How Business As Usual Is Killing Us

Surf & turf and a side of asparagus, lobster bisque, smashed potatoes, and an unlimited bread basket, with cocktails and wine, and tiramisu if there’s room.

Most people don’t eat like this all the time, but how many restaurants are filled every night with rooms full people eating exactly this? Many of my patients may eat like this (or something very similar) multiple times a week.

If you want to drastically increase your risks for gout, acid reflux, severe sleep disruption, brain fog, stress intolerance, high cholesterol, high blood pressure, weight gain, and diabetes, there could hardly be a better recipe than the typical business dinner. Here’s the physiology: 1. Red meat, shellfish, alcohol and asparagus are high purine foods that elevate uric acid levels in the blood, increasing the risk of gout, a painful inflammation of joints, especially the first joint of the big toe. 2. High volume, high fat, and alcohol: All of these delay gastric (stomach) emptying, and may loosen the lower esophageal sphincter, making it easier for stomach acid to escape upward, causing heartburn, chest pain, even shortness of breath. 3. Late and prolonged eating: with an already sluggish stomach, finishing a meal within two hours of going to bed makes it even more likely that the stomach will still be relatively full when lying down, sloshing acidic stomach contents right up against that loosened sphincter in the horizontal position, causing painful night time waking, disrupting sleep and negatively affecting mood. 4. Alcohol itself causes neurologic changes that interfere with sleep, even though it may feel initially sedating. It also increases nocturia (getting up at night to pee), can worsen sleep apnea, and is a mood depressant in itself. Taken together, the compounding consequences of the business dinner make it a formidable enemy of health for many executives.

Now add frequent and often international travel with chaotic jetlag, the stress of high pressure, high stakes business transactions, responsibility for whole workforces of people, and disconnection from family, plus emails, voicemails, text messages, and all manner of 24/7 media demanding attention, energy, and time, all finite and precious human resources. It’s a wonder I don’t witness more heart and panic attacks than I do.

Despite these risks and challenges, though, many of my patients actually do and feel fine. They report high meaning in their work, enjoyment from connecting with colleagues (though nobody tells me they love those dinners). They find time to exercise on the road and at home, manage healthy eating, and get good enough sleep in other ways.

Or so we all thought, until the pandemic hit.

My practice closed along with the rest of the country for about 2.5 months in spring of 2020, and the rest of the year and beyond, most of my patients worked from home. Not surprisingly, and also a little shockingly, many of them showed marked improvements in standard objective biometrics when they came for their annual exams that year. BMI, body fat, blood pressure, and cholesterol fell, often precipitously. All of a sudden healthy behaviors that required heroic effort became almost as easy as rolling out of bed. With their long daily commutes eliminated, people could now make–had–time to exercise…and they wanted to because they weren’t mentally exhausted all the time. They could pace about their home office while on Zoom, maintaining energy and engagement. No more international travel, no more business dinners. Their environment and circumstances suddenly and significantly eliminated all kinds of friction on the path to healthy habits. And more importantly, they felt so much better, because they were sleeping more and better, rushing less, and spending more quality time with people they loved. It’s not rocket science–they had their lives back. [Note: I understand that I’m writing about an extremely privileged population. Please know that this awareness is not lost on either my patients or me, and we talk about it candidly.]

Today, frequency and distance of business travel approaches prepandemic levels. Typical work practices are resuming, with some consideration as to their net benefit, but maybe not a lot of action to experiment with or create new, more optimal models of workflow and interaction. In my office, I see patients’ stress levels rising again, weight coming back on, and an overall sense of bewilderment and resignation at it all.

As I write this, I feel a dense tangle of frustration, exasperation, empathy, impatience, protectiveness, and an urge to throw or slam something. Really I feel kind of rageful, actually. Existing disparites of access to resources, autonomy, security, and overall health and well-being widened and intensified dramatically through the pandemic. It makes me ashamed of humanity. How is it that my patients and I–people with agency, autonomy, knowledge, and power–can feel, and actually be, so powerless to change the systems that make us all, privileged and not, so f*ing unhealthy??

I have no concrete or actionable suggestions for how to make things better.

Sometimes I fantasize about going to these business dinners with my patients, like a chaperone. But rather than policing their choices, the point would be to make it safe for everybody to admit that they don’t necessarily want to be there, doing this conventional thing that social norms dictate. Based on years of conversations in the privacy and intimacy of the physician-patient interview, I feel peer pressure operating at the same intensity, and with just as high social consequences, as when we were all adolescents. It’s fascinating and depressing, like a black cloud that everybody feels, nobody acknowledges, and everybody suffers from in collective isolation.

What would it take for these deeply rooted cultural norms, ones that harm us all, to shift even a little? It’s a question I ask myself every day, in multiple domains. I get agitated and hyperventilate at the glacial pace of change. And then, usually, I can take a deep breath. I call on wiser voices than mine to get through.

I know there are people out there bucking the norm, challenging the status quo. I look for that spark in my patients, and I try to fan it, ignite it further. That’s the little good I can do, I guess. Maybe our little fires will one day light the way to bigger change.

Giddy Up

Sylvan Dale Guest Ranch, Loveland, Colorado

How is your mood/mindset today? Is it intentional, or did it just happen? What word would you choose for it?

For a couple months now I have practiced setting an intention for the day before getting out of bed, encapsulated in one word. I try to make it aspirational, but often I land on something to counter some heaviness or negativity I feel upon waking. It’s like self-reassurance or something, a DIY pat on the back. On 12/15 I awoke mopey, apathetic, and unmotivated. Thursdays are my busiest days at work, so I had to 打起精神來 (da qi jin shen lai), as Ma always says–literally ‘hit rise energy come’–something akin to ‘get moving’ in English. So my mantra for that day became “Giddy up.” I don’t remember the last time these words even occurred to me, but they apparated that day and carried me through.

The next day I started listening to now Senator John Hickenlooper‘s memoir, The Opposite of Woe: My Life in Beer and Politics. Somewhere in the middle of the book, someone attended a psychology class wherein the professor asked a series of questions along the lines of: What is the opposite of joy? Sadness. What is the opposite of X-emotion? Y-emotion. What is the opposite of woe? And a student stood up and said, “I believe that would be Giddy Up.” HA!! It took me a second… 😉 Henceforth Hickenlooper calls up the phrase in his own self-motivating moments.

So now I feel cosmically connected to “Hick” junior (read this Twitter homage to his dad–I dare you to not be moved). My senior year of high school, I was invited by girls I admired to attend an Amnesty International event at the Wynkoop Brewery, which Hickenlooper had opened with some partners only a couple of years before. I will always remember that day fondly, feeling so included. The stories of that restaurant venture, the first ever brewpub in Colorado, and his life in general, are told with moving poignance and good humor in the book, which I highly recommend. Sometime during his tenure as governor of Colorado, I started following him from afar. These last 10ish years, I have always found him to be down to earth, smiling, and approachable in interviews and public appearances. And I absolutely love that he has always refused to run negative ads during any of his political campaigns. His Facebook posts share good work done in Colorado and Congress alike, and help me feel connected to my home state through someone I admire and feel proud to ‘represent’ me.

Throughout the book he tells engaging stories of his meandering life paths, personal and professional intertwined. He owns his flaws as well as his strengths, neither over- nor underplaying either. His ex-wife has surmised that due to emotional losses early in life, he became a pragmatic, rational-dominant thinker and doer, which served him well in business and then politics. Along the way he also had opportunities and support for self-reflection, including marriage counseling. He has done the inner work of developing his emotional mind, which I also very much admire. Today, working in such a polarized governing body as the US Senate, I hope he can set a dialectical example of respect, pragmatism, and collaboration that others will follow.

I know many of my people in Colorado have mixed feelings and opinions about Uncle Hick, as I will now think of him. Of course that is to be expected, and he himself respects it. He recognizes that in government, trade offs are the norm–if nobody is 100% happy with your work, then you’re probably doing it right. Hearing his perspective, both seriously committed and self-depricatingly lighthearted, as a scientist (English major turned geologist who took 10 years to finish college)-entrepreneur-politician, gives me such hope. He discusses the importance of public-private collaboration and the need to update or eliminate obsolete regulations. He embraces an evidence-based, team approach to novel problem solving (eg inventing effective and accountable recreational cannabis policy in the first state to make it legal). He keeps his compass pointed toward the core value of helping people, while leveraging business tactics to grow economies, and not wasting resources. He describes how he chooses battles worthy of fighting, all in good time. After study and deliberation, he is willing to change his mind on important issues, out loud and without shame (eg capital punishment).

I know I must be severely biased toward Uncle Hick just because he is from Colorado. Often during this book, I recalled feeling a similar admiration while listening to Neil Gorsuch’s memoir; he is another Coloradan. I imagine these two men differ greatly in ideology and politics. I also imagine that they respect each other and would engage in healthy dialogue around their differences if given the chance. Colorado is a big place, with a vastly diverse geography and population. It’s also one of the healthiest, most desirable places to live, by any metric. People there are consistently the friendliest folks I ever meet, compared to anywhere else in the world. There is just an ethos, something ineffable and yet palpable, that allows differences to be acknowledged and overcome, and things to get done. One day I will get back there and participate in person. Cannot. Wait.

Giddy up, indeed.

We Should All Listen to Romance Novels

[Note: this post discusses only binary, cis-gender, heterosexual romance, as that is the genre I currently consume.]

Buckle up, friends, we are taking a ride!!

Okay so never in a million years would I have guessed or predicted that I would binge romance audiobooks, and yet here I am. I have finished 46 books in 8 weeks–omg that’s almost one a day, holy cow! And that does not count the ones I have repeated!

Every year I have a brief period when I get a little tired of intellectual non-fiction. Here in 2022 it happened about 3/4 of the way through A Republic, If You Can Keep It by Neil Gorsuch. I finished eventually, and highly recommend it–he reads it himself; you can kind of space out during the pedantic parts, and still get to know him (a little) and his jurisprudence (at least a little). I especially recommend it for my progressive friends; but that is for another post.

During these cerebral time-outs, I scroll around on my Audible account for fun books included in my membership. For whatever reason, The Fix-Up by Kendall Ryan caught my interest this time, and it all started there. “Every reader deserves a hot hero and a happy ending,” her website says. Hallelujah, I say!

One of my favorites, and my first recommendation to many friends–great reviews so far!
And Blakely’s novels are generally lighthearted and fun!

Around book #4 my book club met. I debated whether I should tell my new friends what I was doing (how fascinating)–I, the fiction shunner. Then, cosmically, one of them started talking about how she skips over the sexy parts in romance novels she reads, clearing the path for me to share–openly–because I most definitely do not skip the sexy parts! That night I learned a few things: 1. All of my book club friends have enjoyed romance novels; 2. A novel cannot be shelved as romance unless the ending is indeed ‘happy’; 3. There are ‘closed door’ romances, wherein sexual activity is implied, and ‘open door’ ones, which describe it all in detail (my books’ doors swing wide open). Since then, sharing with more and more friends, I have also learned: 4. Romance may be the best-selling book genre; 5. Almost all of my women friends have read them, but we don’t talk about it (still fascinating!); 6. Almost none of my friends can name any cis-het romances written by cis-het men; and 7. None of us know any such men who have read or would read romance.

“Brain Candy.” That’s how one of my friends describes it. It’s pure entertainment, total vicarious escapism. I agree! That’s why we seek it, no? How better and farther to get away from the mundane and stressful grind of responsible, daily adult life? That’s definitely what I wanted.

Finished all but Book 8; highly recommend–short, fun books that don’t take themselves too seriously.

It’s all so predictable and formulaic, which I love, because I can just relax and enjoy. The stories all follow roughly the same arc: Immediate attraction. Some obvious, primary barrier to togetherness (distance, prior relationship wounds, age gap, coworkers, some other made up reason). Supportive friends and family who “knew all along you two were meant for each other, duh.” By about 20-30 minutes left you’re home free, no more conflict, just happy ever after. I had never heard the word kismet before now, and it comes up everywhere in this genre. And there is an entire romance novel language–for body parts, sex acts, desire in all its forms! The best books hook you right away with witty banter, engaging premise, or just hot sex. My favorites have smart, sassy, free-spirited heroines, lots of cheeky dialogue, and fun plot twists.

All of these books are stand alone novels, and it’s also fun to read them in series. I loved this set, too.

These books have really refreshed my outlook on life and relationships–that was a total surprise! They remind me what it was like to be in love–that optimistic, impetuous, idealistic promise of a bright future, that whatever comes, we can face it together. It’s us against the world, baby! At book #29 I journaled notes for this post: “…stories that remind us of how we all want/long to love and be loved.” These 8 weeks of romance consumption have, remarkably, cracked the mortar of my cynical emotional turrets, and loosened some heavy armor I did not realize I had accumulated. Yahoooo!

Working my way through these (listening first to all of the ones read by Shane East).

I have shared these epiphanies with two male friends–dear brothers on the thoughtful, relational, self-reflective journey of life. They were so supportive and loving, listening as I marveled and waved my hands. Their eyes widened along with mine when we asked ourselves, what would it take for men to also be able to enjoy these fun, erotic stories that get us women so (energized), and then be able to share about it safely [insert gobsmacked emoji here]?

Because here is what I think makes these novels so important, and why we should all cosume them (I highly recommend listening, especially if they are read by Shane East):

Contemporary romance novels celebrate and validate, unequivocally and unapologetically, two things that our culture and society insidiously shame us for:

Women’s libido and erotic sexual desires

Men’s intrinsic need for deep emotional connection

They do this by writing from both partners’ perspectives, describing their honest emotions, inner conflicts, self-delusions, and fears. But since these books are mostly written by women and consumed by women (as far as I know–to my cis-het male readers–do you read [write!?] romance?), I wonder if the male characters I read resonate with men who read them? Hence my query for romance novels written and/or consumed by men…

And they exist, hooooraaaaaaayy!

Turns out, authors Leigh Greenwood, Jessica Blair, Emma Darcy and others are men writing under female pen names (huh–more to unpack there, eh?). Now I have to get my hands on their books–will I relate to their female characters? Many have also pointed me to Nicholas Sparks, so he’s on my list, too. And guys, there’s even an article that lists 7 romance novels to gently set you and your gender on the romance path! “The best thing about romance is that love is for everyone!” it proclaims, and I wholeheartedly agree! What will it take for you to dip (or dive) in? What’s the best thing that could happen?

So there you have it, my unexpected, uncharacteristic (or not?), utterly awesome and ongoing journey into romance audio novels. I’ve never consumed this many books in one year in my life, by a long shot, and I could not possibly be happier about it. Not sure when I’ll get back to the other stuff… (she smirks)