Category Archives: culture

Breaking Point

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“Dr. Cheng, I feel dizzy.”

We’ll call him Joe. I miss Joe. I met him in his early 60s, a pleasant, dapper, rotund man with a jovial demeanor and well-groomed mustache. He was always on time to his appointments and came with crisp reports on his subjective state of health. Whenever I saw Joe on my clinic schedule, I knew at least that part of my day would be good.

Joe lived a conscientious lifestyle. He paid attention to food and movement, and cultivated relationships that held him up in life. When I think of Joe, I remember feeling unworried about his habits and longevity. So it bugged me that his blood pressure was never well controlled. On maximum doses of four medications, it was consistently 140/90 (ideal is 120/80 or less), and it just would not come down. Luckily for me, his previous doctor had done all of the appropriate work up, including sleep study, kidney imaging, stress testing, etc. Eventually they decided together that this was as good as it would get, and Joe would just focus on doing the healthiest things he could every day and get on with life. I concurred.

So when I got the call months later that he was dizzy, my heart sank. We agreed he would come in that day and we’d figure out next steps. I was prepared to call the emergency department and my cardiology friends to let them know I was sending him over for a cardiac event. But on arrival he didn’t look ill or unwell, just moved a little more slowly. His mood was great, though, maybe even better than usual. I asked him why, what had changed? “I retired!”

His blood pressure was 90/60. He was still taking all four of his blood pressure medications, like the diligent patient that he was.

Back then, in a typical primary care practice seeing a patient every 15 minutes, I did not consistently ask deep questions about people’s work stress and meaning, like I do now. Turns out, Joe had a lot of mental stress at work. He managed it well, though–never lashed out at people, never let it affect his performance. Colleagues threw him a big party and he retired feeling satisfied, looking forward to his next life chapter. And it wasn’t until later that he realized how much his work had cost him in health. Over the next several days, we learned that he only needed a low dose of one medication to keep his blood pressure in the 110/70s. The dizziness went away. I think he was getting ready to go on a cruise. I left the practice soon thereafter, and I don’t know about Joe now. I hope he’s still happy and well.

I remember this story so clearly because until recently, it stood out as unique–that my patient could correlate such a dramatic improvement in a crucial vital sign and a leading risk factor for heart disease to retiring from a stressful job.

Not so unique anymore, though. This year, no fewer than four of my patients have experienced the same thing, but in the opposite direction. Having never had high blood pressure before, they all called me with new symptoms: headache, fatigue, full body tension, and just feeling off. Before calling, they thought to monitor their blood pressure, and all of them reported consistent home readings well above 150/90. And they all knew exactly when it started, all correlated with severe work stress escalation. Adjuvant factors included increased travel, longer work hours on global calls, less time for exercise, and continued business eating. It’s all a downward spiral, for sure, and I submit that the underlying cause, the change that makes four people present suddenly in these six months, is our post-pandemic work environment. While I welcome the increased flexibility and autonomy of a hybrid office model, I’m not sure the net effect is good for us long term. Work-life boundaries have perforated, if they even still exist at all. Given the volume of articles in business periodicals progressing from ‘quiet quitting’ to overt labor force decimation, it’s quite clear to me that we have not invented a kinder, more effective work culture. More and more I hear and feel an ‘us versus them’ gulf growing between workers and leaders–yet another relationship domain affected by polarization. It’s as if the short term, profit driven, make money at any cost prepandemic ethos, suppressed and reassessed (I thought?) during three years of acute obligatory disruption, became an abscess that has now ruptured and resurged–exploding like ‘pus under pressure,’ as we say. Organizations scramble to restore anteCOVID earning and productivity status, still measuring success and achievement with the same metrics as before nature showed us how vulnerable we and all of our systems are. We have learned nothing.

All of these patients are now taking at least one blood pressure medication, pulling hard on their stress management skills, and maybe reassessing whether staying in their current roles is worth the cost to their health and relationships. We connect regularly and I always ask, how much longer can you keep this up? How will you know when enough is enough? What will you do then? I don’t recommend that people quit their jobs–that is not my place. But I ask the important questions, lovingly and bluntly.

What does it cost us indeed, as a society, to be killing our workers this way? When will we recognize that sacrificing people in the short term actually wrecks collective success in the long term? When will our culture value people over profit? I hold leaders accountable for their relational output at work, and I also recognize that they–as we all–are simultaneously agents and victims of our complex adaptive systems. Culture does not change easily.

If I have any hand in it, however, more of us will move closer to challenging and changing the most toxic aspects of business culture, one organization, one team, one person, one interaction at a time.

Feel Everything: The Hedonic Stoic

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Okay friends, time to get loose with some words!

The title of this post may not make any sense to you, and it makes all the sense in the world to me! It manifests my deep desire and commitment to embrace and exude healthy paradox, emerging in the form of fun, which I absolutely love. Suspend disbelief and take a dive with me, ya? Maybe you’ll have some fun too:

Stoic: “a person who can endure pain or hardship without showing their feelings or complaining.” — Oxford Languages

Hedonist: “a person who believes that the pursuit of pleasure is the most important thing in life; a ‘pleasure-seeker'” –also Oxford

I got a lot of ‘stoic’ messages growing up, some healthy and some not so much. I fell onto a sprinkler head while playing in the water one young summer, gouging a dime-sized chunk of flesh out of my knee, the kind of wound that would only heal by filling in scar tissue from the edges over a couple of weeks. As my nurse mom applied medicine, her demeanor was calm and clinical, and she told me to be still, be brave–勇敢 (yong gan). Looking back, there was no shaming or denial of my pain, just reassurance that everything would be okay, and I had it in me to endure. It was validating and encouraging. Years later, as I cried audibly in the theater during the most tragic movie I had seen to date, a male relative pinched my thigh–hard–to get me to stop. I understood that message clearly, and it was neither validating nor encouraging.

Feel it maybe, control it always, show it never. How many of us could identify this, or something similar, as an unspoken mantra in our families of origin? Or in our collective culture today? When someone is sad, or even happy, how (un)comfortable are we with their tears? Or our own? What are the acceptable expressions of emotion? Smiling, laughing, hugging, drinking, yelling, honking, gesturing, throwing, slamming, dismissing, deflecting, turning away–including with/at/from ourselves? What does this cost us in psychic energy, physical health, and most importantly, human(e) connection with self and others? And how is it both useful and harmful?

Contrary to what some may think, stoicism is not about repressing, denying, or expelling emotions. It’s more about a commited self-awareness and self-regulation practice, so as to not let intense emotions hijack us into poor decisions and ruined relationships. It’s about balancing feelings with reason, clearing the path for (inter)acting according to our highest goals and core values. It makes sense, then, that a dedicated practitioner may end up with what we colloquially call the ‘stoic’ demeanor–straight posture, neutral expression, generally undemonstrative carriage. And, not necessarily. I think it’s possible–preferable, actually–for a true stoic to live an expressive life; just not excessively or gratuitously so. And even if not outwardly obvious, an ardent stoic can (and does, in my opinion) still experience, even revel in their deep, powerful, and moving emotions, while still keeping a leash on it all. For many, this may be easier said than done; that is why the sister practice of mindfulness comes in so handy, particularly skills that help us manage difficult emotions. Stoicism, then, is a practice of inner peace.

Life is so full of sensations–movement, sound, temperature, texture, taste (omg all the flavors!!), light, color, mass, frangance–I feel giddy just seeking the words! And all of this in addition to the infinite complexities of emotion, relationship, and community, holy cow! We are here for such a short time, how sad would it be to live an entire life without full and vibrant awareness, attention, and appreciation for all there is to possibly sense and experience? This is why I love the idea of ‘healthy hedonism’–an all-in, sensually fulfilling relationship with pleasure, yes, but really I think it’s about joy–the quintessential manifestation of joie de vivre. Hedonism is not the same as debauchery. I think of it as liberated and exuberant engagement with all that our sensory world has to offer, within healthy boundaries–actually similar to stoicism in its grounded mindfulness of and devotion to a Why–living a full and fulfilling, attuned and connected, self-actualized and purposeful life.

Feel it all, manage it well, effuse it appropriately: A new personal mantra in progress, maybe. Allow the feelings, apply good reason, express for connection. Practice withstanding severe discomfort. Equip myself to plumb my emotional depths with confidence. Be with it, surrender–to pain, joy, love, loss, uncertainty, confusion, awe, outrage, fantasy, all of it–and then self-regulate: Do the work, learn the lessons, and apply in relationship, the ultimate human expression. As I write this, it’s so clear that besides mindfulness, self-compassion is another key skill for a hedonic stoic to practice.

To face all feelings without fearing them, to embrace a full spectrum of sensation and aliveness, and to emanate unfettered joy, all while solidly grounded in an ethos of love and contribution: This is the essential spirt of the hedonic stoic.

Sign me up.

Sometimes It’s Blueberries

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Habit change is a lot more complicated than knowing better and then doing better. Because our behaviors are not fundamentally driven by what we know.

“I know what I should do, I just don’t do it.” What is the subtext when patients reply thusly, after I ask about their health habits? It feels defensive and a little ashamed, maybe? They don’t want to talk about it. Not surprising. Our culture pressures us to be perfect: eat organic and plant-based, do CrossFit five days a week, sleep 8 hours, keep up with current events and render strong, articulate opinions, post photos from joyous family gatherings, etc., etc. You name it, and there will be someone telling you you “should” be doing it, and not so subtly implying that you are somehow inadequate if you don’t. As if it’s all so easy.

I think this insight gives us all an opportunity to reflect on what’s actually easy. Sleep happens to be easy for me–I rarely suffer from insomnia (I just don’t spend enough hours in bed, night owl that I am). Some people are natural exercisers, others naturally prefer healthy foods. Some never feel stymied by negative emotions. Some are naturally thin and athletic; others of us are more thick and round. It does not help when we also love all kinds of food, and eat for reasons other hunger (stress, boredom, environmental cues, etc., etc., omg). I have spent the better part of my life judging and criticizing myself for my weight, even though other than pregnancy, it’s been normal–just not thin. Recently I finally understood just how obsessed I have been with policing my own eating. *sigh* What a sad waste of energy and joy.

Healthy eating has never been naturally easy for me. I am a food hedonist. Everything tastes good, I have an incredibly elastic stomach and zero sensitivities or restrictions, and I commune with loved ones around food often. I’m working on sensing hunger and satiety better, balancing starch with fiber, and choosing healthier proteins. I eat less dessert now (maybe?), and I don’t keep ice cream in the house anymore. And still, I struggle and obsess daily.

But a couple months ago healthy eating suddenly became much easier, to my utter shock an awe. Sitting at Ethos after a challenging and empowering total body strength class, I watched Tim popping blueberries like M&Ms out of a pint container. As if it had never crossed my mind before, I realized that I could do that, too. It sounds so silly, right? But I have always had a mindset that berries are too expensive to eat so frivolously. I’d buy them to add to salads or for baking–spread a pint out over many servings and people. To eat a whole pint by myself felt greedy and selfish. But in that moment, my insidious and limiting assumption simply evaporated. It felt random and cosmic at the same time. And since then, I kid you not, an unconscious and involuntary (though wholly welcome and celebrated) transformation has taken place. I feel completely sated with less food. I just don’t crave snacks at night anymore. I feel averse to heavy sauces, large portions, sugary drinks, even ice cream. I revel in a light salad and lean protein, and I don’t feel deprived whatsoever. [Ahem, I still love bread (sheepish grin).] It’s totally irrational, visceral, and not at all because of anything I tried intentionally–at least not directly. How fascinating!

“You cannot reason someone out of a notion they did not reason themselves into.”

So, bottom line: Sometimes behavior change just comes when it comes. We can still nudge and trudge, and stay open to all that may help–lay the groundwork. I think everything I have learned, tried, and failed until now was valuable, just not necessarily effective, given whatever context when I tried it. And the longer I live, the more I believe lasting, sustainable behavior change cannot be forced. Not by guilt, shame, or sometimes even reason. Maybe by peer pressure, but only the kind founded on true belonging and a strong, uplifting sense of community. Or maybe not until it really matters at a core value level, and/or it’s extrinsically easy? Or until our inner nature simply knows it’s the path to take now? Our bodies are built for survival, not modern Western aesthetics. Our cultures and social norms don’t always align with that. We are so judgmental, and there is growing evidence that the psychological harm from that actually keeps us from making the changes we so desperately desire.

Am I totally happy with my weight and my body today? Not really. And, I practice every day to appreciate it more. I’m getting stronger since joining the gym. I’m eating in ways I will regret less in the future. I’m working on getting to bed earlier (not tonight, apparently). And I continue to learn and apply everything I can about relationship, leadership, and all things that make me a better person.

So, ONWARD, my friends. We’re all doing our best here. Let’s all give ourselves and one another a little more grace and understanding, ya? And who knows when we may each have our blueberry moments–may yours catch you joyfully!