Meaning Indeed

Do you not just love when insights occur in rapid and acute succession?

I had ‘Rubik’s cubed’ the last post for a few weeks before finally sitting down to write and publish it last Tuesday. The smoke signal idea came to me while typing—it felt almost tingly, like the most pleasant and rewarding epiphanal effervescence. And here just now I’m only describing that sensation for the first time. How fascinating. Little did I know last week that my own smoke signals have long smoldered in the distance. Since musing about the physical sensations of meaning, I’m suddenly noticing my own, left and right.

I’ve had two prolonged absences from in person clinical work these two years. The first was 2.5 months externally mandated by pandemic lockdown in 2020. The second, ending as of 10 days ago, was a 5 month personal leave. In each case I did my homework prior to returning, reviewing charts and schedules, contacting colleagues for sign out (the verbal transfer of care between clinicians who share patients). Both times I felt ambivalent, missing the nearly 24/7 control over my own schedule (or the illusion of it, anyway), and also anticipating the gratifying interactions of in person clinic.

In June last year, the joy of return enveloped me like the warm, welcoming hand of a soft spring breeze. I had completed the interview part of my first face to face visit since March. We got to the exam room and I did my usual head and neck assessment. I put my stethoscope earpieces in and placed the diaphragm against the patient’s chest. That first heartbeat may have been the most soothing sound I had heard in years. The soft, rhythmic, unobtrusive yet vital thudding of the heart of a live person—a person in my care—wow. I can’t remember if I actually got goosebumps then. But I get them now just thinking of that moment. I had not realized how much I missed hearing it, or how much it meant to me. I lingered an extra second or two just listening, feeling a deep joy and relaxation, a settling of my soul even, maybe. It was profound and totally unexpected.

This time it was a conversation. It’s such a privilege to know people in the intimate space of their health, to appreciate them as whole people, body, mind, and often spirit. In executive health we get the bonus of relating our patients’ whole person health to their roles and responsibilities as designated leaders at work. This intersects also with relationships in their families and personal tribes, just as it does for all of us. Toward the end of an interview last week, once again I felt overwhelmed by a deeply grounding, relaxed and yet energizing sensation. My patient and I were talking, engaging, exchanging ideas and observations, relating, as fellow humans. It felt paradoxically expansive and distilled at the same time, like I had dropped right into, and was operating directly from, my core, best self. I was right where I was supposed to be, doing and saying exactly what I was meant to do and say, right in that moment. I could only marvel inwardly and briefly in real time, as the encounter moved on. It was not until later in the day that I was able to name the emotion as sheer joy. I was lighter on my feet, uplifted in my chest, feeling positively buzzed.

Wow, it’s already the end of October. NaBloPoMo is almost upon us (well, upon me, I guess, as there is no longer an official November event–but this will be my 7th consecutive attempt), and I feel ready! The theme this year is personally meaningful to me (stay tuned for the reveal), and I look forward to the challenge. So good to be back, friends. Onward.

On Finding Meaning

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NaBloPoMo 2016, Letters to Patients, Day 8

To Patients Seeking Meaning:

Try the Three Question Journal.

One of my favorite parts of a new patient encounter is when we talk about your work.  Not only hearing about what you do (as I wrote on Day 3), but what it means to you.  I ask you to rate your overall work stress on a scale of zero to ten.  Then I ask you to rate the overall meaning of your work (to you, not to others), on the same scale.  I’m looking for meaning to rate higher than stress, and above 6 in general.  This ratio, I have observed, represents a sustainable and fulfilling work life.  When I hear you articulate your passions and intentions at work, it inspires me, too.

Some of you realize suddenly that the meaning you once felt has faded, and you get pensive.  Or you tersely state that your work holds no meaning whatsoever, other than as a source of income.  This is where I usually pause for a few seconds to feel out where the conversation will go.  Should I screen you for depression?  Should we explore or move on?  My meaning comes from these inflection points.

Given that we spend most of our waking hours, most days of the week, at our jobs, I assert that it’s worth trying to maximize our sense of meaning.  Why not be happy and fulfilled at work, if you can?  I also assert that this is something we can and should choose, for our health and that of those around us.

My friend Liz recently re-introduced me to an exercise that may help.  It’s from Rachel Remen, physician and author of two deeply moving books, Kitchen Table Wisdom and My Grandfather’s Blessings.  It’s called the Three Question Journal.  You can find background and detailed instructions on her website here.  Basically it’s a daily practice of finding three things in your encounters:

  1. Something that surprised you
  2. Something that touched your heart
  3. Something that inspired you

Many of you may think this is a waste of time, frivolous, meaningless.  You have more important and pressing things to do.  I admit, I am not a consistent practitioner.  I feel anxious: What if I can’t find anything?  That must mean I’m mindless, cold, and utterly un-inspire-able.  Remen says this is okay— “DO NOT BECOME DISCOURAGED!!   Many people find that for a little while the answers to all three questions are exactly the same:  NOTHING, NOTHING and NOTHING.”

Wouldn’t it be so much better to be able to answer with, “This, THIS, and oh my God, THIS!!”  Every day?

We have 22 more days of November.  If you comment that you will challenge yourself to this practice every day for the rest of the month, so will I.  And we can compare notes along the way.  Whattaya say?