About Catherine Cheng, MD

I am a general internist in Chicago, Illinois, mother of two, almost native Coloradan, and Northwestern alum. I want to leave the world better for my having lived, by cultivating the best possible relationships between all who know me, and all whom I influence. Join me on this crazy, idealistic, fascinating journey! Look for new posts on the 10th, 20th, and 30th of each month. Opinions posted here are entirely my own, and in no way reflect the opinions or policies of my employer.

Attune and Attend, Conclusion

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Two posts ago, I related my friend’s experience of feeling unseen and dismissed during a visit to establish care with her new primary care doctor.  I blamed the doctor for not listening, for not exercising his relationship power with enough responsibility.  Last week I described how I see medicine as a complex system, in which each of us is both a contributory and affected member.  I alluded in both posts to forthcoming ‘solutions. ‘

If you have read the last two posts, what were you expecting here, in the last installment?  Quite honestly, the closer I came to writing, the more nervous I got, as if I had promised to deliver some groundbreaking algorithm for instantly fixing physician-patient relationships and our healthcare system at large.  Um, no, sorry.  Hopefully what I write will still be useful.

Events these past weeks have really highlighted for me the profound importance and vulnerability of relationships in a system.  At my kids’ school, a veteran and beloved teacher was terminated suddenly.  No students, staff, faculty or parents were given any warning.  Communication was sparse and poor, and few if any in the community saw evidence of a plan for instruction and emotional support of students in the aftermath.  Students, faculty, and parents alike have raised questions and concerns, all, in my opinion, met with evasion and deflection.  Worst of all, the administration repeatedly refused to acknowledge or own the profoundly negative impact of their actions on their relationships with the school community—a community which they proudly claim to steward.

Once trust has been violated and relationships damaged, the road to recovery looms long and ardent.  Apologies—sincere and heartfelt—serve a necessary and vital role in repair, but they are only the beginning.  We all make mistakes.  But too few of us own up to them and take full responsibility, especially when we have hurt others.  In a medical or educational community, I think we focus too much on scientific and objective decision making, and too little on relationships.  That is to say, we manage the former very intentionally and critically, and the latter only in passing.  This is how, for instance, a surgeon ends up saying to patients, “I can’t help you,” when surgery is not a viable treatment option.  We can always help.

In recent months I have listened to and read myriad resources that point me to some simple (and not easy) guideposts for relationship cultivation and repair.  I have listed the guideposts and their references below.  None of them will surprise you.  You may even roll your eyes and think them cliché.  And yet, all of us in all of our overlapping systems and tribes could do a little better at these practices—physicians and patients, teachers and students, leaders and those they lead.  Which one will you attune and attend to now?  What else should be on the list?

 

Curiosity

By its nature, curiosity makes us open and willing to see more, learn more, and understand more.  What if we got more curious about other people’s feelings and their origins?  What if we did that for ourselves?  Why, for instance, do I get angry when I perceive someone trying to tell me what to do without asking first what I’m thinking?  Could they be motivated by something other than a desire to control and oppress me?  How else could I respond if I thought they were trying to help me solve a problem, if I interpreted their actions as caring rather than interfering?  Check out the distinctions between diversive, epistemic, and empathic curiosity described by Ian Leslie below.  Then the next time you feel conflict coming on, consider these questions (asked in a truly curious tone):

What is this about?

Huh, what else?

Curious, by Ian Leslie

The Art of Possibility by RS and B Zander

Rising Strong and Dare to Lead by Brené Brown.

Kindness

Smiling at a stranger, extending a hand to shake, holding a door, saying hello—small acts of kindness go such a long way.  They benefit not only the recipient and the actor, but also bystanders and witnesses.  Kindness is a primary currency of connection, and reserves can be infinite.  We should never underestimate the potential tidal waves of global benefit from our dropping a pebble of kindness in the waters of humanity.  When a stranger holds the door or my patient asks about my kids, in that moment I feel seen.  I connect with you, my kind counterpart.  My heart lifts ever so slightly, and I am grateful.

A Year of Living Kindly, blog and book by Donna Cameron

Forgiveness

Forgiveness can feel infinitely harder than small acts of kindness.  Will my friend forgive her doctor?  Will I forgive my kids’ school administrators?  What good does it do to carry around grudges, does that get us what we want?  Where else can we direct the energy we expend holding so tightly to resentment?  Could we use it instead to ask, honestly, “What is this about?” or to utter a kind, compassionate word?  Can we see people as people, flawed and trying their best, rather than objects, obstructions, annoyances, and unworthy?

TED Radio Hour, Forgiveness

Leadership and Self-Deception and The Anatomy of Peace by The Arbinger Institute

Accountability

When I hit and dent a parked car, I should leave a note owning my mistake and offering to make up for it—even if I slid on ice, or my child was crying in the back seat, or the other person’s car was parked poorly.  If someone damages my car, I expect the same.  The more we can all/each take responsibility for our own part in any conflict or situation, no more and no less, the better off we will all be.  The key here, when we show up to others, is to do it without qualification.  It’s not, “Yes, I hit your car, but…”  It’s, “I hit your car.  I’m sorry.  How can I make it right?”  I may think you were also in the wrong, but pointing that out in the middle of an argument will not help you own your part, which I need you to do for us to connect and heal.  You may never own your part, and I have no control over that.   But perhaps my example will influence you or others over time.  Humans tend to reciprocate, and mutual exchange of accountability can heal many relationship wounds.

7 Truths About Accountability That You Need to Know”, Inc.com

Humility

Nobody knows everything, even experts.  And certainly when meeting another human, we cannot possibly know all that has shaped their beliefs, values, and emotions, both in the past and in the moment.  In medicine we have never known more than we do today, and it seems to me that for every new piece of knowledge we acquire, we also discover a hundred new things we didn’t know we didn’t know.  So what gives me the right to assume I have all the answers—that I have nothing to gain or learn by asking curiosity questions?  Why should I feel the need to appear all-knowing?  The opposite of humility is arrogance, and we all know how hard it is to be around people like this.  Turns out students and leaders alike, who practice humility, succeed more than their less humble peers.  Makes sense—humility connects us to others, while arrogance separates.  It’s vulnerable, though, and that can be uncomfortable.  But if we have already cultivated our relationships with curiosity, kindness, forgiveness and accountability, perhaps humility can come a bit more easily.

“The Benefits of Admitting When You Don’t Know” by Tenelle Porter

Empathy

In the end, I believe empathy will save us.  It is the bedrock on which the other skills are built.  Google dictionary defines empathy as “the ability to understand and share the feelings of another.”  It will save us because this is how we truly connect to one another.  But it’s not enough to just have the ability to understand and share others’ feelings.  In order for empathy to connect us, we also need to effectively express that understanding and share the emotions actively.  Active empathy allows us to take another person’s perspective.  It keeps us out of judgment and blame.  It helps us recognize others’ emotions by recognizing our own familiar experiences—empathy is how we relate.  It is the medium of relationship.  Some people possess the gift intuitively.  And it can be learned!  Medical training programs across the country have taught doctors how to be more empathic.  Patients of more empathic physicians do better.  And, physicians themselves do better, too–we feel less burned out and more fulfilled in our work.  We all do better when we connect.

Watch a cartoon and hear Brené Brown explain the importance and benefits of empathy.

“How to Teach Doctors Empathy” by Sandra Boodman

The Empathy Effect by Helen Reiss, MD

 

Please forgive the length this time, friends.

What did you think?  In your next encounter with your doctor or your boss, what do you anticipate?  What do you fear?  How does it feel?  What is that about?  Which of these skills could help?  How will you acquire/hone it?  What help do you need?  What will be better if you achieve it?

What else should be on the list?

Attune and Attend, Continued

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Last week I started and ended my post incensed on behalf of my friend, who felt coldly and arrogantly dismissed by her new doctor.  While I considered that his behavior may be influenced by his circumstances and did not attack his character or make generalizations based on gender, age, etc., I did blame him individually for how my friend felt in his presence.

Another friend read the post and said the doctor was not to blame, rather it’s the system.  We exchanged thoughts and agreed that it was not all the doctor’s fault, and the whole healthcare system in our country is just a big mess in general.  I continue to have daily conversations around physician well-being and systems transformation in medicine, and every single encounter advances my understanding of and awe at the whole situation.  Here are my most current thoughts—bear with me, please.

3 Reciprocal Domains of Professional Fulfillment

Most of us working in the physician well-being space have adopted a model for professional fulfillment developed by our colleagues at Stanford.  If you care at all about your doctors’ professional health and how that impacts the care they deliver, I encourage you to read this article that describes their approach.  In it, they define efficiency of practice (eg team workflow, electronic health record use and misuse, systems bureaucracy), culture of wellness (institutional attitudes that advocate for self-care, peer support, and mutual compassion between team members and patients), and personal resilience (individual skills and behaviors that promote personal well-being) as the three mutually influencing factors that determine, for individuals as well as organizations, our overall professional health and well-being:

The many drivers of both burnout and high professional fulfillment fall into three major domains: efficiency of practice, a culture of wellness, and personal resilience… Each domain reciprocally influences the others; thus, a balanced approach is necessary to build a stable platform that will drive sustained improvements in physician well-being and the performance of our health care systems.

For the record, I fully concur with this approach, and with one of the authors whom I met at the international conference in Toronto, that the most important parts of the framework are the arrows reminding us always to look for how the domains intersect and influence one another.

We Are the System

In the article, the authors write, “Efficiency of practice and a culture of wellness are primarily organizational responsibilities, whereas maintaining personal resilience is primarily the obligation of the individual physician.”  This is where I differ somewhat.  I fully agree that an organization’s culture is set at the top.  Designated leaders lead by example, admit it or not, like it or not.  They (and we—all doctors bear this responsibility on any given care team) provide cues for acceptable and unacceptable behavior, positive and negative.

That said, a team or an organization’s culture is executed and manifested day to day, moment to moment, in every interaction, by each individual within the system.  This is the essence of complex systems—they are self-organizing at a global level (hence soon after joining a group we find ourselves adapting to fit in), and also emergent and evolutionary at the granular level (one person can turn a place around over time—have you seen it?).  So in my opinion, both leaders and individuals are responsible for creating and maintaining the Culture of Wellness in medicine.  We are the system.  If you’re interested in more of what I think about this, check out this podcast from September 2018 when I presented to the surgeons and anesthesiologists at the University of Wisconsin at Madison.

In a Complex System, It’s All About Relationships

A person is a complex system.  In my practice (and in my own life) I try always to attend to the relationships between 5 reciprocal domains (labelled intentionally after the Stanford model) of health: Sleep, Exercise, Nutrition, Stress Management, and Relationships.  How do they relate?  When I don’t get enough sleep I tend to overeat; when I eat too much I feel sluggish and unmotivated to exercise.  When I exercise less I am more susceptible to stress, which puts my relationships at risk, which then disrupts my sleep, and the downward spiral persists.

A patient care team, a medical practice, a hospital—these are all complex systems.  Besides the three domains in the Stanford model, what other factors contribute to the self-organizing nature of such systems?  Perhaps individual autonomy, collective loyalty, shared mission, attention to training, and communication?  What inter-relational factors dictate an individual’s or a subgroup’s behavior, and how does that influence the whole organization?

I am reminded of starlings in a murmuration, or sardines in a school.  Seen from afar, the mass of animals appears to move as one agile and sentient organism.  In reality, each animal’s movement is at once independent of and intimately tied to those in its immediate vicinity.  Each animal’s awareness of and response to its neighbors are acute and instantaneous, respectively, and thus the collective is able to evade predators and give humans insight into what true multi-mutual cooperation looks like.  They are attuned.  This is possible because, according to science:

The change in the behavioral state of one animal affects and is affected by that of all other animals in the group, no matter how large the group is. Scale-free correlations provide each animal with an effective perception range much larger than the direct interindividual interaction range, thus enhancing global response to perturbations.

Would your organization, seen from afar, appear as organized and fluid as a flock of murmuring starlings?  What would it require in order to do so?

* * * *

So what does this mean for my friend and how she (and we all) should think about doctors and our healthcare system in general?  How does this actually relate to solutions to the problems I presented last week?  Clearly, as I beat the long dead horse again and again, it’s about relationships, of course.  But we have to think more deeply than just about our behaviors and actions—we’ gotta buckle up and dive into their origins—spelunk our default orientations toward self and others, our automatic settings, and how they manifest in our relationships and create, intentionally and not, our collective systems.

Once again, I have hit 1000 words on this post and it’s late.  I’m getting there, I promise—not that I have the solution!  I’m simply learning and synthesizing more every week about how we can more consciously and mindfully approach the problem.  It has everything to do with the books I started reading recently about complexity, leadership, and mindset, and how they help me see my conversations and relationships in a new, exciting light.

More next week, friends!

Attune and Attend

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My friends, I am offended.  I’m insulted and frustrated.  Part of me screams, stomps, and rages inside.

I am embarrassed.

My friend went to establish care with a new primary care physician last week.  Before the appointment she was told to bring all of her medical records.  No instructions, no specification of which parts or in what form.  So, being the tech-savvy and eco-friendly woman she is, she downloaded all that was available to her onto a thumb drive, as it was rather copious now in her 7th decade of life.

Upon arrival, she presented the drive to the woman who initiated the evaluation.  She thinks this was a nurse; but she’s not sure.  The woman said she could not ‘handle’ the thumb drive, but said, “I can just pull it up here online.”  What?  Ok whatever, clearly the medical record request was simply a routine request made of all new patients.  Thereafter the woman proceeded through routine medical questioning.  But as my friend answered the interrogation, she felt distinctly ignored.  Her concerns were not addressed and she did not feel any rapport.  The woman did an EKG and left the exam room.

Later, while my friend was still sitting on the exam table, the woman returned with an old man in a white coat.  He stood there, hands behind his back, and informed my friend they had called for an ambulance to take her to the emergency department.   The EKG showed an abnormal heart rhythm.  They said she would likely be in the hospital for two days for observation and tests.  The nurse and doctor spoke to each other but not to my friend.  They did not ask her how she was feeling, or what she knew about the/her condition, and they did not check the online record for evidence of past evaluations or recommendations.

My friend refused, for various reasons, not the least of which was that this condition had already been thoroughly evaluated, multiple times, and was actually well controlled.  But the doctor and nurse showed no interest in knowing my friend, nor did they seem to care to include her in any medical decision they made about (for) her.

Granted, this is my friend’s side of the story.  But for right now this is where I focus, because her experience is all too common, and I hate it.  She experienced everything that makes physicians and our healthcare system look and feel so broken, and that contributes to the widening relationship gap between patients and physicians/providers.

She was asked to bring her records, she put forth the effort to do so, and they were not reviewed.

She felt ignored and dismissed, even though the objective of the visit was to establish care and initiate a long term, collaborative relationship with a new primary care doctor.

She was ordered to submit to an ambulance transfer to a hospital emergency department, with neither discussion nor negotiation of other care options, and without regard to the financial and other costs to her.

She felt harassed by the office in the following days, receiving calls admonishing her for not presenting herself to the emergency department.

The bottom line is that my friend felt completely unseen in this encounter.  She felt treated like an object—a set of data, a statistic, a box on a flowchart.  Context, history, and individuality be damned.  When you’re in a relationship with someone who is supposed to help you, on whom you rely to help you understand the best plan of care for you personally, feeling unseen, dismissed, and belittled is exactly the opposite of helpful.

Maybe we should not judge the nurse and doctor too harshly.  We all know the time and volume pressures primary care providers live under these days.  Maybe they were distracted by other, sicker patients they had seen that day.  Maybe that made them more vigilant and aggressive with care recommendations for her, and put them behind schedule so they felt they could not take the time to explain things in more detail.  Maybe the doctor had seen this arrhythmia once before, treated it more casually, and the patient died.  We have no idea.  And it matters, insofar as it impacted how he presented to my friend.  Because his presence was dominating, authoritarian, rigid, and cold.

The patient-physician relationship serves as the foundation for medical care and healing.  No matter how much we talk about and try to honor patient autonomy, the power differential in this relationship remains fixed and real.  The doctor has the power and the responsibility to make the patient feel safe, to earn the patient’s trust.  On this day, in this visit, this doctor blew it, in my opinion.  It was their first encounter.  He should have taken the time and interest to get to know her, even a little, to agree on how they would work together.  If he were truly concerned about her health, knowing she had an arrhythmia (which are often made worse with stress), might he not have noticed the distress he was causing her?  Couldn’t he have given her additional care options, like referring her to a specialist within the week?  Or perhaps he could have opened the electronic health record and looked at her previous cardiologist’s last note?

He did none of these things—or at least not in any way that my friend perceived.

Further, he not only failed to establish a good relationship with her; he undermined her trust in our whole medical system.  How many experiences like this does a person have before she starts to reject the medical community altogether, ignoring symptoms of disease because she would rather deal with pain and disability than try to navigate a hostile system?  Fewer than you might think.  This is how patients end up in emergency rooms with truly life-threatening illness, where, guess what?  They get shamed again for not seeking help sooner.

It’s rather tragic when you think about it.

There is hope, though.  But as this post has already a thousand words, my thoughts on solutions will have to wait.

I hope you all had a restful and joyous holiday season.  My unplanned holiday writing hiatus lasted longer than I intended, and it’s nice to be back.  May we all reconnect with one another in more meaningful, productive, and uplifting ways in 2019.

 

 

Grudges and Boundaries

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Has someone wronged you recently?  Long ago?  (How) Does it still affect you?  Are you a grudge holder?  Does someone hold a grudge against you?

Last night I gathered with good friends and this topic came up—we go deep, my friends and I.  Of course, it started me thinking and wondering:  What does it mean to hold a grudge?  When I hold a grudge, what do I actually do?  What is the motivation?  What are the consequences?  When/how/why does it resolve, if ever?  As we talked, it felt straight forward at first.  Everybody knows how it feels to hold a grudge—but how do you describe or define it?

Google dictionary defines it:

Grudge: /ɡrəj/

noun

a persistent feeling of ill will or resentment resulting from a past insult or injury.

“she held a grudge against her former boss”

synonyms: grievance, resentment, bitterness, rancor, pique, umbrage, dissatisfaction, disgruntlement, bad feelings, hard feelings, ill feelings, ill will, animosity, antipathy, antagonism, enmity, animus;

informala chip on one’s shoulder

“a former employee with a grudge”

verb

be resentfully unwilling to give, grant, or allow (something).

“he grudged the work and time that the meeting involved”

synonyms: begrudge, resent, feel aggrieved about, be resentful of, mind, object to, take exception to, take umbrage at

“he grudges the time the meetings use up”

 

The more we thought about it the worse it felt to me.  I’m reminded of the saying that hatred hurts the hater more than the hated.  Grudges feel like dark clouds hanging over my consciousness, chilling my soul, or at least casting a cold shadow on my joy, freedom of emotion, and possibility for connection.  My friends and I contemplated the utility of grudge holding.   What good does it do, what need does it meet?  I think it’s protective—a defense mechanism, a way of not being vulnerable again—armor, as I believe Brené Brown would call it.

I asked my friends last night, “So is it holding a grudge, or is it setting a boundary?”  I wondered if they are the same or different.  After all, both make you behave differently toward the other person.  But I think it matters whether and how we judge the other person.  When I hold a grudge, I judge the whole person based on the bad thing (I perceive) they did to me.  I may generalize from my own negative experience and write them off as wholly selfish, ignorant, narcissistic, and unworthy of my compassion and empathy.  Perhaps I start to depersonalize them, make them into an abstraction right in front of my eyes—dehumanize them.  Does that seem like an extreme description?  Even so, doesn’t it still describe the feeling?   When I hold a grudge, I do not—cannot—like or even relate to the person.  I avoid them, don’t want to be in the same room with them.  I don’t trust them.

I listened to The Thin Book of Trust by by Charles Feltman (referenced by Brown in her book Dare to Lead) this past week.  He describes four distinctions of trust:  Sincerity, Reliability, Competence, and Caring.  He suggests that when we find someone else untrustworthy, it’s likely that they have disappointed us in one or more of these elements.  I have assumed for a long time that the person I hold a grudge against simply does not care about me or my well-being.  Feltman suggests that of the four distinctions, this may be the hardest one to overcome when violated.  My story about this person is that they don’t care about me, therefore they are categorically untrustworthy.  So I feel justified in denying the validity of their point of view, minimizing their achievements, and casting them as the permanent villain in my story.

Yuck.  That perspective does not align with my core values.

So what can I do?  Maybe rather than holding a grudge, I can simply reorient myself to our relationship.  Instead of harboring bitterness and ill will, can I instead learn, synthesize, and integrate some new information?  When I’m wronged, maybe I can say, with curiosity more than resentment, “How fascinating!”  Maybe I can take care of my own feelings, connect with people I do trust, and regroup.  Then I can decide how I want to present to this person hereafter.  I can set some new boundaries.

Rather than dismiss the person as uncaring in general and holding this against them, I can do other things.  First, I can withhold judgment on their caring and make a more generous assumption.  For example, I feel un-cared for by them, but perhaps their way of expressing caring is different from how I receive it.  I can look for alternative signs of caring.  Or perhaps they truly don’t care about me, but I need to work with them anyway, so I had better figure out a way to do it—are they at least sincere, reliable, and competent?  How must I attend to myself, so I can honor my core values, get the work done, and not get hurt (or at least minimize the risk)?  Second, I can set clear boundaries in our relationship.  I can point out behaviors that I will not tolerate, and call them out if they happen.  I can set realistic expectations about agendas, objectives, methods, and contact.  I can give honest and direct feedback with concrete examples of words or actions that require attention and remedy.

Many thanks to my thoughtful and engaging friends who stimulate these explorations.  I can feel my grip on the grudge loosening already.

How Do You Stay Healthy While Traveling?

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Once again Nate Green stimulates my thinking and connects my professional and personal dots.  Last week he asked newsletter subscribers this question, and I was surprised at the cascade of subsequent questions it triggered for me:

How do we define “healthy?”

What about travel threatens and/or challenges health?

Is it different depending on the person?  The trip?

What about the trip—Destination?  Duration?  Time of year?  Companions?  Purpose?

How, specifically, is travel different from home?

How do we apply the answers to these questions?

plane toronto

In my practice, the patients I see travel, I estimate, an average of 35% of the time.  They endure interstate commutes between work headquarters and home, or fly between company sites and all over to meet customers across the country and around the world.  Inevitably these trips include hours sitting in meetings and then the requisite business dinners.  Such meals present the quadruple threat for acid reflux, among other problems:  They are large volume, fatty, and alcohol-laden, and often occur shortly before people go to bed.  Many patients report that they feel badly after business dinners—bloated, sedate, and a little guilty, or at least concerned, about their health.  They feel little agency to change the pattern—fascinating.  We cannot underestimate the business culture of peer pressure that perpetuates our worst habits of self-sabotage, and I see this as the primary threat to my patients’ health when they travel.  Other challenges include jet lag, poor access to healthy food, and disruption of routine, most importantly sleep and exercise.

I have only started to ask my patients Nate’s question.  One patient knew his answer without hesitation: Do not eat late.  I’m curious to see how others answer, and how their answers may evolve over time.  Perhaps I will add this to my standard questions, after my stress/meaning ratio markers.

Nate’s question invites me to consider for myself, as I prepare to travel for the holidays.

How will I define health on this trip?  I will be healthy if I stay active, protect my sleep, and connect with my people.  I will practice intention and mindfulness.  I will read that which enriches my knowledge, awareness, and relationships, and do my best to avoid click bait, sensationalism, and meaninglessness.

What about this travel threatens or challenges my health?  OMG the food.  It’s not just business dinners that are full of fat, sugar, and portions to satiate hippopotami.  Holiday desserts are my crack—one of these days I might just overdose…  I also tend to stay up too late, usually watching movies, and then sleep in and feel guilty for wasting half a day already.  That kills my motivation to do anything very active, much less a full workout—the day is practically over—what’s the point?  Might as well eat, is there any cheesecake left?

Is this different for me compared to others?  Oh, yes.  My husband seems to have no problem controlling his eating, sleeping, and activity anywhere he goes.  Jerk.

Is travel home for the holidays different from, say, conference travel?  Yes.  I think I am more disciplined at meetings.  There isn’t food everywhere whenever I want it, and medical conferences usually offer more healthy options anyway.  I still stay up too late, though.

So what’s the answer?  How will I keep myself healthy this holiday travel season?

Nate included a video by Matt D’Avella in his newsletter, which made some useful suggestions.  Carve out time at the beginning of each day to exercise.  Get outside if possible.  Make the objective maintenance of fitness and routine, rather than progress—slow and steady prevents injury.   I can probably mark time to do some kind of exercise, just not in the mornings—I hate mornings.

Nate suggests making one consistent meal every day of the trip.  Matt made chicken, black bean, egg, and rice burritos every morning in Sydney.  That fueled his morning workouts, simplified food decision making by one meal a day, and allowed him to explore new foods the rest of each day.  I can probably make breakfast my stable meal each day on vacation.  My morning meal has been haphazard the past few months at home, too, so this could be a great opportunity to regain a routine even after vacation.

JAX gym view

Perhaps my central strategy this time can be labelled “Planning for Real Life.”  Whenever I go home I make grand plans to see everybody, cook a ton, hike, shop, relax, read, write, and organize.  For some reason I always leave feeling disappointed that I could not fit it all in, go figure.  There will be multiple families together this year, lots of little kids.  It’s December, and weather can be neither controlled nor fully predicted.  We can make plans, but kids get tired and lose interest, and adults can have meltdowns of our own.  I can look at the calendar and compare it to my task list for the week.  What do I really need to accomplish?  What did I just write here?  Sleep, move my body every day, read a little, and spend quality time with my peeps.  In other words:  Rest, Train, Learn, and Connect.

Thanks for the prompt, Nate!  And Happy Holidays to you!

Shoots in the Poop

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It’s December 4th… Time to look back?  Honestly, I’d rather just get this year over with and move on,  because I have already been looking back all this time.  Since January I have counted—weeks and months since the knee injury, months since starting the new job, since surgery, since a spring crisis, since the last this or the first that.  What was it all for?  I think I was just reminding myself that there’s been a lot going on, reassuring myself that I’m not just whining, not being weak for letting my personal health habits slip.

I’ve felt like a relative slug for the last 6 months, despite my best efforts.  I think I must have eaten a pint of ice cream every two days for most of the spring and early summer.  Looking back on the calendar, I stopped using smiley stickers to mark workouts around July—their intensity was only worth hand-drawn smileys.  By and since August they aren’t worth smileys at all—I just jot down what I did in shorthand.  Some weeks it was barely anything.   I judge myself every day—perhaps less harshly than I might have a few years ago, and also less compassionately than I might a few more years from now.  I still struggle with the fear of self-indulgence if I allow myself too much self-compassion.  I am still learning self-compassion.  I know it takes time to rewire our limbic brain patterns with knew learnings from our cognitive brains.  So I will keep trying, because I know it’s helping.  And I’m modeling for the kids.  We can do our best and still fail.  The key is to keep moving.  We can practice admitting we need help, seek it from the appropriate sources, lean on it heavily, and stand back up eventually.  And then we remember those who helped us, and prepare to be helpful in return.

I have leaned on so many this year, I feel almost speechless at the outpouring of support and love.  The only way I don’t collapse from this weight of gratitude is by storing it like a battery—ready to be discharged, full power, when someone needs to plug into me.  This may be my favorite thing about humanity—that we are wired to connect so tightly, to help one another in webs of mutual love and kindness that can extend ad infinitum.

moths on poop

So I’ll look back a little.  This week I feel a turning.  Did I say this already recently?  Oh yes, it was November 12.  I was making more room for books, trying to stay off of my phone, off of Facebook.  Being on the laptop every night to post to the blog stymied that last part, but it also bought awareness of how I find loopholes in the best plans for self-discipline.  And the daily writing practice also contributed loads to this internal revolution.  This was my fourth year doing NaBloPoMo.  It was by far the most fun, the smoothest, and the most rewarding attempt yet (I think I also said this last year?), and now I miss writing every day (definitely have not said this before).  Maybe it was the daily dopamine hit of views and likes.  But I think it’s more than that.  Through the daily discipline, I had a chance to process and synthesize so many ideas and connections that had been marinating for months, maybe even years.  I practiced prioritizing, selecting, and distilling those ideas into about 1000 words each day, more for my own benefit than anyone else’s.  That people read and related to them was definitely a happy bonus.

Besides NBPM, I attribute this turnaround to two books that Donna recommended to me earlier this fall:  Leadership and Self-Deception and The Anatomy of Peace, both by The Arbinger Institute.  I have wanted to write about them for the last several weeks, but I haven’t yet figured out how to prioritize, select, and distill the lessons coherently.  The foundational ideas are not necessarily new, but they are profound.  The books are written as modern allegories, and there is just something about the metaphors and analogies that has unlocked and integrated everything I have learned about inner work, communication, relationships, and leadership to date.  And that is saying a lot.  Because of these books, the daily writing, and all the conversations I’m having (with myself and with others) as a result of both, the two most challenging relationships in my life right now have fundamentally improved—mostly because I have been able to shift my own attitude.  As with all things, this new ‘way of being’ will take practice.  I need to keep the training wheels on for a while yet.  But now that I have made this turn, the path looks straight, and I see light.

The manure has piled on all year.  So much fertilizer, oh my gosh.  It’s done its job, though, because I have definitely grown.  I feel strong, healthy shoots of green popping out through the thick, dark carpet of poop.

Feeeel Your Feelings…In Songs!

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Wow, 31st day!  I guess I really love this writing practice…

My kids introduced me to “Mamma Mia!” the movie a couple months ago.  Oh my gosh SO FUN!  The cast, the scenery, the music!!  ABBA!!!  And the epilogue scene of them all singing “Waterloo” is one of my favorite musical numbers, ever!  I intend to convene a group of friends to reenact the singing/dancing scenes someday, what a great workout that would be, and to such great music!

I just love when the kids and I watch our favorite movies together—Harry Potter, Avengers, and now some musicals.  Driving to Target today, after watching the second “Mamma Mia!” movie, I realized why I like these two films so much.  It wasn’t just watching how much fun the actors obviously had making it, and oh my gosh CHER (I can still picture on the cover of my dad’s Half Breed album), and the cute story.  It was the emotions.  In both of these movies, the characters all feel their emotions freely.  There is no repressing, numbing (well, maybe some–cake, anyone?), offloading, or prolonged rationalization.  The sadness, loneliness, regret, anger, and longing, the fear and the lust, as well as the love, loyalty, devotion, grief, forgiveness, and hope—the characters display them all without shame or self-judgment.  And even better, they reach out to each other for support and show up for one another in compassion and solidarity.

We also watched “While You Were Sleeping” today (it’s rainy outside and we are movie people), also a perennial favorite for me.  My daughter says she doesn’t like it because of the lying.  It’s stressful to keep secrets and maintain false appearances.  Even watching it makes some of us uncomfortable—and now that I think about it some more, I recognize the visceral anxiety of seeing it on screen.  There are many ways to create tension and conflict in a story.  The “Mamma Mia!” movies do it in a lighthearted way that feels more fun than most.

In these days of widespread deception, false pretense, mistrust, evasiveness, and broken relationships, musicals like this uplift my family and me.  What a cheer for all that is good about humanity, what a vote of confidence for our silly species!  So grateful.  We will continue to watch repeatedly, I guarantee it.