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.

Love Letter to My Superstar Friends

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Dear Paul & Joanne*,

I cannot tell you how grateful I am to you both for taking the time to meet me last week.  You came out in the pouring rain, not for a lighthearted night of drinks and karaoke, but to talk charged politics with your tortured, melancholic, liberal friend.  I hope it did not feel too burdensome, and that you would do it again.

It was quite the emotional evening for me, unsettling, sometimes uncomfortable, and also dominated by love.  Joanne, we have known each other about 15 years, and I know you are not a fan of politics in general.  Paul, I know you mostly through your witty holiday cards, and your occasional Facebook posts that often touch on politics.  You lean right, it seems, about as much as I lean left.  You gently called me out when I shared a Trump supporter-shaming video, reminding me to hold myself to a higher standard of discourse on all platforms.  That is why I sought you out.  When you engage, you exemplify the attitude toward political discourse that I aspire to.

I described to Joanne over the phone how distraught I had been since November, something akin to “watching the fabric of my generation’s social progress torn to shreds by a maniacally fomenting, double-machete-wielding narcissist.”  You seemed genuinely surprised and curious—why did this election have such a profoundly tormenting effect on me?  What made millions of people pour into the streets around the world in protest?  I was incredulous at your incredulity, and yet I felt a mutual, loving acceptance between friends who only want each other to be happy and feel secure.

At dinner, I could tell that you both cared acutely about my distress, and wanted to help alleviate it.  You reassured me that the worst case scenarios are highly unlikely to actually happen.  You reminded me that hyperventilation and arm flapping are not productive energy expenditures.  You gently encouraged me about the long, jagged, often meandering, and also inevitable path of social progress, and the importance of taking the long view.

I admit that I felt a little defensive at times, as if anything I said about the origins of my distress would be met with, “You’re overreacting,” and “You’re worried about nothing, please…”  We later agreed that it is never helpful to invalidate someone’s emotional response to a stressor, regardless of whether or not we can relate.  Paul, you are so well-read and convicted about your opinions.  I did not see a point in arguing, as you did not seem interested in debate, and I left feeling disappointed that I had not presented a stronger defense of my liberal ideals.  The whole exchange felt lopsided in favor of your position.  But I did learn from your point of view, which was one of my primary objectives.

Most importantly, our conversation revived my mindfulness practice.  You’re right—energy spent catastrophizing about a hell-on-earth future is energy wasted.  As Michael J. Fox says (I paraphrase), “Don’t spend your time worrying, because if what you’re worried about actually happens, now you’ve lived it twice.”  My energy is better spent in the present, attending to what is, rather than what I fear might be.  And I feel justified in my shock and dismay at what is.  In my opinion, Donald Trump has defiled the presidency and brought our politics to a new moral low that I could never have predicted.  I don’t need to ‘go apeshit’ over the future, as there is plenty of wreckage to confront right now, not the least of which is our collective refusal to engage one another in civil discourse.  I can center, ground, and focus, breathe deeply and engage, one step, one person, or one loving couple, at a time.

Last week Dan Rather wrote my heart on his Facebook page:

The threats, the lies, the willful disregard for the rule of law should be limited to the world of Hollywood caricature. To see this played out each night on the news, to read about ramblings and inconsistencies in justifications for actions that should never have been taken, is to see a moment of great peril for our nation.

I remain, however, an optimist. I see the swellings of civic engagement and action. I hear the voices of those who demand that this subversion of our national ideals shall not stand. I have covered social movements of the past, and never have seen one where so much power and numbers lie on the side of the opposition. This is a clash for the values of our nation. Our destiny is in our hands.

Our nation’s patchy, irregular social fabric may be strained to its limits today, and even torn in some places.  But the threat of real disintegration has brought forth multitudes of weavers and quilters to repair and protect its integrity.  I can acknowledge this ‘collateral beauty’ and contribute my part, through conversations like ours, to help mend the tapestry, and bend that moral arc of the universe more toward justice.

Thank you, my dear friends, for helping me train for this marathon.  You hold me up and make me stronger.  I hope I do the same for you.

Sincerely and with love,

Cathy

 

*Not their real names

On the Second Arrow

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NaBloPoMo 2016, Letters to Patients, Day 11

To Patients Who Suffer:

Which arrow causes you more pain, the first or the second?

Fellow blogger Michelle at The Green Study recently posted a piece in which she distinguished between pain and suffering.  It reminded me of a Buddhist teaching that inspires and humbles me.  Blogger and curator extraordinaire Maria Popova quotes it in this article she wrote last year, on a book by Tara Brach:

The Buddha once asked a student, “If a person is struck by an arrow, is it painful?” The student replied, “It is.” The Buddha then asked, “If the person is struck by a second arrow, is that even more painful?” The student replied again, “It is.” The Buddha then explained, “In life, we cannot always control the first arrow. However, the second arrow is our reaction to the first. And with this second arrow comes the possibility of choice.”

The first step to suffering less is cultivating awareness of the second arrow.  This takes practice, and we must resist the self-judgment that comes the moment we realize we have not only shot ourselves again, but have been twisting that second arrow deeper and deeper.  This shame and self-revulsion is, after all, another drop of poison on the second arrow’s tip.  Instead, I like to apply Ben Zander’s acclamation when he finds himself or his students doing something ‘wrong’: “How fascinating!”  Look what I did!  No judgment, just lighthearted observation.

The second step to suffering less is, of course, to avoid the second arrow.  Once we notice, learn how to remove it and tend the wound.  Breathe deeply.  Identify the sources of anger, fear, resentment, blame, contempt, shame, despair, anxiety, bitterness, envy.  Breathe again.  Loosen our desperate grip on these feelings.  Hold them more loosely, ever more loosely.  Breathe.  Breathe.  Hold also the Space, emotional, cognitive, and temporal, for them the move through and exit us.

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.

Life will continue hurling arrows at us.  Some will miss, others will land in our most vulnerable spots.  Mindfulness practice, centered in attention to the breath, helps us evade the wounds and anguish from our own second arrows.  The data, accumulated over the past four decades, is all but irrefutable for the benefits of mindfulness for depression, anxiety, chronic pain, burnout, and overall well-being.  Prolonged practice even changes the physical structure of the brain, and it’s never too late to learn.

If you’d like to learn more, I have included a few more links below.  You may find it worthwhile to invest in the practice.  Be patient with yourself.  And let me know how it goes!

http://www.wildmind.org/texts/the-arrow

http://www.huffingtonpost.com/susan-bernstein/dont-shoot-the-second-arr_b_5102701.html

http://www.nscblog.com/miscellaneous/avoiding-the-second-arrow/

 

 

On Setting Intentions

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NaBloPoMo 2016, Letters to Patients, Day 9

To Patients Seeking Bearing and Beacons

Set your intentions for the day.

In the aftermath of the election…  I feel an intense need to self-soothe and focus.

A wise friend recently introduced me to a morning practice that has impacted my days in wonderfully tangible ways.  He describes a 5×5 grid which he pencils in his journal each morning.  He fills each box with a word that he wants to hold in intention for the day.  For each word, he meditates on its meaning, then what it would feel like.  Then he meditates to feel it and live it already.  Throughout the day he then recalls the words and their sensations.  He started with a 2×2 grid (four words), then gradually increased it to 5×5.

I have had 9 (now 10) presentations to prepare between mid-August and the end of this month.  My practice continues to grow.  The kids’ schedules and activities multiply proportional to their heights.  Learning this anchoring method from him has been a Godsend for focus and grounding, and I am so grateful.

I started with 3 words, and have practiced inconsistently (this appears to be a pattern for me).  But each day that I take time to determine the words and sit with them a while, I notice a remarkable steadiness throughout the day.

Patience.  Compassion.  Focus.  Love.  Empathy.  Ease.  Generosity.  Equanimity.  Joy.  Fun.  Peace.  Forgiveness.  More Love.  Connected.  Center.  Openness.  Curiosity.  Engage.  Movement.  Lightness.  Ground.  Calm.  Acceptance.  Non-judgment.  Happy.

It’s really amazing:  Just a few minutes in the morning are all it takes to frame my mind and resolve my heart.  I feel steadfast as I walk out the door.  I go about my day and forget.  Then, in those unfocused moments, the words rise to conscious awareness and I remember, reset, and re-center.

Maybe you’re feeling a little unsteady now, also?  Give the Word Intention practice a try.  It can’t hurt.  It costs a few minutes of time.  You can start with one word.  You can write it on your hand.  There is no such thing as cheating, only seeking and centering.

Best wishes and peace to you.