Category Archives: physician

Tribe and Fire

Posted on by
9

Another day of threaded media to reinforce my personal biases. Thought I’d share since it feels so cosmic. 😉

Often I find myself with an acute urge to connect with one or a few of my friends. I have long since learned to act joyfully on these urges; in college I wrote letters on pretty stationery and mailed them with confetti (100 in my first year alone). As life got busier that evolved to cards and postcards. And now it’s often an email or text, these days with attached memes or songs, and most recently the 8 minute phone call… I still indulge in the luxury of snail mail often, though.

Today I looked for something touching to share. Scrolling through photos, cartoons, and memes on the phone and laptop, nothing felt quite right. Then this appeared on my Facebook feed:

So unassuming yet poignant, down to earth and still profound. Perfect. I sent via email and also saved the image for myself, before sharing on my own FB page. The more I read it the more it resonated. “Mostly, we don’t want to harm each other… We want…For the waitress to call us honey… We have so little of each other, now…” So I shared with a few more friends–ones who I know practice making the “fleeting temples” (whom I admire and wish to emulate) and ones for whom I wish to meet and feel deeply the “true dwelling of the holy.”

One of my friends then shared the image on her own page, and one of her friends commented on the significance of “So far from tribe and fire,” before referencing a recent gathering of exactly ‘tribe and fire.’ YES. Tribe members take turns tending the fire that keeps us warm, leads us home, holds us together, connects us. So I had this lovely and loving idea swirling around my consciousness all day.

Sarai left her eloquent comment on my last post, reinforcing that anchoring–tribe-and-firing–is a reciprocal activity, between ourselves and those we know, both intimately and apparently not at all, though in reality I am convinced that we all know one another on a cosmic level. “I like your hat.” I must call her soon and relight our shared fire. It’s been a long time, and I’m confident that the embers still glow.

Then I came across Daniel Pink’s post on the book The Good Life, which is now on my 2023 wish list. “Friends are medicine.”

Again, YES! I feel validated asking every patient, every year, about the strength and depth of their emotional support network. It’s not my job to help them cultivate it, the way I advise on ways to lower blood pressure and cholesterol. But I point it out so it’s on our radar, to reinforce the paramount importance of this aspect of whole person health.

A fellow physician mom posted on the FB book club group page about Chasing the Scream by Johann Hari. The Amazon page references his viral TED talk years ago on how wrong we are about addiction, which rang a bell, so I watched it again. It’s only 14:33, well worth your time and attention. We think substances themselves are the problem. Turns out, it’s context. Loneliness and disconnection are far stronger drivers of addiction–to substances and other things–than the things themselves. Hear about ‘rat park’ at 3:30 where rats with toys and friends do not prefer drug-laced water when given a choice, compared to their stimulus- and companion-deprived research counterparts. Continue watching to learn about the unintended human drug addiction study that was the Vietnam War, where only 5% of the soldiers who used heroine in company relapsed upon returning home. His lovely conclusion: “For 100 years now, we’ve been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection.“

Recently I started asking patients to categorize their alcohol use patterns among three overlapping motivations: social, self-medication, and habit. That middle one is a flag, though it’s often camouflaged by the other two. Identifying, accepting, and addressing our demons may be one of the scariest things we do in life. No wonder we avoid it so desperately–even more so when we feel we must do it alone.

Our relationships kill us or save us, I often say. More and more I think it’s not actually the toxic relationships that kill us, not if we have other strong, loving, thick relationships, communities, connections, and meaning to hold us up. No, it’s the lack of relationships, that absence of connection, that kills us. It doesn’t have to be many friends or connections, it just has to be enough–close enough, deep enough, tight enough.

Who’s on your mind today? Why not reach out and let them know?

What Flavor Is Your Narrative?

Posted on by
Reply
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

Posted on by
8

“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.