November 21:  Cardio Catch-Ups Make Me Better

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Ummm, this may not be my photo!  It was on my phone from 2017 and I can’t remember where it came from–I usually ask friends for permission to use… If it’s yours please claim it!

NaBloPoMo 2019

Is there something you should do but you don’t always want to?

Exercise perhaps, or laundry?  Dishes?  Cleaning and decluttering?

Last year I listened to Better Than Before by Gretchen Rubin.  It was a fun, relatable, well-researched and –reasoned book on habit formation and change.  I have recommended it to many patients for its myriad practical strategies.  One that particularly resonated with me was the idea of pairing.  Basically if we combine the thing we should-but-don’t-want-to-do with something we like or do-want-to-do, we are more likely to form and strengthen the habit of the ‘sbdwtd’.

In one of those Eureka! moments of instant understanding and integration, I started saving my favorite TV show to watch while doing the interval program on my elliptical.  Thanks to the hubs for positioning the cardio machine right in front of the TV in the basement!  Sadly, The Big Bang Theory has concluded and there are no other 30 minute shows quite so compelling to get me moving.  Thankfully I have my favorite podcast and Liked Songs list on Spotify, so I’m not totally sedentary.  On days when I’m really motivated, I still do the 7 minute workout or a TRX program.

***

Do you wish you could connect more often with friends?

Years ago I remember talking on the phone while unloading and putting away groceries or folding laundry.  My friend was in San Francisco, I in Chicago.  We knew each other’s days off and would just call when we had a moment, and talk if we were free.  Farther back, in college and med school, we could all just hang out at each other’s apartments, pretending to study, but really just eating and talking.  Now we text, which is nice, but it’s not the same.  Somehow it feels harder to get folks on the phone anymore, and even harder to meet in person…  I miss my friends.

I’m getting a little better, though.  Sometimes I make phone dates with people for my commute.  It can be challenging across time zones, but we make it work.  It’s finite and somewhat reliable—I have to spend 30-40 minutes in the car at some point on any given morning and evening on workdays.  I even managed to connect with two Counsel members for pep talks before important meetings recently.

This month my new friend Alex and I started a new connection method, the Cardio Catch-Up.  She lives in DC and has to walk her dog.  I still need to work out, which I usually do in the evenings.  So we arranged a call over exercise tonight.  It was perfect!  I had to commit to a certain time, and my friend held me accountable.  I got on the machine and didn’t even notice the time going by (okay it just went by a lot faster), while we bonded over our LOH learnings, musings on human behavior and tribal dynamics, and our shared progressive values and aspirations for the planet.  I got my workout in, check.  And we both alighted on themes for future blog posts.  Tonight’s nascent idea:  Is the contagion of urgency the best vehicle for motivation?  Who knows where it will lead, into what it will grow, with what it will merge?  Regardless, it was born of an optimal pairing.

***

The Cardio Catch-Up is the perfect multi-win:  Move the body, release stress and tension, connect with another beautiful human, exercise the mind, and inspire the spirit.  Who wants to do it with me next week?

November 18:  Relentless Curiosity Makes Me Better

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NaBloPoMo 2019

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”
― Rainer Maria Rilke

Tonight, in the month of gratitude, I feel deeply thankful for Coach Christine.  I might have been a curious person all along, but it was not until I got a life coach that I learned the vast and profound value of curiosity in every realm.  As I wrote earlier this month, standing always in curiosity liberates my mind.  It relieves me of unnecessary urgency for an answer.  I can exercise professional creativity in forming better and better questions, and the answers (often multiple, intertwined, and intriguing) emerge more easily and artfully than if I chase them demandingly.

The business of medicine is to solve problems, to heal, to cure.  So we assume that the faster we get to answers, the better.  And they had better be the right ones, because lives are at stake here!  It’s always interesting to me when patients talk about my work as ‘saving lives.’  I can’t remember a time when I could actually make that claim, at least at all directly.  But to my colleagues—emergency medicine and critical care docs, trauma surgeons, suicide hotline counselors—thank you, you really do save lives every day!

I love primary care because I usually have the luxury of ‘(living) the question.’  When patients present with new problems, as soon as I know they are stable, I get really excited.  I’m liberated to get deeply curious, ask as many questions as they will tolerate, paint the big picture together.  I follow the standard physiologic and diagnostic process initially, which often yields a straight forward answer and plan of care.  But life and work would be pretty boring if that were always the case.  When the usual suspects are all acquitted and the mystery persists, that’s when things get fascinating.  This is when I really get to know a person.  When I ask truly open, honest questions—the questions I don’t know the answers to and that are not meant to lead anywhere—I never know where the conversation will go.  And I always learn something new and relevant, something that helps me connect.  This is the information that makes a person memorable, because it is truly unique to them.

One of my favorite moments in a patient encounter is when I have to pause a few seconds to form a really good question.  What do I really want to know, what am I after, what will really break open this conversation?  It happens regularly, and wow, what a rush.  OH, I just never know what I will learn!  You’d think people would get impatient and grumpy with such prolonged, sometimes meandering interrogation.  But I find that they often lean in, look me in the eye.  They get on the train with me and look as eagerly as I around the next bend.  What will we find?  Let’s explore together!

Relentless Curiosity.  It’s the funnest part of my work.  I love it.  And as we all know, loving our work makes us better.

November 16:  Loving Subversion Makes Me Better

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NaBloPoMo 2019

Friends, do you already follow Seth Godin’s blog?  His post from Thursday stirred something a little irreverent in me.  It was about ‘allies and accomplices’:

To be an ally means that you won’t get in the way, and, if you are able to, you’ll try to help.

To become an accomplice, though, means that you’ve risked something, sacrificed something and put yourself on the hook as well.

We need more allies, in all the work we do. Allies can open doors and help us feel a lot less alone.

But finding an accomplice–that’s an extraordinary leap forward.

I thought immediately about my fellow Better Angels volunteers.  We have all committed time, talent, and treasure to the depolarizing of America.  We do it in public, in front of audiences and cameras, to reporters and members of our communities.  We openly challenge the prevailing culture of ad hominem, oversimplification, and overgeneralization.  We all come to it from our own internal optimism and hope.  But in the face of entrenched polarization and a culture of self-protection above all, we could never make any headway as individuals.  It is only together—as mutual accomplices—that we can truly claim and exercise our collective agency.

I feel even more buoyed by Ozan’s latest post.  He describes a series of well-known studies showing that people will organize themselves into in-groups and out-groups with remarkable loyalty, even around random and arbitrary distinctions like taste in abstract art.  This, of course, carries grave and important implications for prejudice and discrimination.  Ozan then points to two exemplars of the opposite, Dr. Martin Luther King, Jr. and Barack Obama.  In their most famous orations (see links), these remarkable leaders speak directly to what unites us as the foundation for solving our problems, rather than what divides us.

MLK:  The marvelous new militancy which has engulfed the Negro community must not lead us to a distrust of all white people, for many of our white brothers, as evidenced by their presence here today, have come to realize that their destiny is tied up with our destiny. They have come to realize that their freedom is inextricably bound to our freedom. We cannot walk alone.

Obama:  The pundits, the pundits like to slice and dice our country into red states and blue States: red states for Republicans, blue States for Democrats. But I’ve got news for them, too. We worship an awesome God in the blue states, and we don’t like federal agents poking around our libraries in the red states.  We coach little league in the blue states and, yes, we’ve got some gay friends in the red states.

I get goosebumps just reading the words.

It really feels like a loving subversion—of cynicism, scarcity, antagonism, and fear.

Who’s not better for that?

 

 

 

November 14:  Playing Piano Makes Me Better

 

Uncle Kawai 2011

NaBloPoMo 2019

Friends, do you play an instrument?

There is just something about music, no?  It’s transcendent.

I started playing piano late, at age 11.  There were two stores, at opposite ends of the mall, which sold pianos.  Our family made multiple round trips one weekend, listening to salesmen play the ebony Yamaha upright at one place, then the walnut Kawai upright at the other.  It had taken me a year, but I finally committed to practicing daily, and my parents agreed to invest in a good instrument.  I knew instantly that it must be the Kawai.  Somehow it took the ‘rents a few more tries (I was very patient—the stakes were high, as I was the one who had to play it) before they finally agreed.  I have always loved that piano.

Into high school, practice flagged often.  But I kept my commitment until volleyball and AP classes took over the waking hours of life.  By then my sisters had started playing, so I was let out of my contract early.  Looking back, it was only a slog at the beginning of any practice session.  Sitting down begrudgingly, intending to play for the minimum required time, I always stayed longer, feeling more relaxed and just a little more accomplished when I stood back up.  I did not realize it at the time, but playing piano soothed me.  Thankfully my mom pointed it out at some point, and I appreciated the experience that much more.

I was never a very good pianist.  Reading music was never easy or natural.  I had no patience to master music theory.  But I saved the music for certain pieces that I loved—Fur Elise, Pachelbel’s Canon in D (played to accompany the Mixed Choir singing The First Noel my sophomore year), and a Sonatina by Clementi.  Still, I did not play for at least 20 years.

My son wanted to play trumpet.  I waited.  Then he wanted to play violin, and I waited some more.  How about piano?  YES.  No mall, no local piano store.  But there was one place in a suburb close to church.  We went to see the cherry upright that I saw on the website.  It looked shabby and sounded terrible.  Looking around the crowded front showroom, no other pieces appealed to me in the least.  There was one walnut Kawai baby grand…  The sound was full, round, and resonant, like a true Kawai.  But it was outside of my price range.  The salesman looked at me a while, as if discerning something.  Then he took me to the back, where another Kawai baby grand stood in the corner, an ebony one.  Recently refinished, you could still see water rings and long, shallow cracks in the wood of the music shelf.  The bottom edge of the key bed had a series of almond-shaped dents, as if it had slid down a flight of stairs once.  It took about five seconds after hearing it played for me to buy it, cash.

Since 2011 our house has enjoyed the sounds of children learning to play music on Uncle Kawai.  The tuner said it was made in 1969, and the keys had never been eased.  Apparently Uncle had never had a home where he could showcase his full potential.  He was waiting for us.  Over the years I have occasionally sat down, pulled out my old sheet music, practiced a few minutes here and there.  Never enough time, always something else I had to go do.

This summer I finally undertook to learn Canon in C, which both kids have now played.  It’s a short, exceedingly simple variation on the theme, and yet sublimely beautiful to hear.  It’s even more glorious to play first-hand.  Even over the parts where I always stumble on the fingering, even though Uncle really needs another tuning, playing these two pages of music calms me, gives me joy, in a way no other activity can.

*sigh*

I’m always better when I’m calm and happy.

November 12:  Edits and Revisions MMB–Fierce Optimism 2.0

 

NaBloPoMo 2019

24 hour learnings:

  1. Unfocused thoughts lead to unfocused writing
  2. I tend toward word vomit when I’m excited

Note:  Hereafter, I will use “MMB” as the abbreviation for “Make(s) Me Better” if the title gets too long.

My deepest gratitude to lovingly honest friends whose feedback on last night’s post inspired me to attempt it again!  Let’s see how this goes—

***

Last Saturday, as I prepared for the Better Angels workshop, I thought of Dr. Martin Luther King Jr.’s inspirational words:  “The arc of the moral universe is long but it bends toward justice.”  I have referred to this quote many times over the years, and a phrase that I often add goes something like, “Bend that arc!  Hang on it with all your might!”  Meaning the arc bends toward justice only because we make it so, by working tirelessly for it, by consistently walking our talk.

Preparing for the presentation, I thought about friends who express hopelessness at any possibility for connection between opposing political sides, that we can actually work together to get anything done.  Some might even say that the Better Angels mission is futile, a waste of energy and time.

Then I felt something akin to a tidal wave rise within me, and I texted a friend, “I intend to make today a day of fierce, infectious optimism.”  At that moment I knew my goal was to take every experience of kindness, connection, empathy, openness, generosity, magnanimity, conviction, and hope, and channel it to the workshop and its participants.  Because though it was to be a skills workshop, teaching a way of doing, what we really need are all of the qualities I just listed—they are the way of being that bring true meaning and connection to the skills.

Google Dictionary defines fierce:  “showing a heartfelt and powerful intensity”; and optimism: “hopefulness and confidence about the future or the successful outcome of something.”

Yes, and:

Fierce Optimism Is:

Urgency with Patience

All important social movements occur (and continue) over generations.  Confrontation and revolution are necessary sometimes, but they are not enough.  It’s consistent, slow, grass roots change on the local level that sustains progress.  Fierce optimism gives me faith that even the smallest actions I make in service of my cause have impact.  I can set realistic expectations for how much I can move this mountain today.  Pacing myself, practicing persistence with patience, conserves energy and prevents burnout.  I can feel empowered and liberated at the same time, confident in my individual agency.

Patient urgency also allows me to look up every once in a while, notice my surroundings, and adapt to subtle changes, like when someone starts to soften.  The bulldozer of impatient words and heavy dogma plows through the door of someone’s mind that might have swung open freely, had I taken a more gentle approach.

Strength with Flexibility

Fierce optimism roots itself in core values, and also allows for learning and adaptation.  It confers the confidence to challenge our own beliefs and values, perhaps reinforcing them, grounding us in and strengthening our own personal truth.  But this confidence also helps us hear others’ stories, which broadens our perspective.  Standing in our core values while reaching out in curiosity, we learn about each other, and curtains open on a vast landscape of understanding that we may never have imagined.

Bruce Lee’s life philosophy included a metaphor of the bamboo and the oak.  Both are admirably strong, but under intense forces of nature, the great oak may break irrevocably.  The bamboo bends; it maintains its integrity, standing straight and strong again after the storm.  Listening with openness and curiosity is not weakness.  Allowing for nuance and the possibility that my mind may be changed is strength.  It makes me calm, agile, adaptable, and more effective.

Conviction with Generosity

Our assumptions matter.  They show up in our presence.  Let us check our attitudes toward the ‘other’.  Assuming and speaking only to their presumed selfishness and malevolence, we make ourselves small.  We become exactly the narrow minded and prejudiced enemy we deride.  How ironic.  Now more than ever, we need generosity.  This encompasses empathy, vulnerability, sincerity, humility, and a willingness to allow the complete humanity of every person.  Extending this grace to others in no way undermines my own cause.  It opens my heart to attract allies from everywhere.  Conviction without generosity too easily becomes tyranny; I want no part of that.

Fierce optimism choreographs an intimate dance between agitation and peace.  It holds tension without anxiety, potential and kinetic energy.

When I live in Fierce Optimism, I can hang on that arc and bend it like a badass.

November 11:  Fierce Optimism Makes Me Better

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NaBloPoMo 2019

On Ozan’s Inner Circle forum today, another member posted about his admiration for Dr. Martin Luther King, Jr.  It reminded me of a favorite MLK quote, which came to mind on Saturday as I prepared for the Better Angels workshop:  “The arc of the moral universe is long but it bends toward justice.”  I have referred to this quote many times over the years, and a phrase that I often add goes something like, “Bend that arc!  Hang on it with all your might!”  Meaning the arc bends toward justice only because we make it so, by working tirelessly for it, by acting visibly in accordance with our core values, and by consistently walking the talk.

I texted my friend the morning of the workshop: “I’m 90% excited, 10% nervous…Maybe 15%…”  Then I thought about the people I know who like the idea(l) of Better Angels, but don’t want to participate.  I thought about my friends who express hopelessness at any possibility that people on opposing political sides can ever connect, that we can actually work together across our differences to get things done.  I thought about the pushback I might get, that the Better Angels mission is futile, a waste of energy and time.  I felt something akin to a tidal wave rise within me, and I texted my friend again, spontaneously, “I intend to make today a day of fierce, infectious optimism.”  At that moment I knew my goal that day was to take every example and experience of kindness, connection, empathy, openness, generosity, magnanimity, conviction, and hope, and channel it to the workshop and its participants.  Because though it was to be a skills workshop, teaching a way of doing, what we really need are all of the qualities I just listed—they are the way of being that brings the skills to bear in the most meaningful ways.

This idea marinated for a couple of hours while I pictured the venue, reviewed the workshop content, made notes about delivery.  I thought again about my friends who feel like our world is crumbling around us, that so much progress made the last century is being eroded.  I completely empathize with this perspective, and I understand how it makes us feel we have to fight, to be aggressive and confrontational, to come at the opposition full force, like a bullet train.  Do they think listening and speaking skills focused on curiosity and openness too passive and ineffective?  Does optimism, the hopefulness and confidence that things will be okay, make me lazy about the issues that matter to me?

Below are the words I texted my friend to describe what I mean by ‘Fierce Optimism’.  Normally I would not share such nascent ideas on the blog, but whatever, it’s all an experiment, who knows what better ideas may come from this early sharing?

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Fierce Optimism Is:

Urgency with Patience

Or should it read, “Urgency without Impatience”?  What I mean here is simply that most things worth doing take a very long time.  All important social movements occurred (and continue) over generations.  At times confrontation and revolution are necessary.  But they are not enough.  Consistent, slow, organic, grass roots change on the local level is what sustains consistent progress, keeps it from regressing.  The acute urgency I feel to address my deep concerns (for instance, the profound rifts in our relationships) drives me to action.  But when that action is directed at another person, I must attune.  I have to set realistic expectations for how much I can move this mountain today.  Pacing myself, practicing persistence with patience, conserves energy and prevents burnout.  It also allows me to look up every once in a while and adjust to my surroundings, adapt to subtle changes, like when someone starts to soften.  If I’m bulldozing with strong words and heavy dogma, I am more likely to plow over and through any crack in the door of someone’s mind that might have swung open freely had I taken a more gentle approach.

Strength with Flexibility

Better Angels does not seek to make everybody—anybody—a moderate.  Rather, the goal is to hold our positions firmly and with principle, and practice seeing why someone else may hold a different position with equally strong principle.  In doing so, two things often happen:  First, by challenging our own beliefs and values, we can reinforce them.  Telling stories about the experiences that led us to our core values reconnects us with their origins, grounds us in and strengthens our own personal truth.  Second, hearing others’ stories helps us broaden our perspective.  Most of the time we only see things from our own point of view—this is our default setting.  But when we share personal experiences, really learn about each other, the curtains open on a vast landscape of understanding that we may never have imagined.  So while I may still hold my goals and objectives firmly, I can more easily release the rigidity of my method, tolerate setbacks with less suffering.  Earlier this year I listened to The Warrior Within by John Little.  He describes Bruce Lee’s life philosophy, which included a metaphor of the bamboo and the oak.  Both are admirably strong, but under intense forces of nature, the oak may break while the bamboo simply bends, sometimes to the ground, but without breaking.  Both stay rooted where they are planted, but one is more resilient.  Listening with openness and curiosity is not weakness.  Allowing for nuance and the possibility that my mind may be changed in some ways, while holding steadfast to my core values, makes me calm, agile, adaptable, and, I think, more effective.

Conviction with Generosity

This is about the assumptions we make.  Too often we cast ‘the other’ in abstract as sinister, evil, less than.  We hold up the most extreme members of the opposing group as representative of a dull and dumb monolith.  We oversimplify and overgeneralize, and then approach any individual we identify as belonging to that group as an assembly line package, a completely known entity.  We think we know all about them already, even if we have never met them, just because they identify today as “Red” or “Blue.”  In so doing, we make ourselves small.  We become exactly as narrow minded and prejudiced as the folks we accuse on the other side.  How ironic.  Now more than ever, we need generosity.  In my mind this encompasses empathy, vulnerability, sincerity, humility and a willingness to allow the complete humanity of every other person, regardless of their political, religious, racial, cultural, or any other persuasion.  Conviction without generosity too easily becomes tyranny, for individuals as well as organizations and governments.

*sigh*

Well, like I said, these ideas were just born two days ago.  Have I expressed them at all coherently?  Have I shown you intuitively apprehensible paradoxes?  Can you feel the dynamic balance of agitation and peace?  Tension without anxiety?  Potential and kinetic energy?  If not, that’s okay.  I’ll keep working on it.  That’s the essential outcome of Fierce Optimism, after all—we keep working, steadily, to bend that arc.

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November 10:  Experimental Questions Make Me Better

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NaBloPoMo 2019

What’s the most interesting question your doctor asks?  What effect does it have on you?

I get to ask some really fun and interesting questions of my patients.  They often come about spontaneously, then I realize how helpful they are, and I integrate them into my routine interview.

It was almost ten years ago now that I was seeing a pleasant young woman for the third time.  She had recurrent, nonspecific physical symptoms, and felt down.  She was having a really hard time at work, and it was having a significant impact on her overall health and well-being.  Around the same time I saw another patient, a young man.  He felt well overall, but was also not happy in his job.  I remember casting around in my mind, looking for a quick and easy way to quantify the negative effect of these patients’ negative work experiences on their health.  I can’t remember which visit sparked the 0-10 stress and meaning scale questions, but it was one of them, and then I repeated the questions on the other soon after.  These were my first two, unsuspecting, experimental question subjects.  On a scale of 0 to 10, how high do you rate the overall stress of your work?  That was easy, but I also had to figure out whether there was some benefit that was worth the cost of the stress.  So: On the same scale, how high do you rate the overall meaning of your work to you?  The bottom line is that we can tolerate very high levels of stress if the work is meaningful—for sustainable work, the meaning-to-stress ratio needs to be 1 or greater, and overall meaning is best at 7 or higher.  That year I realized I could create deeper, more helpful, more insight-revealing questions in my patient encounters.

My own work meaning rating rose by at least a couple integers almost immediately.

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Since then I have consistently asked about body signs of stress, resilience practices, the proportions of threat vs. challenge stress at work or home.  Since I last wrote about these questions in 2016, I have continued the experiments.

By 2016 I was also using the elite athlete analogy with my patients, asking every year about habits in the 5 reciprocal domains of health (after talking about stress and meaning at work): Sleep, Exercise, Nutrition, Stress Management, and Relationships.  But after asking the same questions for a couple years in a row, both my patients and I get a little bored.  So in 2017 I went a little deeper in the relationships category.  After confirming marital status, ages and health of children, I started asking, “Tell me about your emotional support network,” because the more I am reminded of the critical importance of emotional support in our health, the less it makes sense to not ask about it directly.

With each additional set of questions, I learn more about my patients. I learn how people understand the questions—sometimes it’s totally different from my own understanding, and the conversation about the meaning and objective of my asking gives me wonderful insights into people.  Patients are remarkably open and honest in their answers, which always reminds me of the honor and privilege of my role as physician.  The answers to these questions are what allow me to imagine my patients in their natural habitats, engaging with their work and the people in their lives.  The answers provide context and texture to the other patterns we uncover in health habits, and we often come together to a better understanding of both the origins and consequences thereof.  I can’t speak for my patients, but I always come away feeling just a little more connected.  I get goosebumps just thinking about it.

This year I’m excited to introduce 4 new questions.  It started out as three.  The third one wasn’t landing quite right initially.  I wasn’t asking what I meant, and I couldn’t quite articulate what I was after.  So I experimented with the wording until I got to the current state:

  1. In the coming year, what do you see as the biggest threat to your health?
  2. What is the biggest asset?
  3. Having answered these, how does this affect your decision making going forward? …And other iterations I can’t remember anymore
  4. One year from now, when we meet again, what do you want to look back and see/say about your health, relationships, and whatever else is important to you?
  5. (then the corollary question that occurred organically once and I then incorporated–) In order to make this vision a reality, what support do you already have or need to recruit?

I have asked these questions since July.  I always think to myself how I would answer for my patients, based on what I know about their circumstances, habits, and biometrics.  About two thirds of the time, our answers are the same.  Patients seem to receive them well, too.  One asked me to email them to him, so now I offer to email them to everybody.

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You might imagine that I think these questions make me a better physician.  That may or may not be true.  All of these questions make me better—a better, more self-aware person—because I also ask them of myself.  What is my meaning:stress ratio today?  This week?  This year?  I assess the threat/challenge ratio of my own life stressors, especially the acute ones.  I have had the same body signs of stress for many years, but in 2019 I may have developed a couple new ones, darn.  What’s the biggest threat to my health?  My hedonist impulses, no question.  The biggest asset?  My Counsel—those best friends and confidants.  What is my vision for my health a year from now?  I only answered that for myself a week ago (and I’ll keep it to myself, thank you).  And what support do I have/need?  I’m still working on that one!  That I don’t already know the answer to this one surprises me—I assumed I knew, but when I sat down to think about it formally, I realize that this may be the missing piece that holds me back from achieving some of my personal health goals.  HUH, how fascinating!  Did I not just write about how I question some of my patients’ ‘Lone Ranger’ method of self-care?  Well hello kettle, I’m pot!

Now, off to ponder some more, yay!