Walking the Talk: Leading Indicators

Posted on January 21, 2024 by Catherine Cheng, MD

Eureka! and YIKES.

What is the nature of performance anxiety? Is that what I’m having? Or is it increasing resistance as a magnet approaches that which attracts it at one pole and repels it at the other, until it finally anneals and the magic happens? Truly, friends, this book project is kicking. my. butt.

I talk to patients about habit change every day. I have read the books, studied the methods. I’ve written about it ad nauseum. And there is still so much more to learn and practice! I get frustrated, sitting down yet again and analyzing today, judging my slow and ~~intermittently~~ frequently stagnating progress.

And then I smile.
Because there is progress!

I joined Ethos three seasons ago, consistently completing eight strength or conditioning classes per month since then. I had no specific outcome goals at the outset. I just knew I needed to get out of my basement, learn new movements, widen my repertoire. I knew I needed a community for accountability and connection. I trusted the folks at Ethos to meet those fundamental needs, and that my general outcome goals of getting stronger and more fit would be realized with time. And voila, it’s all true. Who knows how much I’ll eventually be able to bench press or dead lift? I’m doing more today than I ever have in 50 years of life, so who cares? All I have to do is keep showing up, bringing what I’ got, and whatever outcome I get will be valuable and worthy of the effort. I sense it already–how my clothes fit, the changing curves and definition, and how I feel–body, mind, and spirit. I also get feedback from others, which is gratifying. It all fuels me to keep going.

As of today, I have completed 14 consecutive days of Sunlight Before Screens, Morning Pages, and delayed caffeine. Thanks again, Shane! Here as well, specific outcomes/lagging indicators are not the goal (what would they even be?); rather it is the practice I’m after. Because I know that a more mindful and intentional start to my day is better for my health and well-being than a mindless and random one. Maybe similar to having my Ethos community for fitness, just knowing that my book hero and fellow fans endeavor, together, to establish and maintain this health practice holds me up? Just like going to the gym, I honestly, shockingly, look forward to getting up early every morning now and cracking open the journal, even if I go to bed late, just to see what may flow from the pen in that unfocused, creative state of my personal daily dawn. I’m only two weeks in, but I perceive significant benefit already: High energy and sense of purpose and confidence; increased attunement to hunger (or lack thereof); decreased craving for coffee (I’ve forgotten all about it a couple times). That last one floors me–I’ve had coffee every day since high school. Years ago when I abstained on non-patient days I noticed a heavy melancholy set in around mid-morning–fascinating, and a little alarming…
But this morning I made a 70/30 regular/decaf blend to start using every day, and I have a strong intuition that it will be just fine; it’s all part of a concerted yet organic evolution.
Everything is connected.

For whatever reason (12 days of cumulative creative opening?), this weekend felt portentious for book work. I posted on Instagram. I texted multiple friends requesting energy sent my way for perseverance and discipline. Whatever they did worked, because the ideas and ink bubble and flow with force. The EUREKA moment came yesterday when I realized that I don’t really know what my book will actually be in the end. That was also the YIKES moment–how do you start a project when you don’t actually know what you’re making? I feel an irresistable call to write something, and I have consistently answered that call for over eight years. I know I can write. I know I want a synthesis, an integrated whole of accumulated learnings, ideas, and original conclusions, in the form of a book. But the structure, organization, and specific content that I will publish is actually still somewhat unknown to me, a coy, elusive, and inviting mystery.
What a strange relief! Because now I can approach it like fitness and mornings.

If I don’t know the outcome, but I have clarity on the process, then I’m free to steward the work with openness, curiosity, humility, generosity, and joy! I can achieve my goal of having a pitch and proposal to present by April 18. I just don’t know, and don’t necessarily need to know, exactly what it will be. Very likely, it will not be what I imagine today. But if I sit BUTT IN CHAIR (BIC) and do today’s work each day, with disclipline and lightness, then I can let go expectations of any particular product. I can trust the process, that whatever turns out will be fine and good, because it will be the result of honest, authentic, deeply committed effort. It will be me, because I showed up every day to create it. How motivating!

I wrote my post on Meaningful Metrics about a year ago now. I think I have shared it with patients almost every week since then. Weight and cholesterol are lagging indicators. Habits are the leading indicators, the concrete, real time metrics that can be monitored, adjusted and maintained, and that have much higher predictive value. I can’t tell you how much you’ll weigh a year from now if you start doing the 7 minute workout. But if you do 7 minutes, three times a week, for 52 weeks, I can tell you that you’ll feel differently, likely better, in your body. And there will also likely be downstream benefits in other domains of your life and health. Focus on the practices; the outcomes will take care of themselves. Trust the process; get help when needed, assess and adjust regularly, and establish effective accountability.

So if I sit down, get centered, and show up for my book each day, it will show up and emerge for me. I set a concrete product goal for April, tied to relevant things that make the deadline meaningful. But if I focus on April today, I get in my own way. Today is for today’s work. I have interim goals to benchmark, to keep me aware. I can continue leashing the gremlins–the ones telling me I ‘should’ have figured this all out long ago, the voices of perfectionism and un-compassion. Thank you, now go sit in the corner. I have work to do.
I’ got this.

What are you working on this year? What leading indicators guide you, keep you on track? What else helps? Who’s on your team?
ONWARD, my friends. The world needs our contributions.

Trust and Influence–Because Shane Said So

Posted on January 15, 2024 by Catherine Cheng, MD

What is your morning routine? Do you run it, or does it run you?

In the video post of the screen shot above, my romance narrator hero Shane East reports on some morning advice he heard on a podcast on New Year’s Day (Huberman?), and invites followers to try it with him:
1. Upon waking, get sunlight for at least several minutes before getting on any screen
2. Delay caffeine intake for at least 45 minutes after waking
For the second, he describes the relationship between caffeine and adenosine, the neurotransmitter that promotes sleep drive. Simply, caffeine is an adenosine antagonist: when it sits on adenosine receptors in the brain, which normally slow cellular function and promote sleep, it has the opposite effect, promoting wakefulness instead.

I dived into the rabbit hole that yielded the articles linked above, trying to understand the rationale behind that second recommendation.
My takeaways:
1. Transition from sleep to full wakefulness takes time; better to let the body do it naturally by drinking water (we get dehydrated overnight) and getting light (preferably full spectrum sunlight, but get what you can that’s not a screen) on the retinas before doing anything else.
2. Caffeine can prolong and/or amplify effects of morning norepiniphrine and cortisol, which have stimulatory effects on heart rate, blood pressure, and other systems of the body. It can interfere with physiologic adenosine recycling in the brain and, depending on dose and interval, disrupt our intrinsic sleep-wake patterns. Introducing caffeine later after waking, when adenosine levels are lower and more stable, can mitigate this disruption.
3. None of this matters nearly as much as simply getting enough sleep (both quantity and quality) as many nights a week as possible, to obviate the need for stimulants in general.
But caffeine and adenosine are not my point in this post.

Rather, why am I suddenly so motivated, almost giddy, to act on this advice just because Shane said so? Really? Not when I heard it in Why We Sleep, not when I have ever read it elsewhere. Not because I’m a doctor and I know it’s good for me and I want to walk the talk. No. My book hero got up on the third day of this new year, made a 00:01:03 extemporaneous video sharing something cool he had recently learned, invited us fans to try it with him, and that lit one of the biggest behavior change fires under my butt since I joined Ethos nine months ago.

Readers of this blog may know my night owl tendencies. I have been known to post at 1:00am, then get up at 7:00 for work. That hasn’t happened in a while, because I’m working on it! And yet, habit change is hard. I have wanted for years to get up early to write Morning Pages, a creativity and wellness practice that calls to me. But before last week, I slept through all the calls. On a good day, if I left on time for work, I’d write in the car after turning off the engine, before walking from the parking garage to the office. For seven consecutive days now, I have risen with my alarm rather than snooze it. I sit up, turn on my full spectrum bedside lamp (the bulb came with my dawn simulator years ago, and has survived its associated device), grab my journal and write three pages, stream of consciousness, so I have something to distract me from my phone and keep my eyes open to light while I wait for my caffeine. I only look at my phone to turn off the alarm and get my writing playlist going. Win-win-win-WIN!
By the end of three pages, here are my consistent findings so far:
1. I feel alert.
2. My mood is excellent.
3. I’ve gotten out ideas that marinated overnight, or maybe worked out some question I had gone to bed with the night before. Or maybe I uncovered addtional questions yet to ponder. Regardless, I have just spent 15 minutes doing something I love, first thing in the morning!
That’s all pretty amazing.

I have known about the benefits of drinking water in the morning for years. I keep a water bottle at the bedside. But it wasn’t until last week that I started chugging in the morning, while I write. And because I’m getting up earlier and spending more time awake and out of the kitchen, my morning coffee consumption now automatically occurs at least 45 minutes after waking. It all feels almost easy.

And bonus: This new practice seems to have created space for insights and ideas to emerge throughout the day. I’ve made entries in the book journal almost every day this week, and momentum grows toward writing actual chapters and a proposal. I have also realized this week that since ideas so frequently occur as I drive to work (I often grab notebook and pen, scribbling while stopped at lights–hence the parked car journaling), I will now forgo the input of audiobooks (ugly cry face) on the morning commute to facilitate my own original output in that naturally creative time. And I attribute all of this to Shane.

What is with this phenomenon?

Normally I would cogitate long and hard, analyzing the psychology of motivation, cross referencing counseling practices for behavior change, looking back at my own past patterns, etc. Not this time. Today, I’m satisfied to wonder at it all a little while, marvel at the minor miracle of it, and then chalk it up to the utterly irrational nature of human behavior. I love and admire Shane as a person. I see him as trustworthy. I appreciate that he shared this advice, prompting me to search and learn more, nudging me toward my better self. I want to report to him that I accepted his invitation and it helped me.

Because that’s one of the best relational rewards, right, when someone tells us how we help them, how we make their lives better? Isn’t this why I’m a physician? My fondest, most loving memories throughout my career are patients and trainees telling me how I have helped them–yes, it’s my job and still, any amount of validation, no matter how small, matters. It’s even more meaningful after we have gone through multiple trials in their lives or training together. The more we acknowledge this bond, the stronger it gets, the more we trust, mutually.

Patients and students absolutely influence me. Because they trust me and consider my advice, I want to be worthy of it. Trust is built slowly, earned with time, energy, and effort. How better to honor that trust than to practice what I preach, visibly, right alongside my charges? Maybe this is why Shane’s video resonates? He’s getting in the boat with us fans, acknowledging the challenge, inviting us all to journey together, do our best, and see what happens. Had he said, “Hey, I learned this cool new thing, you should try it! Good luck, tell me how it goes!” I would have a very different response.

Trust and influence. They are irrational, driven by our qualitative, ineffable, limbic and sometimes labile sense of connection. I think of trust like an oak tree–grown over many years, strong and sturdy, and also susceptible to irrevocable damage in a single breath–a broken branch never grows back. There is no substitute for the attention and nourishment, cultivated through relationship, required to maintain strong trust and real influence.

Though my energy for this new habit is high today, change is still hard. I have significantly altered my daily routine, counter to what I consider to be my innate tendencies, which is not what I usually recommend. We will see how/whether I can sustain it. Maybe it will help that I was already approaching the threshold, and Shane’s video feels like just the little nudge I needed to push me over to the next best version of myself? Fingers crossed! Lasting change is most often incremental and iterative, requiring multiple trials. So I won’t be too hard on myself if by this time next week I am back to snoozing until the last possible minute to rise, rushing out the door 30 minutes later having written nothing and gulped a good portion of my coffee already. I can forgive myself the lapse and commit to trying again–maybe on days I don’t see patients? Something is usually better than nothing. We’re all here doing our best.

Anyway, Shane, if you read this, thank you. You have made my life better for a while, and now again, and given me more things to write about, for the past week, at least. I have two more blog drafts inspired by reflections on your video. I think of them as I walk to work, and I get Resting Peace Face from the gratitude I feel for the possibilities that have opened in my life because of you being you.

And now it’s late (but not too late). Temperature is -6F outside and I need to get up even earlier tomorrow to write, hydrate, and make sure the car starts. So it’s off to bed for me. I look forward to my Pages tomorrow morning–who knows what may come of this new habit? I’m sure I’ll let you all know as it emerges.

2023-2024: Reflections, Connections, and Aspirations (and Books, of course)

Posted on December 31, 2023 by Catherine Cheng, MD

*sigh* *smile* *silence*

How do you feel tonight, friends? What are your body sensations? How is your energy, your mood, your sense of well-being? What does turning a new Gregorian calendar year mean to you? Usually it’s meh for me. But this year feels very different. Looking back on this blog for the past two years, I read it, remember it, relive it: Transformation.

When Son’s college search and launch voyage began in the summer of 2021, my own self-reflection journey intensified. Spontaneously asking his classmates’ parents and then myself, “What do we most want our kids to learn in college? What are the most important life skills?” instigated the yet ongoing exploration of what I now think of as the three reciprocal tenets of well-being: Self-awareness, self-regulation, and effective communication. NaBloPoMo 2021 saw me reviewing practices in those arenas that I strive to model for Son and Daughter. 2022 posts reflect further processing, culminating in a NaBloPoMo with the highest density of personally meaningful posts of any November yet. This year certain concepts saturated, condensed, and distilled in my psyche, and I shared those posts most frequently with patients and friends: Owning my sh*t, standing in my strengths, leading vs lagging indicators of health, and immersing in community.

Repeatedly here on the blog and every day in real life this year, I struggle to find good enough words to express my gratitude, amazement, and utter dumbstruck astonishment at my good fortune to have found Ethos and Shaneiaks, two tribes without whom I honestly think I would not have the audacity to undertake my Big Fat Hairy Goal of writing and publishing the book for which I started this blog in the first place, 8.6 years ago. It’s about time, don’t you think? And yet, it has taken this long. 2023 gave me the synergistic swell of connection, courage, and exposure to makers that has finally ignited my book writing booster engines!

I wrote last week about my back pain and how I attribute it to certain mental stressors. It all continues to evolve. My addendum tonight: It’s the tension between a relentless desire to write this book and share everything I have in my mind and heart, and the profound fear of doing so. That internal tug of war makes me positively squirrelly right now–I’m doing anything but sitting down to write book words and my back is still tight. HOW FASCINATING, where my body puts that ambivalence! Write (HA! unconscious word substitution! I think I will leave it. 😉 ) at my center of gravity, perhaps, where my body folds, hinges, carries. What’s the most useful story I can tell about this, I wonder?

Normally I prefer to sleep through and ignore New Years, but this year I think I may try to leverage it. The idea of resolutions grates me, and I can still meditate and act on meaning, purpose, journey, and goals for 2024. That means stop farting around and procrastinating. As my wise friend lovingly and gently nudged me recently, between thinking/knowing and waiting for that to translate to feeling/inspiration, there is doing. Butt in chair, 500 words at a time. Or 50. Whatever, anything counts. I cannot edit what I have not written. There is a balance between harsh, rigid, self-imposed pressure and lackadaisical excuse making. Perhaps I have leaned too much toward the latter until now? Or maybe it’s all just part of the process? Whatever! How fascinating!

Table of Contents by end of January. Two or three sample chapters by end of February. Proposal and pitch by end of March. Queries by end of April. Quiet, centered, grounded, loving, fun writing. The more I can feel deeply and effusively my own message as the words emerge, the more likely readers will feel it, too. And that is the goal–for readers to feel seen, understood, loved, inspired, and empowered. That I stand alongside them aspiring, practicing owning our sh*t, standing in our strengths, and thickening our ties to the tribes and causes that matter most to us, to be and make our best contributions. When I get quiet, calm, and loving, it all flows so easily. So this may be the year to adopt a formal sitting meditation practice, too–a sister discipline of calm and quiet, in service of the BFHG. Let’s see what happens, ya? :D

Thank you all for the time you take to read this blog. I appreciate the engagement, exchange, and encouragement. I found myself writing to so many people today, expressing gratitude more than anything else. May we harness all of our best learnings and wisdom to date and apply them with humility, generosity, and love in 2024 and beyond, all for connection and healing. Big love and light to all, and may this new year bring all good things!

___

Books and Media 2023

The romance immersion continues, full swing, with no signs of stopping. I am registered to attend and volunteer at Readers Take Denver this April, my first ever romance book convention. I will meet many of my new Shaneiak friends there (met two in person already, with another date scheduled in a couple weeks!), and I cannot wait. Shane will be there, too; Shaneiak Friend Heather has already agreed to stand next to me, stroking my arm, calming me down so I may resist the urge to tackle hug him to the point of cracked ribs. Good luck to her!

I began 193 titles this year, some in repeat. Bolded titles below are my favorites; bracketted are unfinished. Closed brackets indicate low likelihood of completion; open brackets are books currently in progress. I still like listening much more than reading, especially while making cards, cooking, cleaning, driving. In 2024 I can trade some social media for eyeball reading, perhaps. So many possibilities! Onward in verbal joy and learning!

Books