The Prosperous Heartbeat Bank

Okay friends, this is a fun post with some lighthearted existential philosophy. It also talks about sex, so consider yourself warned.

I really do wish everybody peace, love, and health (usually joy, also). People who receive emails, texts, and snail mail from me will all tell you. I also love a cheeky, irreverent expression sometimes, and this one showed up before the New Year:

From The Fuckit List page on Facebook

I shared it immediately with all my friends who would appreciate it, including a brilliant and pragmatic cardiologist. I added ‘etOH [ethanol] and weed in moderation, and the rest–yeah!’

The ensuing email thread between us:

Friend: 😂😆 no orgasms in moderation?!?!

Me: Some things you just cannot get too much of.  No risk.  😉😆

Friend: i’ve never heard a physician say “no risk” – only “low” “moderate” “high” risk. so i’m happy to go with no risk!!!!

Me: Teeheehee / It just occurred to me—YOU are the cardiologist!! IS there a risk?? 😱 / I cannot lead people astray here… / I suppose MI [myocardial infarction–heart attack] during sex does occur, right? / So shit, there is a risk! 😣

Friend: i suppose as a cardiologist, it’s always a risk-benefit ratio. risk is very very low. benefit is likely there every time. plus there’s the added cardiac benefit of ischemic pre-conditioning [training the heart with exercise] in those with significant CAD [coronary artery disesae] wherein you can develop angiogenesis [growth of new blood vessels] and collateral formation [bypass blood flow around blocked arteries] in the context of regular sexual/exercise activity. so it’s a big yes to orgasms!!!!

Me: Omg YYYAAAAAAAYYYYY!!! 💃🏻🎉🥳❤️ / And ENDORPHINS, yes? 😄

Friend: ah, yes, sympathetics. you know there is a hypothesis (totally unproven) that you are born with a certain # of heartbeats and once you use them, your life is over. if that is the case, endorphins, sympathetics and (eek) orgasms are probably no good for us. but again, that hypothesis is totally unproven and the more “exercise” you do, the slower the resting heart rate and the longer (observationally) the life. so probably, all in all, better to stick with the orgasms than to avoid them!!!

Me: Ooooo, fascinating!!  I bet there is some vague, partial and flexible truth to that theory?  Like yes, any given heart has a finite number of future beats left at any given time.  

AND, there are likely many things we can do throughout our lives that give it more or fewer remaining beats—like a bank account that we deposit to and withdraw from… 😜 OH I just LOVE this idea!!

Deposits:

Diet: fiber, healthy fats, lean protein, moderate naturally occurring sugars (Food Rules by Michael Pollan: Eat food, not too much, mostly plants)

Movement: full body, cardio/strength/mobility

SLEEEEEEP OMG 

Stress: wise mind, radical acceptance, inner peace; and FUN!!

Relationships (I would bet anything this is proportionally the DENSEST, highest value heartbeat reserve elevator): love, meaning, connection… 

Of course withdrawls are the opposites of these… I wonder whether bad sleep or toxic relationships are the greatest heartbeat extinguishers?  My money’s on relationships—maybe not even toxic ones—rather the lack of them altogether.  It makes total and complete sense to me that loneliness is a better predictor of mortality than smoking (I think it’s actually phrased that it’s a bigger mortality risk than smoking but I bet it’s a better predictor, too—if you look at the data a certain way?)…

OMG this totally aligns with my framework of the 5 reciprocal domains of health!! 😄 ❤️ ❤️

Ok so my mom told me that her dad told her that we are each born with a finite amount of prosperity in life.  So the idea is to be frugal with spending, consumption, partying etc in your youth, so you have enough to spread out over a longer lifetime.  I do like that idea.  It feels akin to humility and generosity to me…  So I wonder if there can be a pooling effect among one’s tribe—that we all spend/consume/share over a lifetime and extend/improve all of our lives?? 

OH thank you for telling me about this, I will think more (and possibly write) on it!! 😄 xo …And maybe my gong-gong’s theory is also flexible like a bank account, too. 

I think we get to invent it, since it’s all made up to help us feel better about how we choose to live life anyway! 😄

THANK YOU for stimulating such fun thinking tonight! 😄

Ok more soon, big hugs!!! xo

//

All of these thoughts and ideas poured out between us from 4:44 to 7:22pm on 12/28/2022. I’m not sure more writing is required at this point? I thought about doing the math–for each episode of exercise, how many more beats, and does it even out with a resulting lower resting heart rate over a lifetime…? Nah. It was a fun and thought-provoking conversation between two friends which, for me at least, tightened connection and elevated joy. I am definitely heart-healthier for it.

Hope 2023 is off to a peaceful, loving, and healthy start for you all, my friends, if not a moderately buzzed and high, frequently orgasmic, and suddenly wealthy one. 😉

What Flavor Is Your Narrative?

Simon Sinek describing narrative flavor

“Every day I get to ask people the most interesting questions I can think of, to help them know themselves better and live into their healthiest, most fulfilled selves.”

What if I answer this whenever someone asks me, “So, what do you do?”

How does this sound, feel, and taste different from if I just said, “I’m a doctor”? How interesting, to think of a narrative having a taste… What flavor do you assign my answer above, as you read it? Maybe I should add some toppings:

“I have the privilege and pleasure of doing work that stimulates both my thinking and feeling brains. I get to use all that I have learned throughout my life, both personally and professionally, in service of connecting with and serving other humans. I exercise deep expertise and knowledge, and am also humbled to learn something new every single day. I love what I do, I impact people’s lives, and it’s almost all ‘just’ by talking to people.”

Simon Sinek inspired this post when I watched the video clip of him describing why communicating through stories–narratives–is so important and effective. Thinking of narrative in terms of flavor–what a novel and elegant concept! It takes a totally different perspective on words, from thinking or feeling with emotions to putting it in our bodies. Smell and taste are a primitive sense, and highly associated with memory and emotion. It is literally visceral. So when we tell our stories about work, families, core values, realtionships, struggles–anything meaningful–what happens to that meaning when we correlate it all with a taste? Both for ourselves and those who hear/read our tales? How fascinating!

My first thought watching this video was ‘bitter.’ When I think of the deeply grooved, dysfunctional patterns in some of my relationships, I realize that my narratives—the biases and assumptions I make when interacting with (or even thinking about) certain people—set us up for conflict and discord from the outset in any given encounter. Yikes. For some reason, describing them as ‘bitter’, imagining the taste on my tongue, catches my attention, makes me stop and take notice, more than naming it all as resentment, anger, and grudges. It motivates me to change the narrative, to shift my perspective, make more generous assumptions, withhold judgment, and Give the A. Who wants to taste bitter all the time? I want to make these relationships sweet, savory, and refreshing.

How can we expand this metaphor beyond our own individual stories?

What is the story of your workplace culture? How do the mission/vision/values statements land on the workforce? How would you first describe it in the usual adjectives: restrictive, supportive, rigid, chaotic, backstabbing, upbeat? Then what emotions do you associate: happy, sullen, lighthearted, anxious, safe? What about bodily sensations: tense, relaxed, sleepy, wired, restless? And finally imagine a taste for it: bland, spicy, bittersweet, moldy, rancid, salty, aromatic? How does this exercise affect your perceptions/memories/thoughts/feelings about work? Does it move you to think, say, or do anything differently?

I have never before described my work in the exact words I used above. It feels liberating to find and articulate stronger language for my experience. And it did not take me long to land on ‘sweet’ (I often describe my job as ‘the sweetest gig’–funny how we use this phrasing for things that are just that good) and ‘umami‘ for its tastes. I love what I do. I crave it, savor it. I bask in not just the flavor, but the warmth (it’d definitely warm, not cold or hot) and the texture (rich, dense, smooth with bits of crunch and chew). OH this is fun! My work is the most satisfying meal: marbled, medium rare rib eye with a nice crust, roasted sweet potato, sauteed Brussels sprouts, tiramisu, and chai. Oh and there is some flower salt and pepper on the table.

I wonder how my patients would tell their stories of me and our relationships, and how they would translate those narratives into olfactory and gustatory experiences of us? Am I (are we) bran flakes, kale salad, mac ‘n’ cheese, burnt toast, chia pudding, meatloaf and spinach, blue cheese? The possibilities are endless! And it’s important to query and clarify our unique associations with the flavors we assign. I may think blue cheese is fragrant and lovely; my patient may mean it as putrid.

Now I’m thinking of employee engagement surveys. Wouldn’t it be fun, and actually engaging, to include novel questions like these? Surveyors could easily design questions to indicate whether responses are meant in positive or negative ways, and categorize different foods or meals to represent different aspects of work–breakfast as relationships, lunch as tasks, dinner as meaning, dessert as perks.

Okay that’s enough for now. What a fun diversion this was. Now I’m wondering about figures of speech that reference food and taste…what do we mean to evoke with this language? A post for another time, perhaps.

Onward in curiosity, novelty, learning, and connection, my friends!

The Sh*t Sandwich

“I have realized that I really enjoy learning about ***, but I don’t necessarily like studying it and being tested on it.”

And there it is. My mama pride swells at this concise, distilled insight of self-awareness that Son shared with me, about 6 weeks into college. So you really like ***. How much might you be willing to work/tolerate/sacrifice to stick with it? Will you keep *** as a hobby/interest, or can you see yourself making a career out of it? No rush to figure it out! And how cool to know there is a distinction to make?

How much are we willing to give for something we really want? Are we willing to eat the particular flavor of shit sandwich (a la Mark Manson–check out his blog and books!) that’s inevitably served on the path to our goal?

Sometimes we don’t even have to know what we want; clarity about what we don’t want–shit sandwiches we will not eat–is enough to set us on the right path for each of us. Some shit sandwiches I have rejected:

Three Dimentional Calculus and Vector Analysis: Freshman year in college, one problem on the final exam of this class took up 8 pages in the exam book. And why did I have to know it? How did the reasoning help me in life? No more math for me, thank you. I left engineering the following quarter.

Physical Chemistry: Having already gotten a C in physics (which happens when you fail the second midterm because you start dating your husband), empowered with an aversion to math, and knowing already that life is too short for this kind of suffering, I rejected chemistry and embraced biology as a major.

5:30am Rounds: General surgery, my first ever clinical rotation. My intern, the wonderful Gopal Kowdley whom I love to this day, looked at me and said, “You’re tempted, I can tell.” But OMG surgery–the egos, the bombast, the misogyny–AND getting up in the dark every day, forever? Nope.

Lifelong call: I love reading echocardiograms–ultrasounds of the heart, beating in real time. Second year of residency is when internists apply for subspecialty fellowships. That year my cardiology fellow stood right next to me at 10pm, monitoring a dying patient in the cardiac ICU. He had a little girl at home who missed her dad. Later that year, the attending cardiologist, my amazing teacher, sat across from me at the nurses station, in the middle of the night, reviewing the EKG of a lady with a likely heart attack. He had grandchildren already. He had to get up in the dark–in the middle of the night. No cardiology fellowship for me!

I live in Chicago when my home is Colorado. Wut? But Husband is from here, we trained here, and we both found jobs here that fulfill us and allow us to make a difference in people’s lives. WINNER! Love makes us do crazy things, like eat this. huge. shit sandwich. Without hesitation, no matter how it tastes. Every day. For 20+ years.

Through the long hallways of my career, at each door has stood a waiter offering some shit sandwich for me to taste in order to get through. I closed some doors, and walked through others. I wrote last month that I regret none of the work thresholds I’ve crossed to date. Since the beginning, nothing has been be-all, end-all. If I hadn’t gotten into med school the first time I’d have decided to try again or try something else. I committed to finish an internal medicine residency and pay back my student loans; those doors swung heavily one way. Other than that, I have always had the privilege of myriad opportunities to use my skills and credentials in new and interesting ways if I wanted to–generalists are needed everywhere. But the older I get, the more selective I am about what shit sandwiches I’m willing to eat. I think that’s normal.

As Liz Gilbert interprets Manson in her book, Big Magic: “So the question is not so much ‘What are you passionate about?’ The question is ‘What are you passionate enough about that you can endure the most disagreeable aspects of the work?’”

So ONWARD, I say to Son. Keep learning about yourself and the world. Try out different things, taste a little of everything as long as you’re sure it’s not toxic. Carve out your space. I am confident you will find your favorite flavor of shit sandwich.