Category Archives: physician

Calm Down and Connect

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NaBloPoMo 2021:  Do Good, Kid

If you’re a child of the ‘80s and you’re looking for 45 minutes at a time to flash back during mindless cardio, I recommend Halt and Catch Fire on Netflix, a historical fiction series about the advent and uprising of personal computing and the internet.  It’s like watching a slow motion, multi-car emotional pile-up on the highway in your home town.  You see the speeding Porsche coming around the bend, just as the drivers of the F150 that rear-ended the Corolla and pushed it into the MAC truck, all friends of yours, start to realize what just happened.  You feel dread rising, your muscles tense, you know what’s coming.  You cringe and mutter (shout), “Nooo, don’t do it, slooow doooowwnnn!!”  And you can’t look away.

Hubris, ego, vision, Machiavelli, **relationship**, complexity, trauma, identity—I tapped these words onto my iPhone notepad during one particularly vexing episode, while bouncing on the elliptical.  I find myself both cringing and knodding at the raw, intense, and artfully, lovingly rendered drama of human foibles on this show.  There is something about every character that I can relate to.  I’ve been there, I think (feel?) so often.  I’m invested in these characters and their relationships; I want them to succeed—to ‘do good’.  Halfway through season 2 now, I notice what makes me squirm the most: Witnessing decisions made in the throes of emotional hijack—hurtful words slung in rage, impossible promises made under threat, carnal impulses followed in limbic heat.  It’s fiction, which gives me safe distance to reflect on how I know better, while recognizing my own absolute vulnerability to these same and other lapses.

It doesn’t take much, when someone treads too close to a strongly held identity, a fiercely held belief, or an otherwise sensitive spot in my psyche, to upend my attitude from calm clinician to defensive tackle.  I may not lash out in words right away, but I wonder how this affects my decision making going forward, especially at work.  When I experience recurrent threat, rejection, disdain, or disrespect, real or perceived, from or toward you, what stories do I start telling about you (us)?  How do these morph into entrenched assumptions that then cloud my judgment and compromise my objectivity?  In short, how does my being a normal, emotional human put my clinical decision making, and thus my patients’ health and outcomes, at risk?  How so at home?  It’s all potentially dangerous.

I can think of a few ways to guard against relational and decisive pitfalls here:

  1. To calm down, I can take a few deep breaths, remind myself that we are all humans.  We have the same fundamental needs to feel seen, heard, understood, accepted and loved.  I can ask questions, like, ‘What part of me or the other person is not having a need met here?’
  2. Practice ODP:  Observe, Describe, Participate.  This is a mindfulness tool from dialectical behavior therapy that I learned of recently.  I can take my subjective reactions and judgments and substitute objective observations and neutral descriptions.  This helps me slow down, get space and clarity.  Then I can refrain from speaking and acting from a place of hijack.
  3. I can also practice RAIN:  Recognize, Allow, Investigate, and then Nurture my experience, to gain both understanding and acceptance of myself and my circumstances.  Radical acceptance and compassion form the foundation of right relationship with self and others.
  4. Consult objective others.  Colleagues, friends, extended family, therapists—people outside of the index relationship and who have no stake in its workings can give valuable perspective and insight.  Even better if they can make honest observations about me and my hijack patterns, so I may learn and adjust, over and over.

Our lives are most meaningful, I agree with my friend, when we find deep connection with others. But too often it is our encounters and the very relationships we have with people that keep us from connecting. How ironic. Wow, these posts (and this blog) really do revolve around only a few central themes…

Self-awareness and -regulation are key to a life well lived—that is, a life at the end of which we are more likely to look back with the fewest regrets. Keeping practices and connections that tether us to our highest and best selves, even as the gales of life threaten to blow us away, is how we exert positive agency. We make the best decisions and tell the best stories about ourselves and other people when we are truly grounded and stable.

What practices keep you steady?

Stay Connected

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NaBoPoMo 2021:  Do Good, Kid

My friend Liz is amazing.

We met just as I was leaving my last practice 7 years ago, and I knew right away I had to grow this relationship.  She is an elder sister in the profession—a wise, compassionate, generous, empathic, smart, thoughtful, and loving physician and teacher.  After I had the privilege of presenting to her and her amazing colleagues on physician burnout (really, they schooled me that day), Liz showed me the inner world of primary care in a correctional facility.  We toured incredibly aged buildings.  Liz explained the frustrating limitations of working in a jail environment and the difficulties arranging optimal follow up when detainees are released.  But most of all, she showed me what true, deep respect for every person’s dignity, no matter how vulnerable, looks like.  Holy cow, I will never forget that day. 

Liz is also a deeply spiritual person.  She wrote the chapter on spiritual resources for Jewish healthcare professionals in Judaism and Health.  After our day together at the jail, we kept trying to meet again.  I wanted to learn more about Judaism and how she lived it—personally, professionally, and in community.  But my kids were little and the weather was bad on the nights we planned to meet, or something would come up, or- or- or…  It just never worked out.  But as physicians of deep faith, we both always knew we would connect again someday.

We kept in touch all these years mostly through occasional emails, and then YAY Facebook, especially the Physician Moms Group!  By far the most valuable thing about social media is sharing photos and reading life updates.  It really makes you feel like you’re in your friends’ lives up close, going through all the ups and downs, sharing joys and sorrows, witnessing from afar.  When I posted recently about a freak out I had over Daughter’s anaphylactic food allergy, Liz reached out.

We met in her neighborhood, which happens to be my old college stomping grounds.  We walked all over campus and caught up, shared stories, commiserated, and bonded, just like we always knew we would.  I got a copy of the book with a bonus printout of her favorite poem, “The Seven of Pentacles” by Marge Piercy.  I will return the love with my favorite book of poems so far, To Bless the Space Between Us by John O’Donohue. 

The space between us, indeed.  So near, just across town, yet so far, 7 years, and yet so near still, always connected in spirit through the years, light and strong, like dental floss or fishing line… We stayed connected, patiently, faithfully, knowing that divinity operates on its own schedule, and that when we could finally meet again, it would be powerful and lovely. 

And so it was.

It will not be another 7 years, this we know.  And it was well worth the wait.

Meaning Indeed

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Do you not just love when insights occur in rapid and acute succession?

I had ‘Rubik’s cubed’ the last post for a few weeks before finally sitting down to write and publish it last Tuesday. The smoke signal idea came to me while typing—it felt almost tingly, like the most pleasant and rewarding epiphanal effervescence. And here just now I’m only describing that sensation for the first time. How fascinating. Little did I know last week that my own smoke signals have long smoldered in the distance. Since musing about the physical sensations of meaning, I’m suddenly noticing my own, left and right.

I’ve had two prolonged absences from in person clinical work these two years. The first was 2.5 months externally mandated by pandemic lockdown in 2020. The second, ending as of 10 days ago, was a 5 month personal leave. In each case I did my homework prior to returning, reviewing charts and schedules, contacting colleagues for sign out (the verbal transfer of care between clinicians who share patients). Both times I felt ambivalent, missing the nearly 24/7 control over my own schedule (or the illusion of it, anyway), and also anticipating the gratifying interactions of in person clinic.

In June last year, the joy of return enveloped me like the warm, welcoming hand of a soft spring breeze. I had completed the interview part of my first face to face visit since March. We got to the exam room and I did my usual head and neck assessment. I put my stethoscope earpieces in and placed the diaphragm against the patient’s chest. That first heartbeat may have been the most soothing sound I had heard in years. The soft, rhythmic, unobtrusive yet vital thudding of the heart of a live person—a person in my care—wow. I can’t remember if I actually got goosebumps then. But I get them now just thinking of that moment. I had not realized how much I missed hearing it, or how much it meant to me. I lingered an extra second or two just listening, feeling a deep joy and relaxation, a settling of my soul even, maybe. It was profound and totally unexpected.

This time it was a conversation. It’s such a privilege to know people in the intimate space of their health, to appreciate them as whole people, body, mind, and often spirit. In executive health we get the bonus of relating our patients’ whole person health to their roles and responsibilities as designated leaders at work. This intersects also with relationships in their families and personal tribes, just as it does for all of us. Toward the end of an interview last week, once again I felt overwhelmed by a deeply grounding, relaxed and yet energizing sensation. My patient and I were talking, engaging, exchanging ideas and observations, relating, as fellow humans. It felt paradoxically expansive and distilled at the same time, like I had dropped right into, and was operating directly from, my core, best self. I was right where I was supposed to be, doing and saying exactly what I was meant to do and say, right in that moment. I could only marvel inwardly and briefly in real time, as the encounter moved on. It was not until later in the day that I was able to name the emotion as sheer joy. I was lighter on my feet, uplifted in my chest, feeling positively buzzed.

Wow, it’s already the end of October. NaBloPoMo is almost upon us (well, upon me, I guess, as there is no longer an official November event–but this will be my 7th consecutive attempt), and I feel ready! The theme this year is personally meaningful to me (stay tuned for the reveal), and I look forward to the challenge. So good to be back, friends. Onward.