One Cheek in the Saddle


Hello friends!  I live!

The blog is now two years old (celebratory post forthcoming).  Looking back, I have strayed often from the declared theme of patient-physician relationship and communication.  I have yet to figure out my optimum writing practice and discipline.  And every day the thing I long for most is to write for fun!  *sigh* Life.

If my world were a horse, happily trotting along a winding dirt trail in the Rockies, oblivious to my riding its back, then I would have fallen off multiple times from confusion, inexperience, fear, overreaction, awe, inattention, and impulse.  Sometimes I roll a ways down the hill, too.  The past two months or so have seen all of these and more.  Thankfully, as dust-covered and disoriented as I stand at times, the horse always allows me to remount.  At this point I’m about halfway back in the saddle again—one cheek on.  The next few posts will document my return to two-buttock riding.


So much inner work done to date, and so much yet to do!  And I am infinitely grateful for the dense, strong, and unfailing network of support that surrounds me.  2017 could be my most productive and effective year yet, and I need help organizing.  So a couple weeks ago, I scheduled a session with my life coach of 12 years.

Her pre-call questions for me, and my spontaneous answers:

What do I want more of?

Connection, understanding, civil discourse.

To see people being kind to one another.

For people to truly listen to one another and try to understand each other’s points of view.

For us all to hold our shared humanity above all else, and see one another as fellow humans, all trying to make our way through an uncertain life.

Inner Peace.

Time outside, preferably in Colorado, in the mountains, but pretty much anywhere is good.

To write with purpose, discipline, and impact.

Integration—of everything I do, even the small things—for my Why to show up everywhere I go, with everybody I meet, most of all with my kids—to model the Why for them, in person and out loud.

To read primary literature, writings of the great thinkers and contemplatives, past and present.

Discernment—what is worth my time, contributes to my purpose, vs. what detracts from it?

Focus on what I’m for, rather than what I’m against.

Focus in general—to channel my energy to activities that align most with my central mission.  See Distraction below.


What do I want less of?

Rage and seething.

Repression of rage and seething.

Time wasted for lack of discernment.

Distraction.  I feel like Doug, the dog from the movie “Up”—Squirrel!  It all matters, but I cannot do everything at the same time.


What thoughts are uppermost in my mind these days?

The daily shit show that is our government and how it vexes me (see above, rage and seething)—sooo many squirrels.

I need to do something useful, to help, to contribute.

We are all in this together, we have to get through it together.

This is a test.  We can pass, and with flying colors, and only if we work together.

Every time I get angry, sarcastic, etc., I contribute to the negativity and morass.  I need to be better.

Why have I so much trouble walking the talk?  Why have I not achieved inner peace althef*ingready?


I present thusly to my trusted coach. The process always brings new insights, connections, and openings of mind and heart.  I plan to emerge on the other side of 60 minutes with increased clarity, confidence, and drive.  I’ll let you know! 😉

Oh yeah, and the Rules of Engagement also live, just taking an unplanned hiatus.  More of those to come, also.  Like I said, I’m only one cheek back on right now. 😉



On the Golden Positivity Ratio


Courtesy of Bryan Jorgensen, Las Vegas, NV, 2016

NaBloPoMo 2016, Letters to Patients, Day 25

To Patients Seeking Positivity:

Aim for the Golden Ratio!

As many of you know, I have recently undertaken to re-evaluate my Facebook usage.  Not long after I established my account c.2008, I decided to make my page a monument to positivity.  I realized that after I die, it would be the most visible and accessible legacy I leave, and I have total control over what I post.  I minimized complaining and ranting, and when frustrated I would try to write with an attitude of learning, of moving forward.  Lately I tend to leave off the latter.

Somewhere along the way, I think over the past year, but I’m not sure, pessimism and cynicism snuck in, no doubt related to politics.  The layers of consciousness infiltrated by the negative campaigning this time around extend deeper than any other election cycle in my memory—but maybe I just don’t remember.  I think humans have evolved to forget pain as a survival mechanism.  If women remembered all the pain and anxiety of pregnancy, delivery, and caring for a newborn, we would never do it more than once, are you kidding me?

I used to review my Facebook posts and feel elevated.  Today they often bring me down; it feels terrible.

Thankfully, I have some tools to resist the negativity.  I was reminded recently during my 3 Question Journal Shares with Donna over at A Year of Living Kindly.  I remembered something about healthy relationships maintaining a 3:1 ratio of positive to negative interactions.  Turns out it’s actually 5:1, widely attributed to observations by Dr. John Gottman, renowned marriage and relationship psychologist.  I think the same thing applies in other realms, too, such as self-talk—a reflection of our relationship with ourselves.  It’s not a far leap to see how this idea pertains to news, social media, and any other human interactions.

Business researchers have discovered a 5.6:1 ideal ratio in highly functioning organizations, whereas low-performing teams’ ratio landed close to 0.3:1.

For more information on the science behind the theory (and motivation for practice), I highly recommend Positive Psychology in a Nutshell, by Ilona Boniwell.  For a brief overview, check out this PDF.  The book summarizes the origins of positive psychology as a field, and the research and wisdom of its study and application.  For example, psychologist Barbara Frederickson has described how positive emotions contribute to our personal growth and development (taken from Boniwell’s text):

  1. Positive emotions broaden our thought-action repertoires
  2. Positive emotions undo negative emotions
  3. Positive emotions enhance resilience

So hereafter, I will pay more attention.  I will likely continue to share articles that illuminate my concerns for the future.  But I will aim for the 5:1 positivity ratio.  Holy cow, can you imagine if that’s actually what we saw on the news and social media?  And why not aspire to 5:1 in my personal interactions, too?  That’s taking charge of my own happiness, yes.

On What Helps


NaBloPoMo 2016, Letters to Patients, Day 22

To Patients Preparing for Uncomfortable Holidays:

Seek what helps.

What did I write recently about staying off of Facebook and minimizing my social media exchanges?  How fascinating, look what I just did—spent the last two hours on Facebook!  I also write about trying, falling down, and trying again…  So this is me both falling down (in my attempt to stay off) and trying again (to engage meaningfully).

The holidays are coming, yay!  …And, not so yay!  The conversations we have with friends and family in the next 6 weeks or so have enormous potential—for division as well as connection.  Personally, I feel optimistic.  I plan to evoke my core values of open-mindedness, empathy, and integrity.  I want to look back on the gatherings with gratitude and deeper connection.  So today I share with you all the things I have read (today—see?  I endure Facebook for your benefit! teeheehee) that have helped me.  These pieces validate, challenge, reassure, alarm, question and motivate me to Hold the Space, Stay on the Path, and Seek Love.  Please share yours, also!

A fellow physician’s acknowledgement of the humanness of bias, its potential for harm in caring for patients, and a reminder for self-awareness and –management.

Posts by Michelle at The Green Study, reminding us that internal conflict is normal in the face of world events such as ours, with concrete suggestions for actions that align with core values:  “We cannot strengthen our character unless it is tested. We cannot defend our freedoms unless they are threatened. We cannot become better writers or artists or humans unless we have obstacles to overcome.”

An article from The Guardian that points me to reputable sources of alternate points of view, so I may understand better.

A call out from the Wall Street Journal—to help me own my shit before I call out others on theirs.

A gentle message from fellow blogger John Pavlovitz: “Friend, however you choose to navigate these holidays, know that it’s the right way. Give yourself permission to pretend or confront or abstain as you need to, and forgive yourself later if you decide you chose poorly. You’re probably going to get it wrong or at least feel like you did.

“But remember too, to save a little of that mercy for those who sit across the table from you or those who choose not to. They’ll be doing the best they can too.”

And finally, the Prayer of Maimonides, the twelfth century physician and philosopher:


These holidays, wish me persistence and ‘stubborn gladness,’ as Liz Gilbert calls it.  I wish you all the same!

On Rest and Recovery


NaBloPoMo 2016, Letters to Patients, Day 19

To Patients Who Feel Tired:

Take a break.

It’s the home stretch.  9/10 presentations since August are completed, last one in 10 days.  I feel positively exhausted.  I drove 2.5 hours to Champaign Thursday night, arriving around 11:30.  Sleep was not great that night… not for a couple weeks now, actually.  I presented at a conference yesterday morning, then attended other presentations the rest of the day.  I made new connections, re-established old ones.  I received an award, so humbling and touching, and engaged in lively conversation with colleagues at dinner.  I left Champaign by 10:30pm, and swung by to pick up my daughter from her sleepover just before 12:30am, because she wanted to come home.

I got out of bed at noon today.  Had some coffee and leftover carrot cake for—well, breakfast, I guess.  Folded laundry, paid some bills, cleaned off my desk.  The only things I have to do this weekend are write, work out, attend the middle school play, and maybe cook something.  It’s a weekend for much needed rest and recovery.

It’s been four months of intense learning, processing, sharing, and integration.  It’s maybe also been a year of angst, trying so hard to engage with ‘others’ in the personal political arena—mostly online.  Curiosity, probing questions, reading for understanding and hoping for others to do the same—I engaged in good faith.  Now I’m finished.

I have gone back on Facebook since my 24 hour fast this week, very occasionally getting sucked into reading diatribes about one thing or another.  I have minimized posting my own tirades, however.  I see a friend complaining about ‘the left,’ calling out the whole group as hypocritical.  I’m tired.  Tired of the generalizations and name-calling, tired of the fruitless arguments and echo-chamber goading.

So this weekend I’m resting and recovering.  I have reviewed and renewed my charitable contributions.  I’m trying to be more present to the family.  I’m considering my options for civic participation.  I’m saving my political curiosity and engagement for people I meet in person.  I’m sleeping.  A lot.

My last presentation this year will be to a new audience, outside of medicine.  I feel positively giddy with anticipation.  I need to be focused and my best—not just for them, but for me.  The energy I project can amplify exponentially if I get the resonance just right.  Then it recharges me, too.  And that can only happen if I’m rested and healthy.  So this downtime is my investment in future engagement.

What has you tired right now?  What do you need to recharge and re-engage?  Here’s hoping you find it.


On Fasting


NaBloPoMo 2016, Letters to Patients, Day 15

To Patients Who Are Fed Up:

Try fasting.

That pun really was unintended!

I asked a colleague about fasting once—what are the benefits, why does he do it?  He asked, “Don’t you ever feel like it’d be a good thing, every once in a while, to stop eating for a day?”  Ummm… No, are you kidding me?  That would never and still has never occurred to me, I love food too much!

Tonight, however, I think I may understand a little better.  Maybe fasting is about counteracting overconsumption.   Certainly we have a problem with food glut here in the US.  I have heard the word ‘detox’ associated with fasting, too…  Maybe I just refuse to admit how poisoned I am by the food I eat to consider this remedy—I am pre-contemplative here.

I am finally ready to concede, however, that I overconsume Facebook.  Sure, it provides plenty of material for this blog, and I really do interact meaningfully with a lot of people (but wait, do I, really?).  And, I have let it overtake my consciousness too often.  The time suck is interfering with other tasks and yes, relationships, I must admit.  I rationalize that I am ‘reading,’ that it’s a source of so much interesting information and idea exchange.  That may be partially true, and still, it costs too much.

So I commit to a Facebook fast this day, November 15, 2016.  It’s been a long time since my last fast—actually a year, come to think of it—yup, almost exactly!  How funny…

Is there something you need to take a break from?  Something you do habitually, that’s not all bad, but that may be excessive, a little out of control?  Maybe you don’t need to quit it altogether, necessarily.  But maybe taking a little time away will help put it into perspective?  A little break—a pause.  Test your ability to resist, challenge yourself to notice where the habit shows up, what drives it, what you might substitute for it, and how the withdrawl sensations may evolve…

Now I’m wondering if I could actually apply this to my eating.  No, not fasting from all food (again, are you kidding??), but maybe something a little more manageable:  Fast from dessert for a week—substitute fruit.  From sweetened condensed milk on weekdays (“That’s like dessert!” one of my patients exclaimed once)—substitute soy milk.  This looks more like actual behavior change than just fasting… huh.

I will be back on Facebook tomorrow.  It will likely look very similar to my usual pattern, maybe even a rebound effect—a more intense fix after the sudden withdrawl.  Well, we’ll see.  I feel a lightness to trial and error lately, and this is worth a try.  I shall report back, so stay tuned!


On What You Can Do


img_4564NaBloPoMo 2016, Letters to Patients, Day 12

To Patients Wondering What to Do:

Take this Wise Lady’s advice.

I had an inspiring conversation this week, one that lifted me up, which I sorely needed.

This incredible woman grew up in the era before women could have credit cards in their own names, before women could play organized sports, and before spousal rape was finally outlawed.  She survived brain tumor surgery and the death of her son.  She has attained advanced education, acquired innovative skills, built and sold a business.  Throughout it all she seems to have thrived.

I queried her response to adversity.  Was she born wired for resilience?  Did she acquire such effective coping skills simply by experience?  She referenced the teachings of her father.  Through her childhood, she said, he taught her to how to face difficulties.  Before she went off to college her dad had a specific talk with her:  “Here’s how you deal with problems,” he said.  “When faced with a problem, first ask yourself, ‘what can I do?’”  Not what should I do, what do others expect me to do, what would s/he/they do.  “What can I do?”  “If you can’t figure it out right away, stop.  Go outside, take a walk.  Come back and ask again, ‘What can I do?’”

Wise Lady said this one strategy got her through myriad struggles and crises in life, and she taught it to her kids the way her dad taught her.  But life flung faster, sharper arrows her way, and she had to develop additional coping tactics.  Seeking a path to clarity through the mires of crisis, she began asking herself, “What do I need to get rid of?”  And that has made all the difference since.

I will tell you, Wise Lady has a serenity about her countenance that I meet only occasionally anymore.  She has racked miles on her soul, yet I sense no cynicism or regret.  I so want to be like her!

From now on I will ask myself more often,

“What can I do?” and

“What do I need to get rid of?”


On the Second Arrow


NaBloPoMo 2016, Letters to Patients, Day 11

To Patients Who Suffer:

Which arrow causes you more pain, the first or the second?

Fellow blogger Michelle at The Green Study recently posted a piece in which she distinguished between pain and suffering.  It reminded me of a Buddhist teaching that inspires and humbles me.  Blogger and curator extraordinaire Maria Popova quotes it in this article she wrote last year, on a book by Tara Brach:

The Buddha once asked a student, “If a person is struck by an arrow, is it painful?” The student replied, “It is.” The Buddha then asked, “If the person is struck by a second arrow, is that even more painful?” The student replied again, “It is.” The Buddha then explained, “In life, we cannot always control the first arrow. However, the second arrow is our reaction to the first. And with this second arrow comes the possibility of choice.”

The first step to suffering less is cultivating awareness of the second arrow.  This takes practice, and we must resist the self-judgment that comes the moment we realize we have not only shot ourselves again, but have been twisting that second arrow deeper and deeper.  This shame and self-revulsion is, after all, another drop of poison on the second arrow’s tip.  Instead, I like to apply Ben Zander’s acclamation when he finds himself or his students doing something ‘wrong’: “How fascinating!”  Look what I did!  No judgment, just lighthearted observation.

The second step to suffering less is, of course, to avoid the second arrow.  Once we notice, learn how to remove it and tend the wound.  Breathe deeply.  Identify the sources of anger, fear, resentment, blame, contempt, shame, despair, anxiety, bitterness, envy.  Breathe again.  Loosen our desperate grip on these feelings.  Hold them more loosely, ever more loosely.  Breathe.  Breathe.  Hold also the Space, emotional, cognitive, and temporal, for them the move through and exit us.

Eventually, breathing, we can let go the negativity, pull the arrow out.  Breathe.  When assailed by another first arrow, see the second arrow coming and sidestep.  Breathe.  Keep breathing.  Practice self-compassion and forgiveness.

Life will continue hurling arrows at us.  Some will miss, others will land in our most vulnerable spots.  Mindfulness practice, centered in attention to the breath, helps us evade the wounds and anguish from our own second arrows.  The data, accumulated over the past four decades, is all but irrefutable for the benefits of mindfulness for depression, anxiety, chronic pain, burnout, and overall well-being.  Prolonged practice even changes the physical structure of the brain, and it’s never too late to learn.

If you’d like to learn more, I have included a few more links below.  You may find it worthwhile to invest in the practice.  Be patient with yourself.  And let me know how it goes!