Shoots in the Poop

hike flower

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.

Honesty and Integrity

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NaBloPoMo 2018:  What I’m Learning

Last day!  I’m feeling a little elated.  Not sure if it’s Day 30 relief and success, the abnormally large caffeine load I had today, or my awesome breakfast date…

I wish you all to have a friend like Donna.  She is one amazing woman.  A leadership coach, wife, mom, and fellow cosmic journeyer, I count myself infinitely lucky to know her this time around on earth.  I bet we’ve known each other longer than that, though.  We met in this life about 9 years ago.  I can count on one hand the number of people I remember propositioning for a coffee date on our first meeting, and Donna is one.  We meet every two or three months to commune, share, and grow.  I consistently experience two or three separate intellectual and spiritual epiphanies each time.

Today was no exception, and possibly even an exponentially positive anomaly.  Like I said, I’m caffeine loaded and coming off a 30 day freestyle writing challenge—I was primed!  The conversation was so profound I had to type out some notes afterward, as I sense future writings to spring therefrom.  Day 30 was the perfect day to meet her!  I have synthesized and integrated deeply this month thanks to this daily blogging discipline, and sharing with Donna was the quintessential culmination of it all.  I now share with you my favorite segment from our egg-and-toast-laden love-in.

I described a values exercise I did reading Dare to Lead by Brené Brown.  From a list of over 100 words including accountability, courage, faith, openness, respect, and truth, I had to choose two core values, or think of two of my own.  Brown writes:

The task is to pick the two that you hold most important.  …almost everyone…wants to pick somewhere between ten and fifteen.  But you can’t stop until you are down to two core values.

Here’s why:  The research participants who demonstrated the most willingness to rumble with vulnerability and practice courage tethered their behavior to one or two values, not ten…  and when people are willing to stay with the process long enough to whittle their big list down to two, they always come to the same conclusion that I did with my own values process:  My two core values are where all of the ‘second tier’ circled values are tested.

Values list

Dare to Lead, page 188

I listened to this book twice before I received my hard copy from Amazon.  I could. not. Wait!  In anticipation of doing the exercise, I thought the whittling process would take a long time—that I would agonize over it.  But as I skimmed the pages approaching the list, in a cosmic flash, I realized my two: Honesty and Integrity.  It was one of those ‘you just know’ moments, but I had to check in.  Really?  Was I sure?  How did I know?  How could I prove it?  I turned the page and scrutinized every word, comparing it in importance to these two.  Accountability?  Yes, but not as much.  Equality.  Fairness.  Gratitude.  Learning.  Openness, Optimism, Stewardship, and Wholeheartedness:  all important, but not nearly so much as Honesty and Integrity.  I was done.  As surely as I felt self-actualized in seventh grade, I am sure these are my core values.  A few days later, I was describing this moment to another thoughtful and astute friend.  She mulled for a moment and said, “Yes, I agree, I see these as your core values, too.”  Wow, I cannot think of a higher compliment.

Today when I told Donna, her first response was, “Honesty and Integrity… What is the distinction between the two?”  What a great question!  I had a vague, intuitive idea, but had never taken the time to think it through.  As happens so easily when I’m with Donna, and as a person who talks to think, the answer poured forth after only a few seconds.  I used a real life example:

Let’s say my friend asks me, “Does this dress make me look fat?”

Honesty compels me to answer truthfully.  Yes.  Honesty keeps me from lying.  That is outside of my core values, no can do.

Integrity helps me choose my words.  This dress does not flatter your figure the way a different style would.  We are here to choose the dress that makes you look positively stunning and we will not leave until our mission is accomplished!  Integrity frames my response in line with all of my other, ‘second tier’ values: kindness, diplomacy, empathy, love, loyalty, and all the rest.

Thus, Honesty tells me what I cannot do.  It gives me constraints and standards.  Honesty is the guardrail, the floor for my code of conduct.  Integrity then tells me what I can and must do.  It defines the realm of possibility, meaning, and purpose—the Why, How, and What.  How can I be the best friend, mom, doctor, wife, speaker, and leader?  It is the accelerator and steering mechanism that keep me in the lane of who I am.  Or, Honesty is the launch pad; Integrity creates the universe of potential.  I swear I got goosebumps.

Phrases that recur often in my speech and writing are “walk the talk” and “lead by example.”  I always ask myself if I exemplify these, and they are the yardsticks by which I measure all those who lead me.  One cannot do either without Honesty and Integrity at work all of the time.  Brené Brown calls integrity “living into our values rather than just professing them.”  Hallelujah.  I feel the most at home, confident, and grounded when I know I’m living deeply in my Honesty and Integrity.  When I’m outside of these, I feel viscerally uneasy.  I cannot tolerate it, or I can only with great suppressive efforts to manage the dissonance.  I lose sleep; I get irritable and restless.

Practicing Honesty and Integrity is not always easy, though.  Facing the ugly and disappointing truths about myself and my dysfunctional patterns, and then holding myself to a higher standard of conduct—internal benchmarks of behavior and relationship—these aspirations create stress and tension on multiple levels of consciousness.

In the end, though, I know that as long as I hold these two values in front, they will light my right path.  I know I will make mistakes.  There will be times when my behavior absolutely does not exemplify these values.  I wanted to write a blog post right after my A-ha! moment reading the book.  But I was afraid someone would recall a time they witnessed the opposite of these values in my actions, and call me out on it.  But I’m not afraid anymore.  I’m not perfect.  And I’m striving every day.  That’s good enough, because it is my best.  Honest—I swear on my Integrity.

 

 

Things We Take for Granted

BVF ben downhill

NaBloPoMo 2018:  What I’m Learning

When I’m sick the sinus congestion often resists the efficacy of all medication.  I lie awake at night mouth breathing, almost choking every time I have to swallow my own secretions.  Those are the times I really appreciate when I’m well.  The past year, even though I am mostly recovered from knee surgery, I’m still always aware of my one-sided non-normalcy.  When I do my single leg exercises, it’s staggering how I can just do it on the right, and on the left I honestly struggle, as if I could never do some of these things before.  This morning, driving the kids to school and then myself to work navigating slush, sleet, poor visibility, and the inevitably slower traffic, I was grateful that I could simply push the ‘SNOW’ button on my center console and suddenly I had a 4-wheel drive.  You can actually feel the incremental increase in stability and traction—amazing!  Thank you, my engineer friends and family!

Last night was the first real snow of the season in Chicago.  Part of me still hates living here—I absolutely abhor the weather.  But today I found myself grateful more than annoyed.  My kids are old enough to get themselves out of bed, dress, groom, and feed themselves.  We all leave together, and though that morning time in the car can be groggy and silent, it’s still time together.  I drive a car I really like to a job I really love, where I work with a team of generous, funny, kind, and collaborative people.  I have this really warm Land’s End parka with the big, foofy faux fur hood, and I can walk from the parking garage to the office in total comfort on most cold days.

I have job security, health insurance, a great house (with reliable heat and running water, a home gym, and plenty of space for us all to both spread out and gather together), more books than I can read (right now), two healthy parents, a boatload of amazing friends, a universe of information at my fingertips, digital connections with people all over the planet whenever I want, and a phone that takes and sends pictures, for crying out loud.  I don’t have a formal gratitude practice right now, but holy cow, this is a lot to be thankful for.

Not sure what makes me think of the things we take for granted:  Our health, the people in our lives, our homes, our livelihoods.  Think of the thousands of people devastated by wildfires all over the west this year.  In the blink of an eye, imagine all your possessions and the physical spaces of so many cherished memories—all memories themselves.  Imagine your sister, daughter, son, nephew, best friend–missing.  When did you last see them, talk to them?  What transpired between you?  Imagine going about your life, assuming you can handle flu if you get it, then an hour later feeling like you’ve been hit by a truck, then dying of flu a week later.

I’m not trying to be dark or macabre here.  I’m just noticing how much I have, and how much I don’t truly appreciate it most of the time.  I try to be present to the kids as much as possible, engage fully when they talk to me (and fail more than I want to admit).  I really notice their smiles and laughter.  I look through my Facebook feed for pictures of friends and their kids.  I stop to admire flower buds every day in the spring, and bugs on the sidewalk.  I have gotten better at seeing the trees turn gradually green in May and golden in October.  I see pictures of the kids as toddlers and it feels like a hundred years ago and just yesterday, all at the same time.  And don’t even get me started on photos from high school, college, and med school—OMG we were kids!

Another day tomorrow.  Who knows what will happen, how my life could be turned upside down or inside out?  Or not?  Will it feel mundane or miraculous?  I’m learning—reminded, really—that most days, I get to decide.  That’s pretty groovy, I say.

Rally

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NaBloPoMo 2018:  What I’m Learning

In my first practice it was common for whole families to be my patients.  Grandparents, parents, children, grandchildren, cousins, and other webbed relations.  My fondest memories of those years revolve around witnessing the love, tension, and ultimate cohesion of these complex units of humanity.

One day Grandma came for a routine follow up visit.  We reviewed her blood pressure, glucose, and cholesterol numbers.  She wanted to lose some weight.  Everything was stable, but something seemed off.  I could not put my finger on it, and when I asked if everything was okay she said yes.  This scenario repeated maybe once or twice more over some months, and slowly we agreed she was depressed, though I’m not sure if I ever used that word.  There was no trigger, no event.  She had not had a history of depression.  She was just down, she did not know why, and she could not make it go away.

Grandma came from a culture and a generation that did not feel comfortable doing talk therapy.  She was also reticent to take prescription anti-depressants, even if they might help her feel better.  But she was happy to see me more regularly, just so I could keep track of her medical problems and make sure she was okay.  We reviewed the same list each time: fatigue, low mood, anhedonia.  No suicidality, biometrics stable.

Sometimes I would also see Son, Daughter-in-law, or Granddaughter.  I would ask them how Grandma was doing.  They never used the word ‘depressed,’ but they described how she was ‘kind of down,’ ‘sad,’ ‘going through a hard time.’  And then they would tell me what they were doing about it.  Someone would always be at Grandma’s house, keeping her company.  Sister would invite her out to lunch.  Granddaughter would take her out shopping.  Everybody attended to her just a little more, rallying around her, and nobody ever talked about why.

Grandma herself rallied, and her depression lifted over time.  In Chinese the expression for this is equivalent to having ‘walked out’ of it, like depression is a long tunnel in the mountain.  What a privilege to bear witness to this phenomenon—the family saw Grandma walking in a dark place, and they moved in a little closer, each with their own candle, lamp, or torch.  They helped light her way, and they all walked out with her together.

I had a shit day today, mostly of my own making.  Cramming in too many things, all scheduled too close together, trying to do too much, falling down on multiple levels, and adversely affecting multiple people around me.  I almost bailed on a chance to be with an amazing group of people tonight, out of exhaustion and self-loathing.  But these were my friends and I had not seen many of them in several months.  I felt quite listless at the beginning of dinner, not unlike I imagine Grandma felt.  But as I communed with my tribe, reconnected, and met a new friend, I started to feel better.  The yummy duck helped, too.  They could intuit a shadow on me.  And with gentleness and respect for boundaries, my friends rallied around me.  It was not pity or sympathy.  It was genuine empathy and wishes for my well-being.  So I rallied, too.

Things feel overwhelming more often now than before.  The anger, bickering, blaming, and self-righteousness I see, hear, and feel all around (and within) me really gets under my skin—ha, literally, I guess.  I know this will never be a permanent state; I will feel better tomorrow.  It’s also an interesting opportunity to observe how I’m walking the self-care talk—including the self-compassion part.  Fascinating.

Well friends, that’s what’s on my mind tonight.  My patients save me by teaching me.

I’m going to bed.  So I can rally some more tomorrow, and maybe help someone else do the same.

Who’s On Your Pit Crew?

 

Who helps you succeed?

Who checks in with you regularly and gives you feedback on your performance?

Who rushes to your side when you need help?

Who can tell not only when you have a lugnut loose but also how to help you tighten it again?

Who is on your pit crew?

I can’t remember the first time I started using this analogy.  I do recall, of course, it came about in a patient encounter.  For a long time now I have consistently asked patients about their emotional support networks, their connections.  As I get older, I feel increasingly aware of and grateful for all the people at every phase of life who have helped me learn, improve, succeed, and become.  Nobody succeeds alone—hell, all but a rare few of us can even survive alone.

My friend Jeremy Topin, a critical care physician, husband, and dad, writes a heartfelt and honest blog about life as all these things—because he is at once all of them and more—there is no way to truly separate one role from another in life.  His recent post on depression among physicians reminded me of the pit crew idea.  Medical culture does not encourage pit crews for its workers.  It’s evolving, painfully slowly, and I hope to have a hand in that evolution.  But for now, far too many physicians and other caregivers suffer burnout, depression, anxiety, and other work-related heaviness in silence, and it can cost us our lives.

Thankfully, many of us have intact and well-functioning pit crews.  46% of physician respondents to the most recent Medscape survey reported talking to friends and family as a coping mechanism, second only to exercise, and right above sleep.  I count my trainer, my therapist, my life coach, and my Counsel of Wisdom, my closest friends, as my core crew.  I have become more and more open about having a therapist and a coach—ya gotta walk the talk if you’re going to be credible about your work.

Full disclosure, I am not a car racing fan.  Pretty much all I know about pit crews is from Disney’s “Cars” and admiring Lightning McQueens’ motley one.  But that’s how it happens, right?  We acquire and accumulate relationships and connections along the winding way in life.  Who knows when or where it might happen?  I met mine in school, in the exam room, at meetings, and I was introduced by mutual acquaintances.

As I consider further, though, having a pit crew is only part of the success story.  Research shows us time and gain that serving on someone else’s pit crew fulfills a profound human need, also.  I suggest works by Adam Grant and Kelly McGonigal if you wish to read more about this.  But maybe you don’t need to read or hear the research evidence to understand this concept?  How does helping others help you?  On whose pit crew do you serve?  To whose Lightning McQueen are you Mater or Luigi?

If your pit crew is sparse, people who study and do this work recommend finding something meaningful or someone you love to serve.  It could be something simple and non-committal, like serving at a soup kitchen or collecting winter coats for shelters.  It could be reading or playing piano at a senior center.  Or it could be mentoring a junior colleague over many months or years.

Imagine a music teacher who accompanies her cello student at recitals.  She plays piano, fingers and hands moving lightly and nimbly over the keys as her protégé plays her heart out during each performance.  I went to my son’s school this afternoon for a music concert, where this pit crew idea struck me again.  I don’t know if the accompanists were the performers’ teachers, but that’s how I saw them, as they were all clearly middle aged adults playing alongside teenagers—surely they had some wisdom to impart in this relationship?  It occurred to me that ‘accompanist’ may not fully accredit these adults’ roles in the kids’ lives.  The music they contributed not only supported the students’ performances.  These adults integrated their music making with the primary performers’, lifting it beyond where it could go alone.  They contributed their own advanced skills and supportive presence to help these young people succeed.  It was a team effort.  And that’s the point, I think.

How widely could we apply this pit crew metaphor?  How does it resonate with you today?  How else is your life like a racecar driver’s?  What’s exhilarating about it?  How is it faster and more intense than other drivers’?  Is that okay with you?  How much longer can you sustain this work, and what do you need to maintain the joy and reward?

Lastly, what did you think of this post?  It’s much more stream of consciousness and impromptu than I’m used to.  I’m trying to get more efficient with my time—three hours per post finishing at 2am on a weeknight is no longer an option.  Your feedback is welcome!

One more weekly post and then the 30 day marathon that is NaBloPoMo, my friends!  Woo hoooooo, ONWARD!

200th Post: The Best of Healing Through Connection

Harper Columbine 5-31-14

Happy New Year, my friends!  May 2018 bring us all health, joy, connection, and learning!  And may we all look back one year from now feeling more empathy and compassion, and enjoying better relationships than ever before.

If you are new to this blog, welcome!  I hope you find something that resonates.  If you are an old friend, thank you for your support, feedback, and encouragement the last 32 months.  As I reread the last 199 posts this past week, my favorite parts were the thoughtful and enlightening comments.  I never imagined I could make friends writing a blog and yet here we are, connected, engaged, and holding one another up.

What have you discovered about your own writing when you go back and read?  Turns out I have a pretty consistent theme—it’s all about relationships.  Relationships require awareness, insight, active engagement, negotiation, and adaptation.  This is no less true in our relationships with ourselves than with others.  I have divided my favorite posts below into three categories: Health & Self-Care, Physician-Patient Relationship, and Relationships and Communication in general.  Though I have written pieces on politics and healthcare, I realize that these are critical arenas in which to explore relationships, and not my primary areas of focus in and of themselves.

2018 brings big new projects and responsibilities, yay!  So of course there will be big new challenges, also yay!  Looking ahead, I commit to my self-care practices with renewed motivation:

  1. Get to bed by 11:30 every night—Coach Christine has permission to call me out if I’m caught Facebooking past this time.
  2. Maintain 4+ workouts per week. An aging body needs regular vigorous movement!
  3. Keep up with therapy and resume regular coaching calls—reflect internally and project my best self outwardly.
  4. Maximize intake of stems, stalks, leaves, and fruit; minimize refined sugars.
  5. Nurture my ties to my tribes. They hold me up so I can do my best for those whom I lead.

The coming year will also require pulling back on certain things in order to maintain sanity.  While I refuse to renounce my Facebook use altogether, I have already decreased daily hours spent.  And though I still strive to maintain social/political awareness and activism, I will engage less with opposing voices on social media.  The costs, I have learned, far outweigh the benefits.  I would much rather take a politically oppositional friend out to lunch, or even fly to meet them, and have far more meaningful conversations in person.

For now, I plan also to scale back on the blog.  I’ll continue to write, of course, but likely more in the form of stream-of-consciousness journaling, brain-dumping, and snail mail letters to friends.  I expect that once in a while one of these activities will yield a post or two, and I hope to catch them by the tail and publish them before they escape the moment.  I leave here the list of my favorite posts to date.  Please feel free to dip in and out, leave new comments, and share links.  I suspect I will be drawn back to the page before long, as I already have a list of ideas for future posts.  But in case it’s longer than I anticipate, please know that I appreciate every view, every like, every comment, and every connection.

Thank you for stopping by and taking the time to read.  And may you take something away that makes you glad you came.

Sincerely,

Cathy Cheng


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Health and Self-Care

The Sh*tpile  /May 2015

https://catherinechengmd.com/2015/05/01/the-shtpile/

Everybody has one.  We inherit large parts of it from our parents, whose parents passed theirs down, etc.  Life experiences add mass and odor as we grow up.  It sits squarely in the middle of the house of our existence.  For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off.  The surface gets dry and crusty; we grow accustomed to the smell.

 

How Health Begets Health  /November 2015

https://catherinechengmd.com/2015/11/07/how-health-begets-health/

As the kids and I sat waiting to get their flu vaccines this morning, I heard someone blow their nose. It was that thick mucus blowing that feels, at the same time, both gross and gratifying. I took a deep breath through my unobstructed nostrils and looked happily at my uninfected children.

 

Setting Intensions for 2016  /January 2016

https://catherinechengmd.com/2016/01/01/setting-intentions-for-2016/

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare.   After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

 

So You Want to Lose Weight  /March 2016

https://catherinechengmd.com/2016/03/12/so-you-want-to-lose-weight-the-four-as-of-goal-setting/

We set weight loss goals all the time, all of us—physicians included. We choose a number on the scale—an outcome—that represents our better selves, however we see it.  I suggest today that behavior-oriented goals, rather than outcomes-oriented ones, lead to far greater and more meaningful success.  How much are we really in control of what we weigh, day to day?

 

Never and Now  /April 2016

https://catherinechengmd.com/2016/04/17/atozchallenge-never-and-now/

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now.  Never is about the future or the past.  Often it’s a shadowy, catastrophizing perspective of things.  But we cannot predict the future, despite our arrogant human certainty.  And we cannot live every day to come based solely on what has already happened or not happened.  Circumstances and attitudes change.  Landscapes change—at times literally, and in an instant.  We evolve, we learn, we grow.  How can we be so sure that Never is real?

 

Yes, And!  /April 2016

https://catherinechengmd.com/2016/04/30/atozchallenge-yes-and/

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes.  I also remember my own hesitation and self-consciousness.  What do you mean, pimple on my forehead?  Is it really about to burst?

 

On the Critical Importance of Self-Care  /November 2016

https://catherinechengmd.com/2016/11/06/1638/

Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition… I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

 

On the Second Arrow  /November 2016

https://catherinechengmd.com/2016/11/11/on-the-second-arrow/

Eventually, breathing, we can let go the negativity, pull the arrow out.  Breathe.  When assailed by another first arrow, see the second arrow coming and sidestep.  Breathe.  Keep breathing.  Practice self-compassion and forgiveness.

 

On Readiness  /November 2016

https://catherinechengmd.com/2016/11/16/on-readiness/

I confess I am guilty of impatience and judgment.  When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated.  I know you feel it, too.  But know that I don’t blame you. The point is: we don’t make changes until we are ready.

 

Walking the Talk  /July 2017

https://catherinechengmd.com/2017/07/09/walking-the-talk/

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.

 

Just Do It My Butt  /November 2017

https://catherinechengmd.com/2017/11/06/just-do-it-my-butt/

Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys.  But does your doctor’s office have this kind of set up?  Does your insurance pay for these services?

 

Citius, Altius, Fortius!  /November 2015

https://catherinechengmd.com/2015/11/09/citius-altius-fortius/

Every day I live in awe of the astounding miracle that is the human body. It is the quintessential integrated machine.   Almost every part serves a unique and essential purpose in normal daily function, and the parameters for such function are incredibly narrow.  But take something out, wound something else, or trash multiple systems at once, and the whole assembly adapts around the insults, automatically, without any action or awareness on our part.  The body’s compensatory mechanisms exemplify the resilience and tenacity of nature, no doubt about it.

 

Dance For Your Health  /November 2017

https://catherinechengmd.com/2017/11/16/dance-for-your-health/

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun.  How could this not make us all younger?


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Physician-Patient Relationship

The Premise  /April 2015

https://catherinechengmd.com/2015/04/14/hello-world/

Patients and physicians have control over one thing above all else: our relationship with each other.  Relationships live and die by communication.  Barriers on the obstacle course of patient-physician communication loom large and formidable. Our system fails us over and again. And it falls to each of us, not the system, to find our way to connection and healing relationships.

 

What Are You Looking For?  /April 2015

https://catherinechengmd.com/2015/04/22/what-are-you-looking-for/

My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive.  My inner conflict escalated quickly:  Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?

 

More Than Enough Love  /June 2015

https://catherinechengmd.com/2015/06/20/more-than-enough-love/

Like parenting, the path of medical practice is not paved with lollipops and ice cream.  It’s more like an uphill dirt road with pits and grooves, erratic weather, and hairpin turns that make you dizzy and nauseated.  It can also offer astoundingly beautiful scenery along the way—like parenting.

 

Help Me Help You  /July 2015

https://catherinechengmd.com/2015/07/10/help-me-help-you/

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do?  Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these.

 

Closing the Satisfaction Gap  /July 2015

https://catherinechengmd.com/2015/07/20/the-thorn-in-our-collective-side/

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship.  This is how we communicate evaluations to medical students on their performance in clinical rotations.  There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

 

The Burnout Crucible  /September 2015

https://catherinechengmd.com/2015/09/20/the-burnout-crucible/

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out.

 

What Makes You Think You Can Trust Me?  /February 2016

https://catherinechengmd.com/2016/02/01/what-makes-you-think-you-can-trust-me/

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.

 

 

I am Edna Mode  /February 2016

https://catherinechengmd.com/2016/02/20/i-am-edna-mode/

Clearly, Edna trained in the School of Tough Love.  Fortunately for you, I have also studied empathy, compassion, and motivational interviewing.  I can help you persist.  I have patience for your journey.  I can be your pillar of consistency.  Edna is nothing if not consistent!

 

Humbling and Honoring  /April 2016

https://catherinechengmd.com/2016/04/09/humbling-and-honoring/

I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms.  The patients there have no such choices.  If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives.  There are no appointments, and almost no continuity with providers.  It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

 

On Mutual Respect  /November 2016

https://catherinechengmd.com/2016/11/05/on-mutual-respect/

To Patients Who Abuse Medical Staff: Let me be clear: That is not okay.

 

No Substitute for Time  /November 2017

https://catherinechengmd.com/2017/11/03/no-substitute-for-time/

“More information about the value of a physician-patient encounter will always be found in the content of their communication than in what they ultimately do. The difference in… physicians’ behaviors will not be found in any database, electronic medical record, or machine-learning algorithm. I have yet to see data on the contextual information from a history of the present illness in any data set or quality improvement initiative.”

 

Dr. Jerkface In Context: Healing the physician-patient relationship  /November 2017

https://catherinechengmd.com/2017/11/25/dr-jerkface-in-context-healing-the-patient-physician-relationship/

Do patients care about doctors’ suffering?  If they knew how the system harms physicians, would they have compassion for us?  What about if they knew how physician burnout and dissatisfaction directly affects their quality of care, all of it negatively?  What would move patients to stand up with and for doctors?  This is my goal for the indefinite future: to help us, patients and physicians, the end users of our medical system, stand up with and for one another, for positive systems change.


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Relationships and Communication

Gratitude, Generosity, and Peace  /July 2015

https://catherinechengmd.com/2015/07/30/gratitude-and-generosity/

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body.

 

Warrior Pride and a Plea for Kindness  /December 2015

https://catherinechengmd.com/2015/12/13/warrior-pride-and-a-plea-for-kindness/

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy.  We must choose carefully with whom we are willing to undertake such a venture.  And perhaps most importantly, we must be clear about our objective(s).  Do we really expect to change someone’s fundamentally held political or religious beliefs?  How realistic is that?  What other purpose, what other good, could possibly come from such conversations?

 

On Belay  /April 2016

https://catherinechengmd.com/2016/04/02/on-belay/

The interview starts with the two men talking about Hank Williams’ troubled life, his ‘formidable demons,’ as Hiddleston puts it. He expresses compassion for this, as I have seen him do in previous interviews about other characters he has portrayed.  He describes how Williams rose to stardom quickly, but ‘with no real support, no one to anchor him.’  Funny how he uses that word, anchor—like belayer.

 

Opposition and Openness  /April 2016

https://catherinechengmd.com/2016/04/20/atozchallenge-opposition-and-openness/

When I look at the list of definitions of oppose, I feel tired.  When I think of the energy it takes to constantly stand against something, I feel listless and drained.  Fighting, resisting, combatting, Obstructing, standing in the way, hindering, disputing, dissenting, contradicting—it’s exhausting.  I think of times when I meet someone new and all they talk about are the things they hate, that they can’t stand, that they want changed.  I cannot wait to get away and find levity.

 

Every Day a Revolution  /April 2016

https://catherinechengmd.com/2016/04/22/atozchallenge-every-day-a-revolution/

Like the turning of an incandescent light bulb, gently, patiently, and consistently in one direction, the steady work of activists eventually leads to sudden and intense illumination.  Darkness becomes light, cold spaces are warmed.

 

Withhold Judgment  /April 2016

https://catherinechengmd.com/2016/04/29/atozchallenge-withhold-judgment/

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.

 

Playing My Part  /May 2016

https://catherinechengmd.com/2016/05/22/playing-my-part/

Given the awesome support network with which I am blessed, I feel an impulse to do something more with my writing—to amplify and project all this love and connection back out onto the world for some positive purpose.  But how can my words possibly make a difference?

 

Holding the Space for Personal Acts of Peace—On Listening  /July 2016

https://catherinechengmd.com/2016/07/11/holding-the-space-for-personal-acts-of-peace-listening/

I know I will not do justice to all the complexities of our issues in one blog post, but I ask your forbearance for my interpretation, as it has led me to greater conviction for what I can do, I, one person.

 

Holding the Space for Our Suffering to Heal Us  /September 2016

https://catherinechengmd.com/2016/09/22/holding-the-space-for-our-suffering-to-heal-us/

For a moment we felt stuck, we connection seekers.  I looked at our leader.  His expression conveyed nothing but humility and empathy.  His posture conveyed resolution.  Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side.  But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

 

On the Golden Positivity Ratio  /November 2016

https://catherinechengmd.com/2016/11/25/on-the-golden-positivity-ratio/

I remembered something about healthy relationships maintaining a 3:1 ratio of positive to negative interactions.  Turns out it’s actually 5:1, widely attributed to observations by Dr. John Gottman, renowned marriage and relationship psychologist.  I think the same thing applies in other realms, too, such as self-talk—a reflection of our relationships with ourselves.  It’s not a far leap to see how this idea pertains to news, social media, and any other human interactions.

 

Train to Withstand the Discomfort  /February 2017

https://catherinechengmd.com/2017/02/20/train-to-withstand-the-discomfort/

We all know the satisfaction and comfort of echo chambers.  Seeing, hearing, and reading that which validates our existing positions feels so good.  But the farther we regress here, the harder it becomes to tolerate a dissenting view.  We must resist this temptation; we are called to be more disciplined than this.

 

To Train or Not to Train  /May 2017

https://catherinechengmd.com/2017/05/08/to-train-or-not-to-train/

…even if we don’t all talk politics, we all need effective communication skills, especially in the arenas of conflict resolution, negotiation, parenting (which encompasses them all), and the like.  We are social beings—we only survive by cooperating and living well within our tribes, and by tribes living well among one another.  That can only happen if we practice getting along.

 

Tribal Pride and Tribalism  /November 2017

https://catherinechengmd.com/2017/11/29/tribal-pride-and-tribalism/

We all need our tribes.  Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health.  And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us.  But what happens when tribes pit themselves against one another?  How are we all harmed when we veer from “We’re great!” toward “They suck”?

 

 

 

Ode to My Dawn Simulator

DSC_0136

NaBloPoMo 2017: Field Notes from a Life in Medicine

Did you notice the photo on my post Gratitude Again?  That was the view out my office window around 5:30pm last week.  These days I appreciate the winter dusk a lot more than years past, mostly because the physically hardest years of training and my kids’ lives (for me) are over.  My intern year I rotated in the medical intensive care unit (MICU, or MICK-you, or just ‘the unit’ for short) in November.  Usual days started by 6am, and finished whenever my patients were stable enough for me to leave, usually past 7pm.  I really never saw the sun that whole month—not from outside, anyway.  Every third night on call, my resident and I covered the whole place.  The longest I ever spent in the hospital was 5am until 10pm the following night—41 hours straight, only to be back again the next morning at 6.  And that was nothing compared to the generation of doctors who trained before me.  Thinking back on it now, I can still feel the saturating fatigue, the utter hopelessness of ever seeing the call room, let alone lying down on a bed.  Thank GOD those days are over.  They weren’t all bad, though.  Residency was one of the hardest things I’ve done, and it was also intensely rewarding.  The friendships I made those years, the unique shared experiences—I carry these with me also.  They made me strong and gave me confidence.

But if I thought getting up in the dark during intern year was hard, somehow doing it as an attending with two little kids was even harder—go figure.  The sleep deprivation of working motherhood is a completely different animal from that of residency, its toll multiplied on family.  The blaring alarm clock, the utter blackness of the bedroom, the contrast of cozy warmth under the blankets with the cold still air above.  They all conspired to make me peevish, sullen, and supremely unpleasant to be around every morning—an additional cost to my soul every time I lashed out at the kiddos out of my own exhaustion.  To borrow a phrase from Vee over at Cute Kids, I might well have died of a bad mood or something worse if that situation continued.

So Husband staged an intervention: He bought me a dawn simulator for Christmas.  It’s an ingeniously simple device: An alarm clock with a built-in light dimmer that comes with its own full-spectrum light bulb.  All you have to do is connect it to a bedside lamp.  Then you set sunrise time, as well as duration of rise (I set mine to 6:45, 15 minutes).  Every morning for the past 7 years I wake up naturally from a steadily brightening, gentle and warm glow from one corner of the room.  It’s infinitely more pleasing; no blaring involved.  Of course now I have my iPhone ‘by the seaside’ alarm as back up, especially for this month as I stay up too late writing blog posts.  And I’m not a morning person in general, so no Mary Poppins songs bursting forth with domesticated mechanical birds on my windowsill.  But life is infinitely more tolerable between Halloween and Easter each year now—for all of us.

Thanks, Husband.  Ya done good.