Category Archives: medicine

Uncertainty and Lack of Control

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The more I think about it and talk to thoughtful friends, the more I find uncertainty and lack of control at the foundation of the majority of stress and suffering I observe in our fellow humans.

In terms of health, more and more information from commercial blood tests and imaging can be known, but the utility and predictive value of all that extra information is still too often unclear. And so we spiral, worrying about the uncertain future and looking for more tests and the latest ‘hacks’ to ensure the outcomes we want. Capitalist Medicine, as I think of it, preys on our worries, offering test after test without regard to sensitivity, specificity, or predictive value. Too often there is zero clinical consultation before or after people fork over hundreds or thousands of dollars, with minimal explanations for the meaning of ‘green’ or ‘red’ range results. Overloaded and burned out physicians get inundated with messages from worried patients; precious time, energy, and resources are thus expended for unclear and sparse benefit. In time some of these tests, applied specifically and with strong evidence, may help a lot of people. What do we do in the meantime?

@bradstulberg
Author of Master of Change

Follow Brad Stulberg for evidence-based and practical advice on cutting through hype and sticking to what works. Focus on the basics: Sleep, exercise, nutrition, stress management, and relationships. I emphasize relationships because it’s more complex than we want to admit, especially relationship with self, which is basically self-awareness and self-regulation.

What if we’re already great at sleep, exercise, nutrition, and self-regulation, and we’re still anxious, still ruminating more than is helpful on a future that we ultimately cannot control? How do we get to peace with what is, and stop over-worrying about what could be negative, revel more in what is and could be positive? For more and more of us, life feels VUCA: Volatile, Uncertain, Complex, and Ambiguous. Naturally then, we seek stability, certainty, simplicity, and clarity–we grasp at what comforts–even if it’s false. So how do we get to real, true peace with it all?

That’s the inner work, my friends. It’s different and unique for each of us. Whether it’s family of origin stuff (for so many of us), other trauma, or something else (many somethings!), our patterns of anxiety and compensatory attitude and behavior don’t come from nowhere. And we all learn to carry our anxiety, trauma, etc. in our own dys/functional ways. Look at us, getting through life, getting sh*t done, holding it together the best we can! Good on us, FFS!

My wish for us all is that at the end of our lives, whenever and however it happens, we can each feel vastly more peaceful than regretful. That in those last ten minutes, we can look back and feel satisfied that we lived according to our values, spent our time, energy, and resources on worthy causes and connections, and can leave this mortal life with serenity. I have written before that in order to die at peace, I need to live in peace. That means living as comfortably as possible with uncertainty and lack of control, because that is what life is. I don’t mean that we should never feel anxiety, never acknowledge adversity, lose a little hope sometimes, and rail at what enrages us. I want for us to embrace all of it, allow the intense and difficult feelings, move through them (or let them move through us), with the confidence that we can handle it all, get to the other side of anything, and even gain a little wisdom in the process. I think it’s this confidence and security in ourselves and our connections (because we all need help, whether we admit it or not) that helps us make relative peace with uncertainty and lack of control.

Talk therapy
Somatic psychotherapy
Meditation of any kind
Breathwork
Martial arts
Prayer
Spiritual discernment
Mindfulness practice
Medication
Music
Creativity
Bibliotherapy
Walkabout
What else?

I wrote to a patient recently, “I will continue to look for ways to ease your worry.” This is my work. Every conversation informs and educates me on new possibilities, other ways I can help. We go together, my patients, friends, and I, exploring and co-creating according to our values, goals, and aspirations. I do my best not to judge anyone’s anxiety and worry, even as I observe the suffering it causes.
We all have our own unique burdens to carry in this life. Whatever we can do to lighten one another’s loads, let’s find a way to do it, yes?

For Holly

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https://pritzker.uchicago.edu/news/honoring-legacy-dr-holly-j-humphrey

Our friend, leader, and role model has passed.

What a surreal moment of sadness, reflection, slowing, and conviction.

I always knew you as simply Holly, not “Dr. Humphrey.”  The latter was a given and absolutely respected; it just felt too distant a title for how you showed up as program director to us residents.  Our respect for and deference to you was not commanded, demanded, or condescended by you.  It was a natural consequence of your presence: attuned, caring, earnest, authentic, and integrous.  Your essence emanated teacher, leader, mentor, steward, and patron.

I never knew you closely, but I felt known by you.  And that was enough.  Those three years were grueling and also bonding.  The culture you set of caring and encouragement, of looking after one another and always being on the same team, filtered through the chief residents, senior residents, and interns, so that we (when we had the bandwidth) could show caring and encouragement to the medical students.  Back before work hour restrictions existed, this was significant.  The University of Chicago Internal Medicine Residency Program was known as one of the most collegial and compassionate in the country, as well as one of the most rigorous and accomplished.  The longer I practice, the more I observe corporate and academic cultures from various perspectives, the more I appreciate and marvel at that incredible integration, at the uniquely holistic community of my training.  I knew it at the time; did not take it for granted.  And yet even now, more than twenty years out, the lasting impact on my own ethos and those of my classmates continues to move me.  I am so proud and grateful to have the privilege of calling myself a UofC IM graduate.

Reading the long list of initiatives, accomplishments, and accolades attributed to you after my time at UChicago ended, my psyche swells with pride for you, vicarious gratitude for all whom your programs touched, and inspiration to make my own contribution in kind.  Your mission and impact, as I understand from afar, was always to not only lift others directly, but show us all how to lift one another.  You were a leader of leaders—you helped us all identify and call forth that within each of us that would help make one another better.

What an honor and privilege to have shared even such a brief moment of this lifetime with you, Holly.  Those three years of residency, though short, were transformative.  Looking back, I was definitely not my best self at that time.  I cringe, and then I imagine how you might have counseled me, with honesty, compassion, and conviction to be my better self.  You empowered us through your confidence in us.  You held us accountable to a standard of conduct that made us worthy of our integrity.  Your leadership helped shape our character as clinicians and citizens of the profession.

Your life and memory are blessings on all who knew you. 
May we honor you and the impact you had on us all by carrying on the work you so bravely and generously began in innovative and connecting ways–the work of deepening compassion, inclusion, excellence, and humaneness in medicine.

Healing Through Connection Turns 10 This Month

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Dear Friends,

Oh my goodness. It’s been a decade. Holy cow. I’m in the feels, people.

I published the very first post here on April 14, 2015, The Premise. Reading it again now (I can’t remember the last time I read it), I’m proud that I can still stand firmly and proudly behind every sentence. At that time, I had only begun to speak nationally on physician burnout and well-being, culminating in multiple memorable and rewarding collaborations until right before the pandemic. That work carries on now without my direct participation, still championed by colleagues whom I admire more than words can express. My own work in wellness has since touched other professions including design, law, and state and federal judiciaries. How humbling to be invited into these spaces; what a privilege. Every opportunity teaches me, broadens my perspective, and reinforces my Premise:

“Patients and physicians have control over one thing above all else: our relationship with each other.  Relationships live and die by communication.  Barriers on the obstacle course of patient-physician communication loom large and formidable. Our system fails us over and again. And it falls to each of us, not the system, to find our way to connection and healing relationships.”

I thought our healthcare system was broken a decade ago; and here we are, worse off still in too many ways to count. Now more than ever, it is our relationships that will save us. It’s another paradox, connection: So important and fundamental, such a necessity, and also kind of mundane. It can happen in the smallest of moments–a glance, a fleeting facial expression, a passing vibe, a shared language–which can be lifesaving and also taken for granted. It can also require collossal effort–tremendous self-restraint, courage, and tenacity–to achieve it across deep and complex conflict and separation. I submit that both/all forms of connection are equally valuable and necessary for us humans to thrive. The longer I live, learn, practice, and write, the more I believe this to my bones.

It did not occur to me until today to do something big and special for my 10th blog birthday. Honestly I had thought of sunsetting the whole thing before the renewal date rolled around last month. But since I had not made any plans or decisions, I paid the fee and here we are.

So let’s have some fun this month, eh?

I think I’ll try to post daily. Nothing too labor intensive, no obligations, no rules. It’s my birthday party and I’ll write if I want to. I have 100 drafts waiting to expand and engage, four occurring just in the space of this morning’s commute.

It really is all about Connection: This blog, medicine, health, wellness, relationships, life.

How ironic: The world feels more divided and polarized, separated and divergent now than I can remember in my lifetime. And yet in my life personally, I feel more connected to people everywhere now than ever. What is that about? How fascinating and wonderful! Let me attempt to explore it and share in the next 28 days, yes?

Healing Through Connection. Connecting in all possible ways, for the good of us all. It’s what we live for, I’m convinced. So let’s dive in, celebrate, and see what emerges! Oh, this could be fun. See you tomorrow!

Love,
Cathy