Must. Not. Bang. Head. Against. Wall.

Those of you residing in Ireland with me may understand where this is coming from. Those of you working in health care most likely understand exactly where this is coming from. And anyone who has ever been annoyed by an illogical loop of policy and stupidity will definitely know where this is coming from.

I just took a day off of work. (yeah... I know... Liz took a day off of work... Do both of her legs work?!). I worked 7 days straight, including 2 weekend shifts in the A&E spent dodging vomits and getting coughed on. Summed up, it sounds like this: bark bark bark bark cough whinge whaaaaaaah! sniff sniff wheeze bark bark wheeze PUKE! (yeah, that's a croup joke). I rolled home just after 11pm, ate a light snack, set my alarm so I'd get to work at 8.15am, tried to fall asleep... And the vomiting started around 12.30. I'm not going to be exceptionally graphic here, but I was miserably awake until 4am. Clearly when my alarm went off, I had to ring my co-worker and tell her that I wouldn't be able to come into work... And I felt guilty. With next to zero sleep, having been up sick all night long, probably dehydrated, definitely hypoglycaemic, and barely able to move, I felt guilty for not going into work.

I should take a moment to clarify that at present, I'm actually working for a neonatal service. I work with small babies. Small babies that are unvaccinated, because they are too young to have them yet... Prem babies, little babies, very sick babies... And I felt guilty not going into work. Why? According to my contract, if I have to miss more than 2 days due to illness, I need a doctor's note (yeah, I know, soak up the irony)... And I felt guilty taking one day.

Before further exploring this emotion, I need to discuss the last week and an email I've received. This past week, I have been at odds with one of my superiors. At odds is a nice way of putting that I completely disagree with the way they function at work. I have been pushed further and further out of my comfort zone as a doctor. It's been progressively worsening for the past month, and I feel as though I'm not learning, I'm just trying to keep my head above water as more and more work is poured onto my shoulders. Work that I'm neither competent to complete nor qualified to complete (nor am I paid to do)... I had to force my superior to do something they'd asked of me for "Medical-Legal" reasons. I have reached a breaking point when I have to throw down law to keep from doing work. (I won't get into the shifts I work... EU law be damned).

I also received an email from my medical union requesting I fill out a survey. The survey was focused on the working conditions and how to improve to keep the Irish trained doctors from leaving the country. (Spoiler alert: We leave because working conditions are shite and we are over worked, underpaid, and asked to do things that we've never been taught how to do. We aren't taught because all the seniors are overworked and filling the gaps of people that have left or been fired or are on maternity leave and the HSE can't be arsed to pay for cover.) Most of us work the jobs of two or three people, and yet we're expected to somehow take our annual leave, take our study leave, pass our exams, research and publish, and improve the system. You know what, feck off. SHOs burn out for a great many reasons... I've mentioned a few of them. And no, the other systems out there aren't perfect either, but I do know that if I were at home, I'd not have to move cities every 6 months for my jobs.

Now... with all of that, how could I ever, possibly, even minimally feel guilty taking a day off when I'm projectile vomiting for a night? Because I know that without me there, my co-worker will have to do her work AND my work. That anything I didn't do on Friday night will not only be waiting for me, but probably doubled in volume because there are things that can't be handed over to other people. Because there are patients that I've been seeing every day for a week and no one else knows them as well as I do. And because I am me... I've always felt guilty when my body isn't strong enough to do what I want it to do. For that last reason, I worry that I won't be able to remain in Irish medical system.

I will go back to work tomorrow. Just over 24hrs from the last time I vomited, I will go back to work. I have a 24hr rule, some places have a 48hr rule. There's nothing in writing right now that says whether or not I need to go back tomorrow or if I should take another day... Welcome to survival by the goodwill of your workers. But with the best and brightest leaving the country or burning out over the ridiculousness of demands, this system is on a road towards crash and burn. Maybe when I'm sick, I'm more cynical... Maybe I need more sleep... Maybe I'm just being bitchy. Who knows. But I needed a rant, and there it is.

Thanksgiving... Ex-pat styles

As an American, there is no holiday more universal than Thanksgiving. It is celebrated nationwide. It's a family holiday. It's a sports holiday. It's a shopping holiday. It's a 4-day weekend holiday that's notorious for travel (and delays). And in spite of the universality, it's celebrated uniquely in every home.

Many will describe a similar scaffold for the holiday:

• Wednesday: Travel, get stuck, dig out, get stuck again, travel more, arrive a little late...
• Thursday: Cook cook cook bake cook FOOTBALL! At some point, sit around a table, at multiple tables, at the adult table, at the kid's table, on the floor... wherever is comfortable, and EAT... 
• Friday: SHOP! It's black friday, you have to get going on those Christmas presents. Plus, there's more football on TV. And LEFTOVERS!
• Saturday: Uh... Football and Leftovers
• Sunday: More leftovers... more football... And it's time to pack up for travel back. Why does that always go smoother on the return trip?

Everyone has their own traditions. Their own habits. Their own recipes that make the holiday what it is. And it's something you cannot duplicate. And it's something I miss.

The holidays always leave me a little homesick. I haven't decided if knowing my family is together makes it easier or harder to be apart. But in my time away from home, I've learned a few things. Most importantly, you cannot do the exact same thing without the people. I once tried to replicate what my family does at home; that was a mistake that only left me feeling more miserable and further from home. I once had a group of ex-pats make a Thanksgiving dinner and take a small holiday... That too was a bit of a let-down. Sometimes the traditions from different families don't blend together very well.

For nearly a decade, a very generous donor (and member of the board of trustees) has hosted a Thanksgiving dinner for the Domers in Dublin. It's not the traditional Thanksgiving at home, it's not family style serving, it's not sweatpants or looser belts, it's not a beer and the game on TV. But I have to say, I enjoy the ND-Dublin Thanksgiving for all of those reasons. Rather than being in jeans and a sweatshirt, it's semi-formal attire. Instead of a giant bowl of mashed potatoes in the middle of the table, it's five-star fully catered dining. And while football is the normal background entertainment, a small talent show greased by the wheels of a champagne reception is a suitable replacement. I love the ND Thanksgiving because it isn't home. It is different enough not to try to be home. And the food... it's delicious. It's not exactly right, it's not what I'd be having at home, but it's close enough. And for five of the past six years in Ireland, I've been lucky enough to attend this Mass and Meal in celebration of Thanksgiving. And for that, I owe Mr. Martin Naughton a very large and heartfelt thank you. I do have to dash home from work, change clothes (put on something fancy), re-do my makeup and hair, then dash out to Mass. It's all very rushed. And I don't have Friday off work, so I can't make it too late of a night. But Dublin is my home (not that Minnesota is not home), and Mr. Naughton has helped me find a lovely way to have a comfort of home in a grand Irish way.

No offense to the Irish, Thanksgiving is a holiday that's very foreign. And I miss home. It's one of the most difficult holidays for an Ex-Pat... But I have so much to be thankful for. So much here, and so much back home.

Happy Thanksgiving.