Category Archives: Health

What Do You Protect?

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What does this question mean to you?
What comes to mind first?

Voice actors I admire post about vocal rest and nasal/sinus care regimens, hydration, and air purifiers. Of course this makes sense; they protect the source and tools of their livelihoods.

It comes up with my executive patients often. Of all of their habits in the 5 reciprocal domains of health (Sleep, Exercise, Nutrition, Stress management, and Relationships), which are the keystone practices that hold them up and make it possible for them to handle the myriad pressures and responsibilities they shoulder? Exercise often emerges as a primary method of protecting their mental health as much as physical, so they may continue to withstand the demands of a work culture that actively threatens their health and well-being.

After some particularly insightful exchanges with patients and friends this week, I asked myself the question. What do I need to protect? With the next heartbeat, the answer was my empathy. Fascinating! This also makes sense–as a primary care doctor, I function best when I am fully present and attuned to the person in front of me, listening to their stories and concerns, doing my best to understand their subjective perceptions and experiences. Without empathy, I am both less effective and less fulfilled, both in my work and outside of it.

So what are my keystone habits, and how does protecting and strengthening them affect my ability to attune and empathize?

Sleep: This one is easy; I am a very good sleeper. It’s even easier now that I have decreased my weekly caffeine use by about 85%, thanks to 116 days of a new morning routine. I’m even getting close to seven hours of sleep a night now, much better than before (no more 1:00am blog posts!). I don’t think this directly elevates my empathy, but it definitely improves my mood and mental resilience.
Exercise: I have now maintained a regular and challenging exercise program for 10 years, well documented among the 600+ posts here. Strength, core, and cardio training make me more knowledgeable advising patients on their programs, and earns me credibility. I can empathize with the multiple adverse consequences of injury and the emerging limitations of aging bodies, and advise as both physician and fellow athlete.
Nutrition: This is definitely my achilles heel, my most vulnerable health domain. But maybe this makes me uber-empathetic to my patient’s struggles? Because is there anything our society shames and judges more than how we eat, while simultaneously surrounding us with the least healthy food options in gargantuan portions? We struggle together, my patients and I.
Stress management: Today I can confidently say that I lead by example in this domain, thanks to so many teachers, role models, and books. I can engage in almost any conversation with calm confidence, even when conflict is high. I can tolerate adversity and the attendant difficult emotions with far less agitation than even a few years ago. I recover quickly now. Even when a patient screams profanities at me, I can maintain both my composure and my empathy for their distraught state of mind. And then I can respectfully and diplomatically discharge them from my practice.

Relationships: I have said for a while now that the four domains above serve this one. Self-care habits indicate our relationship with self. How we care for and nuture ourselves influences how we show up to the people in our lives, both personally and professionally, and in public. Our behaviors in all of these realms also indirectly impact relationships between other people in our sphere of influence, know it, like it, want it or not. Without question, it is my relationship practices, internally and externally, that most uphold my empathy.

Quality time and contact in deep connection with my people are absolutely what hold me up, so that I might hold up others. It’s the best self-sustaining cycle, really. I have felt so joyful, so euphoric, so absolutely uplifted for so long but the past year in particular, because I attend to my relationships with intention and dedication. I schedule time to write, call, meet, share, and commune. Every encounter is meaningful and nourishes me, body, mind, spirit, and soul. Even meeting someone for the first time, I can bypass meaningless small talk and easily engage in conversation that connects. Who knows what I might discover about anything just by talking to someone, anyone? With this confidence, every stranger has the potential to be my next good friend, and it makes me practically giddy. As I moved from narrator to narrator at Readers Take Denver, I’m still floored at how effortlessly each conversation, even if brief, dropped into heartfelt resonance and mutual uplift. I will forever remember that day and that event as a shining example of the immense possibility of human connection.

My relationships feed my empathy, compassion, presence, openness, curiosity, and learning, and these practices then strengthen all of my relationships, new and old alike. It is the most rewarding postive feedback loop. I take pride in my emotional presence and observational and psychological synthesis capacities in clinical encounters. My friends also admire these skills that I exhibit, and I hope I model them for the kids. The world needs our best relationship skills now more than ever.

So the important question is not only what do you protect, but why?

What are our functional layers of protection, and what do they serve? In the end, how does it all align with our core values and life purpose? What good does it all do? What contribution does it help us make?

What we protect and why indicate what matters most to us, no?

Of course this could all be one giant rationalization on my part. It’s a very new question to me, and I will ponder it further. Thank you for pondering with me.

What else does it bring up, and where will the next questions take you?

How Are You a Helper?

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Photo by Eileen Barrett

I have thought actively about this question for weeks now, if not many years.

It’s easy to see doctors, nurses, teachers, and childcare workers as Helpers–we do it for a living. Do you consider yourself a member of a Helping profession? Why and why not?
Here is my premise: We are all Helpers.

I just spent two days at Readers Take Denver, my first ever book event (it’s all about romance, surprise!). I skipped my annual national professional society meeting, in the city where Son goes to school, to attend this giant convention where I would meet some of my favorite voice actors and fellow Shane East fanatics. It. Was. Glorious.

I decided to get the whole experience, so I registered to volunteer for parts of the event. I was assigned to help Susie Tate for an afternoon, taking pictures with readers and moving books. I knew of her but have not read or listened to any of her work. Turns out she’s a doctor in the UK! We hung out between signings, and when anyone approached the table I got so excited to help a fellow woman physician writer connect with her readers! What a privilege. Looking back on our conversations, it stands out to me that Susie’s work as both physician and romance author helps people immensely. She may see 50 patients a day in her general practice clinic, and when someone is sick she knows how to navigate the system to get them admitted while also caring for everybody else on her schedule. It’s heroic. She draws on her medical knowledge and experience in writing novels with complex characters, living relationships of struggle and redemption. Readers and listeners relate to her stories and gush about how much her books mean to them. Susie Tate and all of her romance author peers are Helpers, no question.

Let’s also consider the amazing, talented, generous, and gifted romance narrators, shall we? I have now met Shane, as well as Jason Clarke, Sofia Lette, Kit Swann, Angelina Rocca, Gary Furlong, Henry Kramer, Sean Crisden, Lessa Lamb, Chris Brinkley, Aaron Shedlock, and Teri Schnaubelt. Not only do they bring these empathic stories to life in our ears, but they are, themselves, some of the most kind, compassionate, present, thoughtful, and attuned people I have met. It makes sense, right? They engage with stories every day, putting themselves in a diversity of characters’ shoes, minds, and hearts, all in service of helping us relate more deeply and meaningfully to our shared humanity. Wow. Helpers. God bless ’em all.

En route to Denver, I texted my Ethos friends (who are all basically 20 years my junior):

The Ethos Breakfast Club showed up! Encouragement, reflection, validation, humor, and love flowed forth more than I could have imagined, and I felt immediately buoyed. I was able to present at the convention not just to Shane, but to everybody I met, all me and all in, feeling humbly confident, grounded, and attuned. If you are a friend, you are a Helper! In times of struggle, pain, defeat, and fear, who but our friends lift us up? In times of joy, accomplishment, celebration, and connection, who but our friends ampify the light most brightly? I say often, “The only way out is through; the best way through is together.” It is a truth I hold sacred; none of us does anything without help from others.

And it was on me to ask for the help I needed, no? Helping oneself, in this case knowing when, where, and on whom to call, is a life skill, as important as any other. Individualistic Western culture promotes a delusion of self-made-ness that harms us. With help from one another, we can learn to balance independence with interdependence and live richer, more stable, and more fulfilling lives. We simply cannot overestimate how much human connection helps and heals.

Know it, like it, want it or not, we are all in relationship. All humans, everything in nature, the cosmos. Therefore, anytime you do something that makes anything better for anyone else, you Help us all. Stocking grocery store shelves. Driving a city bus. Growing food. Performing standup comedy. Listening. Parenting. Taking care of yourself.
Imagine if we defined any given job or activity as Helping? How would this change our perspective about its role in society? How would we show up differently to the work in this new context? ‘Helping,’ as a concept, feels very different from ‘providing a service.’ The former is personal; the latter is transactional.
Helping is connecting, person to person, recognizing and honoring shared humanity.

Identify as a Helper.

How could everything be better if we all practiced this, even a little bit?

Susceptible

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How do you assess risk?

For a long while now I have thought of risk in terms of intrinsic and extrinsic factors. For any given challenge, any individual (or collective) may have certain baseline predispositions for a certain consequence or outcome. The intersection of those innate properties with the external environment and conditions then create the actual outcome(s). This post is about self-awareness and self-regulation in service of mitigating risk in two situations: Infection and severe mental stress.

Infection

When was your last COVID vaccine? There have now been two booster vaccines available after the initial doses back in 2021. In the current endemic state of the virus, repeated vaccination feels less urgent than before. Some will continue to say ‘always’ or ‘never,’ but most of my patients want to discern more thoughtfully. I advise situationally. The following applies not just to COVID, but for any infection we may contract in the wild:

Intrinsic risk: What is your overall state of health? How many risk factors for infection and complication do you have (eg advanced age, respiratory illness, diabetes, other immune compromise)? What are your nutrition, exercise, and sleep habits, generally and now, and do they protect you or make you vulnerable (sleep deprivation and high mental stress increase risk)?

Extrinsic risk: What is your likelihood of exposure, in terms of intensity, duration, and novelty? What is your access to healthcare in case of severe illness? How would infection impact your function, livelihood, and the health and function of those around you (and what are their intrinsic risks, if you were to expose them)?

I did not get my second COVID booster until right before I traveled to Taiwan last month, even though it’s been available since last fall. It was mostly due to inconvenience, though I also did not want to spend a whole day in bed (my reaction to this vaccine), and I assessed my risk of infection and complication to be low. Then Husband got infected at the same time that Friend told me all about her severe and prolonged experience with long COVID, and I learned that cases in Taiwan were still fruequent and severe. I would be traveling alone with Daughter, who has asthma, spending 20+ hours each way and all days in country in crowded airports and public spaces. So while I had no overt intrinsic health risks, I was moved to vaccinate by both subjective and objective extrinsic factors.
I prioritized sleep the week before and all through traveling. I minimized caffeine intake. We wore KN95 masks in all public spaces throughout the trip and washed hands vigilantly. COVID infection during international travel is no joke, and we took no chances. Thankfully, we arrived back home uninfected and healthy.

When thinking about any infectious disease, I consider goals and trade offs. How important is it to avoid this illness, in general and right now? What are we willing to do and not do to prevent infection? What are the real costs of prevention and potential costs of illness? How can I minimize my susceptibility in a realistic, pragmatic, and balanced way? As a physician, I must consider infection impact not just on an individual’s health, but on public health as well.

Severe Mental Stress

In recent years, I have added a slide on distress tolerance to my wellness presentations. Practices like cold water to the face, paced breathing, and progressive muscle relaxation can help de-escalate us in the throes of acute emotional hijack, helping us get back from fight or flight to thinking clearly and acting reasonably. We have all encountered situations when we feel overwhelmed, out of control, and powerless. We each have our own unique triggers and reaction patterns, whether it’s performance anxiety, phobia, vicarious trauma, or simply rage, sadness, shame, etc.

Intrinsic risks for severe acute mental stress include history of trauma, tendency to avoid uncomfortable feelings, difficulty managing and expressing feelings or thoughts, and baseline anxiety, depression, etc.

Extrinsic risks for emotional hijack include inciting events that trigger past trauma reactions, often subconsciously. This could be anything from seeing someone else experience the harm you endured, to simply entering an environment similar to one in which you felt unsafe before. Certain words or gestures can trigger us–it can literally be anything. We each have a different threshold in any given situation, depending on the intersection of our current state, baseline traits, and real time conditions.

Susceptibility to mental stress, however, goes beyond simply passive innate attributes coming in contact with inciting circumstances. We all have our stress tendencies, many of which we can only partially control, if at all. Here is where our daily patterns, habits, and practices can really save us. Sleep deprivation and dehydration make everything feel exponentially worse, in my observation. Regular physical activity regulates the autonomic nervous system and improves sleep quality. Moderation of caffeine and alcohol help mitigate these substances’ disruptive effects on brain and body. Consistent self-assessment of mood and energy, what affects them, and anticipating challenges and threats on the horizon can increase confidence in our ability to meet them. Practices such as mindfulness, prayer, and communion with loving others also boost resilience–both mental and physical. And we cannot overestimate the profound importance of healthy, strong, and loving relationships to hold us up through anything life may bring.

For mental stress, while intrinsic psychological risks matter, our strong and consistent habits in the 5 reciprocal domains of health can (sleep, exercise, nutrition, stress management, and relationships) combine in synergy to minimize (or at least mitigate) our susceptibility to acute emotional hijack. Mindset, self-talk, communication skills, and attunement to others in daily life can set us up generally to encounter adversity feeling grounded and solid or vulnerable and insecure.

Thus, in addition to intrinsic and extrinsic risks, intrinsic assets also matter. The more we strengthen them when things are easy, the more easily we can call them forth when things get really hard.

I remind myself that though dividing risk into intrinsic and extrinsic is clear and helpful, it is also an oversimplification. History of trauma is not innate to me as a person, but the experience is integrated into my nervous system. Repeated subjective experiences accumulate and integrate further. I have, one could argue, adapted to it all in a way that protects me from recurrent harm in the future by alarming my system, mind and body, to similar threats, perceived and real. And while I practice my centering, grounding, inner peace methods, it also behooves me to honor and embrace my natural, un-peaceful tendencies. My best outcomes occur when I hold these all in dynamic balance, with nonjudgmental awareness and self-regulation. Anticipation, preparedness, and seeking support from trusted others also help mitigate my susceptibility to adverse outcomes and suffering.

In the end, I wish for all of us to live more peaceful, self-aware, self-efficacious lives. I want us all to move through good fortune with joy, and through adversity with fortitude and confidence, even while we allow ourselves to fully feel fear and distress. As an advanced practice in this domain, the better we understand our own intrinsic vulnerabilities and the conditions which expose them, and manage them effectively, the more likely we may recognize the unique struggles of others. We may all suffer less when these skills help us see, hear, and understand one another more empathically, compassionately, intimately, and lovingly.
We can, if we choose, help minimize one another’s susceptibility to pain and suffering.