The Knock

“I wish for more doors to open for you than to close or stay closed.”

I love middle age. At this point in life, I have accumulated enough experience to have earned real expertise, solid street cred in my domains of study and work. And yet, there is still plenty of ‘runway’ to do cool shit! That’s assuming I don’t drop dead tomorrow, of course. But even this, the keen and escalating awareness of my own mortality, makes my potential feel that much more exciting and acute.

I have had conversations with multiple friends about this lately. Many of us, especially in medicine, have lived what I would call a social norm-driven life: College, med school, residency, practice/research/academics, leadership. Date, marry, have kids. Launch kids into the same social norm-driven life. Color inside the lines, even if it’s not totally our nature–often not even noticing or questioning whether it’s our nature or not. Huh. Not good enough anymore, I think.

So much emerges now about the vastly, truly wide diversity of human nature, such as gender and sexual fluidity, psychology, physiology, and sociology. Narrow social norms taken for granted by generations, at least in the Western, ‘developed’ world, dissolve and disintegrate under scrutiny exponentially faster, it seems. It feels understandably scary in so many ways, for so many people. We have never been here before, never faced this much newness of both magnitude and volume, in the history of humanity. Anything new is uncertain, daunting. This much new is mind bending. I think we can figure it out, though, just like humans always have. If we can practice effective self-awareness, self-regulation, and communication in the face of high anxiety about the unknown, great things could ensue… though this is a great, big collective ask.

…So, what is this super cool shit any/each of us can do, whether we have lived a mainstream life thus far or not? As Mary Oliver wrote, “Tell me, what is it you plan to do with your one wild and precious life?”

Some of us hear the Knock–a call, a whisper–to do something different, something new, something heretofore unimagined. For me it’s Book (well, I have imagined it for nine years, but hey, some of us also move slowly). For others it may be leaving an office job, exploring new creative outlets, pursuing long hidden or newly emergent dreams. Regardless, there is energy here. I have described it as pushing outward, broadening myself against the walls of a box within which I had not noticed I lived until now. The status quo feels newly small, constraining, unsatisfying. What I understood previously as black or white, open or closed, good or bad, right or wrong, feels ever less clearly dichotomous. Not only do I now perceive the gray, I feel pulled toward it. Touching it, experiencing it, feels liberating, expansive, an existential education that I could only think to seek by having lived this long a certain way.

The call, however, can come with no shortage of ambivalence, even conflict. For those who live with underlying depression or anxiety, this tension between the relative safety and security of the status quo and the freedom and exhilaration of answering the Knock may exacerbate symptoms significantly. When questioning my friend on the phone today about how she feels in her body when imagining the new thing, she could hardly attain, let alone stay in that sensation. Rather, her mind skipped ahead to potential negative outcomes, focusing on uncertainty and risk, bypassing said freedom and excitement. The status quo confines her, body, mind, and spirit; she feels it. Her dissatisfaction with it grows, causing agitation. I could also feel the tumult in her voice, like a roiling swirl of motion without movement, a frenetic vibration seeking resonance. I could only sit with her, from a thousand miles away, holding space. I could relate, help just by validating, even though I could not solve.

At the end of our call, I thought of the door analogy. Trying new things does not have to be all or nothing. We can go slow. There may be many doors to the new place to consider. We can check each for heat, sounds, vibrations from the other side, see which are un/locked. We can turn knobs and open slowly, peeking inside, possibly anticipate what we may find. We can back out quietly, leave it, come back later. No need to kick any doors in, potentially hurting others on the other side or causing recoil that slams ourselves in the face. We can examine potential costs, benefits, intended and unintended outcomes. And we can trust ourselves to handle whatever results from our deliberate and thoughtful decisions and actions. We can be mindful, intentional, honest, and authentic. This way, we will have less to regret, no matter what happens.

The Knock is Possibility. It is a signal of hope, light, and growth, both an uplift and a deepening. Sometimes we hear it only briefly before other sounds drown it out. When it recurs, however, I advocate for listening, following, finding its origin. We are only here for a short time. Fear and anxiety can be overcome; we can find our way to brave, new, big, wonderful things. There is no rush. And it’s probably better if we go together.

Trust and Influence–Because Shane Said So

Instagram, @shaneeastreads, 1-3-2024

What is your morning routine? Do you run it, or does it run you?

In the video post of the screen shot above, my romance narrator hero Shane East reports on some morning advice he heard on a podcast on New Year’s Day (Huberman?), and invites followers to try it with him:
1. Upon waking, get sunlight for at least several minutes before getting on any screen
2. Delay caffeine intake for at least 45 minutes after waking
For the second, he describes the relationship between caffeine and adenosine, the neurotransmitter that promotes sleep drive. Simply, caffeine is an adenosine antagonist: when it sits on adenosine receptors in the brain, which normally slow cellular function and promote sleep, it has the opposite effect, promoting wakefulness instead. 

I dived into the rabbit hole that yielded the articles linked above, trying to understand the rationale behind that second recommendation.
My takeaways:
1. Transition from sleep to full wakefulness takes time; better to let the body do it naturally by drinking water (we get dehydrated overnight) and getting light (preferably full spectrum sunlight, but get what you can that’s not a screen) on the retinas before doing anything else.
2. Caffeine can prolong and/or amplify effects of morning norepiniphrine and cortisol, which have stimulatory effects on heart rate, blood pressure, and other systems of the body. It can interfere with physiologic adenosine recycling in the brain and, depending on dose and interval, disrupt our intrinsic sleep-wake patterns. Introducing caffeine later after waking, when adenosine levels are lower and more stable, can mitigate this disruption.
3. None of this matters nearly as much as simply getting enough sleep (both quantity and quality) as many nights a week as possible, to obviate the need for stimulants in general.
But caffeine and adenosine are not my point in this post.

Rather, why am I suddenly so motivated, almost giddy, to act on this advice just because Shane said so? Really? Not when I heard it in Why We Sleep, not when I have ever read it elsewhere. Not because I’m a doctor and I know it’s good for me and I want to walk the talk. No. My book hero got up on the third day of this new year, made a 00:01:03 extemporaneous video sharing something cool he had recently learned, invited us fans to try it with him, and that lit one of the biggest behavior change fires under my butt since I joined Ethos nine months ago.

Readers of this blog may know my night owl tendencies. I have been known to post at 1:00am, then get up at 7:00 for work. That hasn’t happened in a while, because I’m working on it! And yet, habit change is hard. I have wanted for years to get up early to write Morning Pages, a creativity and wellness practice that calls to me. But before last week, I slept through all the calls. On a good day, if I left on time for work, I’d write in the car after turning off the engine, before walking from the parking garage to the office. For seven consecutive days now, I have risen with my alarm rather than snooze it. I sit up, turn on my full spectrum bedside lamp (the bulb came with my dawn simulator years ago, and has survived its associated device), grab my journal and write three pages, stream of consciousness, so I have something to distract me from my phone and keep my eyes open to light while I wait for my caffeine. I only look at my phone to turn off the alarm and get my writing playlist going. Win-win-win-WIN!
By the end of three pages, here are my consistent findings so far:
1. I feel alert.
2. My mood is excellent.
3. I’ve gotten out ideas that marinated overnight, or maybe worked out some question I had gone to bed with the night before. Or maybe I uncovered addtional questions yet to ponder. Regardless, I have just spent 15 minutes doing something I love, first thing in the morning!
That’s all pretty amazing.

I have known about the benefits of drinking water in the morning for years. I keep a water bottle at the bedside. But it wasn’t until last week that I started chugging in the morning, while I write. And because I’m getting up earlier and spending more time awake and out of the kitchen, my morning coffee consumption now automatically occurs at least 45 minutes after waking. It all feels almost easy.

And bonus: This new practice seems to have created space for insights and ideas to emerge throughout the day. I’ve made entries in the book journal almost every day this week, and momentum grows toward writing actual chapters and a proposal. I have also realized this week that since ideas so frequently occur as I drive to work (I often grab notebook and pen, scribbling while stopped at lights–hence the parked car journaling), I will now forgo the input of audiobooks (ugly cry face) on the morning commute to facilitate my own original output in that naturally creative time. And I attribute all of this to Shane.

What is with this phenomenon?

Normally I would cogitate long and hard, analyzing the psychology of motivation, cross referencing counseling practices for behavior change, looking back at my own past patterns, etc. Not this time. Today, I’m satisfied to wonder at it all a little while, marvel at the minor miracle of it, and then chalk it up to the utterly irrational nature of human behavior. I love and admire Shane as a person. I see him as trustworthy. I appreciate that he shared this advice, prompting me to search and learn more, nudging me toward my better self. I want to report to him that I accepted his invitation and it helped me.

Because that’s one of the best relational rewards, right, when someone tells us how we help them, how we make their lives better? Isn’t this why I’m a physician? My fondest, most loving memories throughout my career are patients and trainees telling me how I have helped them–yes, it’s my job and still, any amount of validation, no matter how small, matters. It’s even more meaningful after we have gone through multiple trials in their lives or training together. The more we acknowledge this bond, the stronger it gets, the more we trust, mutually.

Patients and students absolutely influence me. Because they trust me and consider my advice, I want to be worthy of it. Trust is built slowly, earned with time, energy, and effort. How better to honor that trust than to practice what I preach, visibly, right alongside my charges? Maybe this is why Shane’s video resonates? He’s getting in the boat with us fans, acknowledging the challenge, inviting us all to journey together, do our best, and see what happens. Had he said, “Hey, I learned this cool new thing, you should try it! Good luck, tell me how it goes!” I would have a very different response.

Trust and influence. They are irrational, driven by our qualitative, ineffable, limbic and sometimes labile sense of connection. I think of trust like an oak tree–grown over many years, strong and sturdy, and also susceptible to irrevocable damage in a single breath–a broken branch never grows back. There is no substitute for the attention and nourishment, cultivated through relationship, required to maintain strong trust and real influence.

Though my energy for this new habit is high today, change is still hard. I have significantly altered my daily routine, counter to what I consider to be my innate tendencies, which is not what I usually recommend. We will see how/whether I can sustain it. Maybe it will help that I was already approaching the threshold, and Shane’s video feels like just the little nudge I needed to push me over to the next best version of myself? Fingers crossed! Lasting change is most often incremental and iterative, requiring multiple trials. So I won’t be too hard on myself if by this time next week I am back to snoozing until the last possible minute to rise, rushing out the door 30 minutes later having written nothing and gulped a good portion of my coffee already. I can forgive myself the lapse and commit to trying again–maybe on days I don’t see patients? Something is usually better than nothing. We’re all here doing our best.

Anyway, Shane, if you read this, thank you. You have made my life better for a while, and now again, and given me more things to write about, for the past week, at least. I have two more blog drafts inspired by reflections on your video. I think of them as I walk to work, and I get Resting Peace Face from the gratitude I feel for the possibilities that have opened in my life because of you being you.

And now it’s late (but not too late). Temperature is -6F outside and I need to get up even earlier tomorrow to write, hydrate, and make sure the car starts. So it’s off to bed for me. I look forward to my Pages tomorrow morning–who knows what may come of this new habit? I’m sure I’ll let you all know as it emerges.

Be Myself, Change Myself, Be the Change

Vail, Colorado, 2019

We are who we are from a very early age, maybe even before we are born. AND, we also constantly evolve throughout our lives. 

This is one of my favorite paradoxes.

Image shared on Instagram–one of my favorite quotes

I’m thinking a lot lately about Outer Peace. Our world swirls and bubbles with chaos and toxicity, so many psyches apparently living on the knife edge between tolerance and breakage, between breathing and screaming. How often are we tempted to yell, kick, throw things, or simply stop whatever we’re doing and just cry a while? How do we hold it together and simply function ourselves, much less help anybody else, and/or make any positive difference in the universe?

The longer I live the more I (re)learn that it’s about core values, goals, and trade offs, and not ego. Change is not about fighting. It’s Inner Peace in service of Outer Peace.

“Yesterday I was clever,” I knew better than everybody else. I was smart, and I wanted to show it. I came at rather than coming alongside, made simple and superficial assumptions, jumped to (often wrong) conclusions. This part of the quote expresses the necessary adolescence that we all go through in life–personal, social, and professional–the ‘know it all’ phase that our elders tolerate knowingly because their own elders did the same for them. Impetuous and defiant confidence, disregarding boundaries, testing and finding limits and resonances, if only subconsciously and often painfully. It is the organic growth and pruning of youth to early adulthood. If we’re lucky, we have mentors to guide us, helping us navigate the morass with fewer mental, emotional, and spiritual nicks, bruises, and fractures.

“…so I wanted to change the world.” Because it *should* all be a certain way, the way I think, because I know what’s right. Those who agree with me are my friends; those who don’t are not. I’m oversimplifying. But this is not far from a persistent mindset reality in our social groups well past physiologic adolescence, and not least among those who determine and enforce policy. Change the world how? According to my own world view and life philosophy, however rigid, narrow, and closed. I wonder about the (inverse?) correlation between how tightly we hold onto our rigidities and how far we have traveled, how diverse our experience, how many different cultures and realities we truly understand and empathize with? I submit that if we are honestly paying attention, if we open our eyes, minds, and hearts to the depth and breadth of any given human’s life experience, it instantly puts our all-knowing and arrogant ego in its place, which is at the back of the ‘world change’ bus.

“Today I am wise, so I am changing myself.” I am still clever–perhaps ever more so with age. With wisdom, however, I apply my cleverness in a different, more mindful, relationally intelligent way. I realize that power to change is not power over, it is power to. Strong arming (which includes coercing and shaming) rarely creates lasting, meaningful change, at least not without deep human cost. When I look inward first, seeing how I myself relate to and connect with that which I wish to change, therein lies my strength. I approach any problem from an ultimately human and humane perspective, which makes me more credible, more creative, more holistic in my problem solving. This is a big ask, requiring vulnerability and a willingness to step ‘way outside of my comfort zones. How does this give me any kind of peace? Don’t I risk losing myself, my identity entirely, when I make such daring attempts at real inclusiveness?

Who am I, that I can withstand this broadening, this profound stretching of perspective?

I am clear. I am centered. I am grounded, focused, and engaged–in my Why, in my Just Cause, in my commitment to playing the infinite game of human relationship and connection as long as I possibly can. To be me, my Best Self, means constantly evolving through lived experience, while hewing closely to my core values of honesty, integrity, curiosity, humility, generosity, and kindness. My inner peace comes from knowing, at the end of each day, that I did my best to show up this way, even when it was hard. 

It’s hard when I’m attacked, dismissed, or rejected for asking open, honest questions, for challenging social norms and ‘the way we do things,’ for facing and abutting over and over the rigid, the narrow, the closed. It’s hard when I discover my own rigidity, narrowness, and closures–oh man, that is tough to take. And the practices bring me back; they de-escalate, defuse, disarm, and rejuvenate: Breath. Mindfulness. Writing. Talking. Connection.

Inner Peace may not come immediately or even for a while after a disruption. But it does come, and each training episode strengthens my skills. The peace I eventually feel, then, grows and deepens; it integrates synergistically. It cannot help but then exude, at least while it lasts, until the next trial. Intervals between trials lengthen because what disrupted my peace last year rolls off of my consciousness today. Episodes shorten as I am able to breathe and regulate through them more effectively and efficiently. I become elastic, supple–strong and soft. My peace grows, and I grow with it, as does my capacity to share it.

I am me this whole time, learning, practicing, training, ad infinitum. I am me, rooted while growing. I am me, the change I wish to see in the world.