Category Archives: Uncategorized

Trust and Adjust

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Friends, I am a master procrastinator! What about you?

Since at least high school, my writing is almost always done at the last minute. Term papers, college and med school application essays, blog posts, it’s all the same. There’s usually a sense of thrill and anticipation, a fun challenge, as well as some self-judgment for having to ‘cram.’ And while the product was usually pretty good, I often wondered how much better it could be if I gave myself more time to edit and revise. So for NaBloPoMo 2022 I completed posts 2-3 days in advance, scheduling them to ‘drop’. I edited most pieces in the interim, but not significantly–mostly choosing a different word or tightening a sentence here or there. That was validating.

This works fine when the deadlines are soft–meaning I’m accountable only to myself, and only for fun. And I have never had to ask for an extension in class or missed an important application deadline, so I’m probably still fine, right? I recently attended a writing workshop where I thought I had to present an entire book proposal for critique, and I managed to sit Butt In Chair in enough time to complete a first draft without pulling any all-nighters (Iโ€™ve only ever stayed up all night to finish a Percy Jackson book in adulthood). Writing Buddy was impressed, commenting, “When you get your bottom in the seat, you get sh*t done!” It did help that I was in the mountains, with maybe 10% of the usual distractions.

But if a miracle happens and I actually get a chance to publish a whole book, that will be next level–how do I know my baseline method will be good enough? Will these 8 years of blogging have been good practice? For the most part I have kept up with weekly posts, plus the 30 day challenge every November. I worry that I will either run out of ideas, or I’ll fail to write them coherently enough. But I worry most that I will not have the discipline to finish what I say I want to start. What evidence have I for this fear?

Most of my childhood friends started piano lessons early in life. I hesitated–all that practice… MaBa warned me what kind of investment it would be for them, and after considering for two years I finally committed. At that time there were two music stores at Southglenn mall, and we went back and forth between them one weekend, listening to the Yamaha upright at one and the Kawai upright at the other. It was clear to me from the start that the Kawai was the superior instrument; I advocated patiently and firmly, and won my case. I played with enthusiasm well into high school–not expertly, but enough to really grow some musical neural networks that enrich my life. It’s a form of stress relief, then and now. Today I own a Kawai baby grand, and Son and Daughter both play with similar satisfaction.

Over my life I have committed to and sustained practice in classical Chinese dance and painting, public speaking, volleyball, medical training, practice, and leadership, washi tape art, physical fitness, and now sourdough baking. And blogging… with the idea of writing a book… eventually. When I started HTC in 2015 I never imagined it would last 8+ years. I thought I had a book in me then, but apparently not yet. “You don’t do anything half-ass,” Friend observed to me recently. Well, not anything I care about, anyway. And here I still am, 532 blog posts later and no book. Procrastinate much? I’m much closer now than ever, though, like litera(ri)lly on the threshold. It’s just taken this long, for all the reasons, and it’s okay. I’m having fun, practicing, processing, progressing, connecting, …winding up.

Friend texted me this week to inquire about and encourage my book writing; it was so loving and I felt buoyed. My reply:

Thank you so much my dear friend!! ๐Ÿ™๐Ÿผ๐Ÿฅฐ๐Ÿ’—๐ŸŒŸ
Writing itself is going well!! ๐Ÿ’ƒ๐Ÿป๐ŸŽ‰๐Ÿฅณ โ€ฆthough none of it is actually proposal work, per se ๐Ÿคช I did go really BOOBS OUT on the blog over the weekendโ€”gearing up to pour into the bookโ€”kinda like rubbing stocking feet on carpet in order to shock the next thing I touch! ๐Ÿ˜„ So Iโ€™m feeling overall good, trying to balance the organic unfolding with the intentional effort, you know?
THANK YOU THANK YOU so much for your encouragement, it means the world to me!! ๐Ÿ™๐Ÿผ๐Ÿ™๐Ÿผ๐Ÿฅฐ๐Ÿ’—๐ŸŒŸ๐Ÿ”ฅ๐Ÿ’ช๐Ÿผ

Allow the unfolding with joyous intent. Trust my reliable nature. Adjust my method(s) as needed. Commit to having fun. All in, all me. BOOBS OUT. And deep bows to my amazing Tribe. I get to choose whatever meaning I want out of any and all of it. How awesome!

I’ got this.

Feel Everything: The Hedonic Stoic

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Okay friends, time to get loose with some words!

The title of this post may not make any sense to you, and it makes all the sense in the world to me! It manifests my deep desire and commitment to embrace and exude healthy paradox, emerging in the form of fun, which I absolutely love. Suspend disbelief and take a dive with me, ya? Maybe you’ll have some fun too:

Stoic: “a person who can endure pain or hardship without showing their feelings or complaining.” — Oxford Languages

Hedonist: “a person who believes that the pursuit of pleasure is the most important thing in life; a ‘pleasure-seeker'” –also Oxford

I got a lot of ‘stoic’ messages growing up, some healthy and some not so much. I fell onto a sprinkler head while playing in the water one young summer, gouging a dime-sized chunk of flesh out of my knee, the kind of wound that would only heal by filling in scar tissue from the edges over a couple of weeks. As my nurse mom applied medicine, her demeanor was calm and clinical, and she told me to be still, be brave–ๅ‹‡ๆ•ข (yong gan). Looking back, there was no shaming or denial of my pain, just reassurance that everything would be okay, and I had it in me to endure. It was validating and encouraging. Years later, as I cried audibly in the theater during the most tragic movie I had seen to date, a male relative pinched my thigh–hard–to get me to stop. I understood that message clearly, and it was neither validating nor encouraging.

Feel it maybe, control it always, show it never. How many of us could identify this, or something similar, as an unspoken mantra in our families of origin? Or in our collective culture today? When someone is sad, or even happy, how (un)comfortable are we with their tears? Or our own? What are the acceptable expressions of emotion? Smiling, laughing, hugging, drinking, yelling, honking, gesturing, throwing, slamming, dismissing, deflecting, turning away–including with/at/from ourselves? What does this cost us in psychic energy, physical health, and most importantly, human(e) connection with self and others? And how is it both useful and harmful?

Contrary to what some may think, stoicism is not about repressing, denying, or expelling emotions. It’s more about a commited self-awareness and self-regulation practice, so as to not let intense emotions hijack us into poor decisions and ruined relationships. It’s about balancing feelings with reason, clearing the path for (inter)acting according to our highest goals and core values. It makes sense, then, that a dedicated practitioner may end up with what we colloquially call the ‘stoic’ demeanor–straight posture, neutral expression, generally undemonstrative carriage. And, not necessarily. I think it’s possible–preferable, actually–for a true stoic to live an expressive life; just not excessively or gratuitously so. And even if not outwardly obvious, an ardent stoic can (and does, in my opinion) still experience, even revel in their deep, powerful, and moving emotions, while still keeping a leash on it all. For many, this may be easier said than done; that is why the sister practice of mindfulness comes in so handy, particularly skills that help us manage difficult emotions. Stoicism, then, is a practice of inner peace.

Life is so full of sensations–movement, sound, temperature, texture, taste (omg all the flavors!!), light, color, mass, frangance–I feel giddy just seeking the words! And all of this in addition to the infinite complexities of emotion, relationship, and community, holy cow! We are here for such a short time, how sad would it be to live an entire life without full and vibrant awareness, attention, and appreciation for all there is to possibly sense and experience? This is why I love the idea of ‘healthy hedonism’–an all-in, sensually fulfilling relationship with pleasure, yes, but really I think it’s about joy–the quintessential manifestation of joie de vivre. Hedonism is not the same as debauchery. I think of it as liberated and exuberant engagement with all that our sensory world has to offer, within healthy boundaries–actually similar to stoicism in its grounded mindfulness of and devotion to a Why–living a full and fulfilling, attuned and connected, self-actualized and purposeful life.

Feel it all, manage it well, effuse it appropriately: A new personal mantra in progress, maybe. Allow the feelings, apply good reason, express for connection. Practice withstanding severe discomfort. Equip myself to plumb my emotional depths with confidence. Be with it, surrender–to pain, joy, love, loss, uncertainty, confusion, awe, outrage, fantasy, all of it–and then self-regulate: Do the work, learn the lessons, and apply in relationship, the ultimate human expression. As I write this, it’s so clear that besides mindfulness, self-compassion is another key skill for a hedonic stoic to practice.

To face all feelings without fearing them, to embrace a full spectrum of sensation and aliveness, and to emanate unfettered joy, all while solidly grounded in an ethos of love and contribution: This is the essential spirt of the hedonic stoic.

Sign me up.

What I Wish For Us

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What a privilege to do what I do. Every day I get to meet new people, learn new things, apply my own well-developed knowledge and expertise in fun and interesting new ways. My skills are continually sharpened by each novel interaction, and both confidence and humility are strengthened as well.

Before each full day physical, I ask patients about their highest goals for the day. Their answers can usually be paraphrased thusly:

“I’m looking for a comprehensive assessment of my current state of health, including risks. Let’s identify where habits are healthy, so I can protect/strengthen them. Then discover areas of vulnerability and potential improvement, and co-create a relevant, actionable plan to optimize patterns in the five reciprocal domains of health (Sleep, Exercise, Nutrition, Stress management, and Relationships).”

People get excited (maybe that’s too strong–intrigued, perhaps) to understand the complex interrelationships among patterns and fluctuations within and between the domains, both conscious and unconscious, including extrinsic/environmental/circumstancial factors and their insidious influences. They often start the encounter focused on the biometrics: cholesterol, body fat, etc. And if I do my job well, they leave also attending to the salient behaviors and all of their adjuvant drivers. My reward is when someone leaves the day feeling they were seen and known as a whole person, in their current context. Even better if I can also help them see and know themselves this way more easily.

I recently read Kate Murphy’s You’re Not Listening, which helps me do my job that much better. I was gratified to see that I was familiar and facile with many of the concepts and skills she discusses in the book. It’s not just about making eye contact, repeating people’s words back to them, and voicing sounds that may indicate listening, like ‘uh-huh,’, ‘right.’ It’s about being truly present, listening as a way of being before doing, putting aside our own prejudices, assumptions, judgments, and expectations as much as possible, attuning to the person in front of us–true listening is a practice in deep presence. Easier said than done! And always worth the effort for deeper connection. This connection makes the medical encounter a profound win-win.

Don’t all people deserve this kind of physician-patient relationship? Isn’t the primary care doctor’s job to inform, educate, explore, and conference with people, to help them enact their own health intentions ever more easily and confidently? As your doctor, I wish to help you recruit all the support you need for healthy decision making, to moderate overt and heavy effort–make the healthy path the path of least resistance. It takes a village! Humanities researchers have known for generations now that our behaviors and decisions are heavily dependent on our circumstances, environmental cues, and real time mental state (the more fatigued and stressed [and who is not severely fatigued and stressed right now??], the exponentially harder it is to resist the most immediately gratifying, comforting, and self-soothing behaviors). So it all just makes me wonder, at times with severe agitation: Why do we, as a society, make it so hard for us all to live healthily? Why do we make healthy food, childcare, and mental healthcare so inaccessible and expensive? Why do we make people work 3/5 of their waking hours at jobs that confine them to chairs and screens? Why do we shame and punish people for taking time for medical appointments and care? Why do we blame individuals, telling them both explicitly and implicitly how they are not aware enough, not doing enough, not good enough, when everybody is just doing their best in chaotic, inefficient, and inhumane systems of everything? ACK.

My corporate executive patient population is microscopic compared to the general population, and privileged to the extreme. Current state in American healthcare means that only the uber wealthy, highest status workers can access the care that I so luxuriously provide. I say every day how I have the sweetest gig in all of primary care. I understand and appreciate this deeply, and wonder honestly about its sustainability.

I wish for my patients to leave every annual physical feeling empowered to exercise your agency where the energy will be most efficient and effective, so that by one year from now you can come back and report how much healthier you feel, and why, owning your own actions and appreciating the help you got along the way. And if youโ€™re not feeling healthier, we can talk it through, trouble shoot, and make a new plan. To this end, we doctors need the time, space, and resources to really know you, our patients, to understand the barriers to and facilitators of your best health habits and how it all intersects and evolves over time. Time is really the key here–there is no substitute for the time it takes to be fully present and to listen to the stories–to hear what is said and not said, attune to the subtle nonverbal cues, process it all and consider the best next open, honest, loving question. And then to hold temporal and personal space for thoughtful engagement. How and what we clinicians ask, and the energy we bring to each query, influence deeply (if not straight up determine) the answers we get, and thus the accuracy of our understanding, and the effectiveness and impact of our whole plan of care. Maybe I understood this early on, and that’s why I used to run 45 minutes late in a regular primary care clinic.

So how can we rebalance? As medical knowledge expands exponentially in volume and complexity, and our systems widen and dehumanize the distance between patients and their doctors (even more than when I wrote my ‘About’ page on this blog 8 years ago), how can we restore the close, personal, and healing energetic exhcange between us all?

I have no answers! Alas, our deeply broken and counterproductive healthcare system may be the quintessential complex-adaptive challenge. It requires leaders who can hold tension without anxiety, paradox and polarity without animosity, and patience and courage for experimental, iterative change.

Meanwhile, we workers and consumers of the system must find ways to connect and hold ourselves up, to get through the morass together. What I wish is that we all give ourselves and one another, including the folks who โ€˜runโ€™ our broken systems, a little grace. I truly believe we are all doing our best. AND we can do better. Maybe it starts by simply listening a little better.