Washi Tape Gratitude

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My friends, I have a new and serious obsession:  WASHI TAPE!

I have loved paper and stickers since I can remember, and I have hoarded pretty stationery, stickers, rubber stamps, ink pads and all kinds of other writing accessories for at least 30 years.  I left for college with 100 postage stamps and used all of them before returning home for summer.  I plan to single handedly keep the US Postal Service in business if I have to.  I LOVE SNAIL MAIL!!!

So imagine my joy and enthusiasm when the Gottman Institute published this article suggesting that instead of keeping a gratitude list or journal, we instead hand write thank you notes.  Specifically, write one every day for one year—365 hand written notes in 2019.  I read the piece and exclaimed with abandon, “Done!”

I started January 18 and it only gets better! I have connected with friends, just to say thanks for being my friend.  I have acknowledged people at work for going above and beyond.  I have sent cards to Chicago Streets and Sanitation for always being on top of our snow and working on nights and weekends, as well as JBJ Soul Kitchen for providing meals for federal workers during the partial government shutdown.

Best of all, I get to create stationery again.  My favorite hobby is making cards.  Tonight I wrote a card to my friend Audrey, who introduced me to rubber stamping during residency, almost 20 years ago.  Over the years I have used the kids’ art, my own photos, cut-outs from the Paper Source catalog, and of course, stickers.  I have a rolling drawer caddy full of stamps and tools—I could host my own workshop!  But washi tape can be expensive, and my deep-seated hoarder tendencies would never let me use it in large quantities, so I would never let myself buy any…  Until now!  I’m 45 years old, I make a good living, I love making cards, and they bring my friends and me much happiness, so I can afford to invest in my creativity, for all our sakes!

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These last few weeks I have pulled out cardstock and envelopes from the myriad stacks of cardboard boxes in the basement.  I have opened the giant plastic storage containers where I carefully organized and filed all different kinds of paper, labels, stickers, etc.  I have worked out my washi tape art style, and combined it with my favorite rubber stamps and inkpad—Peacock Gold by ColorBox (discontinued, but no worries, I hoarded at least two refill bottles!).  And, cosmically, last week a friend introduced me to another store here in Chicago that sells the most exquisite paper products: Bari Zaki Studio.  It was like heaven on earth.  When I checked out (after joyfully browsing at least 40 minutes in a space smaller than my bedroom) they packaged every piece in its own little envelope or bag, and closed them with—you guessed it—washi tape!  Even the receipt!

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In the month since I started this practice/commitment/challenge/discipline/excuse-to-play-with-paper-and-tape, I think it has actually elevated my mood and helped me feel more generous toward others.  I notice more small things that make me appreciative.  I have a lower threshold for expressing my gratitude, no matter how small, in writing.  I can share it in a tangible, concrete way, with small pieces of art, created with delight and love.  Even if they end up in the trash (cringe—I keep every piece of personal mail I receive), it will have been worth it if my card brightened someone’s day.  And bonus if it also helps them act generously and joyfully toward someone else!

Because that’s how gratitude works, I think—it starts with a positive observation, then an appreciative expression, generating new observations and expressions that connect us in shared humanity, ever pointing us toward what’s good.  I think we need as much of that as we can get these days, and it makes me happy to make even a small contribution.

 

Synthesis and Integration: Self and Other Focus

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Hey friends, how was your week?  Learn anything new and interesting?  Anneal any new ideas to existing frameworks in your already complex world view?  I did!  And it came in another big wave after my presentation on Friday.

I wrote last week about how I put together a new presentation.  For the first time, I added the idea of medicine as a complex adaptive system to a talk I gave to physicians at various levels of training and practice.  The objective of the presentation was for people to understand the scope of physician burnout, and leave with some ideas of how they could not only cope better themselves today, but also influence the system and move it toward a healthier, more compassionate state in the future.

As usual for my talks, I focused first on personal resilience.  Many physicians push back at this idea, and rightly so, as many medical organizations have instituted physician wellness programs aimed mainly at ‘fixing’ the doctors with yoga and meditation classes, while allowing the system that burns them out to continue its toxic trends toward over-regulation, loss of physician autonomy, and driving metrics that lie outside of, or even counter to, our core values.  I worried that my talk would be taken as just another attempt to tell physicians we aren’t good enough at self-care.

Thankfully, the feedback so far has been positive and I have not heard anyone say they felt berated or shamed.  I hope it’s because in addition to tips for self-care (eg 7 minute workout, picnic plate method of eating), I talked about how each of us can actually help change the system.  In a complex system, each individual (a ‘node’) is connected to each other individual, directly or indirectly.  So, difficult as it may be to see in medicine, everything I do affects all others, and everything each other does affects me.  This means I can be a victim and an agent at the same time, and the more I choose one or the other (when I am able to choose), I actively, if unintentionally, contribute to the self-organizing system moving in one direction or another [URL credit for image below pending].

Nodes in Complex System

My primary objective in every presentation is to inspire each member of my audience to claim their agency.  Before that can happen we must recognize that we have any agency to begin with, then shore up our resources to exercise it (self-care and relationships), and then decide where, when, and how that agency is best directed.

 

In 5 years of PowerPoint iterations, including and excluding certain concepts, I have always incorporated David Logan’s framework of stages of tribal culture.  Basically there are 5 stages, 1-3 being low functioning, and 4-5 high functioning.  The tribal mantras for the first three stages are, respectively, “Live sucks,” “My life sucks,” and “I’m great”.  Stage four tribes say, “We’re great” and in stage 5 we say, “Life’s great.”  The gap between stages 3 and 4 is wide, as evidenced by the traffic jam of people and tribes at the third stage.  In my view, the difference is mindset.  In the first three stages, most individuals’ implicit focus is on self, and subconscious mindset centers around scarcity and competition.  Victims abound in these cultures, as we focus on recognition, advancement, and getting ours.  We cross the chasm when we are able to step back and recognize how our mutual connections and how we cultivate them make us better—together—we see the network surrounding and tied to our lone-node-selves.

This week I realized that crossing the stage 3-to-4 chasm relates to two frameworks I learned recently:

The way I see it, in Logan’s tribal culture structure, one initially works toward self-actualization, essentially achieving it when fully inhabiting stage 3, “I’m great.”  But crossing to stage 4 requires self-transcendence, as described by Abraham Maslow, by recognizing a greater purpose for one’s existence than simply advancing self-interest.  In the same way, through stage 3 we live in what the Arbinger Institute describes as an ‘inward mindset,’ and we cross to stage 4 when we acquire an ‘outward mindset’, which is pretty much what it sounds like.  Essentially in stage 3 we mostly say, “I’m great, and I’m surrounded by idiots,” and in stages 4 and 5 the prevailing sentiment resembles, “We’re great, life’s great, and I’m so happy to be here, grateful for the opportunity to contribute.”

An astute colleague pointed out during my talk on Friday that we do not live strictly in one stage or mindset in serial fashion.  Depending on circumstances, context, and yes, state of mind and body (hence the importance of self-care!), we move freely and maybe often between stages, sometimes in the very same conversation!  The goals are to 1) look for role models to lead us to higher functioning stages more of the time, and 2) model for others around us to climb the tribal culture mountain with us, spending more and more mindset and energy at higher and higher stages.

The problem is the system, and we are the system.  So, onward.  Progress moves slowly and inevitably.  It will take time, energy, and collective effort.

We’ got this.

Self-Care:  Act Local, Think Global

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Gotta be quick tonight, friends, as I have sat in front of this screen too long already today!

Creating and putting together slides for three upcoming distinct and related presentations, I am happy to report continued synthesis in my position on the relationships between personal resilience, culture of wellness, and efficiency of practice in medicine.

Drivers of burnout are systemic, no question, and not related to individual physicians’ lack of resilience and strength.  And yet, it will be up to us physicians, more than any other group, to lead change and make the system better for all of us, physicians and patients alike.  But we will not do it ourselves.  We must engage so many other stakeholders—hospital administrators, nurses and other care providers, insurance and pharmaceutical companies (by way of their leaders), and, of course, patients.

How can we engage any of these groups of people effectively?  Do we expect productive conversations and collaborative decision making when we stomp on the offensive with righteous indignation and passive-aggressive name calling?  Even if our language is polished, people can feel our underlying attitude and can tell when we’re not fully authentic.

I still think it starts with self-care.  Because if I’m not well, I cannot show up my best for anyone else.

Be The Change You Seek:

Curious–Kind–Forgiving–Accountable–Humble–Empathic.

How can I be all of these things, which I referenced last week, if I am sleep-deprived, wired on caffeine, skipping meals, and not connected to my emotional support network?  I finally made my own visual for the reciprocal nature of our habits:

Reciprocal Domains of Health Star

If I am attuned and attentive, then the bottom four serve to hold up my relationships, which is how I interface and interact with the universe.  I am one node in multiple subsystems, all connected, overlapping and integrated in larger and layered super-systems.  So the best thing I can do for the universe—to keep the systems intact and optimal—is make myself the strongest, most stable, most reliable node I can be.  I recently attended a strategy meeting where I learned the SWOT framework: for any given project and the people trying to implement it, what are the Strengths, Weaknesses, Opportunities, and Threats?  It occurred to me to apply this framework to my habits:

Health Habits SWOT grid

It really does show how each domain relates to and influences each other one, and makes it all pretty concrete, especially how stress threatens almost everything.

So in the interests of self-care, and in order to care my best for everyone and everything around me, I will now do today’s free 7 minute workout and get to bed.

Onward!