Category Archives: gratitude

Three Years Ago Today

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Where were you on February 25, 2020? What was happening around you? What were you doing, planning, looking forward to, worried about?

What day did COVID change your life?

On New Year’s Eve, 2019, my niece declared that everybody was overreacting to the infection sweeping across Wuhan, China. It won’t be a big deal, she said. I specialize neither in infectious disease nor public health, but I knew then that what was coming would be a big. fucking. deal.

This morning, stepping out into the bright sun and crisp air at the end of another unusually mild Chicago winter, Daughter and I recalled 3 years ago. We had just spent a long weekend in Seattle, just for fun. Son had said then that he could see himself living there ‘after school,’ and lo, he ended up there for school. Little did we know then that COVID had already landed, right there, where we were.

Within weeks, whole organizations and governments mobilized and immobilized; life mutated irrevocably around us everywhere. COVID hit me in the face by cracking one of my friendships early on. The week of March 9, I begged off of a gathering, and my friend was angry. I respected and admired her, and loved her family–still do. She subsequently railed at the prospect of lockdown and social distancing, citing economic fallout, apparently dismissing my alarm at the risk to our healthcare system, and my own colleagues, if we deferred such drastic measures. It took me by surprise, floored me, and I was hurt. I wanted to talk more about it, talk through it. But these three years, every time we approach our differences here, she respectfully declines to continue. I respectfully agree. We hit a boundary in our friendship then, which I accept. I can engage with difference elsewhere; there is no shortage of opportunities. Over this time I believe I have both sharpened and softened my communication skills around disagreement and dissent, and I’m still grateful for every chance to practice, learn, and improve.

Facebook showed me what I posted three years ago today. I don’t know which leader moved me to profess my appreciation on social media, but I bet it was one of two, so I emailed them both today with the screen snip of the post. “…recalling 3 years ago, watching and waiting for the pandemic wave to hit us, standing in a state of novel awe and uncertainty.  I also remember feeling confident, though; I understood the medical and public implications and trusted my immediate professional and personal circles to think and act rationally and thoughtfully… Our organization has its challenges, both intrinsic and extrinsic.  Each day, though, I’m still convinced and proud that everybody’s doing their best for the greater good. So Happy Saturday, and thank you for you leadership. 🙂” Having led a small practice through the first 14 months of the COVID morass, I suspect any sincere expression of acknowledgement and appreciation, at anytime, even now, boosts any leader’s spirits. We are all still going through it, and we still need to hold one another up.

This is the 42nd post that appears on a “COVID” search of this blog. I process by writing. Reading back, I apparently felt more fear and anxiety at the outset than I may remember. Memory is complex! Today I recall vividly the acutely discordant and uncomfortable conversations with my friend, while minimizing the overall stress of the time and circumstances? How fascinating. We would all do well to ‘remember’ this paradox of recollection as we continue to navigate, negotiate, and collaborate hereafter.

“We write to taste life twice, in the moment and in retrospect.” Anna Quindlen includes this quote by Anais Nin in her book, Write For Your Life. Have you anything to review from three years ago–emails, letters, photos with captions, blog posts? What does any of it show you about your feelings, thoughts, actions, and relationships back then? How has your life evolved and transformed in the short and profound time since? How have your relationships moved? I’m gratified to take some time today to recall and reflect, and to have concrete evidence of myself to do it with.

Write on, my friends.

Why I Take the Scenic Route

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June 23, 2020 somewhere in Colorado

I-70 or 285?

I ask myself every time I leave Centennial, on my way to Silverthorne. If I have time and nobody in the car who will complain, I always choose 285. It takes at least 45 minutes longer, and it’s a much prettier drive. Thanks to dear friend Rachel who took me this way the first time in 2012, I have now stopped at state parks I never knew existed and passed through beautiful valleys and plains that take my breath away. Less traffic also makes for a more relaxing, even contemplative ride, which I appreciate more and more. Fun turns that open up around the bend to expansive landscapes never get old, and depending on time of year or day, and of course weather, I never know what I’m going to get. Every time, I am richly rewarded with yet a new perspective on the path, the journey–this iteration of the way. I get to explore and learn, to savor and revel. I learn what exits lead to which trails, where to get gas, and where to stop for the best views.

I have the sweetest gig any primary care doctor could hope for. With 5% of a typical full time patient panel, I have the greatest luxury in all of medicine: time.

When someone presents with classic signs and symptoms of a well-described and well-understood condition, it’s okay to take the highway of standard testing and conventional treatment. When the story and picture are less clear and straight, we need to slow down, look around, listen harder, wander the side roads. What’s rustling in the bushes? What path was taken to get here, and what roadblock(s) encountered along the way? What equipment do we anticipate needing as we proceed, and will we know how to use it?

Sometimes even the clear and straight path turns icy, muddy, or otherwise unexpectedly obstructed. This is when knowledge of alternate routes really pays off; even better if those routes are familiar. So often I take extra time talking to patients, even when I think I know what’s happening. I ask more questions to flesh out the story fully, to learn more. Have you had this before? What’s same/different about it this time? What was the context? What made you call me about it? How much is this bothering you? What are you worried about? What’s going on in your life now that may have triggered this? What else is happening? What do you think is going on, what story are you telling? Anything else?

I never know what I’ll learn in these meandering exchanges; most of the time I just get to know my patient a little better. That’s worth so much in itself. And eventually, I have learned, all of this accumulated familiarity matters. My ‘impression and plan’ for any given problem can evolve quickly over a history and physical exam, sometimes taking sharp turns. And it’s the best feeling when my patient and I can look at each other and say, “Wait, remember when…?” and it sheds light from the past on what’s happening today.

Today’s objective may be relief of pain and discomfort. Depending on the severity and urgency of the problem, we may race to that end speeding on the freeway. Our journey together as physician and patient, however, is more like a long and winding road trip. We have much to explore, if we travel together long enough. When you’re not in pain and have some time, we can take the scenic route together, get to know each other better. All of the photos, wildflowers, stories, and memories we collect along the way just make the trip, and our connection, that much more beautiful.

Tribe and Fire

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Another day of threaded media to reinforce my personal biases. Thought I’d share since it feels so cosmic. 😉

Often I find myself with an acute urge to connect with one or a few of my friends. I have long since learned to act joyfully on these urges; in college I wrote letters on pretty stationery and mailed them with confetti (100 in my first year alone). As life got busier that evolved to cards and postcards. And now it’s often an email or text, these days with attached memes or songs, and most recently the 8 minute phone call… I still indulge in the luxury of snail mail often, though.

Today I looked for something touching to share. Scrolling through photos, cartoons, and memes on the phone and laptop, nothing felt quite right. Then this appeared on my Facebook feed:

So unassuming yet poignant, down to earth and still profound. Perfect. I sent via email and also saved the image for myself, before sharing on my own FB page. The more I read it the more it resonated. “Mostly, we don’t want to harm each other… We want…For the waitress to call us honey… We have so little of each other, now…” So I shared with a few more friends–ones who I know practice making the “fleeting temples” (whom I admire and wish to emulate) and ones for whom I wish to meet and feel deeply the “true dwelling of the holy.”

One of my friends then shared the image on her own page, and one of her friends commented on the significance of “So far from tribe and fire,” before referencing a recent gathering of exactly ‘tribe and fire.’ YES. Tribe members take turns tending the fire that keeps us warm, leads us home, holds us together, connects us. So I had this lovely and loving idea swirling around my consciousness all day.

Sarai left her eloquent comment on my last post, reinforcing that anchoring–tribe-and-firing–is a reciprocal activity, between ourselves and those we know, both intimately and apparently not at all, though in reality I am convinced that we all know one another on a cosmic level. “I like your hat.” I must call her soon and relight our shared fire. It’s been a long time, and I’m confident that the embers still glow.

Then I came across Daniel Pink’s post on the book The Good Life, which is now on my 2023 wish list. “Friends are medicine.”

Again, YES! I feel validated asking every patient, every year, about the strength and depth of their emotional support network. It’s not my job to help them cultivate it, the way I advise on ways to lower blood pressure and cholesterol. But I point it out so it’s on our radar, to reinforce the paramount importance of this aspect of whole person health.

A fellow physician mom posted on the FB book club group page about Chasing the Scream by Johann Hari. The Amazon page references his viral TED talk years ago on how wrong we are about addiction, which rang a bell, so I watched it again. It’s only 14:33, well worth your time and attention. We think substances themselves are the problem. Turns out, it’s context. Loneliness and disconnection are far stronger drivers of addiction–to substances and other things–than the things themselves. Hear about ‘rat park’ at 3:30 where rats with toys and friends do not prefer drug-laced water when given a choice, compared to their stimulus- and companion-deprived research counterparts. Continue watching to learn about the unintended human drug addiction study that was the Vietnam War, where only 5% of the soldiers who used heroine in company relapsed upon returning home. His lovely conclusion: “For 100 years now, we’ve been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection.“

Recently I started asking patients to categorize their alcohol use patterns among three overlapping motivations: social, self-medication, and habit. That middle one is a flag, though it’s often camouflaged by the other two. Identifying, accepting, and addressing our demons may be one of the scariest things we do in life. No wonder we avoid it so desperately–even more so when we feel we must do it alone.

Our relationships kill us or save us, I often say. More and more I think it’s not actually the toxic relationships that kill us, not if we have other strong, loving, thick relationships, communities, connections, and meaning to hold us up. No, it’s the lack of relationships, that absence of connection, that kills us. It doesn’t have to be many friends or connections, it just has to be enough–close enough, deep enough, tight enough.

Who’s on your mind today? Why not reach out and let them know?