Thank You, My Patients

November Gratitude Shorts, Day 23 (I think they will all be late now…)

Though my formal medical training ended in 2002, my real education has continued in earnest since then.  I spent 7 years in my first practice, 5 years in the second, and I have been in my current situation about 18 months.  I have known thousands of patients in that time, some very closely, as well as their families.  It is perhaps the greatest privilege I can imagine, to be allowed so intimately into the lives of so many.

The best part comes after I have had enough encounters and important conversations to say that I truly know a patient.  When I can predict their responses to diagnoses or preferences for treatment; when I can tell by just looking how they feel physically, emotionally—that is when I know a true relationship is established.  Sometimes it’s built over many years of regular visits.  For others the interval is short, because they are dealing with some acute, distressing event or circumstance.  Coming through serious illness with a person bonds you like nothing else.  Sometimes it’s subtle, too.  You come in for a cold, but you never get sick, this time it got you and brought you down hard.  That’s a chance for me to ask some important questions.  What’s going on in your life today?  I never know what lies on the other side of that question, and it’s a tremendous opportunity for connection.

Or, our initial encounter (or two, or three) leaves me feeling tense and frustrated.  I start making up stories about you that may or may not be true.  The next time, we get to a point in the conversation where we can open up to each other about the relationship, and talk it out, figure out the best way forward.  Maybe we come to some new mutual understanding and everything changes for the better—these are the patients who teach me the most.  Other times we agree to part ways, and that’s okay too.  Not everybody is meant to be together.

Either way, there is no substitute for time and face to face meetings.  Every relationship is a two-way street, and my patients teach me every day about withholding judgment, staying curious, asking for their story, and telling the story that I make up.  They teach me to monitor my assumptions, ask more questions, and explain my rationale clearly.  They hold me accountable for my words and actions, as I hold them, too.

They make me a better person, every one.

My Friend Yakini

November Gratitude Shorts, Day 22 (Late again!)

I give thanks for my friend Yakini.

Yakini ran the home daycare where both of my children spent their first two years. She and her family are our extended family, and boy, are we lucky. Grandma, Yakini, her husband Coffey, and their kids all participated in the care of the babies and toddlers, and all loved them.

In the beginning I called twice a day to check up, because my son had severe food allergies and eczema.  He would wound himself scratching every day after his nap. I had to make mitts that buttoned to his onesie sleeves, that the daycare had to put on and take off every day. One woman who worked at the daycare finally told me, “We take good care of your son.”  I said I know, I just worry. She said, “I know you worry, but you need to get a grip!”

My husband got nervous that the daycare would fire us for my high maintenance nagging. My mouth went dry when Yakini called that night to talk. This is it, I thought, we have to find a new place. But she didn’t fire us. She said she called to validate my behavior. She wanted to know what I needed to be free from worry and trust that my kid would be okay in her care. A sacred contract, she called it. We talked only a few minutes and I never had to check up again. That was over ten years ago.

Since then I have watched Yakini raise her own two children with high expectations, fierce love, and unwavering discipline. She does it all leading by example first. She studies the literature in child development, she knows the science of relationships. And then she puts all that information through her own core values filter, and determines for herself whether the expert opinions apply to her family. And if not, she keeps seeking, stays on the path, follows what she knows to be right, always guided by love first.

She posted a video of President Obama’s 11 ‘blackest moments’ on her Facebook page recently. Yakini and her family are black. And I have always felt her to be a sister. I shared the video and wrote, “Thank you for sharing, Yakini!! I’m not black, have no idea what it means to be black. But I love every one of these moments. I think that means something good.”

I think it simply means that I have had the privilege of knowing an incredible woman from an incredible family, to whom I relate because we share values and ideals about our world. Lucky me.

Facebook Fast, or Coming Home

November Gratitude Shorts, Day 21 (Late entry)

Thank you, friend Donna.

We had one of our usual soul-feeding brunch meetings on Friday.  I expressed excitement, intensity, diversion, passion, apprehension, exhilaration for all kinds of things, and also concern that in all my ambition to achieve my professional vision, I would neglect my family.  We talked through all the connections between my activities, my values, and the world at large.   You helped me explore my inner world, slow down and examine the concerns that I might otherwise gloss over.  I described my urge to be home, pay attention to the kids, be present.

Conservatively, I probably spend 3+ hours on Facebook, email, or WordPress per day. You suggested I do a social media cleanse–what was it, a week?  A month?  Whoa nelly, let’s not get carried away!  But it caught my attention. I’ve been struggling for a while with FOMO, as David Brooks calls it, or Fear of Missing Out. I scroll through my Facebook feed for articles. I check my WordPress stats to see how many views and visitors, comparing one day to the next. It all diverts my attention from the family, when I’m with them. I’ve tried to implement limits, like no Facebook after 9pm. That lasted maybe a week. It’s become a habit, a compulsion—walk by the phone, pick it up, check this, then that. A multi-day cleanse seemed a bit drastic. But maybe a fast? Just try, we said. No pressure. See if I can go 24 hours without checking Facebook, Twitter, or WordPress, and look at email minimally. We agreed I would try Saturday—today is as good a time as any.

It wasn’t as hard as I thought it would be. I feel liberated and reassured. Turns out I can live without Facebook for a day, and I don’t dissolve into cold sweats and tremors. I meant to post my November Gratitude Shorts on time, but I let up on myself for those, too. I knew I’d get them done. It’s not the end of the world if my daily posts are a little delayed.

I spent time with the family. We watched a movie together, decorated the Christmas tree, and had some good friends over for a potsticker party. I didn’t miss out on anything, and all is well. I still may not be ready for a week-long cleanse, but I can definitely make fasting a regular practice. As I continue to pursue my professional mission(s), I can use social media as a source of ideas and information, and I can also put it down and engage in person with those around me.

Thank you, friend Donna, for the invitation.


Superhero Exploration!

November Gratitude Shorts, Day 20 (Late entry)

Man of Steel, Ironman, Thor, Avengers, Captain America, Mission Impossible, Jason Bourne, Hallelujah!

In the last several years my preferred movie genre has shifted from romantic comedies to superhero action flicks. I’m not exactly sure why, though I suspect it has something to do with letting go childish wishes of happily ever after and embracing a more, shall we say, assertive form of entertainment.

The story follows a similar arc, regardless of the movie. We meet the heroes, then follow along as some colossal menace emerges that only they can fight.  In at least one scene they narrowly avert some mortal threat at the last millisecond.  No matter how desperate and hopeless the situation, no matter how fast my heart races and I tremble and fret, in the end the heroes win and all is saved…until next time—tune in next summer!

I learned recently about three types of stress:

  1. Threat stress: This is what we generally mean when we say ‘stress.’ It’s the fight, flight, or freeze response, when we sense a threat to survival, or we appraise that we lack the resources to cope with our circumstances. It’s mediated by cortisol.
  2. Challenge stress: We face a challenge that we feel at least somewhat qualified to tackle but it will be hard, test our limits. If we’re lucky, it’s something we care deeply about and we rise to the occasion—I’m thinking this could lead to a state of flow. This stress results in increases in DHEA and testosterone.
  3. Tend and befriend stress: This is empathy. We see a friend in need and we respond with compassion and love. We feel connected through their struggle. Oxytocin rises here. [Addendum, 04/26/16: This is an incorrect interpretation of the tend and befriend response.  Read my updated understanding here.]

This is intriguing to me, and I will study more about this construct in the very near future. I have experienced a fair amount of the latter two recently, and I’m positively exhausted.  So here is what I have learned: Not all stress is bad.  But even good stress costs energy, and we need to recover from it.

So maybe this is why superhero action films appeal to me? The heroes experience a call to adventure.  They, and we, wonder if they are up to the challenge.  They are tested, sometimes to their very limits.  In the end they prevail.  Maybe watching these movies vicariously feeds my challenge stress hunger, helps me believe that I, too, can rise to the occasion of my challenges in life?  None of the heroes do it alone, they all have at least one loyal partner who believes in them and their cause—the partners tend and befriend them—they have connection.  We all need help to get where we need to go.  The true superheroes know this well.





Look for the Helpers

November Gratitude Shorts, Day 19

I never intend to write on politics here, but I suppose if I am to be authentic in blogging, as in life, I need to express potentially controversial things at times.

In the past few days I find myself glued to Facebook, looking for information and reflecting on friends’ posts. I am grateful today for all the writers more knowledgeable and articulate than I, who strive to contribute peace and understanding in the face of fear and destruction. I hope I can make my own small contributions, too.

I share now the timeline of articles that have helped me cope with recent world events.

Saturday, November 14:

My friend posted this photo, which prompted me to wonder… “But what does it mean for an ordinary citizen to ‘stand with’ a whole other country at a time like this? It’s more terrorism happening, right? The root of that is hate, anger, self-loathing, and other pain, from what I have read. So maybe ‘standing with’ France or any other victims of violence means exercising more curiosity and compassion, less judgment and negativity, toward the people right around us, whomever they are, wherever we are. We may not redeem a terrorist this way, but we can at least not help make one?”

I did not know about the bombing in Beruit, and learned important perspective about media coverage of world events from this article.

Then, a friend posted an even deeper discussion of how we truly cannot relate, as Americans, to the horror in the Middle East, and an invitation to open our hearts and minds to awareness.

Tuesday, November 18:

Increasing news coverage about US governors announcing refugees unwelcome in their states.   A friend posted a history lesson from the Washington Post.

I see opposing viewpoints emerging in stark and sometimes vehement relief on my friends’ pages. No refugees until all of our veterans are off the streets and taken care of!  If you refuse refugees you let ISIS win, you are a pawn of fear, stop being a coward! Look at all the atrocities committed by Muslims! Oh yeah? Look at all these other atrocities committed by Christians!  Do we really want to play this game of one-ups-manship?

Just when it felt overwhelming, and I wondered again what a single citizen could do, another friend posted this picture:

And another posted this article about a past governor of my home state of Colorado, who stood out and up for his inner sense of humanity.

And another posted this quote and photo of Robert Kennedy:

Finally today, I felt impatient with all the negativity. Everybody is scared. How could we not be?  I have thought more than once just this past month that the world may actually end in my lifetime, the way things look now. But all the verbal attacks and undermining, the incendiary comments, stereotyping,  judgment, and impulsivity, on all sides, just is not helpful. If your neighbor or friend rejects refugees out of fear, how does mocking that fear make anything better?  Why must we choose between housing our veterans and granting asylum to refugees?  Surely, if we call upon the best that is America, we can do both and more?

I posted on my own page today: “I need to look for articles on the GOOD that Muslims, Christians, and others do around the world. Comparing the harm that one group does, to the harm that other groups do, keeps our focus on dark, destruction, and pain. In order to really see one another in light, we have to shift our attention to the light.”

So I looked, and once again, other writers held me up:

A lot of people quote Mr. Rogers these days, and rightly so.  Look for the helpers, his mom told him.  “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers.  You will always find people who are helping.'”  We should take this advice, and not only look for the helpers, but try to be helpers, too.

look for helpers


Books! Thankful for books!

November Gratitude Shorts, Day 18

Yesterday I meant to post about books!  There are so many, how can we ever read them all?  Thank goodness for all these authors, who take the time and expend the energy to create and publish for the benefit of us all!

I keep a list of my favorites:

  1. The Art of Possibility, Rosamund Stone Zander and Benjamin Zander
  2. Everyday Blessings: The Inner Work of Mindful Parenting, Jon and Myla Kabat-Zinn
  3. Healing From the Heart, Mehmet Oz, MD
  4. Now, Discover Your Strengths, Buckingham and Clifton
  5. The Power of Mindful Learning, Ellen Langer
  6. A Whole New Mind, Daniel Pink
  7. The Five Love Languages, Gary Chapman
  8. On Gratitude, Aaron Jensen
  9. Complications, Atul Gawande, MD
  10. Blink: The Power of Thinking Without Thinking, Malcolm Gladwell
  11. Made to Stick, Chip and Dan Heath
  12. Positive Psychology in a Nutshell, Ilona Boniwell
  13. Kitchen Table Wisdom and My Grandfather’s Blessings, Rachel Naomi Remen, MD
  14. The Inner Game of Tennis, W. Timothy Gallwey
  15. The Heart Speaks, Mimi Guarneri, MD, FACC
  16. Proof of Heaven, Eben Alexander, MD
  17. Peaceful Piggy Meditation, Kerry Lee Maclean
  18. The Timekeeper, Mitch Albom
  19. The Social Animal and The Road to Character, David Brooks
  20. Finding Flow: The Psychology of Engaging With Everyday Life, Mihalyi Csikszentmihaly
  21. The Mind’s Own Physician, ed. Jon Kabat-Zinn, Richard J. Davidson
  22. Daring Greatly and Rising Strong, Brené Brown
  23. Resonate, Nancy Duarte
  24. Start With Why and Leaders Eat Last, Simon Sinek
  25. Big Magic, Elizabeth Gilbert

During visits with patients, many of these titles routinely come up either in my mind or in conversation.  I found myself sharing them so often that I finally decided to keep them on a Word file to share electronically, and I add to it regularly.   Often, people have already read one or more, which is when I know I am connected with a like soul.  I love when that happens!

There are so many books I have yet to read, indeed that I am dying to read–I have bought most of them already!  My bookshelves are almost out of space, and the books are spilling out onto most other horizontal surfaces in the house.  Here are some titles I plan to read in the next year (the next few months, ideally!); please feel free to suggest others:

  1. The Alchemist, Paulo Coelho
  2. Being Mortal, Atul Gawande
  3. Drive, Daniel Pink
  4. The Book of Forgiving, Desmond Tutu & Mpho Tutu
  5. How the Body Knows Its Mind, Sian Beilock

I have yet to read most of the ones on this shelf, though I have dipped into many of them a few times.  I like to dig deep, mark them up, and take them down over and over again when I make connections between them.


The book post was meant to be lighthearted…  Books bring joy, wisdom, knowledge, connection, learning, laughter, pictures–it’s all good!

Today feels heavier, and my focus on reading and writing takes a serious turn…  More on that for Day 19…