November 20:  A Little Profanity Makes Me Better

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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.

November 18:  Relentless Curiosity Makes Me Better

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NaBloPoMo 2019

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”
― Rainer Maria Rilke

Tonight, in the month of gratitude, I feel deeply thankful for Coach Christine.  I might have been a curious person all along, but it was not until I got a life coach that I learned the vast and profound value of curiosity in every realm.  As I wrote earlier this month, standing always in curiosity liberates my mind.  It relieves me of unnecessary urgency for an answer.  I can exercise professional creativity in forming better and better questions, and the answers (often multiple, intertwined, and intriguing) emerge more easily and artfully than if I chase them demandingly.

The business of medicine is to solve problems, to heal, to cure.  So we assume that the faster we get to answers, the better.  And they had better be the right ones, because lives are at stake here!  It’s always interesting to me when patients talk about my work as ‘saving lives.’  I can’t remember a time when I could actually make that claim, at least at all directly.  But to my colleagues—emergency medicine and critical care docs, trauma surgeons, suicide hotline counselors—thank you, you really do save lives every day!

I love primary care because I usually have the luxury of ‘(living) the question.’  When patients present with new problems, as soon as I know they are stable, I get really excited.  I’m liberated to get deeply curious, ask as many questions as they will tolerate, paint the big picture together.  I follow the standard physiologic and diagnostic process initially, which often yields a straight forward answer and plan of care.  But life and work would be pretty boring if that were always the case.  When the usual suspects are all acquitted and the mystery persists, that’s when things get fascinating.  This is when I really get to know a person.  When I ask truly open, honest questions—the questions I don’t know the answers to and that are not meant to lead anywhere—I never know where the conversation will go.  And I always learn something new and relevant, something that helps me connect.  This is the information that makes a person memorable, because it is truly unique to them.

One of my favorite moments in a patient encounter is when I have to pause a few seconds to form a really good question.  What do I really want to know, what am I after, what will really break open this conversation?  It happens regularly, and wow, what a rush.  OH, I just never know what I will learn!  You’d think people would get impatient and grumpy with such prolonged, sometimes meandering interrogation.  But I find that they often lean in, look me in the eye.  They get on the train with me and look as eagerly as I around the next bend.  What will we find?  Let’s explore together!

Relentless Curiosity.  It’s the funnest part of my work.  I love it.  And as we all know, loving our work makes us better.

November 17:  Elasticity Makes Me Better

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NaBloPoMo 2019

What was school like for you growing up?  Were you bored?  Confused?  Frustrated?  I had a pretty easy time, but many of my classmates did not, even the ‘smart’ ones.

In high school I was on the speech team.  One of my events was persuasive speaking.  I chose one year to advocate for teachers to broaden their teaching styles to match a wider variety of learning styles.  I used the Gregorc Mindstyle Delineator as an example of how styles can vary (mine is Abstract Random, go figure).  It was an interesting thesis and I sincerely believed what I wrote and presented in those 8 minutes each weekend.

Thirty years later, I wonder how much I walk this talk of meeting people where they need me.  Simply asking the question, raising my awareness, makes me better.

Parenting.  It doesn’t matter how many parenting books you read or how well you think your parents raised you.  General principles apply, of course.  But every kid is unique, and we parents do better when we realize that the methods we use for anything on kid #1 won’t necessarily work with kid #2, #3, an onward.  Flexibility is key to a happy and functional household, for getting out the door every morning without yelling.

Marriage:  According to the Dr. John Gottman, about two-thirds of marital problems are perpetual, meaning they will never actually resolve.  So how do couples stay together successfully?  Among other things, they learn to accept one another and work around the hard stuff.  At least partially, we have to soften our rigidities, learn to bend and sway, embrace the supple, intimate dance of commitment.

Teaching:  Not all students learn best by watching.  Not all learn best by doing.  Or by hearing, mimicking, or competing.  Luckily, medical education gives trainees multiple platforms on which to acquire the necessary knowledge and skills to care for patients.  For all its flaws, our profession actually does well here.  I’m happy that I realized this in my own experience.  When I precept students in clinic, they shadow, scribe, see patients alone or lead a joint encounter, so they can experience the work from different perspectives.  I think this mutual versatility and adaptability makes us all better.

Patient Care:  Over the years I have accumulated myriad articles and books to share with patients.  But not everybody’s a reader like me.  Not everybody wants to meditate or journal.  Some people do better with a personal trainer, others in spin class.  It’s my job to assess how each patient is most likely to succeed in health habit optimization, and present the most appropriate resources for consideration.  Primary care definitely does not work with a one size fits all approach.  So now I include audiobooks, podcasts, phone apps, and YouTube videos in my repertoire of medical information sharing.  I am blunt when it’s needed, and also gentle and diplomatic.  I can speak from the head and the heart, often both at the same time.

Speaking Engagements:  Here is where my elasticity has grown the most in recent years.  For the first decade of my career, I still used the expository presentation style I learned in high school.  Thankfully in 2014, I watched Nancy Duarte’s TED talk on transformative oral presentations, and then read her book, Resonate, in 2015.  Make the audience the hero, she says.  Tell a story, contrast what is with what could be, paint the vision of the blissful future clearly.  Engage people’s emotions and aspirations.

This is not easily done with Power Point decks full of words.  But words are my medium!  I had to add color, diagrams, cartoons, photographs.  I started making my presentations more interactive, between myself and the audience, and between audience members themselves.  Now I have people stand up and move their bodies.  I may bring raisins to my next talk and do a mindful eating exercise.  I need to learn how to embed music and videos into my slides.

What is the objective in all of these relationships?  It’s connection.  How do we best connect?  We reach out.  We extend ourselves to others—make ourselves relaxed, flexible, spring-like.  That is how we gather people closer.  It’s not formless or weak.  A strong elastic maintains its integrity even under high tension.  But it must be stretched often, or it becomes stiff, brittle, and ultimately ineffectual.