November 25:  My Journals Make Me Better

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NaBloPoMo 2019

“You both have multiple journals that are all partially written in?” I asked, feeling vaguely twitchy.

On an online forum where I like to think I’m making new friends, three of us have bonded over our shared love of journals.  I wrote to the group last week, “I may have almost as many blank journals as I have books–the potential in them, the invitation to fill them with experience and life–they just make me so happy.”  The other two musketeers described their journals of various sizes, shapes, and designs, scattered about their homes.  They get written in whenever inspiration strikes.

That idea made me a little uncomfortable—that thoughts and ideas might be strewn about in different books, lying randomly around a home, disconnected, alone!  Hence the question above that I keyboard-blurted tonight.  I thought at first, “I can’t do that.”  Then I realized, I do do that—I have at least 4 journals going at the same time.  But I do organize them (not that my friends don’t—I have asked them to clarify).  I have a personal one, where I keep all original content. This one has at least three different designs of washi tape tabs, for blog ideas, presentation ideas, and other recurrent themes.  One is for work–a record of meetings, tasks, initiatives and their progress.  In a third I take notes at conferences or other formal learning.  Yet another holds insights from coaching calls and exercises from LOH.  I carry at least two, sometimes all, of them around with me every day. It’s common for me to have at least two out and be writing in both of them at the same time–taking notes from a meeting or presentation in one, then writing reflections, insights, and revelations in the other.  I often flip them over and write from the back covers, to keep lists and other short, serial records.  I attach email printouts and sticky notes, and when I reread I highlight and write in the margins.  These are well-used and well-loved books.

***

In 2010 I went to a Mindfulness in Medical Education retreat.  I was physically ill that week with a respiratory virus.  But I had been mentally and emotionally unwell for months, turbulent and restless inside.  All I could do was ruminate, turning thoughts, conversations, and memories over, raking the same terrain, uncovering nothing new, no insights to show for all that psychic energy spent.  On the first night of the retreat we were given some quiet time and a pad of paper.  I filled my mug with hot tea, climbed into the bay window, and started writing.  For a month I had had inexplicable and persistent cubital tunnel syndrome—inflammation of the ulnar nerve at my right elbow that caused such sensitivity and pain in my forearm that I could hardly stand wearing long sleeves.  That night I unloaded the whole of my pent up frustrations onto that legal pad, many pages worth—a total brain dump.  I always journaled growing up, and somehow it had been years since I had last penned for myself.  I had forgotten how cathartic, how therapeutic, it was.  The next morning my arm felt normal.  I have kept a journal ever since, and that pain has never recurred.

***

Another friend mentioned recently that he may leave his house without his wallet or his keys, but he never steps out the door without his journal.  I can totally relate!  Now I suspect there are more of us than I thought.  It’s the most satisfying feeling to have a reliable, accessible repository to record insights, ideas, and discernments, whenever they occur.  When I cannot do this—usually when I’m driving—it’s like having to pee until I can get out the journal at the next stoplight (or pull over).  It occurs to me occasionally to stop accumulating blank journals.  I’ve already set a moratorium on buying yoga pants and washi tape (for now).  But if a blank journal calls to me, I will buy it.  It’s good for my soul.

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.

The Importance of Peer Support

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What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

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When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.