November 28:  Gratitude Makes Me Better

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Haha, DUH!

How cliché to write about gratitude on Thanksgiving, right?  Kind of feels like professing love on Valentine’s Day.  At the same time it’s nice that we have a day designated to acknowledge all that we are thankful for, it also feels a bit contrived, perhaps?

But seriously, gratitude really does make us all better.  Read more about this here and here.  In summary, practicing gratitude seems to correlate with improved physical and psychological well-being, better sleep, increased empathy and self-esteem, and decreased aggression.  But how do we feel this on a daily basis?

As some of you know, I started a daily thank you note practice in January.  I’m proud to say that on average, I have written at least one note per day since I made the commitment.  Occasionally a few days go by and I write none.  But many days I write multiple.  I love to use my washi tape cards, but sometimes it’s an email or Facebook message, other times I post on a website or in feedback comments to a company.  It’s become a habit now.  Every day I feel gratitude acutely.  I recognize the people who make a positive difference in my life, repeatedly, reliably, and without expectation of anything in return.  My expression of gratitude connects us further, holding us all up through days of mundane grinding.  If I use my washi tape cards there’s also a flourish of color in there.  This practice has given me leave to reach out to authors, companies, people and organizations who may not otherwise know the positive impact they have on any given individual.  It feels good.

Tonight I’m grateful for so many things—nature, the most meaningful work I can imagine, all of my first world comforts and resources.  But no question, I am most thankful for people. My parents, holy cow.  My sisters, husband, children, extended family.  My friends—the family I choose.  Colleagues, students, patients.  Fellow activists and volunteers.  Challengers and worthy rivals.

I will pay more attention and reflection to this last group in the coming year.  When I accepted my new leadership role two years ago, Coach Christine had me identify my ‘allies.’  Of course all of my loving, supportive friends and family came to mind first.  But Christine also pointed out the challengers—those who vex me, the thorns in my side, the dissenters–they are also allies.  Of course!  Some of my best growth and progress is born of struggle, interpersonal and otherwise.  So how can I be but grateful for the people in my life who make it a little harder?  Whatever doesn’t kill us, right?

I hope you all had a loving, delicious, and fulfilling Thanksgiving, friends.  May we all carry some of this warmth and connection forward through the holiday season and beyond.  We only have one another.  We will not always agree.  We will all struggle.  We can only do our best every day.  Grateful for each day to try to do better, again and again.

November 26:  Practicing Peace Makes Me Better

 

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What helps you find peace these days?

With so much tumult in the country/world and Thanksgiving gatherings fast approaching, what will get you through this season and the coming year with minimal suffering and relationships intact?

Lately my inner peace feels tested on multiple fronts.  Anxiety, guilt, fear, regret, and insecurity accelerate their rotations through my limbic brain.  Thankfully, with age, therapy, and loving, compassionate friends, I have let go of self-judgment for experiencing stress and distress.  I don’t resist negative feelings as much as I used to.  I wish I could say this makes them less unpleasant, easier to tolerate.  Sadly, no.  But I am better able to let them pass through me, to ease into peace.

The more I observe, the more I notice that rather than allow and release our emotions, we tend to either deny/repress or fixate on them.  The consequent suffering can be disabling.  I started wondering how peace comes so much more easily to me now than before.  Below is a partial list.  What would you add to it?

***

Breathe

Rose may have saved my career.  One day in early in practice, running around exasperated and cranky yet again, I returned to my spot at the counter to find “TAKE A DEEP BREATH” posted in large font on the wall in front of me.  It was one of those immediate and profound, perspective-shifting, life-changing moments.  One. Deep. Breath.  Everything goes smoother and happier since that day.  Later I learned about tactical breathing, which trains inner peace both mentally and physically.  I’m not facing mortal combat (primitive stress reflex responses notwithstanding), but it helps me find peace all the same.

Smile (especially when I see my kids)

I was a dormitory resident assistant my senior year in college.  Though it was my job to serve as counselor and guide to college life for my fellow residents, it was wise freshman who taught me about exercising agency in the face of adversity.  I can still see her joyful, welcoming face and posture, feel her free and loving spirit.  I wish I had gotten to know her better.  She wrote on my message board, “Smile, Cathy, you’ll feel ten times better!”  Of course she was right.  Over the past 25 years I’m proud to say that I’m much better at finding my smile now.  Thank you, sweet girl.

Quote Michael J. Fox

MJ Fox worry

Focus on the Now

My daughter had an anaphylactic reaction while I was at work.  The sitter called and I could hear my preschooler stridoring in the background.  My son called 911 as I raced out of the office to meet them at the emergency department.  I was shaking and could barely see straight—how was I going to drive?  What if she died?  I still had to keep it together for my other kid.  That was a morbid turn, I remember thinking.  How quickly we catastrophize.  Thank God for the mindfulness training I had recently started.  Right now, everybody’s still alive.  Paramedics are on their way.  They already did the EpiPen.  Things are okay right now.  This mantra occurred to me as I pulled out of my parking space.  It carried me through that crisis and has held me up through numerous others since.  Mindfulness works, my friends.

Let Go Outcome

See quote by Michael J. Fox.  No matter how much we plan, what we expect, or how prepared we are, we just don’t know what will happen.  This practice is also an extension of mindfulness.  I can only control my own attitude and action right now.  I can cultivate relationships that influence others, attempt to enroll them in my ideas, and recruit them on my mission.  But I cannot control their reactions, their behavior, or the myriad circumstantial dynamics that facilitate or stymie our activities.  If we work steadily for our highest goals, stay on the path of honesty, integrity, and authenticity, and commit to ethical process, then we can deal with any outcome.

Stop Chasing Confirmation

Early in marriage and parenting, I used to fight.  I would flood my family with more and louder words, convinced I could prove my point and win.  The more I spoke (yelled), the more blank and silent my loved ones became, and the louder and larger I got in their faces, demanding understanding, agreement, acquiescence.  [Please feel free to laugh out loud while cringing here.]  These encounters inevitably ended in frustration for all of us.  Somewhere along the way I noticed people demonstrating the behaviors I demanded, even though they had never agreed to them.  Maybe there’s a better way?  Perhaps if I state my case calmly and lovingly, and let go of the immediate outcome, the doors in their minds might stay more open and I can still get what I want, without all the hurt feelings and wasted energy.  *sigh*

***

Four more days, friends.  Almost there!  Thank you for your views, likes, and comments!

November 24:  Alone Time Makes Me Better

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How many hours do you get to yourself at a time?  I mean not just in the shower or commuting, or to work out. I mean how much time do you get to really, only take care of yourself?  When there are no kids to pick up or drop off, no meals to plan or prepare, no immediate work deadlines, no call, no commitments?

I had 36 hours this weekend—there are about 25 minutes left.

I realized at the end of Wednesday that my irritation at fellow drivers was probably a projection of anxiety and agitation about my kids being away this weekend, each to a different place, a first experience for both of them and me.  Anxiety often manifests as anger and irritability for me.  I called forth many of my cognitive behavioral and mind body practices to manage the fear and worry, so that I could actually enjoy this amazing alone time—the first such stretch since the elder kid’s birth.

And holy cow, I’ gotta do this more often.

I will spare you the list of restorative activities!  But suffice it to say that I managed to balance sleep, music, food, productivity, creativity, solitude, and connection.  It really was a perfect rhythm.  Deep breath.  And now I’m ready for the family’s return and re-entry into life as usual, a little more relaxed and peaceful.

This year has been intense, fast-paced, and dense with learning, both personal and professional.  I think we all appreciate the idea of alone time, and we understand its importance intellectually.  But like so many things, to actually experience it first hand, for real, is completely different and profound.  I finished listening to Range this morning.  In it David Epstein describes how teams do best when members have a balance between solitary and interactive, collaborative work, as opposed to all one or the other.  Coaches know that training for any skill, be it athletic, musical, or otherwise, requires alternation between periods of sustained, focused practice and rest, time away.  New neural pathways require downtime to fully integrate.  This weekend, I was able to synthesize ideas from Epstein’s book on diversity of experience, and assimilate them with what I’m reading in Ozan’s book, Think Like a Rocket Scientist, on combinatory play.  In the quiet of an empty house, freed from rushing off to the next activity, insights arose more freely, and I connected dots to previous experiences and learning much more easily.  Today I started The Infinite Game by Simon Sinek.  More transformative ideas (simple and profound) to start incorporating into my world view and leadership practice, and to write about later—Yahoo!

I wondered if I’d be lonely this weekend… Nope, not at all.  This time alone was exactly what I needed.  Loving thanks to the family for gifting it to me.

November 22:  Listening to People’s Stories Makes Me Better

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What a long, strange week.  I almost forgot to write a post, just wanted to relax and do nothing.

Looking back, overall it was good. And it was people who held me up, as always.  I had some pretty moving and meaningful conversations with patients, and I really helped some people, I think.  But it was a new acquaintance who really made my day today.

I finally had time to bring my car to the body shop this afternoon.  After an unfortunate encounter with a fire hydrant while backing out of a very poorly planned driveway, my front bumper has been partially detached for about 7 weeks.  Every single person at this shop was remarkably nice—from the lady on the phone, to the young man who so politely offered to move my car when I parked it in totally the wrong place.  The waiting area was clean, neat, and well lit, with comfy, non-holey chairs.  After a short wait, a petite and pleasant woman, maybe 40, introduced herself.  She would provide the estimate on my repairs.  We headed outside.  She pointed to the ledge at the doorway on which I had tripped walking in, so I would not do it again.

After I brought her to the car she said I could go back inside and wait, but I asked to hang out with her, because I like to see what other people do.  I know less than nothing about cars, and I loved that here was a youngish, friendly woman who clearly knew her way around them.  I admired her right away.  She was thorough and conscientious, looking inside and out.  She was also extremely knowledgeable and patient, showing me everything, talking me through the parts and functions, and answering my ignorant questions, down to how the VIN includes the paint mix of the make, model and year.  She stayed with me through the whole process, including walking me out to show me the key drop box, because they can’t fix my car for another two weeks.

Before we said goodbye I could not help myself.  I told her how happy it makes me to see a woman doing a job that I have only seen men do.  She seemed genuinely proud and thankful for the compliment, and I’m glad I said something.  I didn’t mean to make her stand outside in the cold any longer, but she started reflecting and telling me her story.  Turns out this was her first day on her own at this job—I thought she had done it for years already.  Nope.  She had done inventory for a railroad company, and programmed machines that cut industrial dies.  She had worked in shops and factories of various kinds, it sounded like, always surrounded by and holding her own among men.

I asked her if it feels different (and hopefully better?) being a woman in these male-dominated fields now, after all these years.  She thought for a moment (looking completely comfortable, while I had started shivering already).  It almost seemed like she had never considered the question before?  She concluded that her peers and coworkers have never been the problem.  It’s the customers.

She kept talking, as if the subsequent story had been waiting days for a sympathetic ear.  In her last days of training, a man brought in a car with severe rear body damage, clearly from a collision.  He gave her a history, she made her appraisal, and he was suspicious and dismissive toward her the whole time.  To assuage him, she brought her trainer to review the case, whose assessment and recommendations were the same as hers.  This time the customer told a different story—admitted to lying to her, basically—and accepted the trainer’s evaluation.  No apology, no remorse, no respect.  She was still affected by it today, and upset with herself that she had let him get under her skin.  Whatever, she said in the end, she’s here to do a job, and there will always be people who underestimate her because of her sex.  Thankfully her trainer was an ally, which made me proud of the good men in our midst.

This woman’s life experience, though clearly different from mine, felt relatable and real to me.  In those few minutes, in the waning daylight of a brisk fall evening in Chicago, surrounded by broken cars, I felt solidarity with and pride for her.  It made me better for reminding me once again of our shared humanity:  Hers, mine, my patients’, those crazy drivers on Wednesday, even her lying customer.

We’re all here doing our best with what we’ got.  I firmly believe this, but sometimes I forget.  Hearing folks’ stories always brings me back.  So I’m thankful for them.

 

November 20:  A Little Profanity Makes Me Better

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I swear I was surrounded by idiots today.  Not at work or home…  Mostly on the roads.  It started early, my friends, and they were everywhere.  Is the moon full?  Maybe there’s a toxic gas leak somewhere?  I found myself aggravated before I even got to the office, where usual hiccups in schedule and daily operations continued to poke my inner rage monster.

*deep breath*

Thankfully, I have learned a few helpful strategies over the years.

One is to vocalize.  There is a reason babies and little kids cry and scream at the drop of a hat.  It’s the most efficient way to discharge an acute emotion.  Then it’s over and they can get on with playing and learning.  As adults, this isn’t socially acceptable most the time.  But in the privacy of one’s own car, it can help.  After the fourth or fifth encounter with the truly insane on my morning commute, I growled.  It was not a planned, but I’m doing it more often over the years, perhaps.  It was spontaneous, and I noticed instant release and relief.  Then I literally chuckled a little.  I continued on my way and forgot about those vehicular fools.  I even found a little charity—must be the weather, or that toxic gas.

A dear friend recommended a book this year, The 15 Commitments of Conscious Leadership, which I love.  The third commitment is ‘Feeling all the Feelings’.  The authors explain: “Feeling a feeling all the way through means letting that feeling have its full life cycle (less than 90 seconds) by breathing, moving and vocalizing, resting in calmness, and riding the next wave through to completion.”  In other words, rather than repressing, denying, or wallowing in our emotions, we can acknowledge, identify, accept, honor, and release them.  Then they don’t rule us, driving us to hurtful action, damaged relationships, and toxic work environments.

Here is their method:

When a feeling arises, pause and…

  • Locate the sensation in your body. What are the ‘bits’ doing?
  • Breathe and allow the bits to simply do what they do.
  • Move and/or make a sound to match what the bits are doing.

Sometimes the bits need something more than private growl.

Recall the daily work hiccups.  Most of the time, I can roll with them easily.  I am blessed with a truly amazing team—flexible and smart, able to anticipate patients’ and my needs with keen precision.  But today was a true aberration for me—my already tenuous mental state (apparently not yet resolved) unraveled quickly in the first hour of work.  So, in the safety of the workroom, surrounded by the team I knew could hold the space, I let loose at least two or three sonorous f-bombs, accompanied by some appropriately expressive full-body gestures.  Not only did the team tolerate the outburst, they offered loving support and encouragement.  “Let it out,” one told me.  Once again, I felt instantly better.  I took a deep breath, thanked them, exited the Cave of Camaraderie, and faced the rest of my day with exponentially more grace and generosity.

It was not my best moment.  I should apologize for making anyone feel uncomfortable—cursing in the workroom is not the example of professionalism that I aspire to set.  Still, I don’t regret it.  And it will not become a recurring pattern, I can say with confidence.

Some evidence suggests that swearing raises pain tolerance and relieves stress.  I didn’t lash out at anyone, I didn’t destroy any property.  But my little episode helped me regroup, get my head on straight, and show up my best for my patients today.

Looking back, there were probably no more insane drivers out today than any other day. I will reflect more on what I brought to this day that created my experience. I attribute my ability to approach this reflection with calm and intention to the freedom from emotional tumult that vocalization and a little swearing affords me.

Recent research has shown that swearing while exercising increases physical strength and power.  I may test this self-improvement theory in my workouts this week—in the seclusion of my home gym, of course.

November 19:  Board Review Makes Me Better, For Sure

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Are you required to do continuing education for your work?

Since 2013, the Illinois Chapter of the American College of Physicians has run a weekly internal medicine board review webinar, MKSAP Live Online Study Hall.  We use questions that ACP publishes through the Medical Knowledge Self-Assessment Program, covering topics in general medicine and its subspecialties, including cardiology, pulmonary, infectious diseases, and rheumatology.  Every Tuesday night at 8pm Central time, two of us moderators and one webinar organizer get online and review about 14 questions, SAT-style.  We interact with audience members through a chat function on GoToWebinar, and we poll some of the questions each session.

I love this program for multiple reasons.

First, I was there when it started.  Gathered around then Governor Dr. Marie Brown’s dining room table, a handful of local ACP members brainstormed and created what is now an international, comprehensive internal medicine board review webinar series.  After some playful, off-topic, post-prandial banter between Dr. Sean Greenhalgh and me, our colleague across the table said wryly, “I’d watch that for an hour.”  Hence the dual-moderator, morning radio DJ style webinar was born.  That was in the fall of 2012, and the Study Hall is now halfway through its third two-year cycle.

Second, I get to hang out with my doctor friends online.  Besides Marie and a couple others, I did not know any of the dozen folks involved in the project before that night at her house.  We did improv workshops at the beginning to form our team and ease our communication skills.  Since then we have all become friends—a clique, even.  We have followed kids’ graduations, births of babies and grandbabies, and some personal challenges as well, all while getting together every few weeks to talk shop for an hour online.  We have even become celebrities of sorts—first at Illinois Chapter meetings and now sometimes at ACP National, people come up to us to say how much they like the program.  We’ve become a fixture in some colleagues’ lives.  We feel pretty proud and special about that.

The best thing about the Study Hall, though, is that just in the space of one hour on a Tuesday night, I am consistently humbled by the sheer volume of knowledge there is to absorb, just in internal medicine.  This is only one specialty of the whole medical profession!  And it’s not just the volume—it’s the complexity, the context, and the ever-evolving research, diagnostic and treatment development, and guidelines.  MKSAP publishes a new set of comprehensive questions every two years, and I do not envy the writers their colossal task of keeping us all up to date.  Without fail, every session I learn something that I will use the following week in clinic.

As this month of daily posts progresses, I feel increasing awe and gratitude for all of the people and opportunities in my life.  Thanks to all my colleagues, leaders, family and friends who make this life so full and loving.

November 18:  Relentless Curiosity Makes Me Better

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“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”
― Rainer Maria Rilke

Tonight, in the month of gratitude, I feel deeply thankful for Coach Christine.  I might have been a curious person all along, but it was not until I got a life coach that I learned the vast and profound value of curiosity in every realm.  As I wrote earlier this month, standing always in curiosity liberates my mind.  It relieves me of unnecessary urgency for an answer.  I can exercise professional creativity in forming better and better questions, and the answers (often multiple, intertwined, and intriguing) emerge more easily and artfully than if I chase them demandingly.

The business of medicine is to solve problems, to heal, to cure.  So we assume that the faster we get to answers, the better.  And they had better be the right ones, because lives are at stake here!  It’s always interesting to me when patients talk about my work as ‘saving lives.’  I can’t remember a time when I could actually make that claim, at least at all directly.  But to my colleagues—emergency medicine and critical care docs, trauma surgeons, suicide hotline counselors—thank you, you really do save lives every day!

I love primary care because I usually have the luxury of ‘(living) the question.’  When patients present with new problems, as soon as I know they are stable, I get really excited.  I’m liberated to get deeply curious, ask as many questions as they will tolerate, paint the big picture together.  I follow the standard physiologic and diagnostic process initially, which often yields a straight forward answer and plan of care.  But life and work would be pretty boring if that were always the case.  When the usual suspects are all acquitted and the mystery persists, that’s when things get fascinating.  This is when I really get to know a person.  When I ask truly open, honest questions—the questions I don’t know the answers to and that are not meant to lead anywhere—I never know where the conversation will go.  And I always learn something new and relevant, something that helps me connect.  This is the information that makes a person memorable, because it is truly unique to them.

One of my favorite moments in a patient encounter is when I have to pause a few seconds to form a really good question.  What do I really want to know, what am I after, what will really break open this conversation?  It happens regularly, and wow, what a rush.  OH, I just never know what I will learn!  You’d think people would get impatient and grumpy with such prolonged, sometimes meandering interrogation.  But I find that they often lean in, look me in the eye.  They get on the train with me and look as eagerly as I around the next bend.  What will we find?  Let’s explore together!

Relentless Curiosity.  It’s the funnest part of my work.  I love it.  And as we all know, loving our work makes us better.