“Hey friend, favor? “When you think of me, what things do you hear me say all the time that signify to you who I am and what I’m about? 🤔 “…Collecting ‘Chengerisms’”
The compulsion overtook me Thursday evening, when I should have been finishing clinic notes and packing for LA. I texted a slew of people in a flurry with the question above, intending to assemble their answers into backbone for National Blog Posting Month in November. For those who don’t know, NaBloPoMo challenges bloggers to publish 30 posts in 30 days, all written in real time. It coincides with NaNoWriMo, National Novel Writing Month, a sprint to write a 50K word manuscript in the same time.
This will be my tenth consecutive NaBloPoMo challenge–BRING IT, I say!
My “Chengerisms” query, I see now, was actually me gathering validation and support for showing up all me, all in, BOOBS OUT at the Writers Rising retreat this weekend. My subconscious intuition knows what I need; I sense, trust, and follow better with age. Replies rolled in with speed, earnestness, and so much love it positively bowled me over. Highly recommend!
The strongest messages I perceived throughout the conference reinforced all of my highest writing and living values: Let loose your curiosity Take risks Tell the truth Honor your Central Self Own Your Shit You are enough Assemble your pit crew Connect, connect, connect!
How tightly these correlated with the Chengerisms my friends mirrored to me: What is that about? How fascinating! Tell me more… Hey friend How did that feel? Love you love you Yaaaay! One breath Walk the talk BOOBS OUT (apparently catching on in my small circles–yaaaayy!) Tribe Sooo human.
This spontaneous, subconscious-driven exercise shows me the profound importance of good, loving feedback and the absolute value of meaningful relationship. My response to almost every reply was a sincere and heartfelt, “I feel seen!”
While I continually noodle on content and structure of Book (I’m getting closer, really!), I feel a limbic and visceral certainty about how I want readers to feel throughout and especially at the end–seen, validated, inspired, empowered, and convicted. This NaBloPoMo, I aim to color in and sharpen that vision, saturate my thinking and writing brain with it.
At the end of an executive physical, I want my patient to feel thoroughly understood. I show that I know them, even if I only see them once a year, by reflecting their stories back to them, interpolating and extrapolating what’s not said, checking in, and providing what I know patients need from their doctors: personal connection in service of self-efficacy for health. So this year for NaBloPoMo, I commit to the theme:
What I Wish For You
Thirty things I want patients, readers, or anyone, really, to experience after encountering me in person or in print. Chengerisms in action. I will resist wallowing in guilt and shame when I notice how often I fall short of these aspirations. When I see perfectionist self-loathing approach I will divert it to the nearest off-ramp. All part of the process.
This could be both fun and enlightening! Let’s see what happens, eh? Ready, set, let’s go.
All day, every day at work I talk to people. I query their perceptions about their health, their habits, relationships, and leadership. I ask about their families, challenges, and struggles. We get as personal as they are willing, and it is always a privilege and honor to be allowed into people’s lives like I am. Between the pre-call, the morning interview, and the debrief, I spend about two hours with each patient during their annual exam, reviewing the year past and anticipating the year ahead. The best days end with me feeling joyously spent, having attuned and attended to each patient intently while mining all my cumulative expertise, both personal and professional, to compile the most collaborative, relevant, and holistic action plan I can muster.
I have saved face sheets from these annual exams for the past year, all the encounters that felt meaningful to me. Each paper bears my notes from the interview, essentially a list of ideas/concepts, resources, and recommendations to include on the action plan. It’s a set of organic notes for myself, a record of how I know each person, what stands out about their life today, the most salient aspects of health and relationships this year.
Internal Medicine is a ‘cognitive’ field—we don’t do procedures. “I think, therefore I.M.” my American College of Physicians mug says. I literally talk to people for a living. And then I write about it. Each clinic note reports my patient’s state of being, in the context of their life at the time. Every year I add on to the cumulative ‘social history’—work, eating and exercise patterns, sleep, stress, and relationships. Reading through that section of the note, I can see how many years I have known the patient, and how each of these aspects of their health has evolved over time. They rise in the ranks of work, change jobs. Weight fluctuates. Kids grow up, graduate, leave home and go to college, get married. Grandchildren accumulate. My annual exam note is the record of a person’s life as I hear it.
Each encounter note’s ‘Assessment and Plan’ is essentially a problem list with my description of each active medical issue, interpretation of potential causes and implications, and plan of care. It serves to guide anyone who cares for the patient in the future (myself included) and to inform patients themselves, so they may know the rationale behind my recommendations.
This past week, I started a new journal to document each encounter for my own benefit—to recall and reflect on each interaction and log my own perceptions (intellectual, relational, visceral, and otherwise) and insights. Each entry ends with the heading “FEELING”—my attempt to articulate how the encounter affected me personally, what meaning I derived from it. I LOVE this new practice.
Similarly, I have often journaled feverishly after conversations with my best friends—the deep, philosophical, and bonding ones wherein I grab my journal in real time to jot ideas, insights, and epiphanies. My days off fill up with calls and coffee dates well in advance, and I now set aside time after each of these encounters to make similar recordings to those after my patients’ annual exams. Between friends who have known me decades (‘stem cell friends’, as I have named them this week) to lovely new ones who may be decades younger or made in specific contexts (‘tissue friends’), the connections made of late flourish as if doused in Miracle Gro concentrate. And I’m writing it all down!
This blog will be ten years old in April. This is the 630th post. It all started because I wanted to write a book on physician-patient relationship and how to save it. And yet the focus, content, and organization of Book has eluded me all this time. But it’s okay; I’m having so much fun with the process, feeling my way through, attending to and reveling in each twist and turn of the journey. I’m getting closer. I have no deadline or expectation, no goal other than fostering and honoring what emerges from the most organic and authentic places within me, for no other reason than to connect with people for whom it will be meaningful.
I talk to people. I listen. I connect. I write about it for all our benefit, so our bonds may hold strong long after each encounter, cumulatively, in the most intersecting and inclusive ways. I do it for a living—not just for an income, but for my very livelihood—I traffic in the spoken and written word to make the highest, deepest connections and meaning in life. Wow, what a duh-HA! revelation. And how lucky that my life calling and profession should align so perfectly? Book will come eventually, I am confident. I can feel it. Onward.
There has never been a better time to be menopausal than now.
It has taken 20+ years in practice, and living it first hand, to truly understand the experience. For those who don’t already know: This sh*t is real. I feel almost apologetic to all of my women patients for whom my advice to date has fallen flat, even as I have done my best to earnestly listen and understand. Now I feel the struggle in my own body and I get why it is so hard to explain or tolerate. But I could not know what I did not know; there is no substitute for learning through living. Thankfully, the current state of menopause science and culture has turned an important corner. We finally talk about it openly, normalize it, and study women as a unique and whole demographic unto ourselves, and not in comparison to men. This is my first post summarizing my understanding and recommendations to date.
By ten years ago, I had noticed two primary attributes of my women patients who sailed through menopause, compared to those who suffered the most. First, they were at peace with the whole idea. Menopause presented no threat, did not undermine their personal identities or attitudes about youth, beauty, etc. Second, they had their health habits in the five reciprocal domains established well in advance: Sleep, exercise, nutrition, stress management, and relationships.
That said and notwithstanding, each woman’s menopause experience is acutely unique and influenced by myriad more factors than simply personal habits. Genetics and external circumstances together probably drive as much or more of our menopause ‘outcomes’, in complex intersections with our own agency and behaviors. I will not discuss habits or personal practices in this post. Rather, I offer 1) a distilled description of the experience so that my women patients and peers may feel seen and understood and the men in their lives might also get an inkling, and 2) some resources I have found helpful personally and for patients, both men and women.
The Experience (aka The Shitshow)
Altered metabolism and body habitus The most prevalent and distressing symptom of menopause in my practice is weight gain and mass redistribution. We thicken around the belly and get squishier in general, even if our lifestyle habits have not changed. I think many of us accept this to some extent–unless we have been naturally thin our whole lives, it’s not surprising to see and feel the slide into a widening body shape around age 50. But for a great many women this is incredibly tormenting, because we have exerted heroic time, energy, and resources to barely maintain the middle aged body we had to start with. Look no further than America Ferrera’s monologue from last year’s Barbie movie to see how the pressures of body shape and social norms of youth and beauty make the changes of menopause such an insidious source of pain, shame, and self-loathing for so many women, not to mention just feeling generally lesswell in our bodies altogether.
Sexual changes Vaginal dryness, low libido, and pain with sex rank highest among the sexual complaints I hear from my perimenopausal patients. The last couple of years I have asked my men patients specifically about how their partners’ menopause experience influences their own sex life and overall relationship, and the conversations have opened up more meaningfully than I could have imagined. I want to acknowledge here, with great sincerity and appreciation, the quiet and earnest concern and compassion these men express for the women they love. So often men feel flummoxed and helpless, wide-eyed bystanders living in the wake of erratic and recurrent storms wielding only flimsy umbrellas, watching their partners brave wild winds and waves, wondering when it will all calm the f*ck down. Relationships weather the tumult of menopause how they will, many with torn sails and damaged hulls when waters finally recede.
Compounding the direct negative changes in sexual health and function, all of that body shame described above looms large and dark. Sexual relationship is sensual at its core, and when a woman feels poorly in and about her body physically as well as psychologically, sensual connection, both to self and partner, becomes exponentially harder. As a culture we are finally allowing women to talk about this openly, and we all, women and men alike, benefit from the awareness.
Sleep disturbance I have known for a long time that two things make everything else feel ten times worse: dehydration and sleep deprivation. Sleep can get severely deranged in menopause, both in its central nature and also from vasomotor instability–hot flashes and night sweats. Of the five health domains, sleep can be the hardest to manage because we feel the least in control of it. Both men and women tell me there is hardly a worse feeling than being exhausted and still not being able to sleep. Consider when you have been chronically sleep deprived: How well did you handle stress? How effective, patient, and loving could you show up for those you lead at work, and for your family at home? How clearly could you think and focus, accomplish life tasks each day? Now imagine all of this, on top of feeling suddenly like a fat, unattractive slug who can’t even enjoy an orgasm to relax. Problems and threats often loom larger and scarier at night, and the struggles of menopause are no exception.
When I think of menopause in just these three simple, intersecting aspects (there are so many deeper and more complex consequences of this life phase), I have to marvel at how we women hold it all together so remarkably well every damn day.
Some Resources (I have no financial or other interests in any of these entities)
The Menopause Society I consider this to be a standard source of evidence-based, clinically sound information and advice. There are sections for both healthcare professionals and patients. It’s just dry and requires time and patience to navigate. I use it like the WebMD of menopause.
Let’s Talk Menopause This resource is new to me and I will continue to explore. It looks promising as a credible source for information, experience, and a diversity of advice. The podcast features interviews with practicing physicians on topics relevant to our daily lives.
Dr. Jen Gunter I have followed Dr. Gunter for years and she is a badass. Seasoned OB/gyne physician, gifted writer and author of The Menopause Manifesto (which I have not yet read but my colleagues recommend highly), her advice is evidence based and she sells no products; she simply writes and shares information on social media.
Esther Perel I have followed Esther Perel for many years, since I listened to her book Mating in Captivity and watched her TED talk on the psychology of infidelity. I recommend patients to peruse her website for articles and courses on intimacy, communication, and relationship.
Stacy Sims Exercise physiologist and researcher Stacy Sims has advocated for many years that “Women are not small men.”(TM) I am not deeply familiar with her premise or programs, but my colleagues in menopause domains respect her and recommend her work. She is also easy to follow on social media.
The Betty Rocker Bree Argetsinger is consistently empathic, compassionate, encouraging, and realistic about menopause and all its implications for health. She shares extensive fitness, nutrition, and mental health articles and programs, all presented in readily digestible and actionable portions. You can also follow Bree on Instagram.
Dipsea, Quinn, and Romance in General We don’t always have the bandwidth to overhaul our sleep, exercise, nutrition, stress, and relationship patterns. And sometimes sexual health and connection just needs a little spicy nudge to get going. I have written about Quinn and referenced others’ writing on romance fiction as vehicle to sexual re-awakening and un-inhibition. The advent of these platforms, as well as the rapidly rising popularity and accessibilty of romance audiobooks and their creators (authors and voice actors alike)–which women and their partners increasingly experience together–elevate women’s sensuality, and thus sexuality, at any age and in any body. The romance community leads the long overdue movement of sex and body positivity in the West. Thank goodness.
If we women live long enough, menopause is inevitable. We each get to choose how we will approach and travel our individual journeys, and I’m so gratified to see a wide, deep, and diverse community of helpers emerging to cheer us on. Increasingly I advise addressing decision making as first defining goals and trade-offs. What do we want, and what are we willing and not willing to do to get it? I recommend reassessing often and honestly, and recruiting the most valuable support and feedback we can access.
This post serves as my first personally curated patient information handout on menopause. It is certainly far from comprehensive, and will undoubtedly update and evolve over time. There are so many valid and effective resources out there, and I thank colleagues, patients, and friends alike for pointing me to so many of them.
We’ve come such a long way, and have so long yet to go. So let us celebrate the wins and march onward together, yes? The only way out is through. The best way through is together.
Healing Through Connection 