DIY Pep Talk

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“Wait, I have mantras for this!”

How are you affected by anxiety, rumination, or otherwise tenacious yet counterproductive thoughts and feelings in life? Many of us lose sleep. We lie awake, before falling asleep or having awoken at night, or both. I talk with patients about this regularly, a common problem that manifests for each of us in our own unique way.

Recently a patient mentioned it to me during a routine visit. After decades of stress-induced insomnia of various causes, there was a sense of placid acceptance in his tone and posture, and also hope that he may still find a way to overcome. He listed some prior life stressors, none of which had turned out nearly as badly as he had ‘unncessarily worried.’ He said when he remembers this, he is able to de-escalate in general, but it doesn’t necessarily help him at night. Since meeting me he had also been practicing box breathing to relax and calm his nervous system, which sometimes helps him sleep. So we agreed he could try to combine the two when insomnia hits: Breathe intentionally and rhythmically while repeating a reassuring, de-escalating mantra of his choosing. I’m excited to hear how this goes for him.

For some months I had been ruminating on and off about friction in a longstanding relationship. I journaled, spoke to multiple friends, and also lost sleep, which happens to me rarely. I entertained exiting the relationship altogether, but that was neither justified nor productive. I saw it as a personal challenge to walk my talk of showing up, sticking with it, and being my best relational self, despite feeling unappreciated and disrespected. What other story could I tell about this person and our relationship? The day before an upcoming encounter I felt almost squirelly from anticipation and ambivalence about how to approach the meeting. Then it hit me: I have mantras for this.

  1. I’d rather regret being too kind than not kind enough.
  2. Strong back, soft front.
  3. Do no harm, take no shit.

And just like that my conscience cleared, fight or flight turned off, and dread transformed into optimistic anticipation. I marvel still at how I recite my mantras everywhere to patients, on this blog, in social media posts and comments–I have even made stickers of them–and yet they escaped me when I needed them in a period of distress. I am all about relationships and yet this one flummoxed me–significantly. The mantras saved me–better late than never, and even better just in the nick of time!

I can neither prove nor disprove, but I tell the story that because I presented with honest equanimity and humbly confident professionalism, the encounter went smoothly. The relationship might even have improved? …I can’t say. I think I generally show up this way by nature and practice, but this time I had to talk myself into it. So I wonder, in all these years of friction (at least on my side) in this relationship, how much was actually mine to own, or in my imagination? This dynamic is definitely an outlier, so I don’t want to fixate on it; yet sometimes the exceptions point to areas of deeper potential insight and learning, no? Regardless, I’m grateful for how this episode has illuminated a new awareness for me and sharpened my attention to my own default attitudes and assumptions.

So what are your DIY pep talk methods? How did you come across them and why do they work so well? What mantras hold you up?

Happy Sunday, friends. Have a great week!

Recipe for Friendship

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At Loba Pastry and Coffee in Chicago: “Honey ~Squiggle~ Things” and “Fancy (ask for flavor)” pastries. It doesn’t matter what you get here, friends. You simply cannot go wrong.

Happy 19th day of National Card and Letter Writing Month!
Happy 11th Anniversary to Healing Through Connection!
Happy 100K+ total views on this blog in these eleven years–and thank you to all the humans who have viewed, commented, and followed all this time!

Today’s NCLWM prompt is Recipe. What is your recipe for deep, meaningful friendship?

Last weekend I communed with Phara, Christine, Heather, and Grant.
This weekend it was Donna, Jacob, Amber, Kasey, Troy, and James.
Holy cow, I am the luckiest person in the world to know so many amazing people and have the privilege to call them friends.

Donna cut through months of circular rumination and clarified the core of my mental and emotional struggle with one particularly vexing patient relationship. She and Jacob both helped me solidify ideas, structure, and themes for Book. Amber taught me about her generation at work and what it means to be a software engineer. And Kasey, Troy, and James just filled my tank the way they always do–sitting at brunch with them today made me wonder about and attempt to articulate my own Recipe for Friendship:

Ingredients:
–1 frontal lobe for Openness – enough to be willing to meet someone new
–1 or more Shared Interests – things over which we bond, in which we can grow together
–Many scoops Attention – each to the other, for both verbal and nonverbal communication
–Open faucet Curiosity – consistent interest in learning more about each other
–Demonstrated Common Ethos – core values that hold up our integrity in relationship with self and one another
–Consistent and regular Effort – demonstration that the relationship is worth our energy to cultivate and maintain
–When possible, In Person Contact – can substitute phone and video when needed; best results when added regularly
–Measured, in-context Vulnerability – key for depth and meaning
–Heaps and loads and oodles Love; impossible to add too much
–Time – no substitute, the more the better
–Trust and Devotion- will develop with Time, the last ingredients that occur spontaneously and multiply themselves, like strong sourdough starter

Method:
–This recipe can be made in any setting or context, at any time.
–Carry the ingredients on your person–mind and heart–at all times, ready when the opportunity to cook up a new friendship arises.
–Ingredients above are listed in likely order of occurrence, though most can be added at any time and then repeatedly, ‘to taste,’ in cooking/cultivating process.
–Additional ingredients of your choice encouraged, to personalize and make your friendships special to you and your friends
–Keep multiple recipes going at all times, each at various stages of mixing, stirring, rising, preheating, shaping, baking, simmering, braising, aging, cooling, etc.
–Even projects that have been apparently inactive for long periods may be self-sustaining without loss of flavor or nutrients, depending on stage of cultivation.
–Once a recipe is well underway, however, it will likely require regular additions of at least Attention and Effort to succeed over Time, depending on proportions and mixtures of the other ingredients.

This is a staple recipe. I cook by feel; as this is my first attempt at articulating my method, it will likely evolve if I keep trying to capture it in words. Now that I think of it, I could use sourdough starter as the whole metaphor, no? Oh well, maybe another time.
Everybody should have their own favorite friendship recipe–or maybe multiple ones!–on hand, written or not, like figuratively sturdy, dog-eared index cards with evidence of repeated use–stains, wrinkles, folds, and tweaks written in small cursive, legible only to the owner.
The strongest and most successful recipes are likely to be shared, mixed, and matched for additional depth of essence, character, temper, etc.–we all know the best loved recipes last the longest–often for generations.

My deepest and brightest thanks too all the friends who brought this forth for me today.
Love you all.

Collegial Love And Then Some

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Audible Narrator Hall of Fame Class of 2018 and 2026 Inductees

Who are your colleagues?
What connects you?
What do you share with these people that others do not and cannot understand or relate to?

Last week Audible celebrated their second cohort of Hall of Fame narrators, including a couple of my favorites, Andrew Eiden/Teddy Hamilton, and Steve West/Shane East. Andi Arndt, Hall of Fame Class of 2018, gushed about her colleagues on Instagram the night before, reminding me of that deep collegial love that I feel every day in medicine. My impromptu comment on her post stuck with me all week.

The photos of celebration and connection, the joy and energy of the Audible event moved me, too. I haven’t been to an American College of Physicians national meeting since 2019 (it was next weekend in San Francisco, but I came to Portland, Oregon instead, to visit with friends–hence this delayed post), and I miss seeing my colleagues from all over the country, going to sessions and learning together, having coffee, sharing stories, catching up.
Voice acting can be very solitary work, so I imagine these artists relish opportunities to gather and commune, especially when it centers around celebrating their shared love of the work.

I wrote to a VA acquaintance once, “I hope (imagine) that you get enough positive feedback, validation, and reinforcement for your work! 😀 I also hope you get enough contact and connection with your colleagues. I can always walk down the hall and consult mine on challenging cases or difficult encounters. We are friends. My professional support network is at my elbow and fingertips; I hope yours is too!”

I spent time this weekend with Christine, my life coach and friend of 20+ years. She described her experience of ‘supervision,’ wherein she was required to debrief with elder colleagues during a segment of her training, exploring potential personal pitfalls and blind spots that client work may uncover, and how to beware of and manage it all. As coach and physician, our conversations weave in and out of mutual support and informal ‘supervision’ in organic and collegial ways. Our work overlaps with that of therapists, nurses, and probably any other helping profession. Walking along the Willamette River with Grant today, we reflected on how easily we can apply our professional training and skills in any domain where humans interact.

Back in 2017, the night before presenting at general surgery grand rounds (unusual for an internist), I wrote about tribal pride and tribalism:
“We all need our tribes. Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health. And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us. But what happens when tribes pit themselves against one another? How are we all harmed when we veer from ‘We’re great!’ toward ‘They suck’?”

Nine years on, how do we assess the relationship between tribal pride and tribalism in any given domain on the current geopolitical landscape? Surgery vs. medicine, staff vs. leadership, conservatives vs. progressives, advocates for vs. against AI… How can we maintain our human connections above all, no matter what our divergence? I have often thought of myself as a ‘lumper’ as opposed to a ‘splitter’–always looking for connection, commonality, and relationship everywhere, among all people. In the same message to my VA acquaintance:

“Acting and medicine: What do you imagine are the overlapping aspects of our respective work?  I see it mostly in story—empathy for and holistic understanding of the full human experience, from the euphoric highs to the most sorrowful lows.  For both of us, to be truly excellent at our work, we must call forth real and sincere empathy from our own depths, which is vulnerable and courageous in a lot of ways, don’t you think?  For you, the stories are complete, and you get to interpret and bring them to life, to present them for our benefit.  I get to elicit the stories, coax them to emerge in real time, and interpret them along with my patients.  What stories do people tell about their health, their lives, their agency to influence it, and the outcomes they can/not achieve?  We get to dissect and discuss and then act on our shared interpretation.  We edit and revise together over time.”

So this weekend I communed with two of my coaching friends. I spent quality time with Phara who has a degree in psychology, and Heather, a fellow writer. We bonded over parenting–the unique mental load of moms, especially working moms. This theme has emerged powerfully in my medical practice, no matter the moms’ day jobs and no matter our kids’ ages.

Colleagues share language, training, experience, and perspective. We compare notes, tell stories, and connect. But we do this not just in professional circles. Our tribal memberships intersect and overlap, often in ways we could not predict or design. So really, we can find love in commonality anywhere, with anyone, if we just open up and ask, no?

What a fun exercise to come across an idea on social media, feel it in my heart, react in real time, then process it for days and see what arises in stream-of-consciousness blogging while stuck at the airport! Tomorrow I get to co-present on health and wellness to the Illinois Judiciary–another esteemed tribe of helpers, as I see them. What a privilege.

My tank is so full from a long weekend of deep and thick connection with my amazing friends here in the Pacific Northwest. I will miss this year’s chance to commune with my fellow internists nationally, but I’ll get back to the office this week and soak it all up locally. How lucky I am, truly. I hope whatever your profession, whomever you call colleagues and friends, that you get to enjoy this deep, collegial love born of shared humanity. And if you can recognize and strengthen it across domains, even better. That’s what will save us all, I am convinced.