Love Letter to My Superstar Friends


Dear Paul & Joanne*,

I cannot tell you how grateful I am to you both for taking the time to meet me last week.  You came out in the pouring rain, not for a lighthearted night of drinks and karaoke, but to talk charged politics with your tortured, melancholic, liberal friend.  I hope it did not feel too burdensome, and that you would do it again.

It was quite the emotional evening for me, unsettling, sometimes uncomfortable, and also dominated by love.  Joanne, we have known each other about 15 years, and I know you are not a fan of politics in general.  Paul, I know you mostly through your witty holiday cards, and your occasional Facebook posts that often touch on politics.  You lean right, it seems, about as much as I lean left.  You gently called me out when I shared a Trump supporter-shaming video, reminding me to hold myself to a higher standard of discourse on all platforms.  That is why I sought you out.  When you engage, you exemplify the attitude toward political discourse that I aspire to.

I described to Joanne over the phone how distraught I had been since November, something akin to “watching the fabric of my generation’s social progress torn to shreds by a maniacally fomenting, double-machete-wielding narcissist.”  You seemed genuinely surprised and curious—why did this election have such a profoundly tormenting effect on me?  What made millions of people pour into the streets around the world in protest?  I was incredulous at your incredulity, and yet I felt a mutual, loving acceptance between friends who only want each other to be happy and feel secure.

At dinner, I could tell that you both cared acutely about my distress, and wanted to help alleviate it.  You reassured me that the worst case scenarios are highly unlikely to actually happen.  You reminded me that hyperventilation and arm flapping are not productive energy expenditures.  You gently encouraged me about the long, jagged, often meandering, and also inevitable path of social progress, and the importance of taking the long view.

I admit that I felt a little defensive at times, as if anything I said about the origins of my distress would be met with, “You’re overreacting,” and “You’re worried about nothing, please…”  We later agreed that it is never helpful to invalidate someone’s emotional response to a stressor, regardless of whether or not we can relate.  Paul, you are so well-read and convicted about your opinions.  I did not see a point in arguing, as you did not seem interested in debate, and I left feeling disappointed that I had not presented a stronger defense of my liberal ideals.  The whole exchange felt lopsided in favor of your position.  But I did learn from your point of view, which was one of my primary objectives.

Most importantly, our conversation revived my mindfulness practice.  You’re right—energy spent catastrophizing about a hell-on-earth future is energy wasted.  As Michael J. Fox says (I paraphrase), “Don’t spend your time worrying, because if what you’re worried about actually happens, now you’ve lived it twice.”  My energy is better spent in the present, attending to what is, rather than what I fear might be.  And I feel justified in my shock and dismay at what is.  In my opinion, Donald Trump has defiled the presidency and brought our politics to a new moral low that I could never have predicted.  I don’t need to ‘go apeshit’ over the future, as there is plenty of wreckage to confront right now, not the least of which is our collective refusal to engage one another in civil discourse.  I can center, ground, and focus, breathe deeply and engage, one step, one person, or one loving couple, at a time.

Last week Dan Rather wrote my heart on his Facebook page:

The threats, the lies, the willful disregard for the rule of law should be limited to the world of Hollywood caricature. To see this played out each night on the news, to read about ramblings and inconsistencies in justifications for actions that should never have been taken, is to see a moment of great peril for our nation.

I remain, however, an optimist. I see the swellings of civic engagement and action. I hear the voices of those who demand that this subversion of our national ideals shall not stand. I have covered social movements of the past, and never have seen one where so much power and numbers lie on the side of the opposition. This is a clash for the values of our nation. Our destiny is in our hands.

Our nation’s patchy, irregular social fabric may be strained to its limits today, and even torn in some places.  But the threat of real disintegration has brought forth multitudes of weavers and quilters to repair and protect its integrity.  I can acknowledge this ‘collateral beauty’ and contribute my part, through conversations like ours, to help mend the tapestry, and bend that moral arc of the universe more toward justice.

Thank you, my dear friends, for helping me train for this marathon.  You hold me up and make me stronger.  I hope I do the same for you.

Sincerely and with love,



*Not their real names



…by a friend of a friend.

It’s okay to lament the darkness. Grief is normal and healthy.

But then go get a candle and light it.  Then go about lighting other people’s candles with yours.

The best part is, the light just multiplies. Your light shines no less brightly for giving some away.

And pretty soon darkness gives way to all of our light.

Peace and hope, friends. 

On Thanksgiving–Meh


NaBloPoMo 2016, Letters to Patients, Day 24

To Patients Who Feel Lukewarm About Thanksgiving:

I’m with ya.

Not that I have anything against Thanksgiving…  I just have difficulty pouring forth a great gush of gratitude every fourth Thursday of November for a national holiday.  I thought this week it was just because of the tensions of the year, but looking back, I’ve never really loved this day.  I feel sheepish to write it, like people will think less of me.  Then again, something tells me I might not be the only one?

Yesterday I shared the most eloquent treatise on gratitude I have ever read, and I believe every word.  I try to live the premise every day—to pay attention and feel gratitude at the deepest cosmic level, connected to everything in the universe.  I marvel every day at all that I have, all that I am privileged to witness and do—to live this life, so full of learning and connection.  Today I’m supposed to summon and articulate all that moves me to thankfulness…  Why do I resist?

I imagine many would read this and think, “Wow, she is so ungrateful,” or maybe un-American?  I think most people who know me would disagree.  And those who know and love me best would hold the space with me to explore the curiosity of it all, without judging me for it or trying to ‘fix’ it.  And I’m ever so grateful for them, because I’m not sure it’s something that needs to be ‘fixed.’

I think it’s okay to feel not particularly grateful today, no more than any other day.  I also think it’s okay to feel especially grateful on this day, significantly more than any other day.  What’s not okay—what I see causing so many people to suffer—is when we shame others for thinking and feeling differently from us.  We physicians do this more than we realize, I think.  When patients don’t seem to take blood pressure, diabetes, obesity, or flu as seriously as we do, we can get very judgmental.  When they have different ideas about what will make them better (natural supplements, unusual diets, acupuncture, shamanic journeying, homeopathy), we can become positively hostile.  This is rarely helpful.

So if you, like me, are not particularly into Thanksgiving, and/or if you don’t subscribe to all conventional wisdom around certain things medical, I will try to withhold judgment.  I am indeed grateful for the chance to gather and enjoy one another’s company this week.  I don’t advertise my apathy for the holiday, as that would diminish others’ joy—and that would be antithetical to my core values.  I also appreciate the freedom to celebrate modestly rather than exuberantly.  I respect your right to choose therapies according to your values and beliefs, as long as your choices do not harm others.

I’ll continue to explore my relative indifference toward Thanksgiving.  Thank you for not trying to make me feel bad for it.

On Experiencing and Expressing Gratitude


NaBloPoMo 2016, Letters to Patients, Day 23

To Patients Seeking Words for Gratitude:

I found them!

As we head to gatherings tomorrow and seek words to honor and express the occasion, I’m particularly grateful today to see the post below by David Whyte.  Where, you ask?  Why on Facebook, of course!  Back tomorrow with my own original words.  Until then, peace and gratitude to you all!

***  ***  ***


is not a passive response to something we have been given, gratitude arises from paying attention, from being awake in the presence of everything that lives within and without us. Gratitude is not necessarily something that is shown after the event, it is the deep, a-priori state of attention that shows we understand and are equal to the gifted nature of life.

Gratitude is the understanding that many millions of things come together and live together and mesh together and breathe together in order for us to take even one more breath of air, that the underlying gift of life and incarnation as a living, participating human being is a privilege; that we are miraculously, part of something, rather than nothing. Even if that something is temporarily pain or despair, we inhabit a living world, with real faces, real voices, laughter, the color blue, the green of the fields, the freshness of a cold wind, or the tawny hue of a winter landscape.

To see the full miraculous essentiality of the color blue is to be grateful with no necessity for a word of thanks. To see fully, the beauty of a daughter’s face across the table, of a son’s outline against the mountains, is to be fully grateful without having to seek a God to thank him. To sit among friends and strangers, hearing many voices, strange opinions; to intuit even stranger inner lives beneath calm surface lives, to inhabit many worlds at once in this world, to be a someone amongst all other someones, and therefore to make a conversation without saying a word, is to deepen our sense of presence and therefore our natural sense of thankfulness that everything happens both with us and without us, that we are participants and witness all at once.

Thankfulness finds its full measure in generosity of presence, both through participation and witness. We sit at the table as part of every other person’s strange world while making our own world without will or effort, this is what is extraordinary and gifted, this is the essence of gratefulness, seeing to the heart of privilege.

Thanksgiving happens when our sense of presence meets and fully beholds all other presences. Being unappreciative, feeling distant, might mean we are simply not paying attention.

© 2015 David Whyte
In CONSOLATIONS: The Solace, Nourishment and Underlying Meaning of Everyday Words.
© David Whyte and Many Rivers Press 2015

On What Helps


NaBloPoMo 2016, Letters to Patients, Day 22

To Patients Preparing for Uncomfortable Holidays:

Seek what helps.

What did I write recently about staying off of Facebook and minimizing my social media exchanges?  How fascinating, look what I just did—spent the last two hours on Facebook!  I also write about trying, falling down, and trying again…  So this is me both falling down (in my attempt to stay off) and trying again (to engage meaningfully).

The holidays are coming, yay!  …And, not so yay!  The conversations we have with friends and family in the next 6 weeks or so have enormous potential—for division as well as connection.  Personally, I feel optimistic.  I plan to evoke my core values of open-mindedness, empathy, and integrity.  I want to look back on the gatherings with gratitude and deeper connection.  So today I share with you all the things I have read (today—see?  I endure Facebook for your benefit! teeheehee) that have helped me.  These pieces validate, challenge, reassure, alarm, question and motivate me to Hold the Space, Stay on the Path, and Seek Love.  Please share yours, also!

A fellow physician’s acknowledgement of the humanness of bias, its potential for harm in caring for patients, and a reminder for self-awareness and –management.

Posts by Michelle at The Green Study, reminding us that internal conflict is normal in the face of world events such as ours, with concrete suggestions for actions that align with core values:  “We cannot strengthen our character unless it is tested. We cannot defend our freedoms unless they are threatened. We cannot become better writers or artists or humans unless we have obstacles to overcome.”

An article from The Guardian that points me to reputable sources of alternate points of view, so I may understand better.

A call out from the Wall Street Journal—to help me own my shit before I call out others on theirs.

A gentle message from fellow blogger John Pavlovitz: “Friend, however you choose to navigate these holidays, know that it’s the right way. Give yourself permission to pretend or confront or abstain as you need to, and forgive yourself later if you decide you chose poorly. You’re probably going to get it wrong or at least feel like you did.

“But remember too, to save a little of that mercy for those who sit across the table from you or those who choose not to. They’ll be doing the best they can too.”

And finally, the Prayer of Maimonides, the twelfth century physician and philosopher:


These holidays, wish me persistence and ‘stubborn gladness,’ as Liz Gilbert calls it.  I wish you all the same!

On Trudging the Road Forward

img_4456NaBloPoMo 2016, Letters to Patients, Day 21

To Patients Who Doubt Your Ability or Endurance:

Don’t give up!  Stay on the path!!

Holy COW, Day 21!!  That’s three whole weeks that I have managed to post every single day!  So it really is true, the more times you try, the more likely you are to succeed.

I tried NaBloPoMo last year with “November Gratitude Shorts.”  It felt scary at first, then stressful, then deflating.  Then this past April, I did my first A to Z Blogging Challenge.  I had the insight to warn my family that I would be busier, and then halfway through announced that I would basically stop cooking until it was over.  It was not nearly the slog of NGS, but I did feel quite overextended and anxious for many days that month.  I submitted the last one with 30 minutes to spare on April 30.

The evolution here is worth examining, as it parallels other endeavors in life—exercise, parenting, the cultivation of other relationships… When I counsel patients around health behavior change, I often hear, ‘I tried that before, it didn’t work.’  This is usually when I point out that ‘before’ was a very different time.  Then they concede that since then, their experience, circumstances, and priorities may have evolved, sometimes drastically so, and maybe ‘it’ might work this time, who knows?

If we live consciously, observantly, and mindfully, I believe that all of our experiences make us stronger.  Trials and learnings in one realm of life inevitably pertain to all others.  If we can manage to see and appreciate this, then the potential for application and personal growth expands exponentially.  How much more could we accomplish if we just allowed ourselves to pick up and keep going, not only expecting to fall along the way, but anticipating it with gladness for the learning?

So let’s lighten up on ourselves, shall we?  Even if you have tried many times to quit smoking, establish an exercise routine, ‘eat healthier’ (whatever that means for you), and then consistently gone back to old habits, don’t give up!  Stay on the path!  Keep moving forward!  Try something new, learn something new, integrate, and continue!  Life is so much more fun when we don’t take it all so seriously, no?

So now that I have bragged on Day 21, what do you bet things will fall apart as we approach the Thanksgiving weekend?  Oh well, we shall see!  Even if that’s the case, I already have some valuable lessons stashed away:

  1. Try not so schedule so many conferences and presentations during NaBloPoMo.
  2. 500 words and 60 minutes are very reasonable limits for daily posts.
  3. Definitely warn the family; set expectations in advance.
  4. Protect the sleep!!

Happy Monday, all—and here’s to trudging the path together!

On Expanding Our Potential

10-growth-mindset-thought-conversionsNaBloPoMo 2016, Letters to Patients, Day 20

To Patients Whose Identity is Fixed:

Why not adopt a Growth Mindset?

Have you already read Carol Dweck’s book Mindset?  I first learned about the premise of a growth mindset several years ago, in the context of parenting.  Basically we should praise kids’ efforts more than their attributes: “Way to keep at it!” instead of “Wow, you’re so smart!”  When I think of myself primarily as ‘smart,’ I am less likely to try new things or take risks, for fear of appearing ‘not smart’ and ruining my reputation, or worse, my self-image.  That is what Dweck calls a ‘fixed mindset.’  A growth mindset, in contrast, allows room for experimentation and, well, growth.  I could still think of myself as ‘smart,’ but it means something different—rather than all-knowing, I am smart because I am an avid and effective learner.

Now I see it in broader terms, and it applies to people of all ages, in all phases of life.

From now into January, I have committed to moderate a weekly board review webinar on infectious disease (‘ID’).  I review questions, prepare a slide deck with explanations of correct and incorrect answers, and go online Tuesday nights with a partner to teach fellow practicing internists.  I really enjoy the webinars, but the topics sometimes not so much.  My fixed mindset at the outset this time: “I hate ID.”  Last week’s slide prep session may have been the longest two hours in recent memory.  I answered 6 of 8 questions wrong.  “I hate ID!”

Then I thought of Dweck’s premise.  I started to think of my patients who see themselves decisively as non-exercisers.  Or who hate vegetables.  Or who say they are ‘all or nothing’ folks who simply cannot moderate their eating, alcohol intake, or anything else.  They say, “That’s just who/how I am/it is; nothing I can do.”  Until now I have accepted these self-assessments without question or challenge.


And now I wonder:  If I allow for a different assessment of my relationship with infectious disease, how much better could I learn the material?  If I open my mind to the possibility that I could actually remember all those (damned) drug names and mechanisms, the myriad tick-born diseases and their cardinal symptoms, and all the rest, could I actually have fun?  And then, how much better could I teach it?

If we all saw in ourselves just a little more possibility, or redefined our attributes to allow for unrestricted growth and evolution, what more could we achieve?  How liberated could we feel to explore diverse aspects of our personalities?  What novel ideas could we exchange with others, to create and innovate around interpersonal, communal, and political life?

From now on I will recite a new mantra for the ID webinars:  “There’s a lot to learn here.  I can get better at this.  Bring it.”  Yup, feels good.  Hmmm, I wonder where else I could grow my mindset?