200th Post: The Best of Healing Through Connection

Harper Columbine 5-31-14

Happy New Year, my friends!  May 2018 bring us all health, joy, connection, and learning!  And may we all look back one year from now feeling more empathy and compassion, and enjoying better relationships than ever before.

If you are new to this blog, welcome!  I hope you find something that resonates.  If you are an old friend, thank you for your support, feedback, and encouragement the last 32 months.  As I reread the last 199 posts this past week, my favorite parts were the thoughtful and enlightening comments.  I never imagined I could make friends writing a blog and yet here we are, connected, engaged, and holding one another up.

What have you discovered about your own writing when you go back and read?  Turns out I have a pretty consistent theme—it’s all about relationships.  Relationships require awareness, insight, active engagement, negotiation, and adaptation.  This is no less true in our relationships with ourselves than with others.  I have divided my favorite posts below into three categories: Health & Self-Care, Physician-Patient Relationship, and Relationships and Communication in general.  Though I have written pieces on politics and healthcare, I realize that these are critical arenas in which to explore relationships, and not my primary areas of focus in and of themselves.

2018 brings big new projects and responsibilities, yay!  So of course there will be big new challenges, also yay!  Looking ahead, I commit to my self-care practices with renewed motivation:

  1. Get to bed by 11:30 every night—Coach Christine has permission to call me out if I’m caught Facebooking past this time.
  2. Maintain 4+ workouts per week. An aging body needs regular vigorous movement!
  3. Keep up with therapy and resume regular coaching calls—reflect internally and project my best self outwardly.
  4. Maximize intake of stems, stalks, leaves, and fruit; minimize refined sugars.
  5. Nurture my ties to my tribes. They hold me up so I can do my best for those whom I lead.

The coming year will also require pulling back on certain things in order to maintain sanity.  While I refuse to renounce my Facebook use altogether, I have already decreased daily hours spent.  And though I still strive to maintain social/political awareness and activism, I will engage less with opposing voices on social media.  The costs, I have learned, far outweigh the benefits.  I would much rather take a politically oppositional friend out to lunch, or even fly to meet them, and have far more meaningful conversations in person.

For now, I plan also to scale back on the blog.  I’ll continue to write, of course, but likely more in the form of stream-of-consciousness journaling, brain-dumping, and snail mail letters to friends.  I expect that once in a while one of these activities will yield a post or two, and I hope to catch them by the tail and publish them before they escape the moment.  I leave here the list of my favorite posts to date.  Please feel free to dip in and out, leave new comments, and share links.  I suspect I will be drawn back to the page before long, as I already have a list of ideas for future posts.  But in case it’s longer than I anticipate, please know that I appreciate every view, every like, every comment, and every connection.

Thank you for stopping by and taking the time to read.  And may you take something away that makes you glad you came.

Sincerely,

Cathy Cheng


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Health and Self-Care

The Sh*tpile  /May 2015

https://catherinechengmd.com/2015/05/01/the-shtpile/

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.

 

How Health Begets Health  /November 2015

https://catherinechengmd.com/2015/11/07/how-health-begets-health/

As the kids and I sat waiting to get their flu vaccines this morning, I heard someone blow their nose. It was that thick mucus blowing that feels, at the same time, both gross and gratifying. I took a deep breath through my unobstructed nostrils and looked happily at my uninfected children.

 

Setting Intensions for 2016  /January 2016

https://catherinechengmd.com/2016/01/01/setting-intentions-for-2016/

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare.   After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

 

So You Want to Lose Weight  /March 2016

https://catherinechengmd.com/2016/03/12/so-you-want-to-lose-weight-the-four-as-of-goal-setting/

We set weight loss goals all the time, all of us—physicians included. We choose a number on the scale—an outcome—that represents our better selves, however we see it.  I suggest today that behavior-oriented goals, rather than outcomes-oriented ones, lead to far greater and more meaningful success.  How much are we really in control of what we weigh, day to day?

 

Never and Now  /April 2016

https://catherinechengmd.com/2016/04/17/atozchallenge-never-and-now/

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now.  Never is about the future or the past.  Often it’s a shadowy, catastrophizing perspective of things.  But we cannot predict the future, despite our arrogant human certainty.  And we cannot live every day to come based solely on what has already happened or not happened.  Circumstances and attitudes change.  Landscapes change—at times literally, and in an instant.  We evolve, we learn, we grow.  How can we be so sure that Never is real?

 

Yes, And!  /April 2016

https://catherinechengmd.com/2016/04/30/atozchallenge-yes-and/

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes.  I also remember my own hesitation and self-consciousness.  What do you mean, pimple on my forehead?  Is it really about to burst?

 

On the Critical Importance of Self-Care  /November 2016

https://catherinechengmd.com/2016/11/06/1638/

Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition… I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

 

On the Second Arrow  /November 2016

https://catherinechengmd.com/2016/11/11/on-the-second-arrow/

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.

 

On Readiness  /November 2016

https://catherinechengmd.com/2016/11/16/on-readiness/

I confess I am guilty of impatience and judgment.  When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated.  I know you feel it, too.  But know that I don’t blame you. The point is: we don’t make changes until we are ready.

 

Walking the Talk  /July 2017

https://catherinechengmd.com/2017/07/09/walking-the-talk/

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.

 

Just Do It My Butt  /November 2017

https://catherinechengmd.com/2017/11/06/just-do-it-my-butt/

Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys.  But does your doctor’s office have this kind of set up?  Does your insurance pay for these services?

 

Citius, Altius, Fortius!  /November 2015

https://catherinechengmd.com/2015/11/09/citius-altius-fortius/

Every day I live in awe of the astounding miracle that is the human body. It is the quintessential integrated machine.   Almost every part serves a unique and essential purpose in normal daily function, and the parameters for such function are incredibly narrow.  But take something out, wound something else, or trash multiple systems at once, and the whole assembly adapts around the insults, automatically, without any action or awareness on our part.  The body’s compensatory mechanisms exemplify the resilience and tenacity of nature, no doubt about it.

 

Dance For Your Health  /November 2017

https://catherinechengmd.com/2017/11/16/dance-for-your-health/

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun.  How could this not make us all younger?


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Physician-Patient Relationship

The Premise  /April 2015

https://catherinechengmd.com/2015/04/14/hello-world/

Patients and physicians have control over one thing above all else: our relationship with each other.  Relationships live and die by communication.  Barriers on the obstacle course of patient-physician communication loom large and formidable. Our system fails us over and again. And it falls to each of us, not the system, to find our way to connection and healing relationships.

 

What Are You Looking For?  /April 2015

https://catherinechengmd.com/2015/04/22/what-are-you-looking-for/

My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive.  My inner conflict escalated quickly:  Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?

 

More Than Enough Love  /June 2015

https://catherinechengmd.com/2015/06/20/more-than-enough-love/

Like parenting, the path of medical practice is not paved with lollipops and ice cream.  It’s more like an uphill dirt road with pits and grooves, erratic weather, and hairpin turns that make you dizzy and nauseated.  It can also offer astoundingly beautiful scenery along the way—like parenting.

 

Help Me Help You  /July 2015

https://catherinechengmd.com/2015/07/10/help-me-help-you/

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do?  Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these.

 

Closing the Satisfaction Gap  /July 2015

https://catherinechengmd.com/2015/07/20/the-thorn-in-our-collective-side/

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship.  This is how we communicate evaluations to medical students on their performance in clinical rotations.  There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

 

The Burnout Crucible  /September 2015

https://catherinechengmd.com/2015/09/20/the-burnout-crucible/

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out.

 

What Makes You Think You Can Trust Me?  /February 2016

https://catherinechengmd.com/2016/02/01/what-makes-you-think-you-can-trust-me/

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.

 

 

I am Edna Mode  /February 2016

https://catherinechengmd.com/2016/02/20/i-am-edna-mode/

Clearly, Edna trained in the School of Tough Love.  Fortunately for you, I have also studied empathy, compassion, and motivational interviewing.  I can help you persist.  I have patience for your journey.  I can be your pillar of consistency.  Edna is nothing if not consistent!

 

Humbling and Honoring  /April 2016

https://catherinechengmd.com/2016/04/09/humbling-and-honoring/

I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms.  The patients there have no such choices.  If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives.  There are no appointments, and almost no continuity with providers.  It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

 

On Mutual Respect  /November 2016

https://catherinechengmd.com/2016/11/05/on-mutual-respect/

To Patients Who Abuse Medical Staff: Let me be clear: That is not okay.

 

No Substitute for Time  /November 2017

https://catherinechengmd.com/2017/11/03/no-substitute-for-time/

“More information about the value of a physician-patient encounter will always be found in the content of their communication than in what they ultimately do. The difference in… physicians’ behaviors will not be found in any database, electronic medical record, or machine-learning algorithm. I have yet to see data on the contextual information from a history of the present illness in any data set or quality improvement initiative.”

 

Dr. Jerkface In Context: Healing the physician-patient relationship  /November 2017

https://catherinechengmd.com/2017/11/25/dr-jerkface-in-context-healing-the-patient-physician-relationship/

Do patients care about doctors’ suffering?  If they knew how the system harms physicians, would they have compassion for us?  What about if they knew how physician burnout and dissatisfaction directly affects their quality of care, all of it negatively?  What would move patients to stand up with and for doctors?  This is my goal for the indefinite future: to help us, patients and physicians, the end users of our medical system, stand up with and for one another, for positive systems change.


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Relationships and Communication

Gratitude, Generosity, and Peace  /July 2015

https://catherinechengmd.com/2015/07/30/gratitude-and-generosity/

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body.

 

Warrior Pride and a Plea for Kindness  /December 2015

https://catherinechengmd.com/2015/12/13/warrior-pride-and-a-plea-for-kindness/

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy.  We must choose carefully with whom we are willing to undertake such a venture.  And perhaps most importantly, we must be clear about our objective(s).  Do we really expect to change someone’s fundamentally held political or religious beliefs?  How realistic is that?  What other purpose, what other good, could possibly come from such conversations?

 

On Belay  /April 2016

https://catherinechengmd.com/2016/04/02/on-belay/

The interview starts with the two men talking about Hank Williams’ troubled life, his ‘formidable demons,’ as Hiddleston puts it. He expresses compassion for this, as I have seen him do in previous interviews about other characters he has portrayed.  He describes how Williams rose to stardom quickly, but ‘with no real support, no one to anchor him.’  Funny how he uses that word, anchor—like belayer.

 

Opposition and Openness  /April 2016

https://catherinechengmd.com/2016/04/20/atozchallenge-opposition-and-openness/

When I look at the list of definitions of oppose, I feel tired.  When I think of the energy it takes to constantly stand against something, I feel listless and drained.  Fighting, resisting, combatting, Obstructing, standing in the way, hindering, disputing, dissenting, contradicting—it’s exhausting.  I think of times when I meet someone new and all they talk about are the things they hate, that they can’t stand, that they want changed.  I cannot wait to get away and find levity.

 

Every Day a Revolution  /April 2016

https://catherinechengmd.com/2016/04/22/atozchallenge-every-day-a-revolution/

Like the turning of an incandescent light bulb, gently, patiently, and consistently in one direction, the steady work of activists eventually leads to sudden and intense illumination.  Darkness becomes light, cold spaces are warmed.

 

Withhold Judgment  /April 2016

https://catherinechengmd.com/2016/04/29/atozchallenge-withhold-judgment/

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.

 

Playing My Part  /May 2016

https://catherinechengmd.com/2016/05/22/playing-my-part/

Given the awesome support network with which I am blessed, I feel an impulse to do something more with my writing—to amplify and project all this love and connection back out onto the world for some positive purpose.  But how can my words possibly make a difference?

 

Holding the Space for Personal Acts of Peace—On Listening  /July 2016

https://catherinechengmd.com/2016/07/11/holding-the-space-for-personal-acts-of-peace-listening/

I know I will not do justice to all the complexities of our issues in one blog post, but I ask your forbearance for my interpretation, as it has led me to greater conviction for what I can do, I, one person.

 

Holding the Space for Our Suffering to Heal Us  /September 2016

https://catherinechengmd.com/2016/09/22/holding-the-space-for-our-suffering-to-heal-us/

For a moment we felt stuck, we connection seekers.  I looked at our leader.  His expression conveyed nothing but humility and empathy.  His posture conveyed resolution.  Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side.  But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

 

On the Golden Positivity Ratio  /November 2016

https://catherinechengmd.com/2016/11/25/on-the-golden-positivity-ratio/

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 relationships with ourselves.  It’s not a far leap to see how this idea pertains to news, social media, and any other human interactions.

 

Train to Withstand the Discomfort  /February 2017

https://catherinechengmd.com/2017/02/20/train-to-withstand-the-discomfort/

We all know the satisfaction and comfort of echo chambers.  Seeing, hearing, and reading that which validates our existing positions feels so good.  But the farther we regress here, the harder it becomes to tolerate a dissenting view.  We must resist this temptation; we are called to be more disciplined than this.

 

To Train or Not to Train  /May 2017

https://catherinechengmd.com/2017/05/08/to-train-or-not-to-train/

…even if we don’t all talk politics, we all need effective communication skills, especially in the arenas of conflict resolution, negotiation, parenting (which encompasses them all), and the like.  We are social beings—we only survive by cooperating and living well within our tribes, and by tribes living well among one another.  That can only happen if we practice getting along.

 

Tribal Pride and Tribalism  /November 2017

https://catherinechengmd.com/2017/11/29/tribal-pride-and-tribalism/

We all need our tribes.  Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health.  And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us.  But what happens when tribes pit themselves against one another?  How are we all harmed when we veer from “We’re great!” toward “They suck”?

 

 

 

Stability is Strength

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The holidays are coming.  People will be bustling up and down Michigan Avenue with large shopping bags and puffy coats, fuzzy hats and determined gait.  If someone knocked into you on the sidewalk, would you be stable enough to hold your space and not get pushed over?

I asked this to a friend today, a woman about my height and twenty pounds lighter, ‘bird-boned’ by her own description.  I swear, she looks like a feather to me.  We were talking about our habits, what seems to be changing as we approach menopause, and how we envision our best selves in old age.  I thought about the elder women in my family, who are all healthy in general, but not necessarily fit.  What if someone knocked into them this holiday season, would I be dealing with a hip fracture over Christmas?  The mortality rate for people over 65 in the year after a hip fracture is somewhere on the order of 25%.  My friend and I definitely do not envision this for ourselves.

So what needs to happen in order for me to stand my ground in the face of some external force?  I need a stable foundation, my feet in firm contact with the ground.  I need a low, massive center of gravity.  I need fast reflexes to contract and relax opposing muscles groups to bear the sudden and unexpected load.  I cannot be rigid and brittle; rather I must exert flexibility, to absorb enough force to move with it and away from it on my own terms.  I need to stand tall and face the force head on, with openness and grace, firmness and self-assurance, ready to assess instantly whether it was inadvertent or intentional, benign or malicious.  And then I need clear-minded judgment to determine how to respond to either condition.

This may come naturally and easily in our 20s.  Today, bum knee notwithstanding, I feel confident that I could meet such a force with appropriate strength and stability.  My friend and I agreed today on a shared vision: STRONG OLD LADIES.  We understand that this will not just happen because we will it; we need to fuel and train, rest and recover, and cultivate our mind-body connections, as well as our connections with others.  Small habits, sustained over time, positive or negative, will yield predictable results.  So the time is now to pay attention and establish some excellent patterns.

It occurs to me that this idea of stability and strength relates our physical to our mental and emotional well-being.  While Amy Cuddy’s research has recently been called into question, I still adhere to the idea that power posing and physical posture can enhance or diminish confidence and self-efficacy. Wide stance, low center of gravity, elongated spine, and open arms:  Stand strong, feel strong, think strong, speak and act strong.  I have practiced power posing before presentations since 2015 and I believe I am better for it.  And if it’s a placebo, I’ll take it—the benefits so far have outweighed the risks and costs.

Lastly, I think we can also apply this stability and strength awareness to our inner lives.  Here I refer to our integrity.  Our world changes ever faster, technology offering capabilities we had not dreamed even a decade ago.  It seems every interaction these days is shorter, more ‘efficient,’ less personal.  That is the default goal—low cost, high speed above all else.  Change is often good.  But we must also exercise judgment, and practice taking the long view, casting light from our core values onto a cautiously optimistic future, attending to and addressing the shadows.  We should gut-check, with ourselves and one another.  What are we really getting here?  How will we use it mindfully? How can it serve us, rather than us serving it?  When we are stable and strong in our shared humanity and collective goodwill, we arrive at the best answers to these questions.  Then we can all be stable and flexible, and stronger as we age together.

 

Hopey, Changey Hero Making

IVY Litt 11-8-17

NaBloPoMo 2017: Field Notes from a Life in Medicine, Day 8

Funny how I just wrote last night about connecting new dots to old dots.  It just happened again tonight!  A couple of weeks ago I responded to an online ad for an IVY Ideas Night with David Litt, author of Thanks Obama: My Hopey, Changey White House Years, entitled, “How to Inspire, Persuade, and Entertain.”  Litt was a senior speechwriter for President Obama, so I thought I could learn new tips for presentations, and feel a little closer to the president whom I miss so much.

I’ve done public speaking since eighth grade, when our speech teacher first taught us abdominal breathing and I discovered the thrill of holding the attention of a room full of people with only my words.  I work at an academic medical center and I hold zero publications, but my CV documents over 10 years of professional presentations to various audiences.  I thought I was pretty good at this speaking thing.

Three years ago I came across this TED talk by Nancy Duarte, whose ‘secret structure’ of great presentations I have used since I subsequently read her book, Resonate.  Essentially, she recommends that we invite audiences on adventure stories, create active tension between what is and what could be, and most importantly, make the audience the hero.  I have done this better and worse since then, but I always recognize the framework when I see it.  Those familiar with this blog know that I am also a fan of Simon Sinek, whose central message is that we perform at our best when we are crystal clear about our Why.  “People don’t buy what you do, they buy Why you do it,” he says.  Barack Obama employs both authors’ principles with eloquence and finesse, which I noticed reading We Are The Change We Seek, a collection of his speeches as president.  The best speeches delivered in this construction create audiences who are inspired, motivated, and empowered to hail a meaningful call to action.

Obama is could be core values

That’s basically what David Litt conveyed tonight.  When asked what advice he was given that served him best, he said, “Imagine someone in your audience will tell their friend tomorrow about your talk.  What is the one thing you want them to say about it?”  What is the Why of your talk?  Even though he no longer writes speeches for the most powerful person in the world, he expressed a desire to continue inspiring, empowering, and promoting personal agency in all whom his work touches. Make each and every audience member their own hero.

It turns out, however, that this approach applies to much more than public speaking.  On my 50 hour, 500 mile, aspen-pursuing weekend in Colorado last month, I described to my dear friend my favorite moments at work.  At the end of a patient’s day-long physical, after I have spent 90 minutes listening to their stories of weight gain and loss, work transitions and complex family dynamics, and reviewing their biometrics and blood test results, I meet with them for an additional 30 minutes to debrief.  This is when I present an integrated action plan compiled by the nutritionist, exercise physiologist, and myself.  It is a bulleted summary of our conversations throughout the day, centered on the patient’s core values and self-determined short and long term health goals, and crafted with their full participation.  I get to reflect back to my patients all that I see them doing well, and shine light on areas for potential improvement.  It’s an opportunity to explore the possible—to Aim High, Aim Higher, as the United States Air Force exhorts.  I often present the plan with phrases like, “Strong work!” “You’ got this,” and “Can’t wait to see what the coming year brings!”  My friend turned to me as we wound through autumn gold in the Rocky Mountains, a bit tearfully, and said, “You make them the hero of their own story.”  Yeah, I do, I thought, and I got a little teary, too.

Words are powerful.  They are our primary tool for relating to each other, for making another person feel seen, heard, understood, accepted, and loved.  You don’t have to be a public speaker or a presidential speechwriter to make a positive difference with your words.  At work, in your family, with your friends, with people on the street and in the elevator—what is the one thing you want someone to remember from their encounter with you?

What If I Slip?

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NaBloPoMo 2017: Field Notes From a Life in Medicine

40 hours out from my non-traumatic, sports-induced knee collapse, I’m off crutches, woo-hoooooo!  The knee is still swollen and stiff, and people still look twice when they see me limping.  I’m thinking of ordering from Peapod–the thought of walking around the grocery store, which I normally love doing, makes me wince a little.

I’m much more afraid, though, of the back slide that may ensue in these next days and weeks.  I’ve worked so hard the last few years, establishing and entraining an excellent exercise habit, and I was just hitting a period of new growth and ability, so exciting!  I was getting lighter and nimbler on my feet, and now I lurch clumsily, Trandelenburg-like (not really, but kinda).  All year I have felt sluggish and tense if more than two days went by without a work out.  I barely moved yesterday and I loved it, which scares me.

The last few months also saw a shift in my eating, recapturing a sense of control.  I was eating less without hunger or feeling deprived, and though my weight had remained roughly the same, my figure was noticeably streamlining.  I liked looking in the mirror again.  Last night I found myself grazing steadily after dark.  …Stress eating sucks.  I only recognized a few years ago that I do it, and I have since had much more empathy for my patients with similar patterns of food, tobacco, alcohol, and other ‘substance’ use.  I know I should not be shoveling tortilla chips, ice cream, cookies, and candy in my mouth at 10pm.  I know I don’t need the calories, I’m not really hungry, and I will feel guilty on the other side.  And I do it anyway.  It comes in cycles, and I have yet to find a healthier behavioral alternative in those moments (drink a full glass of water, get on the elliptical, drop and 20 push-ups!  Ooo, that last one might work…).

The point is, I really worry how this setback with my knee will derail and reverse all that I have accomplished until now.  (hyperventilation) GAAAAAHH!!

But wait, the injury was less than two days ago…  And I continue to feel better, regaining range of motion and limping slightly less with the help of ibuprofen and RICEing.  What did I write the other night about resting and recovering?  And what I have been preaching to patients about mindfulness, radical acceptance, and doing what you can at the time?  About small change steps sustained over time, and about how worry is counterproductive, because to paraphrase Michael J. Fox, if what you’re worried about actually happens, now you’ve lived it twice!?

Okay, I’ got this.  Plenty of movement I can still do with a bum knee (including maybe push-ups when I feel a late-night ice cream hankering).  I’m still the same motivated workout beast I was 60 hours ago, the same person who just got through a 30 day food challenge with only minor transgressions.  And JEEZ, it’s only been 40 hours.

Well thanks for helping me work through that, my friends.  I’m good now.

The Doctor Becomes the Patient

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Grandma Has Hurt Herself.

Tonight at volleyball, I was given the perfect set, my timing was getting better, I sprang and hit the ball over the net… I think it landed in, but I was distracted by the crunching sensation and noise I felt in my left knee, and then breathtaking pain as I landed the jump.  Immediately I went rolling, writhing on the floor, lamaze breathing long and slow (nice how that comes in handy at times like this).

As I sat sidelined, the medical inventory began:  No torsive forces, just a buckle.  No ankle or hip pain, only knee.  It’s the bad knee, had similar pain landing a little jump a few months ago, though not nearly this bad.  Pain primarily posterior, deep, left of center, worse with knee extension and dorsiflexion.  Anteromedial joint line pain with weight bearing.  Immediate but mild swelling/effusion.  Hmmm, maybe medial meniscus, possibly also PCL strain/tear?  When should I get the MRI?  How long before I can start PT?  Where is that knee sleeve I got before?  600mg ibuprofen STAT.

The young people were so loving, gathered around asking me where it hurt, getting ice, helping me up, grabbing blocks to put my leg up, glancing over empathetically as I RICEd.  I felt cared for and also embarrassed.

Not just embarrassed.  I felt guilty, maybe even ashamed.  What had happened?  I’ve been training, I’m a good jumper, what did I do wrong?  Was it karmic payback?  I left home just as my kid was struggling with some homework—but nothing I thought she couldn’t handle.  Or maybe I had been getting too cocky that I could actually do this at my age?  Just yesterday I posted videos of my most recent progress on the TRX—I was openly bragging–“toot-toot!” I wrote gleefully.  Or it was an error in judgment: I have not slept enough this week, and I knew I was tired before I went tonight.  But I wanted to go meet my new friends, I wanted to play and have fun.

The frustration came all at once, and with considerable force.  Thankfully I had a friend nearby with a consoling ear and some crutches to lend.  All athletes get injured, she said.  I didn’t do anything wrong.  Yes, I’ve been training, and I was also weekend warrioring it all these months.  This has been my problem knee for at least 15 years, maybe it was going to happen anyway.  It’s still interesting to watch, almost from outside myself, the emotional lava lamp of fear, regret, anxiety, dread, catatrophization, and sorrow.

Experience and maturity, however, make me optimistic.  It’s a temporary setback, and I have resources available to me for recovery, growth, and even enhancement.  Now I get to learn how to use crutches, and I can relate much better to my patients with knee injuries.  I also get to test my newly formed theory that though we may slow down in general with age, we need not resign ourselves to inevitable and morose decline.  Patients ask me often, what should they expect to be able to do at this age or that, how can they know their limits?  For a long time I had no good answer.  But as I have regained strength, endurance, stability and mobility these last few years (tonight notwithstanding), I now tell them: It depends on what you want and how much you invest.  My 1977 Oldsmobile will not run like my 2012 Highlander.  But if I really want to drive that thing, I can put in all the special care and maintenance required and make it roadworthy.  It’s the same with our bodies.  They are incredibly resilient and adaptive, and also mortal.  So we must Fuel and Train, then Rest and Recover appropriately.

I guess I pushed past my current limits tonight.  Setback acknowledged.  I don’t regret the last five months–I made new friends and played and had fun!  I anticipate a high-learning road to recovery.  And I think I’ll get back before they forget me.

 

 

Applying the Wisdom of Atticus Finch

Atticus_and_Tom_Robinson_in_court

“You never really understand a person until you consider things from his point of view—until you climb into his skin and walk around in it.”

–Atticus Finch

To Kill a Mockingbird, by Harper Lee

 

How do you practice and achieve empathy?  How do you notice others doing it?

It’s been on my mind a lot these last two weeks.  Current American politics resembles an interminable abscess, oozing ever more copious and putrid gobs of pus, from ever more unforeseen tracts of deep, diseased tissue.  How can we find any Healing Connection in the midst of all this?

Here’s my answer:  Role play and storytelling.

Role Playing Game Males Lego Duplo Play Build

 

Role Play for the Good

I used to hate role play, and now I jump at any chance to try it!  It all changed through a 7 week teaching workshop I did during my chief resident year, and I am forever grateful for the experience.  Now I regularly use role play to teach motivational interviewing, or MI, to medical students and residents.  Put simply, MI is a counseling technique that focuses on patient autonomy, and aims to reinforce intrinsic motivation for change.  My teaching method has evolved over time, due to my own unexpected experience of ‘climbing into the skin’ of others.

In the beginning I used to play the patient, letting students take turns practicing their MI skills on me.  After a couple of sessions I realized that even though I was pretending, I really felt like the students were earnestly trying to help me change my health habits, or making me feel bad about myself, depending on their proficiency.  So to give them the benefit of this perspective, I had them take turns playing both patient and physician.  The feedback revealed a richer, more insightful experience for all.

In 2015 I attended the Active Lives conference, where my technique was further enlightened.  I got to role play four times with a partner: first as patient, then physician, doing it the ‘wrong’ way (directive, authoritative, confrontational), and again in both roles doing it the ‘right’ way (collaborative, empathetic, nonjudgmental).  I felt the immediate contrast of the four roles emotionally and viscerally.  When all I heard from the doctor was, “Yes, I know you’re busy, but you have to find time to exercise,” and “Why don’t you do this…” and, “You should… You need to… If you don’t, then…” I felt absolutely no impetus to take any of this advice.  But questions like, “How important is it to you to…  How confident are you to… What would it take…what would need to happen in order for you to…” and, “What would life be like if…” invited me to explore possibilities, helped me to imagine and create my own future.  As an authoritative physician, I felt frustrated at my patient’s resistance to my evidence-based and well-intentioned advice.  By contrast, as a collaborative doctor, I feel freed to embark on an improvisational Yes, And adventure to reveal each patient’s personal path to healthier habits.  Now I offer my students the opportunity to experience all four roles.

I remembered this insight evolution last week when I came across a 1970 video of Jane Elliott’s classroom racism experiment.  She divides the class by eye color, asserts that blue-eyed children are better than brown-eyed children on one day, then reverses the premise the next.  While she makes privilege assignments that likely would not fly today, she also debriefs with the kids, helping them identify their assumptions, feelings, actions and reactions—much more authentically and directly than I think we are willing to do today.  She does it all without judging or shaming, pointing out biases and encouraging her students to examine them for themselves.  I admire her for pioneering this exercise, and I bet it affected her students in profound and lasting ways.

storytelling

 

The Importance of Story

Clearly, we cannot possibly depend on such academic practices to develop everyday empathy.  Luckily we now have infinitely easier access to one another’s stories than ever before, which is the next best thing.   Lately I feel a keen new appreciation of the importance of storytelling for conveying experience and stimulating mutual understanding.  Obligingly, the universe (read Facebook) has provided me with numerous testimonies of my fellow humans’ experiences and conditions, and this week they touch me even more acutely.  Here are some of them:

  • Former white supremacists talk about the importance of upholding others’ humanity, even as we denounce their beliefs.
  • A black writer recounts multiple instances of racism over her lifetime, inviting her white high school classmate to imagine and consider how they exemplify his white male privilege.
  • The head of neurosurgery at the Mayo Clinic in Florida tells his story of illegal, then legal immigration, and a subsequent life dream realized.
  • Neil DeGrasse Tyson shares stories of genitals on fire, educators’ responsibility to the electorate, pressure from his black classmate to contribute to ‘the black cause,’ realizing that he is doing just that, and why he wants to be buried instead of cremated (he has changed my mind, by the way).
  • David Duke’s godson credits the college friends who welcomed him despite his pedigree, with helping him defy and shed it.

 

What’s the Point?

The overarching goal here is to intentionally thwart the abstraction and dehumanization of people who are different from ourselves.  Stepping into another person’s shoes, ‘climbing into (their) skin,’ imagining how they feel, and actually feeling it—this is the best protection against bias, prejudice, and discrimination.  Empathy forms the sticky webs of connection that stymie the hymenoptera of hatred mid-flight, or catch us in the face and remind us to look where we’re going.  Where do we want our thoughts, words, actions, and relationships to take us?

I imagine a world of colorfully flawed humans, who acknowledge our biases openly and honestly; who recognize the risks that those biases carry; who accept ourselves, warts on soles and souls and all; who commit to a lifetime of extending that acceptance to one another; and who understand that it is our relationships, all of them, that kill us or save us.

So let’s play and tell—and feel and listen.  Really,  it’ll be good for all of us.

 

Love You Into Being

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A couple of weeks ago I met my new medical students.  These 10-12 trainees will be my small group for the next two years.  We will meet monthly to discuss the soft stuff of medical training—hierarchy, tribalism, death and dying, medical errors, difficult patients, etc.  Some call it “third year medical student support group.”  This is my 6th year of the pleasure and privilege (I inherited my first group halfway through, when their previous preceptor moved out of state).

With each successive group I am ever more amazed at the students’ level of insight.  They articulate compassion, humility, and maturity that I don’t think I had at their level of training. Or maybe it’s because we did not have classes like this to explore such things when I came up (or maybe I don’t remember?).  More and I more I see my role as facilitator more than teacher.  I am not here to impart medical knowledge.  Rather, it is my job to stimulate exploration, conversation, and meaning.  It’s so freeing, really—there is no standardized test to teach to.  And yet I see it as my responsibility to help prepare these gifted young people to face the greatest challenge and reward of the profession: human relationships.

I feel no fear or trepidation.  We cannot ‘fail’ at this class, any of us.  Because the point of it is simply for everybody to participate, contribute, consider, and learn—myself included.  Each month the students are given questions to answer in the form of a blog post.  For example, “Recall an example of inspiring or regrettable behavior that you witnessed by a physician.  Describe the situation, and its impact on you, the team, and/or the patient.”  I read them all and facilitate discussion, tying together common themes and asking probing questions.  My primary objective is to help them maintain the thoughtfulness and humanity that led them to medicine in the first place.  Medical training has evolved in the past 20 years, for the better in some ways, not so much in others.  One way we do much better nowadays is recognizing the hidden curriculum, and shining light on its effects, both positive and negative, through classes like this.

We all have those teachers who made a difference in our lives—or at least I hope we all do.  I have multiple: Mrs. Cobb, 4th grade; Mr. Alt, 7th grade math; Ms. Townsend (now Ms. Anna), 7th grade English; Ms. Sanborn, 7th grade social studies; Mrs. Stahlhut, 9th grade geometry; Mrs. Summers, 10th grade English; Coach Knafelc, varsity volleyball; Dr. Woodruff, primary care preceptor; Dr. Roach, intern clinic preceptor; Dr. Tynus, chief resident program director.  My mom is one of these teachers, also.  She leads nursing students in their clinical rotations.  I have seen her student feedback forms—they love her.  And it wasn’t until I heard her talk about her students that I realized why they love her and what makes her so effective—she loves them first.  Teaching is often compared to parenting.  Our parents, at their best, see our potential and love us into our best selves.  They cheer us, support us, redirect us, and admonish us.  They show us the potential rewards of our highest aspirations.  If we’re lucky, they role model their best selves for us to emulate.

All of my best teachers did (do) this for me.  I’m friends with many of them to this day, and I still learn from them in almost every encounter.  I love them because I feel loved by them.  They held space for my ignorance and imperfections.  I always knew that they knew that my best self was more than the last paper I wrote, the last test I aced, or the last patient encounter I botched.  To them, my peers and I were not simply students.  We were fellow humans on a journey of mutual discovery, and they were simply a little farther along on the path.

This is my aspiration as a teacher, to live up to the example of all those who loved me into the best version of myself today.  This kind of love allows for growth and evolution, from student to colleague, to friend, and fellow educator.  This is not something attending physicians typically express to medical students, positive evolution of medical education notwithstanding.  But when I met this new group, I was overcome by love for them.  So I told them.  “If you take away nothing else from our two years together, I want you to have felt loved by me.  I wish to love you into the best doctors you can be.  That is my only job here.”  Or something like that.  It was impulsive and possibly high risk.  But it was the most honest thing I could say in that moment, my most authentic expression of my highest goal for my time with them.  I only get to see them once a month, and I want them to be crystal clear about what I am here to do.  We have lots to cover these two years, so much to learn and apply.  And love is the best thing I can offer to hold us all up through it.