November 29:  Reflection Makes Me Better

IMG_4550

NaBloPoMo 2019

How was 2019 for you, friends?

Looking back, what stands out?  What gives you pride and joy?  Guilt and regret?  What’s the best thing you learned?  What do you look forward to the most in 2020?

In the first post of this month, I described my last role play experience, one marked by intensity around domestic violence and dense communication skills practice.  Dr. Orit Kalnieri-Miller led the workshop, and I will forever be grateful for her groundbreaking work incorporating reflective practice in medical education.

Wikipedia says reflective practice is

 the ability to reflect on one’s actions so as to engage in a process of continuous learning.[1] According to one definition it involves “paying critical attention to the practical values and theories which inform everyday actions, by examining practice reflectively and reflexively. This leads to developmental insight”.[2]A key rationale for reflective practice is that experience alone does not necessarily lead to learning; deliberate reflection on experience is essential.[3][4]

Regular reflective practice, I think, is mindfulness in action.

This whole month I have been reflecting.  Looking back, seeking patterns.  What really does make me better?  Better for whom?  For What?  How does it all help me going forward?  I have probed my habits, my relationships, roles, activities, ideals and attitudes.  Writing the reflections every night as a blogging challenge probably does not give each idea much time to sink in.  But now they are recorded.  They are a collection that I can review over time; I can revise, rewrite, and continue the reflection-learning-practice cycle of self-improvement.  Reading past posts reminds me of where I was then, which allows comparison and contrast to today.

I am, still and always, me.  I’m also always learning and changing.  Reflection helps me to know myself better and more deeply, to claim and exercise my authentic agency in service of the causes that matter to me.  Reflection keeps me focused on my Why.  In the coming year, it will help me identify, refine, and enact my next Just Cause.  Very exciting!

But maybe the best part is that reflective practice is not a solitary activity.  When I have any opportunity to get feedback from those whose perspectives I respect, the learning is that much deeper and more meaningful, even (especially) if it challenges and agitates me.  People mirrors do not always show the reflection I want, or the self-delusions I believe–they call me out.  But sometimes they show that I’m living exactly and fully in my integrity and values.  Both are equally valuable.

So I will continue looking for reflections everywhere.  They keep me honest, and that makes me better.

November 26:  Practicing Peace Makes Me Better

 

IMG_2014

NaBloPoMo 2019

What helps you find peace these days?

With so much tumult in the country/world and Thanksgiving gatherings fast approaching, what will get you through this season and the coming year with minimal suffering and relationships intact?

Lately my inner peace feels tested on multiple fronts.  Anxiety, guilt, fear, regret, and insecurity accelerate their rotations through my limbic brain.  Thankfully, with age, therapy, and loving, compassionate friends, I have let go of self-judgment for experiencing stress and distress.  I don’t resist negative feelings as much as I used to.  I wish I could say this makes them less unpleasant, easier to tolerate.  Sadly, no.  But I am better able to let them pass through me, to ease into peace.

The more I observe, the more I notice that rather than allow and release our emotions, we tend to either deny/repress or fixate on them.  The consequent suffering can be disabling.  I started wondering how peace comes so much more easily to me now than before.  Below is a partial list.  What would you add to it?

***

Breathe

Rose may have saved my career.  One day in early in practice, running around exasperated and cranky yet again, I returned to my spot at the counter to find “TAKE A DEEP BREATH” posted in large font on the wall in front of me.  It was one of those immediate and profound, perspective-shifting, life-changing moments.  One. Deep. Breath.  Everything goes smoother and happier since that day.  Later I learned about tactical breathing, which trains inner peace both mentally and physically.  I’m not facing mortal combat (primitive stress reflex responses notwithstanding), but it helps me find peace all the same.

Smile (especially when I see my kids)

I was a dormitory resident assistant my senior year in college.  Though it was my job to serve as counselor and guide to college life for my fellow residents, it was wise freshman who taught me about exercising agency in the face of adversity.  I can still see her joyful, welcoming face and posture, feel her free and loving spirit.  I wish I had gotten to know her better.  She wrote on my message board, “Smile, Cathy, you’ll feel ten times better!”  Of course she was right.  Over the past 25 years I’m proud to say that I’m much better at finding my smile now.  Thank you, sweet girl.

Quote Michael J. Fox

MJ Fox worry

Focus on the Now

My daughter had an anaphylactic reaction while I was at work.  The sitter called and I could hear my preschooler stridoring in the background.  My son called 911 as I raced out of the office to meet them at the emergency department.  I was shaking and could barely see straight—how was I going to drive?  What if she died?  I still had to keep it together for my other kid.  That was a morbid turn, I remember thinking.  How quickly we catastrophize.  Thank God for the mindfulness training I had recently started.  Right now, everybody’s still alive.  Paramedics are on their way.  They already did the EpiPen.  Things are okay right now.  This mantra occurred to me as I pulled out of my parking space.  It carried me through that crisis and has held me up through numerous others since.  Mindfulness works, my friends.

Let Go Outcome

See quote by Michael J. Fox.  No matter how much we plan, what we expect, or how prepared we are, we just don’t know what will happen.  This practice is also an extension of mindfulness.  I can only control my own attitude and action right now.  I can cultivate relationships that influence others, attempt to enroll them in my ideas, and recruit them on my mission.  But I cannot control their reactions, their behavior, or the myriad circumstantial dynamics that facilitate or stymie our activities.  If we work steadily for our highest goals, stay on the path of honesty, integrity, and authenticity, and commit to ethical process, then we can deal with any outcome.

Stop Chasing Confirmation

Early in marriage and parenting, I used to fight.  I would flood my family with more and louder words, convinced I could prove my point and win.  The more I spoke (yelled), the more blank and silent my loved ones became, and the louder and larger I got in their faces, demanding understanding, agreement, acquiescence.  [Please feel free to laugh out loud while cringing here.]  These encounters inevitably ended in frustration for all of us.  Somewhere along the way I noticed people demonstrating the behaviors I demanded, even though they had never agreed to them.  Maybe there’s a better way?  Perhaps if I state my case calmly and lovingly, and let go of the immediate outcome, the doors in their minds might stay more open and I can still get what I want, without all the hurt feelings and wasted energy.  *sigh*

***

Four more days, friends.  Almost there!  Thank you for your views, likes, and comments!

November 25:  My Journals Make Me Better

IMG_2460

NaBloPoMo 2019

“You both have multiple journals that are all partially written in?” I asked, feeling vaguely twitchy.

On an online forum where I like to think I’m making new friends, three of us have bonded over our shared love of journals.  I wrote to the group last week, “I may have almost as many blank journals as I have books–the potential in them, the invitation to fill them with experience and life–they just make me so happy.”  The other two musketeers described their journals of various sizes, shapes, and designs, scattered about their homes.  They get written in whenever inspiration strikes.

That idea made me a little uncomfortable—that thoughts and ideas might be strewn about in different books, lying randomly around a home, disconnected, alone!  Hence the question above that I keyboard-blurted tonight.  I thought at first, “I can’t do that.”  Then I realized, I do do that—I have at least 4 journals going at the same time.  But I do organize them (not that my friends don’t—I have asked them to clarify).  I have a personal one, where I keep all original content. This one has at least three different designs of washi tape tabs, for blog ideas, presentation ideas, and other recurrent themes.  One is for work–a record of meetings, tasks, initiatives and their progress.  In a third I take notes at conferences or other formal learning.  Yet another holds insights from coaching calls and exercises from LOH.  I carry at least two, sometimes all, of them around with me every day. It’s common for me to have at least two out and be writing in both of them at the same time–taking notes from a meeting or presentation in one, then writing reflections, insights, and revelations in the other.  I often flip them over and write from the back covers, to keep lists and other short, serial records.  I attach email printouts and sticky notes, and when I reread I highlight and write in the margins.  These are well-used and well-loved books.

***

In 2010 I went to a Mindfulness in Medical Education retreat.  I was physically ill that week with a respiratory virus.  But I had been mentally and emotionally unwell for months, turbulent and restless inside.  All I could do was ruminate, turning thoughts, conversations, and memories over, raking the same terrain, uncovering nothing new, no insights to show for all that psychic energy spent.  On the first night of the retreat we were given some quiet time and a pad of paper.  I filled my mug with hot tea, climbed into the bay window, and started writing.  For a month I had had inexplicable and persistent cubital tunnel syndrome—inflammation of the ulnar nerve at my right elbow that caused such sensitivity and pain in my forearm that I could hardly stand wearing long sleeves.  That night I unloaded the whole of my pent up frustrations onto that legal pad, many pages worth—a total brain dump.  I always journaled growing up, and somehow it had been years since I had last penned for myself.  I had forgotten how cathartic, how therapeutic, it was.  The next morning my arm felt normal.  I have kept a journal ever since, and that pain has never recurred.

***

Another friend mentioned recently that he may leave his house without his wallet or his keys, but he never steps out the door without his journal.  I can totally relate!  Now I suspect there are more of us than I thought.  It’s the most satisfying feeling to have a reliable, accessible repository to record insights, ideas, and discernments, whenever they occur.  When I cannot do this—usually when I’m driving—it’s like having to pee until I can get out the journal at the next stoplight (or pull over).  It occurs to me occasionally to stop accumulating blank journals.  I’ve already set a moratorium on buying yoga pants and washi tape (for now).  But if a blank journal calls to me, I will buy it.  It’s good for my soul.

November 24:  Alone Time Makes Me Better

IMG_2520

NaBloPoMo 2019

How many hours do you get to yourself at a time?  I mean not just in the shower or commuting, or to work out. I mean how much time do you get to really, only take care of yourself?  When there are no kids to pick up or drop off, no meals to plan or prepare, no immediate work deadlines, no call, no commitments?

I had 36 hours this weekend—there are about 25 minutes left.

I realized at the end of Wednesday that my irritation at fellow drivers was probably a projection of anxiety and agitation about my kids being away this weekend, each to a different place, a first experience for both of them and me.  Anxiety often manifests as anger and irritability for me.  I called forth many of my cognitive behavioral and mind body practices to manage the fear and worry, so that I could actually enjoy this amazing alone time—the first such stretch since the elder kid’s birth.

And holy cow, I’ gotta do this more often.

I will spare you the list of restorative activities!  But suffice it to say that I managed to balance sleep, music, food, productivity, creativity, solitude, and connection.  It really was a perfect rhythm.  Deep breath.  And now I’m ready for the family’s return and re-entry into life as usual, a little more relaxed and peaceful.

This year has been intense, fast-paced, and dense with learning, both personal and professional.  I think we all appreciate the idea of alone time, and we understand its importance intellectually.  But like so many things, to actually experience it first hand, for real, is completely different and profound.  I finished listening to Range this morning.  In it David Epstein describes how teams do best when members have a balance between solitary and interactive, collaborative work, as opposed to all one or the other.  Coaches know that training for any skill, be it athletic, musical, or otherwise, requires alternation between periods of sustained, focused practice and rest, time away.  New neural pathways require downtime to fully integrate.  This weekend, I was able to synthesize ideas from Epstein’s book on diversity of experience, and assimilate them with what I’m reading in Ozan’s book, Think Like a Rocket Scientist, on combinatory play.  In the quiet of an empty house, freed from rushing off to the next activity, insights arose more freely, and I connected dots to previous experiences and learning much more easily.  Today I started The Infinite Game by Simon Sinek.  More transformative ideas (simple and profound) to start incorporating into my world view and leadership practice, and to write about later—Yahoo!

I wondered if I’d be lonely this weekend… Nope, not at all.  This time alone was exactly what I needed.  Loving thanks to the family for gifting it to me.

November 23:  Range Makes Me Better

IMG_1833

NaBloPoMo 2019

One of my teachers in med school told me why he loves primary care.  He said at any time, he can decide he wants to be more expert in something and do it for a while, like managing all of his patients’ thyroid illnesses, rather than referring to endocrinologists.  Then when he gets tired of that, he can start referring again and do something else, like nonsurgical orthopaedics.  That was over 20 years ago…  The complexity of both medical knowledge and practice has expanded exponentially since then, so I wonder if he still thinks this way?

Regardless, I agree.  Being a generalist affords me tremendous flexibility and freedom to explore and apply from all fields of medicine.  While I could never approach the expertise of my specialist colleagues, I get to (and to a large extent am expected to) learn a little about everything.  That breadth of exposure and knowledge makes every workday unique and stimulating.  This week, I’m listening to Range by David Epstein, a book that validates everything about my generalist, boundary-spanning life.  From the book description:

Range makes a compelling case for actively cultivating inefficiency. Failing a test is the best way to learn. Frequent quitters end up with the most fulfilling careers. The most impactful inventors cross domains rather than deepening their knowledge in a single area. 

I feel validated about this because I’ve never been especially good at any one thing (except today I’d say I’m an exceptionally good communicator, though that’s a highly subjective and biased self-assessment).  I have, however, observed, explored, tried and experienced myriad things, and I have always seen this as an asset.  And now a New York Times bestseller affirms it. Yay!

Growing up bilingual and bicultural gave me a huge advantage for living and working in an increasingly diverse global society.  Before I started piano, I learned classical Chinese painting in two styles, as well as Chinese folk dancing.  I started skiing in elementary school, volleyball in middle school, golf in college, and in my 40s have picked up kettle bells, yoga, and TRX.  I learn coaching techniques from being coached.  I learn about leadership from reading and interrogating my patients who are leaders, and now actually leading some folks.  I interact with information through podcasts, audiobooks, paper books and journals, and online formats.  I read New England Journal of Medicine and Harvard Business Review, Annals of Internal Medicine and Fast Company, Journal of the American Medical Association and Psychology Today.  I prefer nonfiction, but I recently joined a book club and read my first novel in many years.  My music playlist includes Dierks Bently, Camila Cabello, Bruce Hornsby, Shawn Mendes, Miranda Lambert, Sara Bareilles, The Piano Guys, Mamma Mia and The Greatest Showman soundtracks, John Denver, and Pink.  I attend conferences focused on clinical medicine as well as communication.  I speak to audiences of physicians, business leaders, and designers. I make washi tape cards and moderate Better Angels communication workshops.  It’s kind of an eclectic list of activity; please forgive my self-centered navel gazing here.

If you make a similar list for yourself, I bet it will be more diverse than you think.  How does this help you, make you better?

Epstein posits that generalists’ advantage lies in their ability and propensity to see deep relational connections between diverse domains, use analogical thinking, and practice ‘active open mindedness.’  He also provides multiple examples of when specialists’ narrow perspective hinders creativity and innovation, and even effective problem solving.  Throughout, however, he acknowledges the complementary, yin-yang relationship between focus on the specific and wide-ranging view of the broad.  The book just makes my ENFP heart sing.

I honestly believe range makes me better…  For no other reason than giving me a life full of new and exciting experiences to write about on a blog.

 

November 20:  A Little Profanity Makes Me Better

IMG_2073

NaBloPoMo 2019

I swear I was surrounded by idiots today.  Not at work or home…  Mostly on the roads.  It started early, my friends, and they were everywhere.  Is the moon full?  Maybe there’s a toxic gas leak somewhere?  I found myself aggravated before I even got to the office, where usual hiccups in schedule and daily operations continued to poke my inner rage monster.

*deep breath*

Thankfully, I have learned a few helpful strategies over the years.

One is to vocalize.  There is a reason babies and little kids cry and scream at the drop of a hat.  It’s the most efficient way to discharge an acute emotion.  Then it’s over and they can get on with playing and learning.  As adults, this isn’t socially acceptable most the time.  But in the privacy of one’s own car, it can help.  After the fourth or fifth encounter with the truly insane on my morning commute, I growled.  It was not a planned, but I’m doing it more often over the years, perhaps.  It was spontaneous, and I noticed instant release and relief.  Then I literally chuckled a little.  I continued on my way and forgot about those vehicular fools.  I even found a little charity—must be the weather, or that toxic gas.

A dear friend recommended a book this year, The 15 Commitments of Conscious Leadership, which I love.  The third commitment is ‘Feeling all the Feelings’.  The authors explain: “Feeling a feeling all the way through means letting that feeling have its full life cycle (less than 90 seconds) by breathing, moving and vocalizing, resting in calmness, and riding the next wave through to completion.”  In other words, rather than repressing, denying, or wallowing in our emotions, we can acknowledge, identify, accept, honor, and release them.  Then they don’t rule us, driving us to hurtful action, damaged relationships, and toxic work environments.

Here is their method:

When a feeling arises, pause and…

  • Locate the sensation in your body. What are the ‘bits’ doing?
  • Breathe and allow the bits to simply do what they do.
  • Move and/or make a sound to match what the bits are doing.

Sometimes the bits need something more than private growl.

Recall the daily work hiccups.  Most of the time, I can roll with them easily.  I am blessed with a truly amazing team—flexible and smart, able to anticipate patients’ and my needs with keen precision.  But today was a true aberration for me—my already tenuous mental state (apparently not yet resolved) unraveled quickly in the first hour of work.  So, in the safety of the workroom, surrounded by the team I knew could hold the space, I let loose at least two or three sonorous f-bombs, accompanied by some appropriately expressive full-body gestures.  Not only did the team tolerate the outburst, they offered loving support and encouragement.  “Let it out,” one told me.  Once again, I felt instantly better.  I took a deep breath, thanked them, exited the Cave of Camaraderie, and faced the rest of my day with exponentially more grace and generosity.

It was not my best moment.  I should apologize for making anyone feel uncomfortable—cursing in the workroom is not the example of professionalism that I aspire to set.  Still, I don’t regret it.  And it will not become a recurring pattern, I can say with confidence.

Some evidence suggests that swearing raises pain tolerance and relieves stress.  I didn’t lash out at anyone, I didn’t destroy any property.  But my little episode helped me regroup, get my head on straight, and show up my best for my patients today.

Looking back, there were probably no more insane drivers out today than any other day. I will reflect more on what I brought to this day that created my experience. I attribute my ability to approach this reflection with calm and intention to the freedom from emotional tumult that vocalization and a little swearing affords me.

Recent research has shown that swearing while exercising increases physical strength and power.  I may test this self-improvement theory in my workouts this week—in the seclusion of my home gym, of course.