What Doesn’t Kill Me

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NaBloPoMo 2018:  What I’m Learning

What does your doctor tell you about flu vaccine?  What about shingles vaccine?  Antibiotics?  This week I have had a series of both unifying and gratifying conversations around these topics.  I thank my patients for sharing their opinions and questions, which stimulate and sharpen my thoughts and expressions, all in service of making us healthier.

People have a lot of reasons for declining flu vaccine.  It’s usually something around not believing it does any good (it does), feeling they don’t need it and are not at risk for serious illness or death (we all are), and a general aversion to ‘putting something in my body that isn’t natural.’   Most people who decline flu vaccine still accept tetanus/diphtheria/pertussis, hepatitis, meningitis, or other vaccines.  I find this interesting.  The rationale behind all vaccines is the same—saving lives and minimizing serious illness and complications, especially for vulnerable populations like babies, the elderly, and people with immune-compromising conditions (pregnancy, cancer, diabetes, autoimmune disorders).  We are contagious before we feel sick—this is the natural genius of viral survival and spread.  So this flu season, cover your face with your arm when you sneeze, wash or sanitize your hands after every encounter with any surface, and don’t share drinks or utensils with anybody.

Shingles is interesting.  You cannot get shingles unless you have had chicken pox or the chicken pox (varicella zoster) vaccine (though shingles after vaccination is rare).  After the acute illness (and sometimes after vaccination), the virus does not go away.  Like other herpes viruses, it lives in your body permanently and reactivates under certain conditions.  In my experience the most common trigger for shingles (zoster) is stress, either physical (eg sleep deprivation) or mental and/or emotional—often both.  The virus resides in the spinal cord and reactivates usually along a single nerve root, hence the typical pattern of a band of blisters on one side of the body.  For someone who has not had chicken pox or the vaccine, infection occurs through contact with respiratory droplets from someone with either chicken pox or shingles illness.

Here is my best analogy for how vaccines work:

Think of your immune system as law enforcement or a military operation.  Its job is to hunt down offending agents, apprehend them, subdue them, and kill them, if possible.  All such operatives need training to be effective.  Vaccines are like battle simulators.  We deploy them into circulation and trigger a drill response from immune system troops, making mobilization for the real, live attack more efficient and successful.  In the case of flu, offenders are shapeshifters, constantly changing their outward appearance to evade capture.  So simulators must be updated annually to prepare the troops in kind.

For shingles, think of varicella zoster virus (VZV) as the prisoner, your spinal cord as the prison, and your immune system as the prison guards.  Usually VZV breaks and enters when we are young, when our guards are also young, fit, and agile.  Over the years, our guards age.  With age comes sluggishness, memory loss.  The prisoner, however, remains as virulent as ever.  So it looks to escape through one window or another—maybe a left thoracic nerve root this time, a right lumbar next.  Shingles vaccine takes our dad-bod prison guards back to boot camp and reminds them what the enemy looks and acts like, so they may better thwart any escape attempts.  The new shingles vaccine, Shingrix, is recommended at age 50.

So, vaccines are basic training for our immune system soldiers.  I’ve never been anywhere near the military (God bless all of you who serve, and does residency count for something?).  For those who have, do you agree that there may have been times during training when you questioned your likelihood of survival?  And when you did survive, did you not emerge stronger and more confident for the experience?  What doesn’t kill me…

It’s the same for bacteria exposed to antibiotics.  There is no question, we use antibiotics too much.  Now think of bacteria as a horde of enemy invaders.  Our immune military wages war with these throngs at every orifice and mucus membrane of our bodies every day.  Every time we take antibiotics, however, it’s like coming over the battlefield with an imprecise explosive device aimed at the bad bacteria, but that also can cause collateral damage (eg friendly fire on our good gut bugs).  The problem with antibiotic overuse (and, in theory, shortened or incomplete courses of antibiotics) is that the bacteria who were already equipped to survive the blast now make up the majority of the surviving invasion party who can procreate.  They will pass on these survival traits to their progeny, and voila, antibiotic resistance.  The next time you have a respiratory infection, do not automatically assume you need antibiotics.  Talk to and/or see your doctor.  If it’s an uncomplicated viral illness, ask what else you can do to suffer less while your troops battle this transient, non-lethal invader.  Support them by hydrating, sleeping, eating healthy, and avoiding caffeine and alcohol.  Support yourself by medicating for the symptoms.  You’ got this.

What does not kill me makes me stronger.

It works both ways.

Living Large in Seventh Grade

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NaBloPoMo 2018: What I’m Learning

Did you know that Abraham Maslow never represented his hierarchy of needs as a pyramid?  I didn’t either!  To be clear, I have not read the paper I just linked; it was linked in a different article I read today, describing more about Maslow’s work than I have ever known before.  It’s in Scientific American, entitled, “What Does It Mean to be Self-Actualized in the 21st Century?” by Scott Barry Kaufman.

Especially later in his life, Maslow’s focus was much more on the paradoxical connections between self-actualization and self-transcendence, and the distinction between defense vs. growth motivation. Maslow’s emphasis was less on a rigid hierarchy of needs, and more on the notion that self-actualized people are motivated by health, growth, wholeness, integration, humanitarian purpose, and the “real problems of life.”

I was intrigued by this piece because I remember so clearly when I first learned about Maslow’s Hierarchy.  It was in seventh grade, and I can’t remember anymore the class or context.  I just recall that it made so much sense, and I felt such a swell of joy at the possibility that something so complex could be distilled and explained so simply.  It would have been fair to predict at that time that I would go on to become a psychologist.  The boy I had a crush on that year (and all through high school, actually) asked me where I saw myself on the pyramid.  I remember looking at the tiers and thinking, very clearly, oh, I’m at the top.  I felt a little sheepish, afraid I would be seen as bragging, but it was the honest answer, and I said so.  “Bullshit,” was his reply.  I can’t remember our verbal exchange thereafter, but I think I was able to convince him that I really felt like I was ‘there.’  And I left that encounter feeling both a bit more self-aware and also proud that I had stood my ground and defended a truth.  You could also have guessed I would later entertain a brief interest in law school.

Kaufman has revisited Maslow’s work, including his hierarchy of needs, and evaluated the components in the context of modern life.  Reassuringly, 10 of 17 of Maslow’s self-actualization characteristics still stand up to ‘scientific scrutiny,’ (not sure how he measured this).  He names the ten characteristics in the article, and you can ‘take the quiz’ to see how self-actualized you are today.  I love quizzes like this.  I have done the Myers-Briggs at least 5 times.  Others I love are Gregorc Mind Styles, Insights Discovery, and the Gallup Strengths Finder.  The most useful ones tell you what you already know about your strengths, and also offer advice and insights on how to manage your blind spots.

But the most interesting aspect of Kaufman’s article to me was Maslow’s interest in self-actualization and its relationship to self-transcendence.  We can understand self-actualization as ‘achieving one’s full potential’ and self-transcendence as ‘decreased self-salience and increased feelings of connectedness,’ (again, not read the paper; it’s linked in Kaufman’s article) or basically subsuming and/or integrating oneself within a greater whole.  At first you may think that these are mutually exclusive states of mind and being.  The coolest thing is that it’s not actually an either/or proposition; it is absolutely both/and:

While self-actualization showed zero relationship to decreased self-salience, self-actualization did show a strong positive correlation with increased feelings of oneness with the world.

Self-actualized people don’t sacrifice their potentialities in the service of others; rather, they use their full powers in the service of others (important distinction). You don’t have to choose either self-actualization or self-transcendence– the combination of both is essential to living a full and meaningful existence.

It reminds me of another subsection of Chapter 3 in Leading Change in Healthcare, wherein Suchman et al discuss holding the tension and balance between self-differentiation (clear sense of individuality) and attunement (deep awareness and acceptance of how we are connected and resonant with those around us).  It also reminds me of Brené Brown’s work on trust; she describes eloquently in Rising Strong how we can neither trust others nor be trustworthy ourselves without clarity and boundaries around who we are and our core values, and living in that integrity all of the time.

Once again, I find encouraging and validating evidence for something I really feel I have known since an early age:  We are all our best selves and our best communities not in competition, but in collaboration.   Cohesion in diversity weaves a stronger social fabric of connections, more flexible and elastic.  But that means we need to know exactly what we as individuals each bring to contribute.  Personal, intrinsic meaning and purpose are foundational for substantive interactions with others and resilient communal relationships.

Our world can meet each and every one of our physiologic, psychologic, and self-fulfillment needs—we can provide this for one another.  We can each strive for our own goals, alongside our peers, and still help each other on the rocky, uphill parts.  We really need to stop with the scarcity thinking and get on with the business of working together, maximizing each of our strengths, and making society better for all of us.

Onward.

Hope You’re Safe in Chicago

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NaBloPoMo 2018:  What I’m Learning

My friend texted me these words at 4:01pm Central Standard Time today.

Tamara O’Neal, an emergency medicine physician just one year out of training, was shot to death by her ex-fiancé.  He then went on to kill two others, and he himself died, though it remains unclear if he shot himself or died from a police officer’s bullet.  She was on her way to work, saving lives for a living, many of them probably victims of gun violence.

Samuel Jimenez, a 28 year-old police officer, also only beginning his career, was killed.  He leaves behind a wife and three young children.  He was doing his job, protecting innocent lives from deadly violence.

Dayna Less, a 25 year-old pharmacy resident, was also killed.  She was still in training, planning to go home to Indiana tomorrow to celebrate Thanksgiving with her family, and planning a wedding next year.

It could have been my hospital, or my husband’s hospital.  Or one of the hospitals where my sister or my friends or my mom work.  It could have been my children’s school.  An elementary school a few blocks away was locked down until 5pm.  What must that have been like for the kids and their parents?

I was safe in Chicago—today.  But none of us are actually safe, as long as we collectively continue to do nothing about the public health crisis of gun violence that grips and gags us.  And make no mistake it is a public health issue before it is a political issue.  That said, we in healthcare must continue rise up and call for action in policy.  We must demand more of our elected officials.  They must represent us and our collective public interest first and foremost.  A majority of the American public supports common sense gun laws like background checks, licenses for gun dealers, and restricting gun ownership by known domestic abusers.  This should be reflected in our laws and law enforcement.

Please read about the victims of today’s shooting.  Remember them before you read about tomorrow’s victims.  Look up the people who died in Parkland and Pittsburgh.  Put yourself in their shoes, as events unfolded on what started as just another day in their lives.  Imagine what must have flown through their minds—thoughts of children, parents, spouses, regrets, things they wish they had done, things they had looked forward to.  Imagine the terror, the disbelief, the pain, the utter loneliness, the longing for the comfort of loved ones, the wish for another day to be with them, to say goodbye.

Imagine being their family members now, trudging on each day without them, senselessly, with no justice, no closure.  Imagine caring for patients and their families in the emergency department, the intensive care unit, the neurological rehab hospital.  Imagine looking into the eyes of these people, the remaining years and decades of their lives irrevocably altered for the worse by events that unfolded over a few minutes.  And then imagine, as you continue to gaze into their eyes, telling them sorry, there’s nothing we can do about it, this is just the way it is.

The only way enough of us will be moved to take action is if enough of us can truly relate to the experiences of the victims and their families.  Nobody needs to actually live through such horror to be able to empathize.  The human brain is wired for empathy and connection.  At the same time that we cannot imagine what it must be like, we can absolutely imagine.  But we choose to separate, to disconnect, when things are too uncomfortable, to protect ourselves.  This is how tragedies like Columbine continue to happen, every week, every year, for decades.  Not. Acceptable.

Read the American College of Physicians position paper on reducing firearm injuries and deaths.  Apply a critical and objective eye and mind.  Try to understand its reasoning and look up the citations.  Read the appendix, the expanded background and rationale.

Do you want fewer people to die from gun violence in the United States?

What will you do to help reduce the harm?  Because we all need to help.

 

 

 

 

 

The Feels Are Good

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NaBloPoMo 2018:  What I’m Learning

I’ve been working for many years now on feeling my feelings rather than thinking them.  Rationality and analysis in service of self-awareness and understanding are great, but I have tried too long to will my hard feelings away, or experience them all as anger rather than what they really are—sadness, shame, fear, etc.

With books like The Art of Possibility, Mindsight, and Rising Strong, after multiple readings, along with years of therapy, I have acquired the skills to allow these feelings to emerge, engage, and pass.  I understand much better now the purpose of emotions: they are simply signals.  They are meant to draw our attention to something meaningful in our existence.  This could be a threat, a connection, a relationship, anything.  We modern humans spend a lot of time judging our emotions (and thus one another’s), trying to suppress the ones that make us feel bad, masking them, numbing them, and offloading them.  For whatever reason, we are not good at simply allowing them, learning from them, and letting them go.

I started following Nate Green on Facebook just before he deactivated his page.  He now communicates with readers through email newsletters, and his is one of the few I actually read.  This week he sent a rare second message, linking to his recent article for Men’s Health, “There Will Be Tears: Inside the Retreat Where Men Purge Toxic Emotions.”  If you read nothing else this weekend, read this.

Nate participates in an Evryman retreat in Big Sky, Montana, a project “aimed at teaching men how to access and express their emotions.”  When I saw the headline I felt a squirming in my gut, which surprised me.  We, especially we women, are always urging men to be more ‘in touch’ with their feelings, right?  Don’t we always want our men to be more sensitive and caring, more empathic and expressive?  Don’t we want them to role model all of this for our children, especially our boys?

Nate describes the retreat and its exercises:

My thoughts are racing. I shift my feet. Andrew shifts his. We continue to stare at each other. Finally, Andrew takes a deep breath and speaks. “If you really knew me, you’d know that I smoke too much pot and use it as a coping mechanism. And you would know I’m ashamed of it.”

His gaze lowers, embarrassed. He looks back up and we lock eyes. Now it’s my turn.

“If you really knew me, you’d know that I sometimes drink too much alcohol and it worries me.”

I have never spoken those words out loud before. I instantly feel lighter, like a giant
weight I didn’t even know was there has been lifted. Andrew smiles, happy to not be alone in his confession.

“Thanks,” he says.

“Thank you,” I say.

…To our left and right are 16 other men, paired off just like us. Behind us sits a gigantic log cabin that will be our home for the next two nights. After that, we’ll carry 50-pound packs into the backcountry of Yellowstone National Park, where we’ll walk and sleep among the grizzlies, mosquitoes, and stars for three more nights.

We all met maybe an hour ago.

Yikes.  I’m pretty emotionally confident and open, and this would be hard for me.  Imagine (or maybe you don’t have to) how hard it would be for outwardly strong, independent, and stoic men to do this.  What would it take for you men to go on a retreat like this?  Women, how do you picture the men in your life going through something like this?  How would we react if our men disclosed their innermost fears to us, cried openly in front of us, at home, at work, on the field?

For a long time I did not understand how hard this is for men.  I thought they were all just shallow and simply did not have emotions (other than anger and sarcasm).  In Daring Greatly Brené Brown writes how she learned about the severe threat that vulnerability really is for men.  After one of her presentations she was approached by an older man, a husband and father of her superfans.  He pointed out to her that though we say we want men to show more vulnerability, the moment any man does, he immediately pays a steep price.  I like to think we would welcome it, but I have a feeling many of us would react with shock and dismay, at least initially.  We complain about how women are perceived as weak and ‘hysterical’ when showing emotion, and if I’m honest, I might feel the same or worse about a man doing it.

So our mission should be to make it okay for all of us, men included, to ‘be emotional.’  That does not mean losing control and acting out.  It does not mean using emotions as an excuse for abusive behaviors.  It means allowing and holding space for our common human experiences to affect us at our core, and acknowledging how it feels.  It means helping each other breathe and walk through it all, holding each other up through the hard parts.  In Rising Strong and Dare to Lead, Brown takes us through steps she and her team have developed for working through hard emotions, called the Reckoning, Rumbling, and Revolution.  I’m getting really good at the first step, also known as the Shitty First Draft.

I know I have included multiple links here with minimal explanation.  It’s late.  And you can click and read at your leisure.  Or maybe you don’t need to; maybe you know exactly what I’m referring to and you march with the same mission already.  If so, let’s connect.  Let’s find all of us who understand the profound need for this shift in culture and society.  Let us form a chorus and sing loudly to whomever will listen, and make the world better for all of us—men, women, children—all of us for one another.

 

Less Phone, More BOOKS!

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NaBloPoMo 2018: What I’m Learning

Hi, I’m Cathy, and I’m addicted to my phone.

Last month I finally decided to do something about it, mostly so I could be more present to the kids.  It’s been a fascinating journey so far, and I’m proud to say I’ve already made progress.  First I banned Facebook after 6pm.  That went well until I traveled.  Then I took the Facebook app off of my phone.  The withdrawl continues to spike at times.  I also notice that I use other things to substitute—New York Times, email, Washington Post, email, WordPress Reader, email.  I notice an anxiety, a frustration, a kind of crazed, darting hankering– I crave that dopamine hit.

The awareness of it all, however, and the commitment to get disentangled from my screen, has cleared space for a recently dormant impulse to surface afresh:

READ!

* * *

At the conference last month I was turned on to the idea of complexity (or chaos) theory and how it relates to fixing physician burnout and turning our whole medical system around.  It was positively mind-blowing (for me—most others did not seem quite as lit).  The speaker was Anthony Suchman, my newest hero.  Some highlight ideas:

  • Every system is perfectly designed to get exactly the results it gets. Our current healthcare system evolved to this point precisely from serial and cumulative decisions made over years, even though the current state was never the intent.
  • We think of organizations as machines, with predictable, linear consequences of adjustments in one part or another. This is rarely how organizations (of people) actually work.  Rather, we can think of organizations as conversations, and let go our expectations of particular outcomes, the illusion of total control.  We can let things unfold and go where the outcomes lead us, all while holding to core values and goals.
  • Patterns are (re)created in each moment, and also self-organizing. So at the same time that a pattern (eg culture) seems inevitable and self-propagating, sometimes small, almost imperceptible perturbations can create new and dramatic cascades that lead to transformation (the butterfly effect).
  • Emergent Design thus embraces the approach of “finding answers we are willing to not know,” trusting that we will get where we need to go simply because we are paying attention (or that’s how I interpret it today).

This theory that everything within a system both results from and also contributes to the whole system (a fractal) validates an idea I have been advocating to my patients for years, and that I continue to personally relearn ad nauseam: It’s all connected.  The most concrete examples are Sleep, Exercise, Nutrition, Stress Management, and Relationships—I used to call them the 5 Realms of Health; now I call them the 5 Reciprocal Domains.  Each one is inextricably connected to every other one, and they all move in concert, with subtle or dramatic dynamics.

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I browsed around my local bookstore a couple weeks ago and came across a colorful title on the shelf: Emergent Strategy by Adrienne Maree Brown.  So of course I snatched it up.  The blurb says:

Inspired by Octavia Butler’s explorations of our human relationship to change, Emergent Strategy is radical self-help, society-help, and planet-help designed to shape the futures we want to live.  Change is constant.  The world is in a continual state of flux.  It is a stream of ever-mutating, emergent patterns.  Rather than steel ourselves against such change, this book invites us to feel, map, assess, and learn from the swirling patterns around us in order to better understand and influence them as they happen.  This is a resolutely materialist “spirituality” based equally on science and science fiction, a visionary incantation to transform that which ultimately transforms us.

Holy cow, YAAAAS!!  I could not wait to read it!  So I bought it, along with Make Trouble by Cecile Richards, What If This Were Enough? By Heather Havrilesky, and The Dharma of “The Princess Bride” by Ethan Nichtern.  I had also ordered Leading Change in Healthcare, coauthored by Dr. Suchman and two others.  That copy arrived last week.

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I feel this as all part of a slow turn, getting off my phone and diving into books again.  I’m so excited.  I have done this before—buy a bunch of books and never read them.  They occupy whole shelves in my bedroom.  But I honestly feel a transformation coming on.  Yesterday I spent a couple hours reading, researching, and writing the blog post, then I turned off the computer and opened Brown’s book.  I read through the long introduction and resonated with sentences like, “Emergence is the way complex systems and patterns arise out of a multiplicity of relatively simple interactions.”  This is a quote from Complex Adaptive Leadership: Embracing Paradox and Uncertainty by Nick Obolensky (which I have also now ordered).  I also love (ha!), “Perhaps humans’ core function is love.  Love leads us to observe in a much deeper way than any other emotion.”  Also:

all that you touch

you change

all that you change

changes you

the only lasting truth

is change

god is change

That is a quote from Parable of the Sower by Octavia Butler.

Then before bed I opened Suchman et al’s book and found these words, also in the introduction:

Complexity theory here is enriched by the focus on relationships [Hallelujah!], rather than the more traditional reference to science.  “Relationship-Centered Care” is a way of thinking that brings love and all that is personal into a world, the world of healthcare, that is mostly interested in more control and more data-based, evidence-based practices.

The point is made throughout that administrators cannot bring real change into their healthcare institutions without going through change themselves.

(The book describes) the relationship-centered social dynamics that are at the heart of Lean and a major source of this method’s success.  Unfortunately, these social dynamics are overshadowed or even displaced by the analytic technique in some Lean implementations, compromising results.

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So I’m learning about new ways to think on change.   It’s changing how I approach trying to change my patterns, how I see my relationship to them, how I see all relationships.  Wow.

All of this to say, I feel a deeply personal, yet global and cosmic impulse for growth, for transformation—a shift into more mindful and intentional use of my time and energy, and how I manifest it outward.  Less distraction, more focus.  Less incidental information consumption, more integrated learning and coordinated application.  Less phone, more BOOKS.

What will be the outcome?  I have no idea, that’s what makes it so exciting and wonderful!  Onward!

 

Running Strong In Our Lane

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NaBloPoMo 2018:  What I’m Learning

So the NRA tweets, “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

Hmmm, self-important.  Yes, sometimes.  After four years of college, four years of medical school, up to seven years of residency and then another 3 years of fellowship to earn the privilege of operating on the spines, nerves, organs, and blood vessels of gunshot victims, to maybe give them a chance to stay alive much less walk and talk, I can tolerate a little (just a little) self-importance in my emergency medicine, neurosurgery, trauma surgery, critical care and other colleagues.  They are f*ing rock stars.

Anti-gun.  I have yet to meet any physician, or any person, really, who is wholly anti-gun.  We are pro-gun safety, anti-violence by guns.  We would like for toddlers to not kill their siblings and parents by accident.  We would like for domestic disputes to not escalate to someone shooting their family and then themselves in an impulsive fit of rage.  We would like for depressed and suicidal patients not to actually kill themselves, which is too much easier to do with a firearm than any other method.  We just want to stop being the only country where so many die every year from being shot by guns.

The American College of Physicians (ACP), the internal medicine professional society and my home for professional communion and development, and the largest medical specialty organization, has published an updated position paper on reducing firearm deaths in the US:

In 2015, 9 (the ACP) joined the American College of Surgeons, American College of Obstetricians and Gynecologists, American Public Health Association, American Psychiatric Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, and American Bar Association in a call to action to address gun violence as a public health threat, which was subsequently endorsed by 52 organizations that included clinician organizations, consumer organizations, organizations representing families of gun violence victims, research organizations, public health organizations, and other health advocacy organizations (2). Yet, firearm violence remains a problem—firearm-related mortality rates in the United States are still the highest among high-income countries (3).

Cited in their tweet, the NRA Institute for Legislative Action posted an article (no author identified) picking apart the ACP’s research citations and approach, stating, “This position paper leaves one wondering if the authors reviewed the evidence, or just found works that suited their needs. For all of the bluster about their own important role in the anti-gun movement and all of the misuse of research findings, the ACP makes one thing clear: they respect their own rights and opinions far more than they do those of law-abiding gun owners.”  *sigh*  As I have not read the primary literature on gun mortality and public health myself, I will not comment on that here.  I will just say that I wholeheartedly trust in the integrity of my colleagues and leaders at the ACP.  I’m proud of our advocacy for patients and, more recently, for physicians ourselves and our well-being.

My physician colleagues have posted a multitude of passionate responses on Twitter; you can read them here, here, and here.  And I just now saw this open letter to the NRA from the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) and signed it.  Below are highlights—please take a look.

I admit, I initially responded with profanity at seeing the NRA tweet.  My threshold for swearing is very low these days.  And I wanted to just post screenshots of the anti-NRA tweet storm and let them speak for me.  But that’s not me. I have yet to really decide how I want to design my public platform and conduct on issues like this.  For now, I can just say that tweets and articles like the NRA posted are disappointing.  I don’t want to follow that lead.

* * *

Dear National Rifle Association,

On Wednesday night (11/7/2018), in response to a position paper released by the American College of Physicians (ACP) Reducing Firearm Injuries and Death in the United States, your organization published the statement “Someone should tell self-important anti-gun doctors to stay in their lane.”

On that same day, the CDC published new data indicating that the death toll from gun violence in our nation continues to rise. As we read your demand for us doctors to stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death–gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must ALL come together to find meaningful solutions to this very American problem.

We, the undersigned – physicians, nurses, therapists, medical professionals, and other concerned community members – want to tell you that we are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

Our research efforts have been curtailed by your lobbying efforts to Congress. We ask that you join forces with us to find solutions. Help us in our non-partisan, physician-driven research efforts at AFFIRM Research.

We invite you to be part of the solution.

You dismissed the ACP’s position statement on preventing death and injury from gun violence by stating, “Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

We extend our invitation for you to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence, and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane.

 

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.