Category Archives: gratitude

On Finding Meaning

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NaBloPoMo 2016, Letters to Patients, Day 8

To Patients Seeking Meaning:

Try the Three Question Journal.

One of my favorite parts of a new patient encounter is when we talk about your work.  Not only hearing about what you do (as I wrote on Day 3), but what it means to you.  I ask you to rate your overall work stress on a scale of zero to ten.  Then I ask you to rate the overall meaning of your work (to you, not to others), on the same scale.  I’m looking for meaning to rate higher than stress, and above 6 in general.  This ratio, I have observed, represents a sustainable and fulfilling work life.  When I hear you articulate your passions and intentions at work, it inspires me, too.

Some of you realize suddenly that the meaning you once felt has faded, and you get pensive.  Or you tersely state that your work holds no meaning whatsoever, other than as a source of income.  This is where I usually pause for a few seconds to feel out where the conversation will go.  Should I screen you for depression?  Should we explore or move on?  My meaning comes from these inflection points.

Given that we spend most of our waking hours, most days of the week, at our jobs, I assert that it’s worth trying to maximize our sense of meaning.  Why not be happy and fulfilled at work, if you can?  I also assert that this is something we can and should choose, for our health and that of those around us.

My friend Liz recently re-introduced me to an exercise that may help.  It’s from Rachel Remen, physician and author of two deeply moving books, Kitchen Table Wisdom and My Grandfather’s Blessings.  It’s called the Three Question Journal.  You can find background and detailed instructions on her website here.  Basically it’s a daily practice of finding three things in your encounters:

  1. Something that surprised you
  2. Something that touched your heart
  3. Something that inspired you

Many of you may think this is a waste of time, frivolous, meaningless.  You have more important and pressing things to do.  I admit, I am not a consistent practitioner.  I feel anxious: What if I can’t find anything?  That must mean I’m mindless, cold, and utterly un-inspire-able.  Remen says this is okay— “DO NOT BECOME DISCOURAGED!!   Many people find that for a little while the answers to all three questions are exactly the same:  NOTHING, NOTHING and NOTHING.”

Wouldn’t it be so much better to be able to answer with, “This, THIS, and oh my God, THIS!!”  Every day?

We have 22 more days of November.  If you comment that you will challenge yourself to this practice every day for the rest of the month, so will I.  And we can compare notes along the way.  Whattaya say?

 

On Training

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NaBloPoMo 2016, Letters to Patients, Day 1

To The Patients Who Trained Me:

Thank you, from the bottom of my heart, and God bless you, every one.

To the elderly lady with heart failure, who donated your body to science so that I may learn anatomy:  You were the greatest gift.  Your heart was literally as big as your head, and at the time I just thought it was peculiar.  Now I understand the extraordinary adaptive capability of the human body, and I marvel at it every day.

To the inpatients who endured hours of repetitive interviewing and clumsy physical exams by us medical students, all in the name of teaching:  Your engagement in the midst of your own suffering testifies to the infinite potential generosity of humanity.  Your contribution to medical education cannot be overestimated.

To the kindhearted artist in my resident clinic, the first patient to page me for advice:  You showed me that I knew what I was doing, even in training.  You had classic of sinusitis, and I called in the appropriate prescription.  In a moment of sudden panic I wondered if I should have called my preceptor first.  No, I can do this, I realized.  I’m meant to do this.

To the articulate, confident housewife whose retired husband drove you to me in acute agitation:  I learned from you that life phases never cease to evolve.  Our relationships, however longstanding, hold infinite complexities that manifest in jarring and also predictable ways throughout life.  You taught me that stability is overrated, and also underappreciated.

To the wonderfully kind man, one of my first patients in practice, who came in with the nasal balloon:  Your patience and trust will humble me forever.  The emergency room doctor had placed the balloon for a prolonged nosebleed.  He instructed you have me take it out.  I had never seen such a device before, much less deflated and removed one.  You let me examine it, think it through, and finally just cut the tubing with scissors.  We bonded over that and you continued to teach me about collaboration and sharing between patient and physician all the while I knew you.

To all whom I encountered in those early years:  There are too many of you to name, too many to acknowledge fully.  But every one of you helped make me the physician I am today.  With each new meeting now, each applied principle and physical exam technique, I thank you and honor you, my esteemed teachers.

Holding the Space for Connection Through the Hard Conversations, Part II

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Today I watched this video of Trump supporters at his rallies.  Their words, actions, and expressions represent the basest human emotions.  I posted the video to my Facebook page, commenting:

(Donald Trump incites rage and hate) in his followers. He stokes the worst in people. He provokes the emotional states that preclude rational thought and reasonable behavior–he is the king of emotional hijacking. Nobody ever makes a good decision while emotionally hijacked; that is when relationships and connection are destroyed, often violently and permanently.

And here’s another irony:  We non-supporters are similarly hijacked by his belligerence.  He and his supporters incite us to rail against them all, collectively and wholly as individuals, as racists, bigots, idiots, haters, etc.  Name-calling is the easiest and most convenient way to separate ourselves from what we disdain, what we fear, and what’s too uncomfortable to tolerate.  But how does this help anything?

On my last blog post I wrote:

I intend to avoid:

-Speaking and writing in sweeping generalizations

-Following snap judgments about groups, or individuals based on their group membership

-Labeling and shaming people or groups as ‘racist,’ ’ignorant,’ ‘stupid,’ ‘lazy,’ etc.

Today I wrote about Trump’s supporters:

I’m trying not to label and pigeon-hole these people, trying not to judge them and discard them, just by what I see here.  That only advances the exact mentality I seek to reverse: more separation, more hatred, more “you are less than me, you don’t matter.”

I guess I have to keep reminding myself.

I can hardly imagine what it would be like to sit down, one-on-one, with someone who sincerely supports a Donald Trump presidency, and have a conversation about it.  But I can easily imagine talking to a Trump supporter about the trials and joys of parenting, the breakneck evolution of technology, and a mutual love of Marvel movies.  Who knows, maybe I already do.

I think most of my friends know my political persuasion.  Most of them also share it.  But probably more than I realize don’t share it, and we avoid talking about it.  Why?  Because it’s uncomfortable.  We don’t trust ourselves to avoid the emotional hijacking.  We’re afraid we’ll say something we’ll regret and damage the relationship.  Or (and), we see the only objective of such conversations as trying to change the other person’s mind, or having our mind changed, which feels at the same time futile and scary.  So our avoidance of the hard, uncomfortable conversations is an attempt to maintain connection (with ourselves as well as one another).  We intrinsically understand that our relationships are important.  So we limit our conversations to topics on which we agree.

At this time in our human evolution, however, we are called to do more.  It’s too easy to live in the echo chambers of like-minded friends and media sites.  It’s too easy to filter our perceptions through repetition and reinforcement, to think that our point of view is the only one, or worse, the only right one.  It’s too easy to label others as wholly racist, sexist, bigoted, idiotic, communist, misogynist, mindless, right-wing, extremist, or evil, based on impulsive interactions in comment sections on a blog or Facebook post.  It is simply too easy to fall victim to premature judgment and conviction based on skewed and incomplete evidence.  We are called to so much more.  We are called to the hard conversations, the interactions that require effort and persistence.  Why?  Because the rewards of this work are understanding, compassion, empathy, connection, and love.

My friend wrote to me, “We have to do this work for your beautiful children.”  Yes, my dear friend, for all of our beautiful, innocent children.  Let us model for them what it means to Hold the Space for Connection, even, and especially, when it’s hard.  This is the work we are called to do.