December 7, 2022

by Dr. Plastic Picker

My big task this morning is to figure out a title for the HMO Regional Asthma Symposium Presentation I’m giving on Friday morning. I think I’m going to name it “45 and my 2nd Act as a clean air advocate: @drplasticpicker a burnout story.” I’m opening up powerpoint right now and going to update slides I used for the MGHfC/Harvard Grand Rounds I gave in November.

Actually I renamed it. I think this works better “My Second Act as a Clean Air Advocate and SDPCA.” I’m going to talk about burn out, but focus on two recent projects we are working on which is rallying against the Mitsubishi Cement Plant and thousands of more diesel trucks in the Environmental Justice neighborhood of Barrio Logan. And also I’m going to touch on indoor air pollution and the push for building electrification.

I don’t really tell anyone other than the SDPCA/AAPCA3 email list and then my immediate clinic friends about the things we are doing. The clean air work and this beautiful alternate world as a climate and health doctor has been this beautiful thing that has happened. It’s connected to our department as all the players are also part of it, but it’s also outside of work as it’s all volunteer for us and for me. It’s a non-transactional relationship and completely a transformational journey for many of us, and has been for me

With that, it’s been hard. I left middle-management willingly and enthusiastically to pursue environmental health advocacy. The outside work needed to be done, and it was volunteer and honestly not enough people are showing up to do this work. With small efforts, I have a greater impact on child health than sitting at middle-management meetings. I had no grand plan for when I felt quietly exited middle management, but I knew it was the right thing to do. I’ve moved on to more regional and national work within our HMO. I’m making connections with climate and health advocates in Oregon, Northern California and other regions. We are all working toward the same goal and interestingly there are a lot of people like me, former chiefs and assistant chiefs, who realized we had to work outside to change the inside.

But I do get sad sometimes. I’ve chosen to be very quiet and let my former middle management colleagues figure out their second act. But as I see what I had worked on for five years be dismantled piece by piece, I get sad. But I know that everyone has to recreate their own reality. If you don’t make it yourself, you never feel that sense of ownership. I had thought I had been doing that work collaboratively, but as little things are changed that had remnants of my former administrative self – I naturally feel hurt. That had been years of effort. Years of worry. Years of how I felt things were efficiently organized to make life better for all of us. I had my colleagues wellness and my own wellness at the forefront always during those five years as Assistant Boss, and then the previous 5 years as lead of our clinic. It was a decade of my life, and a decade is a long time.

But one has to say goodbye and a department moves on. I’m a bit player sitting in my corner, and going to just wait it out. Wait until the new generation takes over at some point. It’s too painful for me emotionally to go to meetings and to participate. I listen in, or listen to the recordings. I find so much joy in my actual patients and clinical medicine, and I often wonder what insanity led me into management before. And I’m reminded that it was because the work was being dumped on me anyway as a young mommy doctor, and I had decided that if I’m going to be pressured to do the work than I might as well have the title and get the tiny little bonuses that are associated with it. I think that was the right thing to do as a woman doctor. And that led to the next which led to the next, which led to burnout.

But I’m happy and it’s best not to question our life’s journey. I have realized now that it’s in my own self-interest to acknowledge my emotions and that how I’m feeling is important too. So that’s how I’m feeling now. I’m also incredibly sad about our family’s pseudo kdrama. Nothing has happened otherwise, but it had been such a beautiful time of dreaming together about a shared future and family and friendship. We are doing very well and our daughter is flourishing in her speech team, and academically and in the midst of normal 14-year old worries about her sports teams. I learned so from that time. I learned that I need to place boundaries around how much I am involved in her life. I learned about para-social relationships (she taught me that), and to cherish the real relationships I have. I learned about my own intrinsic biases and we confronted at least a decade earlier than planned, how we at parents want to begin to navigate having young adults who will at some point date and hopefully create their own families. But the most important thing I learned is how incredibly wise my own daughter is, and how also incredibly young. I get flashes of the future woman she will do, and then stark reminders that she is firmly fourteen.

Rather than trying to meddle in her life or have para-social relationships with future in-laws and future son-in-laws, I’m allowed to lay in her bed and watch her study at her desk. She’s a beautiful child and of course I know I am biased because she is mine. But I lay there and I look at her, and I see her profile with her blue-blocking glasses perched on her beautiful nose. She’s always working on her schoolwork, and perfecting the presentations and making sure she presents her best work. I’m proud to say she’s one of the top students in her class, which I’m still puzzled about because not once have I asked her to do that. In fact during elementary school when the students were allowed to test into the higher spanish and math, I did not sign her up because I didn’t want my former preemie 28 weeker to be stressed. But she ended up in those classes anyway just through her performance. But I get to lay there and watch her study. She’ll ask me questions here and there, and smile at me. But I get to hear her quiet mutterings and comments to herself. She is one of those, very chatty to herself. She sings in the bathroom. She talks to herself at times. And two nights ago, the fourteen year old who now knows she can wear a shade of lipstick and pull an outfit together and wow some speech judges – had in her imagination already told her same-age law-school boyfriend that he’d have to wait for her at Yale Law because she had to go to fellowship and live in a flat in London. So she has been dreaming too along with me, about the future. But I’m glad now that it’s an amorphous person that does not have a name yet. Just a fuzzy thought it the back of her mind.

So we are firmly at fourteen and she turned to me yesterday and I told her I was done with my musings and imaginations about her future husband. And she looked at me with wise eyes and said, “That is good mommy. You told me I can’t date anyway until after my SATs.” She’s got better things to do. But I’m so happy we got to go shopping again for shoes and she looked beautiful at her speech tournament. I’ve realized that she’s very picky about friends and likely about future romantic interests. And I’m so proud of her for that. She won’t settle for just anyone and doesn’t encourage others to pay attention to her in that way. She just wants to preview what it would be like to be a “fancy lawyer lady.”

So I’m lucky, inordinately lucky. My department has moved on. Our family has moved on from our family’s pseudo Kdrama (although in the back of my mind it was just a weird coming of circumstance that I think they’ll meet again in a decade by accident). And I’m still here happy to be a general pediatrician and get to do clean air work. I get to be the mother of two great teenagers, and a 14-year-old who likes to go shopping with me. And I get to be with you dear reader on my blog. Oops, she’s coming down the stairs. Let me sign off!