New Body Signs of Stress

How does stress manifest physically for you? 

I’ve asked patients for years now.  Some people know exactly what I’m talking about and answer without hesitation—“Oh, migraines—MONSTER migraines.  As soon as I feel one coming on I know I’ gotta unplug and go for a run!”  Some need a little prompting—I give them other examples like chest tightness, loss of appetite, or insomnia.  For others, it helps to ask what their significant others or children tell them.  “What would your wife say if I asked her,” usually gets a pretty immediate and animated reply.  Very occasionally, even after all of that, some still don’t really understand the question, or deflect, and we move on.

I noticed neck pain as my stress signal sometime in my 20s.  I suspect my body learned this nerve pattern during residency, when my heavily laden white coat pockets dragged my posture toward the floor for well over 80 hours a week.  I remember taking the coat off (aaaaahh, relieeeeef), then picking it back up later to put it on (aaaaaarrgh).  I’d say it probably weighed a good 5 to 7 pounds.  If you’ve never experienced this, and you’re also looking for a great laugh, check out this video of the Try Guys wearing boob weights for a day. You’re welcome!

For years a simple backrub or even just a good night of sleep would take care of it.  But in spring of 2010 I started having a hard time sitting still at work.  Increasingly I was distracted by tightness, and eventually searing pain, all around my neck and shoulders.  It was diffuse and constant, and I could never find a comfortable position, day or night.  Ibuprofen would not help, and hour long massages only very briefly.  It had been six months since starting a new position, and I was ‘way more stressed than I realized.  The day before vacation I thought, I bet this goes away in Colorado.  And voila, by the time we landed in Denver I was already feeling like myself.  After a week in my happy place, I returned to work expecting the neck pain to recur.  Happily, it didn’t!  Hooray, all fixed!

Not so fast.

A month later I developed astonishing pain and sensitivity in my right forearm—cubital tunnel syndrome—to the point where I had to roll up my sleeve because I could not stand the touch of the fabric.  I barely got through CPR training one morning; I told my mind-body physician friend, thinking he’d recommend a supplement or something.  He listened compassionately and reflected how often he’d heard the same story from patients.  “Sometimes the body just puts it in another place,” he said simply. 

Thankfully at the end of that week, I went away to my first ever mindfulness retreat with other medical educators.  I could not remember the last time I had so much quiet time to myself, not having to rush somewhere, make a decision, or take care of someone.  After dinner we had free time and I climbed into a bay window and started writing.  On a random legal pad I dumped everything that had swirled in my mind for however long—deep, complex thoughts that poured forth from the pen in a torrent, pages and pages full.  By that night going to bed, my forearm felt normal, and that pain has not come back.  I’ve been journaling regularly ever since.

Over the years, the neck pain has come and gone, and improved significantly since I left that job.  But even in the last two years as I have taken on more at work, and in the past six months of utter chaos, it has only recurred mildly. 

***

Out of nowhere last week, I developed a sore throat.  Strange.  It came on and worsened suddenly over a few hours, then abated after an hour Zoom call with my Braver Angels pals and a big mug of honey tea.  I had no other symptoms—no fever, body aches, fatigue, nasal congestion, or headache—just a really irritated throat, and only on the right side.  On further reflection, I had also been doom scrolling, eating, and online shopping more. Huh. 

This is exactly what happened back in March, when I wrote four blog posts in eleven days about the pandemic.  Looking back, I see the same pattern of behavior—staying up late, reading voraciously, ruminating, anticipating, problem solving, and looking for things to do to help.  For days in a row I had mild, barely perceptible throat irritation and nothing else.  It came and went, without discernable patterns or correlations. 

New body sign!  How fascinating.

This time I had to call in sick to work.  The team sprang into action and rearranged schedules.  My patients all agreed to speak by phone; my colleagues did their physical exams in my stead.  Everybody was so understanding and gracious, their day turned upside down, all because I had a sore throat for a few hours. 

Rightly so.  What if it were an infection?  What if the person I was with 5 days earlier, who was now home sick, had COVID (they didn’t, and we were both masked and distanced, together for only 15 minutes)?  What if I ignored the sign of potential infection and came to work, and then transmitted to the team and my patients?  Yes, it was a huge hassle for everybody to make last minute workflow changes.  But that was nothing compared to the potential, exponentially larger hassles of a whole workforce having to stay home sick, all because of me.

Right now we should take no chances.  Now more than ever we must build, sustain, and advocate for work systems that support the health and well-being of the workforce.  We need to make it safe—and expected—for employees to take care of themselves, thereby caring for coworkers and clients.  Short term inconvenience is the investment for the returns of long term loyalty, cohesion, and success.

If we slow down and pitch in—if we all take care of each other on the team—maybe we will have the mental and temporal space to notice new patterns.  Not just new personal body signs of stress, but new community signs of need, new collective signs of connection, and new team signs of creativity, innovation, and core values expression.  Wow, wouldn’t that be something?

Excavating the Dark Side of the Shitpile

Who’s ready to get off this roller coaster?

Bazinga, no dice!  We are strapped in like fat toddlers to professionally installed car seats and this hellish ride ain’t stopping anytime soon. 

What am I talking about?  COVID?  Racial injustice?  The economy?  Politics?  Riots and looting?  Wildfires?  Square dancing hurricanes?  Climate change?  Well, all of it, of course.  We are in it, my friends.  Oh. Yeah.

*sigh*

As always, my friend Donna enlightens me and I feel better.  In our recent conversation I recalled her assertion a decade ago that humanity pushes toward ever increasing consciousness and enlightenment.  Right after the 2016 election I may have laughed out loud (or cried) at this idea.  But today I take a different perspective.  How can I say this in the middle of all the tumult and crisis?  Because tumult and crisis are exactly the evidence of impending breakthrough.  Anyone who has done any truly deep, inner work knows that enlightenment cannot come without a whole shit-ton of pain and suffering.  We also know that on the other, light side, when we get there, the effort was always worth it.  My “Sh*tpile” post may be only the second or third I ever wrote on this blog:

Everybody has one.  We inherit large parts of it from our parents, whose parents passed theirs down, etc.  Life experiences add mass and odor as we grow up.  It sits squarely in the middle of the house of our existence.  For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off.  The surface gets dry and crusty; we grow accustomed to the smell.  No big deal.

Once in a while, something moves us to start digging, like that sudden urge to clean out the closet.  We quickly learn that sh*tpile insides stay fresh and painful, like unhealed wounds when scabs suddenly get torn off.  Our eyes water, our senses are overwhelmed, and we want to escape, and fast.  Maybe we avoid that room for a while, or we come back driving a tank to flatten the pile, to the destruction of other property.

Then last year I wrote about the poop flinging that happens when somebody else knocks off a piece of our shitpile, in “All Hail Your Dark Side”: 

What triggers you?

I don’t mean your pet peeves (please, stop using “there’s” when speaking about anything in the plural).  I mean what gets under your skin and affects you viscerally, really hijacks you?  I’m talking about the thing that escalates you so fast or intensely it’s like an out of body experience—you know you’re overreacting, you know it’s irrational, and yet all you can do is sit by and watch it unfold, powerless to control or direct it.

I submit that we are at this moment, collectively, neck deep in our triggered societal shitpile. I’m thinking mostly about systemic American racism, but I also include our profoundly political, ideological, and cultural polarization.  We’ got some serious reckoning to do, my peeps.  How the hell did we get here, and how the f*** do we get out?

“What if this is not the darkness of the tomb, but the darkness of the womb?”  Valarie Kaur asks.  What if this is exactly the Work we all need to do to reach that higher plane of human relationship?  What if we are all called to participate—fully, both feet, deep end—with only one another as life preservers?  Brené Brown calls it “Day 2,” the messy middle between realization and resolution, where the Reckoning, Rumbling, and Revolution happen.  It’s the second act in Joseph Cambell’s hero story arc, after the hero has tried every way of avoiding, denying, deflecting, and averting the task, and finally resigns, and rises, to meet it.  The gripping, tense, thrilling part of any story is this messy middle, the part we dread and relish at the same time.

In the Shitpile post I assert that we can use our life manure to cultivate a life garden that brings joy, fulfillment, and peace.  I use the metaphor of wise gardeners and tools that we can recruit to make the Work easier and more meaningful.  The pile is deep, pungent, and squishy in that way that creates a vacuum, sucking you further in every time you move, apparently impossible to escape.  But we can do it.  Look for help from people who already wield the most effective implements—Curiosity, Humility, Respect, Openness, Non-judgment, Kindness, Empathy, Self-Awareness, and Self-Control.

I present below my hardware store of other tools, accumulated to date, that help me relish ‘way more than dread.  They inform, educate, challenge, and stimulate me.  Along with my pit crew, these resources and practices give me the vital energy and strength, and really the joy, to pursue the hard conversations, to engage ‘the opposition,’ and to make a God. Damn. Difference.  I hope at least some of it resonates with you.  What else would you add to the store?

The Books

Talking to Strangers by Malcolm Gladwell

Four Days to Change by Micheal Welp

How to Be and Antiracist by Ibram X. Kendi (still getting through this one—it’s the esoteric lecture)

Me and White Supremacy by Layla F. Saad (will revisit this one—it’s the life workbook)

But I Don’t See You as Asian by Bruce Reyes-Chow

Caste by Isabel Wilkerson

The Websites/Groups/Resources

Braver Angels—depolarizing America, one conversation at a time

Uprooting Inequity –Ayo Magwood—American history scholar teaches history of racism in America online.  I’ve taken two of her classes and recommend them highly.

The Root—“The Blacker the Content the Sweeter the Truth”

The Dispatch—conservative news

All Sides—news from left, center, and right organized around topic/issue

David French, The French Press

Chris Ladd, Political Orphans, and formerly GOPLifer

The Concepts and Practices

Technical vs Adaptive Challenges and Change—Heifetz and Linsky

PEARLS:  Fostering connection in communication—a copyrighted framework from the Academy of Communication in HealthcarePartnership, Empathy, Acknowledgement, Respect, Legitimation, Support

Asking truly Open, Honest Questions—Parker Palmer, Center for Courage and Renewal

Cone in the Box:  Perspective taking—Judy Sorum Brown

Managing Polarities—Barry Johnson