Monthly Archives: April 2016

#AtoZChallenge: Never and Now

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Fire swamp

Photo found at http://www.cinemablend.com/images/reviews/6079/main.jpg

Scampering into the Fire Swamp to escape Prince Humperdink and his cronies…

Buttercup: “We’ll Never survive.”

Westley: “Nonsense. You’re only saying Never because no one ever has.”

 

“I will Never pay more than $___ for a house.”

“I will Never be able to swing a 14kg kettlebell without hurting myself.”

“I will Never get through all 12 weeks of this TRX Force program.”

“I Never thought it would turn out this way.”

As we all know (“’to blave’ means to bluff…” and holy cow, if you don’t know, please stop reading this instant and watch The Princess Bride!), Westley and Buttercup make it through the Fire Swamp, albeit with a few bumps and bruises.  Despite Buttercup’s grim forecast, Westley leads her one step at a time: past the Flame Spurts, out of the lightning Sands, and in spite of the ROUSs, or Rodents Of Unusual Size.  Having believed him dead, then being rescued by him from a trio of bandits, tumbling down a mountainside after him, and following him through the Swamp, Buttercup learns a critical lesson in overcoming passivity and nihilism.  Okay maybe that’s a stretch, but whatever, this is my post.

We all have our Nevers. The ones above are just a few of mine.  I spent more than I ever planned on my house and regret nothing.  I can wing a 14kg kettlebell with confidence—I rather kick ass, if I do say so myself.  I Never could have predicted my life looking this way—the good, the bad, the gorgeous, the ugly—and yet here I am.  And it is, really, mostly good (as opposed to “mostly dead”).  I’m starting to see possibility around the TRX thing, but I still think, I’ll believe it when I see it.  No, actually, I look forward to it.  On any given day of the program so far, I have thought, No.Way. It wants me to do what?  I try anyway, just to see how far I will get, and lo, turns out I actually get through.  So who knows what I can really do?

What helps us overcome our Nevers? In Buttercup’s case it was clearly Westley’s courage and love.  For me, the kettlebells, and the TRX, it’s Melissa, my trainer.  She has completed the program herself, she knows what’s required, and she knows what I can do—better than I know myself.  As for the rest of my life, well, it’s everybody else—my family, friends, colleagues, mentors, patients, et al.  I’ve said and written it ad nauseam—it’s my relationships that hold me up and save me.  I have very few Nevers anymore, because I’m surrounded by people who give me the courage to try.

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now.  Never is about the future or the past.  Often it’s a shadowy, catastrophizing perspective of things.  But we cannot predict the future, despite our arrogant human certainty.  And we cannot live every day to come based solely on what has already happened or not happened.  Circumstances and attitudes change.  Landscapes change—at times literally, and in an instant.  We evolve, we learn, we grow.  How can we be so sure that Never is real?

Mindfulness teaches us to redirect our attention to what actually is.  It invites us to let go of what and how we think things should be, or will be, or were.  We don’t have to like it, and we also need to be comfortable with, or at least accepting of, our dislikes.  When we practice mindfulness, we slow down.  We see and think more clearly.  Anxiety and depression loosen their vice grips on us.  Mindfulness liberates us from the constraints of Never.

We are better off thinking, speaking, and acting in the Now. It is the mindset of agency.  This is what I know Now.  This is what I can promise you Now.  My sincerity is real Now, and I ask you to trust me.  I will keep my eyes and ears open to the new Nows; I will roll with the punches.  Westley makes no guarantees.  He simply forges ahead with conviction, bringing with him all (and only) the knowledge, skills, and wit he has acquired until this moment, when he realizes the only way out of the Fire Swamp is through.  He is present to the swamp’s dangers, and also to the potential tools available to him in this harsh environment.  He has no idea what will happen, whether they will actually survive.  He only refuses to accept the Never, and focuses like a laser on the Now.

There may be some things to which we can truly apply the word Never. I think we need to reserve it for the truly deserving statements, and leave the rest of our minds open to possibilities and growth.

Still, most of me thinks I will Never try bungee jumping…

#AtoZChallenge: A Mantra For Mistakes

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This month’s topic of discussion with my awesome third year medical students was dealing with medical Mistakes and adverse outcomes.  The students are required to write blog posts each month, answering a particular question related to the topic.  It is then my job to facilitate a small group discussion around their responses.  I struggle with it every month, because their writing brings up so many thoughts and responses in me, and yet I know I need to hold that back and focus on fostering their dialogue, instead.  Every meeting feeds my soul, and I always walk away rewarded.

The conversation this time started out more animated than usual, which made me very excited.  It seems they felt like the topic had been well-flogged by now, starting from videos during first year orientation warning that we all commit errors and to just expect it.  And though the topic might have seemed tiresome, their energy in discussing was the opposite.

We recounted some of the stories they told in their blog posts, in which they consistently expressed empathy for patients, families, and care teams when mistakes were made or patient care was compromised in some way.  I wanted to steer the discussion toward reconciliation.  We all know that mistakes will happen; doctors are human, after all.  But then again, our errors often result in grave consequences.  Further, grave consequences happen even when no errors are committed.  So how can we best prepare for, prevent, and manage these situations?

One of the Stud(ent)s eventually offered that patients just want to be seen and heard.  Ding-ding-ding-ding, flashing lights, confetti poppers, and The Price Is Right you-just-won-a-brand-new-car! music immediately vibrated in my head.  I wonder if they noticed, but I think I was completely emotionally hijacked—in a good way for me, not so sure for them.  It’s because this is what I have been thinking and saying for years now.  Whenever I’m in a room with a patient, or when I’m practicing and teaching motivational interviewing, my chief concern is whether or not the patient feels acknowledged.  Because nothing I say or do will be accepted if they don’t feel I’m fully present.  I immediately jumped on the idea and professed my own list of what patients (and really, all of us) want: To be seen, heard, understood, accepted, and loved.  Then, assuming we all agreed on these as relationship goals between patients and us, I asked the group to list what actions they could take to achieve them.  When standing at the doorway before a patient encounter, what can we remind ourselves to do to make patients feel these five things?  At this point I was definitely seized—I could not hold back, I would not let go—I had to drill the list over and over—our ‘discussion’ turned didactic for a while.  *sigh* I got a little carried away.

The students take turns documenting the central ideas from our sessions.  Here is what the appointed Stud Scribe wrote:

THE MANTRA:

  • SEEN
  • HEARD
  • UNDERSTOOD
  • ACCEPTED
  • LOVED

Strategies:

  • greet the patient
  • sit down
  • make eye contact
  • tell them what you are doing
  • no interrupting, gentle redirection
  • reflective listening
  • prioritize problem list (together)

 

I love that word, Mantra.  It’s a reminder—an anchor, or a beacon—that keeps us focused on our central values and goals.  It gives us stability and bearing when we find ourselves adrift.  I did not suggest that word to our transcriber, but I am grateful he chose it, as it was perfect for the ‘M’ post in this A to Z Challenge.  That list really is a Mantra, isn’t it?

We mentioned the idea that malpractice lawsuits occur less, when patients feel their doctors have communicated well and truly care, regardless of whether errors are committed.  And though our principal objective in medicine should not be simply to avoid lawsuits, I think the incidence of malpractice claims can serve as a kind of barometer for patient-physician communication and relationship.

I think the Mantra and behaviors the students outlined are simple and effective, and can be applied in all relationships.  Kudos to the group for tolerating my little outburst and staying engaged.  I sincerely hope they found it helpful in some way, and I will try to control myself better next time.  Maybe they can forgive my Mistake this time, if I successfully practiced the strategies in service of our Mantra. 🙂

 

#AtoZChallenge: LOVE

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Teeheehee, a Little Late…

One year ago yesterday I launched this blog, Happy Blogoversary to me! 😀

It started as a platform to explore ways to reconnect patients and physicians in the increasingly divisive healthcare system.  And while that idea still stands central to the theme of the blog, I soon realized a much larger and more important principle:  The best practices apply across all relationships, not just doctor-patient relations.  The more I write, read, and explore, the bolder I have grown in my writing.

The very best outcome (so far) of starting this blog has been the LOVE I have received from others around it.  From the beginning, fellow bloggers have engaged, welcomed, encouraged, challenged, and nurtured me.  My friends and family have also held me up—following me via email, commenting on Facebook and the blog itself.  A vast community of support has stood up around me as I took this risk to share my mind publicly.  If they looked down on blogging, they kept it to themselves and encouraged me anyway.  If they thought I wouldn’t stick with it, I imagine they secretly wished me persistence, and then grace if I failed.  Because of all of these people, I have confidence to continue striving to bring forth the best in me, to share with everybody, in the hopes of creating something meaningful.

What if everybody had this chance?  What if every time someone wanted to do something bold and new, we met them with this much LOVE, cheer, praise, and affirmation?  Doing so does not mean blindly endorsing frivolous endeavors and wasted energy.  We can always offer LOVE along with tactful words of truth and pragmatism.  Even when, or especially when, projects fail terrifically, everybody can learn and grow.  LOVE from others at the outset makes us more resilient to failure.  LOVE from others at the moment of failure, as opposed to ridicule, shame, and sarcasm, makes us humble, grateful, and more brave, as opposed to defensive, angry, and humiliated.

Adequate words do not exist to express my deepest and most sincere gratitude to all who have LOVED me throughout my life, including those who have LOVED me through my blogging adventure so far.  May I pay it forward, and find ways to LOVE others whenever I have the chance.  If I can do that, then I will truly contribute to making the world a better place.