#AtoZChallenge: Applying Zen And Zeal

IMG_4473

Here we are, friends, the sprint to the end!! If I get this up by midnight that will be 5 posts in 2 days, a personal record!  I shall carry that pride for a while yet.  Many thanks to all who have visited from the A to Z Challenge this month, to all those who supported me through it, to the regular readers, and to the writers whose work I have had the distinct pleasure of reading.  We made it!!  And now, the last…

Webster’s Ninth New Collegiate Dictionary, again:

Zen:  a Japanese sect of Mahayana Buddhism that aims at enlightenment by direct intuition through meditation. [On this last post I interject my own connotation for this word, as synonymous with peacefulness and thoughtful serenity.]

Zeal:  eagerness and ardent interest in pursuit of something: fervor, syn(onym) see passion.

Today listening again (still) to Amy Cuddy’s book, Presence, I learned a new relationship between cortisol and testosterone, in terms of power and behavior.  Cortisol rises under threat, when we feel powerless.  Testosterone rises when we feel confident and powerful.  But they are not mutually exclusive, and just like meaning and stress, they can coexist in variable amounts.  By Applying Zen and Zeal, I mean to describe what it looks and feels like when we think and act in the combined state—a low cortisol, high testosterone milieu:  Confident, strong, calm, powerful, and proactive.

One more time, through the alphabet:

Attitude.  Peaceful passion.  Confidently Aspiring to higher goals.

Behavior.  Measured, less impulsive.  Intentional, purposeful.

Conduct.  Consistent.  Steady.  Forthright.

Demeanor.  Welcoming, friendly.  Inviting.  Quietly exuding a mission.

Effect.  Inspiring.  Aspiring.  Cohesive, motivating.

Focus.  Clear, directed, sharp.

Goals.  Meaningful, worthy.

Happiness.  Derived from within, determined by Honoring core values.

Influence.  Stirring, benevolent, collaborative.

Judgment.  Wise, responsible.

Kinship.  With all of humanity, transcending skin color, ideology, rhetoric.

Lessons.  Lifelong Learning in humility, applied with grace and gratitude.

Mantras.  Expressive, centering, grounding.  Ideas to foster engagement with the world.

Narrative.  Analytical, honest, ongoing.

Objective.  Peace in action.

Pursuit.  Integrity, fairness, equality.

Query.  Self-awareness, withholding judgment, telling new stories.

Rest.  Respected, taken in intervals.  Recharging, never slothful.

Strength.  When collaborating with others—Synergistic.

Timbre.  Deep.  Resonant.  Moving.

Universe.  Vast, inclusive, mystical.

Vibration.  Stimulating.  Multi-synchronous.

Wealth.  Deep connection.

Xanadu.  World peace.

Yield.  World peace.

Zenith.  World peace.

 

Peace to all.

#AtoZChallenge: Yes, And!

IMG_4387

Some practices take a while to establish, and it’s worth.every.minute.

I first learned about “Yes, and” from my residency classmate, c.2001. She was taking an improv class in her spare time (a revelation in itself for me at the time—you can do that?).  One day after rounds, she came into the workroom eager to share this new learning.  I warily accepted her invitation to try it.  For those of you unfamiliar, the “Yes, and” exercise goes thusly, according to Wikipedia:

“Yes, and…” is a rule-of-thumb response in improvisational comedy that suggests a participant should accept what another participant has stated (“yes”) and then expand on that line of thinking (“and”).[1][2]

“Yes”

The “Yes” portion of the rule encourages the acceptance of the contributions added by others.[3] Participants in an improvisation are encouraged “to agree to the basic situation and set-up.” Thus, “By saying yes, we accept the reality created by our partners and begin the collaborative process.” [1]

“And ”

In addition to accepting the premise offer by others, a participant in an improvisation is expected to add new information into the narrative. Hence the phrase “Yes, And!”[1]

 

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes.  I also remember my own hesitation and self-consciousness.  What do you mean, pimple on my forehead?  Is it really about to burst?  I need a mirror!  I was distracted, trepidatious, reserved—less than an engaging partner.  Sadly, I think she left that interaction a bit deflated.  So sorry, Carol!

In August of 2003, I read an interview with Tina Fey.  [Hey, isn’t that AMAZING, that I can Google “tina fey interview 2003 yes and” and it pops right up??]  In it, she recalls, “A couple of times I’ve been called on to do things—jobs or whatever—where I’ve felt, ‘Maybe I’m not quite ready. Maybe it’s a little early for this to happen to me.’ But the rules are so ingrained. ‘Say yes, and you’ll figure it out afterward’ has helped me to be more adventurous. It has definitely helped me be less afraid.” For whatever reason, perhaps primed by Carol’s invitation to try improv, this spoke to me, and I resolved to say Yes more often.  The very next day, I was invited to attend a luncheon at my church at the last minute, when another attendee had cancelled.  Normally I would have said no, thanks, and gone home.  I would not have wanted to overstep usual social boundaries, assume a position higher than my own (the luncheon was to honor benefactors).  AND, as I had nothing else going on that day, I thought of Tina Fey’s advice, and said yes.  I learned about all the people who give their time, talent, and treasure to help our faith community thrive.  I was humbled and grateful to be included.  Years later, I would give the keynote address at that annual event.

In 2005 I started working with my life coach, Christine. The “Yes, and” idea resurfaced again, this time as a practice in mindfulness.  Rather than saying, “I want to be in Colorado, but I am stuck in Chicago,” I redirected to say instead, “I want to be in Colorado, AND I am stuck in Chicago.”  The first was a straight-up complaint—a whine.  Changing the one word made all the difference, propelling me beyond the ‘stuck’ness.  After the ‘and’ statement, I intuitively accepted the current situation as it was, and a logical, sequential question arose: “So, what do I want to do now?”  In the following year, I moved (somewhat) past my resentment, feeling anchored in Chicago for the rest of my professional life, and embraced the opportunities a life here could offer.  The but-to-and modification played an important role in this attitude shift.  I was even able to apply it to my patient interactions, holding space for their stuck-ness and inviting them into new possibilities.

Fast forward to 2009, my first time at the Harvard Coaching Conference.  I had the enormous fortune to attend a presentation by Rosamund Stone Zander and Benjamin Zander, based on their book, The Art of Possibility.  I had my picture taken with Mr. Zander, and soon became of disciple of the book’s teachings, including the practice of substituting ‘and’ for ‘but’ in daily vernacular.  ‘But’ implies limitation and scarcity.  ‘And,’ conversely, opens our minds to movement and possibility.  I would say that by this time, my Yes, And practice was almost second nature.

And, it was February of 2013 when everything truly gelled. I was offered the privilege of leading a group of internists in the Chicago area, in an innovative educational initiative—weekly board review webinars for practicing physicians.  The format was new to all of us, so we took an improv workshop to hone presentation skills and build the team.  My partner, Sean, and I engaged in iterative exercises to demonstrate the power of ‘No,’ ‘Yes, but,’ and finally, ‘Yes, and.’  You can try it yourself.  Get a partner, and whatever you say, your partner says, ‘No.’  Do that a few minutes, then switch to ‘Yes, but,’ then finally, ‘Yes, and.’  The first two responses have essentially the same effect—shutting down the conversation, tempting the initiator to disengage in exasperation.

When we got to ‘Yes, and,’ I could feel my anticipation rising. Where would this go, what positively outlandish ideas could we possibly come up with?  I understood Carol’s excitement at sharing an imminent journey of imagination and creativity.  Between Sean and me, we devised a plan to hitchhike to California through the Badlands and Yellowstone.  We would stop on the Golden Gate bridge after our car broke down and help tourists take pictures.  Then we would steal one of their cars and joy ride down to Jay Leno’s house, or some professional athlete’s house, by way of Candlestick Park, I can’t remember for sure.  We would somehow convince the celebrity to drive with us, in his car, back to Chicago, taking selfies along the way, and make a presentation to our colleagues about the importance of primary care…  Or something like that!  I patted myself on the back; I am a Yes, And pro.

Our webinar series is now well into its second two-year cycle, and the Yes, And approach has guided us well through changes in communication, marketing, staffing, and expansion.

I’m reminded of a strategy that that Dr. Phil McGraw’s team implements when they brainstorm content for his show: “We love every idea for fifteen minutes.” That is the essence of Yes, And!  Take any idea, love it, embrace it, flesh it out, water it, pour Miracle Grow on it, throw it around, bounce it off the walls, crack it open, dissect it, sit on it, taste it!  You never know what will come of it until you let loose your imagination—YES, AND it!

Yes, And can be applied in every conversation, every relationship, every decision. Yes.  And?…

#AtoZChallenge: Xerophyte People

Webster’s Ninth New Collegiate Dictionary

Xerophyte: a plant structurally adapted for life and growth with a limited water supply esp. by means of mechanisms that limit transpiration or that provide for the storage of water.

AC cactus 2016

Photo courtesy of Cyndie Abbott, Green Valley, Arizona, 2016

 

Water is essential for growth and survival—of plants and animals alike. So how is it that some plants can not only survive, but thrive and even reproduce, with so little water?  On top of that, they also provide beauty, habitation, and even sustenance for others.  Their short-lived flowers splash color onto monochromatic landscapes.  Regional animals are adapted to live nestled among some xerophytes’ barbs.  Survival programs tell us to seek these plants as a source of essential hydration when stranded in the dessert.

Humans share many of these tough flora’s adaptive qualities. We evolved as omnivores, able to eat most things that grow in nature.  Our big forebrains allowed us to cultivate plants to eat.  We learned to capture, then herd, animals for our own use.  We have come so far as to alter and control our environments, in order to live in places where nature may never have intended.

But the more interesting parallel between xerophyte plants and Xerophyte People is resilience.  If we consider metaphorical water for human life, many things come to mind: joy, security, connection, purpose, meaning, love.  Think of all the people who live with little or none of these things.  Think of those who once had these things, and then had them forcibly taken away, often indefinitely—by war, abuse, illness, death.  In medicine, we witness this kind of suffering regularly.  Our hearts break alongside those of our patients and their families.  But it’s not always forever.  In primary care, where I have the privilege of knowing patients over long periods, I have also celebrated remarkable reversals.  New relationships, revelations, births, treatment innovations—you never know what will happen to turn the tide.

So what keeps us hanging on? Like plants, maybe we figure out ways to prevent further loss—limit transpiration.  Thick skin and prickly spines keep us protected.  Only the very persistent or the specially equipped can penetrate our defenses.  But more important, we have adapted to store what we need.  Even if we cannot readily identify or articulate it, something keeps us going.  Maybe it’s hope, remembrance, or some core value or aspiration we have yet to realize—some inner pilot light that never goes out.  Some might call it the human spirit.  Whatever it is, I stand in reverence of its mystery, its utterly saving presence.

To all the Xerophyte People in our world, I say as Glennon Doyle Melton does:  Carry On, Warriors.

IMG_1680.JPG

Tent Rocks National Monument, New Mexico, June 2015

#AtoZChallenge: Withhold Judgment

403532_3541039079225_1032738700_n

My brain is so tired. All month I have racked it trying to figure out what to write next, how to render it most authentically, and finally get it out looking close enough to how I intended.  On top of that, I have also engaged in multiple exchanges on Facebook around gender identity, public restroom use, vaccine rationale, and presidential politics.  It really has been shang nao jin, as we say in Chinese—literally wounding the mind.  I realize these are all activities that I choose, and none of them have significant bearing on the world at large.  And, I would do it all again.  My mental exhaustion is the hurt-so-good kind, like the muscle soreness after a particularly strenuous workout, when I know I have pushed myself to my limit and maybe extended it a little.  The writing and conversations are ways that I engage with my world and practice what I preach—open-mindedness, curiosity, and cultivating connection.

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.  Here are some illustrations from the past week:

I shared this post on my Facebook page on Saturday.  I agree with the author’s sentiments, basically that discrimination is wrong and we should open our minds and bathrooms to all people.  I also thought her writing was cogent and forceful.  One of my friends pointed out her name calling, as she labeled supporters of the North Carolina HB2 legislation, and people who boycott Target as a result, as hateful.  He then asserted that the left “can’t argue a point without calling people who disagree with them hateful,” or at least they choose not to. At once I see both sides generalizing in ways that preclude any possibility of meaningful mutual understanding.

After this I became more sensitive to name calling in articles I read. Even ones with relevant data and useful information can be tainted, as I found here, in which the writer calls bigots the same people that the previous author called hateful.  Why must we stereotype and label like this?  Is it just to get published, for attention?  Can we not convey our message just as effectively without all this vitriol?

Finally I read and shared this article, in which the author does not call anyone names directly, but writes a brilliant and searing piece of satire that also inflames and incites.  I suppose that is the point of satire, after all?  It was the comments on this last article that really drove home to me the perilous state of assumptions and judgment that drive many of our interactions these days.  If you support this law, you’re hateful.  If you oppose it, you’re irresponsible.  Perform one act that is, superficially, inconsistent with your professed beliefs, you are forever a hypocrite.  Commit one lapse in judgment and you are instantly unworthy of respect, now or in the future.  Snap judgments can degenerate our encounters to a series of sound bites of rhetoric and aggression.  They seriously inhibit, if not completely destroy, our connections, and they consign us to echo chambers of isolation.

The doctor who rushes me through my 15 minute appointment for a sinus infection, after making me wait 30 minutes already, is uncaring and just wants to make more money. Actually, she just spent the last 45 minutes telling her patient of 10 years that he has metastatic cancer and answering his questions, and she is anxious to get to her son’s school play tonight, his first lead role.

The woman who yells at the receptionist and makes a scene with the nurse is just another angry, entitled patient. Actually, her son was killed by a drunk driver last year, she lost her job and her home, and her mother is dying.

Fellow blogger and talented artist Jodi posted this beautiful piece today, including these words:

Skip the religion and politics,

head straight to the compassion.

everything else is a distraction.

— talib kweli

It really spoke to me, because compassion lives at the core of human connection. If we can remember compassion for one another more often, no matter our circumstances and state of mind otherwise, we can probably also remember to Withhold Judgment and listen for the rest of the other person’s story.  Listening more, yelling less, moving slower to the keyboard, showing up in person, asking more questions for understanding—these are the practices of Withholding Judgment.  Please, let us make the effort; it may save us all.

#AtoZChallenge: VAGINA! No Fear of Words, Please.

IMG_3363

Sexuality can be hard to talk about.  I think this is true for adults far more than for children.  Children are naturally curious and nonjudgmental.  They just want to know, what is that, what’s it for, why are yours different from mine, and why does he have one of those and I don’t?  It’s we adults who squirm and dodge, deflect and bolt.  From a very early age, children learn that it’s not okay to talk about certain things because it makes the grown-ups uncomfortable.  I want to change that.

My kids have known formal names of body parts forever—breast, vagina, penis, femur.  They also know what the parts do, how they ‘go together,’ etc.  Anytime they ask a question, I try to answer as honestly as possible, in an age-appropriate way.  For instance, I have had to clarify that babies do not come out of a woman’s ‘butt.’  First I had to clarify the general use and meaning of ‘butt.’  Then I explained that men have two holes down there, and women have three, and the baby comes out of the middle one, between where pee and poop come out.  Maybe it’s because my husband and I are both doctors and science nerds—we say these words all day long and never think twice.  I think also it’s because I’m a terrible liar, and everybody can tell.  It’s just not worth telling one story now, only to recant and revise later.  Moreover, even if they don’t challenge the fib I’m telling today, their intuition that I’m not being fully forthright undermines my trustworthiness.

There are important parallels here for physicians and patients, too.  In medical school we learned how to take a sexual history.  I think most of us handled it fine, but there was some blushing and gnashing of teeth at times.  Again the key is repetition and getting comfortable with saying the words without embarrassment or judgment.  “Are you sexually active?  With men, women, or both?  How many partners do you have now?  How many in your whole life?  Ever have anal sex?  Receptive, insertive, or both?  Do you use condoms?  Every time?”  It also applies to other aspects of the social history.  “Do you or have you ever used recreational drugs, such as marijuana, cocaine, heroin?  Acid, mushrooms, PCP, MDMA?  Anything else?”  The underlying implication is, ‘tell me anything, I really want to know, and I will only judge the risks to your health, not you as a person.’  Once I get to the end of these lists, patients can see and feel that I am comfortable talking about anything related to sex, drugs, and whatever else, and I make no assumptions.  They are much more likely, then, to tell me honestly about their behaviors and experiences.  I can then make a more accurate assessment of their health risks, and give more relevant advice.  As a bonus, we often establish a deeper connection, because that sense of safety now likely extends to other things they may want to disclose.  This is often when stories about sexual assault and relationship abuse surface.

I want my children and my patients ask me about sex, drugs, cancer, death, Alzheimer’s, depression, anxiety, and all kinds of other things.  All of these topics can render us deaf, dumb, and blind so often, just by virtue of the acute discomfort they induce.  But if we as parents and physicians cannot tolerate them, despite our responsibility in these relationships, how can we expect our children and patients to navigate them successfully?  Yes, there is plethora of information on the internet.  Much of it is actually accurate and helpful, and I Google as much as anyone.  But when it comes to such personal and emotional topics as these, people need more context and interaction than a screen can provide.  Google does not know your unique situation.  It cannot help you sort through your emotions, your family dynamics, or the implications of your decisions today on your future and the future of your loved ones.  We all need a human connection to do that—a safe, trusting, and loving connection.

When parents and physicians share freely our knowledge and expertise, in words that children and patients can understand and apply to their own experiences, we empower them to make decisions in accordance with their core values and highest goals.  We partner with them in service of their own self-determination.  Our role is supportive, guiding, ancillary.  We help demystify the process.

My goal is to help my children and patients be responsible, autonomous individuals who exercise good judgment for their own health and that of those they love.  Since words are my primary mode of communication, I cannot afford to be afraid to use any of them.

 

Of note:  My family and I recently discovered the book, It’s Perfectly Normal, by Robie H. Harris and Michael Emberley, and I (sing-song voice) loooove it!!  We own the 20th anniversary edition, updated to include information on sexuality for this digital, online, social media age.  This book appeals to me because it totally demystifies the body and sexuality, and does so with objectivity, openness, inclusion, and good humor.  We highly recommend it!

 

#AtoZChallenge: Unraveled, Unbound, and Unified

 

CO trip May 08 080A dear friend and fellow blogger texted me two days ago, saying she’s been enjoying my posts. Yay!  Even the smallest positive feedback makes me feel so good—I think if they looked, psychologists could actually see dopamine squirting out of its various reserves in my brain. My friend texted, “Hope all is well. :)” I love my friends who love emojis.

I texted back, “…I’m holding it together, kinda barely—I think that will be the U post!! ;P”

To which she replied, “Unraveling?” I love even more my friends who can read my mind.

So I procrastinated. I wanted to describe, artfully and with great insight, the struggles of the past week: Feeling shameful and inadequate for falling behind on the alphabet posts, the Unexpected and acute trauma of a negative patient encounter, moral conflict over staying at a Trump hotel later this year, new presentation deadlines, and how my friends United to help me though it all. This morning I realize that the details are boring and pretty irrelevant. Here is what I learned:

At first I was feeling Unraveled in a bad way—coming apart, losing function. Then I realized the unraveling was more like an Untangling—an opportunity to explore between the fibers, to see what’s gotten mushed in there, like batter accidentally smeared on baking twine. I rediscovered my own triggers of ‘not doing enough,’ ‘not good enough,’ and ‘just not (f*ing) enough.’ It kinda sucked, which is probably also why I didn’t want to write about it. AND, I sincerely believe that each time I recognize this deep-seated fear, I move ever closer to freeing myself from it—I’m slowly getting Unbound.

I started listening to Presence by Amy Cuddy this week. It’s the second or third book in recent memory that references Carl Jung’s philosophy of integration and individuation. I loved Cuddy’s TED talk. I have used her strategies before presentations and also yesterday before I met the patient again who I felt abused me last week. I have referenced it to patients, colleagues, and friends. The whole book is so dense, full of insights and stories, research and synthesis—I highly recommend it! Anyway, it really hit home for me this week because this is exactly what I’m after—Unification.

My aim in life is to integrate all that is me—the good, the bad, the gorgeous, the ugly—to the point where those labels don’t even matter anymore. Because I have a calling, which is to make the world better. And I can only do that if I am my whole self. One does not become one’s whole self easily or without struggle. It’s not baking twine, it’s that giant rope that I could never climb in PE class at Highland Elementary. Maybe I don’t have to Unravel the whole thing.  Maybe I can live Unbound by the memory of repeated failure to touch the big wooden disc at the top. I can still aim to live this life in the most Unified possible way, one day, one moment, one breath at a time.

#AtoZChallenge: Of Trials and Tribes

IMG_2786

Since my last post, I’m thinking more about this Tend and Befriend response to stress–to Trials. When I first mentioned it in this post, I did not really understand it, though I thought I did.  I thought it was about empathy, responding to others’ stress.  Later I started calling it the ‘mama bear’ response, but this is not exactly right, either.   It is attributed to a maternal aspect of human nature, but the bear metaphor conveys too much of the ‘fight’ reflex.

As I reread this summary article, I modified my frame to the ‘mama anything’ response.  The author describes work by Michael Meaney at McGill university, that shows the ‘tend’ aspect:

“He and his colleagues remove rat pups from their nest for brief periods–a stressful situation for pups and mothers–and then return them to the nest and watch what happens. The mothers immediately move to nurture and soothe their pups by licking, grooming and nursing them. This kind of tending response stimulates the growth of the pups’ stress-regulatory system.”

Further in the article, the ‘befriend’ aspect is explained:

“Taylor and her colleagues detail evidence from rodent studies and studies in humans that when they are stressed, females prefer being with others, especially other females, while males don’t. Indeed, in humans, women are much more likely than men to seek out and use social support in all types of stressful situations, including over health-related concerns, relationship problems and work-related conflicts.”

YES! It reminds me of a post I wrote last November about Teams.  Now I’m thinking about prides of lionesses, herds of elephants, and Tribes of people.  Throughout my life, I have had Throngs (okay maybe not, but it’s a great T word!) of people to reach out to in times of need.  Off the top of my head, here are some tribes I belong to:

Mamas

Docs

Mama Docs

Mama Docs of Children With Anaphylactic Food Allergies

My Cheng Cousins

My Hwang Cousins

American Born Chinese (ABCs, the so-called second generation)

AHS Warriors

Patient care Teams (including medical assistants, nurses, receptionists, ultrasound technicians, nutritionists, exercise physiologists, and other physicians)

Northwestern University

The University of Chicago

Conscious Life Journeyers

The Counsel of Wisdom and Caring, convened on my 41st birthday

 

More from the article, research by Nancy Collins, PhD:

“…tend-and-befriend may be just as adaptive for men as for women in certain contexts, says Collins, whose research finds no gender differences when examining how often husbands and wives seek support from their most intimate companions–for example, each other.”

So really, as the article concludes, Fight or Flight(, Challenge,) and Tend & Befriend are just a spectrum of human stress responses.  Not mama bear, not just mamas, not even just parents, but all of us.  Tend and befriend simply describes and exemplifies the basic human need to belong—we all need our Tribes.