost uncomfortably close to the way people with eating disorders track their food intake/exercise. I’m not a clinical psychologist but it strikes me as something perhaps worth exploring with a professional.

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