Train to Withstand the Discomfort


Exploring the Rules of Engagement for Healthier Political Discourse, First Query

How fascinating!  I thought this series would be so easy to write…  I spend so many hours every day deliberating on how to talk to people, fantasizing about successful encounters, and preparing mindful defenses against verbal attacks.  Yet crickets have chirped here for two weeks, and even now as I type, I feel almost overcome with apprehension.

The Better Part of Valor…

I had this lofty goal last month to seek out and engage in person, all of my friends on ‘the other side.’  I even sent a card to a couple of them on the other side of town, asking if I could come to visit and “talk.”  I feel an urgency to reconcile and reconnect.  But today I realize that you can’t force it.  Sometimes it’s just too uncomfortable.  You never know what the other person will say, or what you will say, that will trigger one or both of you and emotionally hijack the whole encounter.  So sometimes it’s best to just not go there.

Meanwhile, Back At the Ranch

But what can we do in the meantime?  How can we train now, to make it easier in the future?  It seems somewhat like exercise to me.  There is an app called TRX Force (I have no interests in this business), a twelve week progressive strength and interval training program using those torturous straps that hang from the ceiling.  When I first started the program with my trainer, I dreaded every session.  The shortness of breath, the shaking, the pain, gaaaagh!!  Every session early on, I secretly hoped she would let me off the hook.  But I also knew that with her support, I could overcome the discomfort and finish.  I have gotten through every session, some more easily than others.  Last Tuesday was Day 2 of Week 11. I felt so much weaker and less motivated than usual that day (all this stress, grrrr), and it was the hardest workout yet.  The ‘during’ part SUCKED.  My biceps and quads felt like jell-o melting off of their bones.  Then afterward, the victory of accomplishment filled me with pride.  It lit a new intrinsic fire, and my home workouts now are harder and longer than ever before.

Maybe it’s the same for talking politics.  Just thinking of encounters with ‘the other side’ can fill us with dread and tension.  We catastrophize immediately, not only about what they might say, but at how it might unleash torrents of our least controllable emotions.  So we instinctively run the other way.  What if we could train to withstand this discomfort?  What if we could find a safe space to practice, so we might feel stronger when challenged for real?  I propose two methods here.


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.  I have friends and family who post articles and videos from sights like Conservative Fighter and Red State.  I find the headlines inflammatory, and my initial reaction is to cringe, dismiss, and move on.

Lately I have resolved to open at least one of these posts every few days.  To walk the talk of reaching across the divide, I must try seeing from others’ point of view.  These are my friends, people I grew up with, my colleagues.  What about these stories and articles appeals to them?  In the privacy of my home, at times of my choosing, I can practice opening my mind to a potential partial truth from any source.  I learned from life coaching a long time ago that, “we are all right, and only partially.”

In no way does opening my mind to possible other truths mean that I abandon skepticism or critical appraisal.  It does mean, however, that I practice excluding prejudice.  It means looking and listening with objectivity as much as possible.  “I have to pace myself,” a friend told me recently.  Yes.

In a recent episode of Bill Maher’s show, he interviewed the controversial alt-right figure Milo Yiannopoulos, during which he admonishes his audience, “Don’t take the bait, liberals.”  I think I agree.  The goal here is eventually to rise above the reflexive, emotionally hijacked state.  When I feel my brow furrow, lips curl, heart rate accelerate,  and armpits sweat, I know I’m close to my limits.  I can choose to disengage and try again next time.  Just like with TRX Force, my tolerance and openness core will strengthen the longer I stick with the program.  I can then engage with an intact and rational intellect, guided by my core values of connection and shared humanity, seeking common interests and goals.

Uphold the Devil’s Advocate

Since the election, I often feel attacked by people on ‘my side’ whenever I suggest that ‘the others’ may not all be racist and misogynist xenophobes.  It’s not safe in some of my own circles to consider the humanity of the other side.  This refusal to consider multiple points of view, even among those who mostly agree with us, seriously threatens our capacity for meaningful discourse, from the inside out.  The echo chambers reverberate ever louder, drowning out our intellectual and emotional calling for generosity and connection.  Us vs. Them group-think oppresses, and it’s dangerous to our dialogue.  I wonder if moderates on the right also experience this.

Hereafter, I resolve to stand up a little taller in defense of people in general.  When I hear broad brush generalizations, I will play Devil’s Advocate and speak up for a valid alternative point of view.  I will ask questions starting with phrases like, “What if they also…” and “What is a more generous assumption we can make about…”  I hope more of us can practice holding this precious space.  Making room for another’s point of view does not weaken our own.  Respectful debate of dissenting opinions makes us more agile and articulate.  And the best place to practice is first within our own tribes.

Moving Forward

I had a list of ideals for this series, like “Rehumanize the ‘Others’” “Mind your limits,” and “Stay in Curiosity.”  It’s hard to separate and prioritize them; as I think of any one, the others inevitably intertwine.  So it will take me a while between posts to disentangle my thoughts.  Thank you for your patience and your feedback.  Maybe we can all be training buddies on this long journey.

On What You Can Do


img_4564NaBloPoMo 2016, Letters to Patients, Day 12

To Patients Wondering What to Do:

Take this Wise Lady’s advice.

I had an inspiring conversation this week, one that lifted me up, which I sorely needed.

This incredible woman grew up in the era before women could have credit cards in their own names, before women could play organized sports, and before spousal rape was finally outlawed.  She survived brain tumor surgery and the death of her son.  She has attained advanced education, acquired innovative skills, built and sold a business.  Throughout it all she seems to have thrived.

I queried her response to adversity.  Was she born wired for resilience?  Did she acquire such effective coping skills simply by experience?  She referenced the teachings of her father.  Through her childhood, she said, he taught her to how to face difficulties.  Before she went off to college her dad had a specific talk with her:  “Here’s how you deal with problems,” he said.  “When faced with a problem, first ask yourself, ‘what can I do?’”  Not what should I do, what do others expect me to do, what would s/he/they do.  “What can I do?”  “If you can’t figure it out right away, stop.  Go outside, take a walk.  Come back and ask again, ‘What can I do?’”

Wise Lady said this one strategy got her through myriad struggles and crises in life, and she taught it to her kids the way her dad taught her.  But life flung faster, sharper arrows her way, and she had to develop additional coping tactics.  Seeking a path to clarity through the mires of crisis, she began asking herself, “What do I need to get rid of?”  And that has made all the difference since.

I will tell you, Wise Lady has a serenity about her countenance that I meet only occasionally anymore.  She has racked miles on her soul, yet I sense no cynicism or regret.  I so want to be like her!

From now on I will ask myself more often,

“What can I do?” and

“What do I need to get rid of?”


On Setting Intentions


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.

On Finding Meaning


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?


On the Lightness of Moving the Body


NaBloPoMo 2016, Letters to Patients, Day 7

To Patients Who Struggle With Exercise:

Anything is better than nothing!

Are you a natural exerciser?  Do you move your body every day because you just can’t help it, as opposed to the rest of us, who do it occasionally because we know we ‘should?’  If so, this post is not for you.  But I do have a request:  The next time you’re with us, the unnatural exercisers, don’t judge us.  We are secretly inspired and awed by you, even as we hate you.  Your active non-judgment, which serves as passive encouragement, may be just enough to lower our threshold for doing something.

Okay so, for the rest of us:  How can we overcome the exercise barrier?  Wouldn’tcha know it, I have a suggestion!  Wait for it…  Do anything!  It sounds silly, right?  Too simple?  I have learned that simple is key, and silly can be fun.  Three years ago I was decidedly a non-exerciser.  In early 2014 I connected with a personal trainer and have since rediscovered my inner athlete, one baby step at a time.

Our initial sessions focused on awakening my core (apparently I had gluteal amnesia).  I never knew I could break a sweat holding a simple yoga pose.  I got discouraged at the prolonged lack of progress in cardiovascular endurance and strength.  But little by little, I could do more.  Early last year I downloaded a free workout app and aimed to exercise 7 minutes (read: get through one circuit, however feebly), 3 times a week.  Holy cow, how humbling to discover how 30 seconds of jumping jacks could make me so breathless?  Suffice it to say, I established an unequivocally low baseline.  But somehow I was able to let go the judgment of the failure to be fit already.  I congratulated myself for trying at all, and decided to keep going.  I bet I can get better, I thought.

And that’s the point:  We can always get better.  So often we don’t even try because our expectations are unattainably, if unintentionally, high.  We can tell because it feels pointless.  The workaround is to set our expectations stupendously low, guaranteed success-low, simple- and silly-low…  Then trust that iterative success will drive progressive improvement.  By mid-year I had a smiley sticker for every week, mission accomplished.  This year I set a new goal: 5 times a week, 3 times ‘intense.’  Don’t get the smiley stickers every week, but now it feels positively abnormal to not move for more than one day.  That progress is remarkably gratifying.

When we take our short-term goals more lightly, we allow for the freedom of modifications (push-ups on the knees at first) and trial and error.  We become open to previously unseen options.  We live in the present and appreciate what we can accomplish already today.

If it helps, read this article and repeat to yourself, “Floss one tooth, ” or “One push-up.”  ONWARD!



On Primary Care


NaBloPoMo 2016, Letters to Pateints, Day 2

To Those Who Disdain Primary Care:

Maybe you don’t know what you’re missing.

“I don’t need a doctor, I never get sick.”  And yet, optimum health means so much more than the absence of illness.  I am called to steward your health as a whole person.  I value the chance to know you as such.  I seek to understand your temperament, your history, your past experiences, and how they influence your current perceptions and choices.  That is how I help you optimize your health—by reflecting your own patterns back to you, so you may determine how they serve you, and when they need updating.

So often our daily routines take the path of least resistance, like spring runoff tumbling inevitably downhill between the rocks and shrub roots of a mountainside.  Without attention and navigation, topsoil erodes and the landscape can get disorganized, unstable.  But with some intention and guidance, we can channel your energy and activities toward the mighty river of health.  There your strengths and motivation preserve the ecosystem that is your best you, for the long journey of life.

As a general internist, I have the privilege of getting the first call when something takes you down.  I get to hear the story first, to initiate the investigation.  If I know you already, I can apply history and context in the most personalized way.  Together we can examine and understand the mudslide triggers (there’s almost always at least one).  We can make an appropriate plan to slow the erosion, and then rebuild.  With each episode, our tools sharpen.  We become a team.

I relish the chance to help you dig deeper into your own capacities for self-care.  Each encounter is an opportunity to share and connect, in service of your long term health.  I want you to live not just to be an old man or woman, but a STRONG old man or woman.

But to do that, I need to know you starting now.  I need to connect with you early and often, in good times and bad.  It’s a relationship like any other.  I can’t help unless I see, hear, and understand.  There is no substitute for time and contact.  So think about it.  I’m here to help.

On Training


NaBloPoMo 2016, Letters to Patients, Day 1

To The Patients Who Trained Me:

Thank you, from the bottom of my heart, and God bless you, every one.

To the elderly lady with heart failure, who donated your body to science so that I may learn anatomy:  You were the greatest gift.  Your heart was literally as big as your head, and at the time I just thought it was peculiar.  Now I understand the extraordinary adaptive capability of the human body, and I marvel at it every day.

To the inpatients who endured hours of repetitive interviewing and clumsy physical exams by us medical students, all in the name of teaching:  Your engagement in the midst of your own suffering testifies to the infinite potential generosity of humanity.  Your contribution to medical education cannot be overestimated.

To the kindhearted artist in my resident clinic, the first patient to page me for advice:  You showed me that I knew what I was doing, even in training.  You had classic of sinusitis, and I called in the appropriate prescription.  In a moment of sudden panic I wondered if I should have called my preceptor first.  No, I can do this, I realized.  I’m meant to do this.

To the articulate, confident housewife whose retired husband drove you to me in acute agitation:  I learned from you that life phases never cease to evolve.  Our relationships, however longstanding, hold infinite complexities that manifest in jarring and also predictable ways throughout life.  You taught me that stability is overrated, and also underappreciated.

To the wonderfully kind man, one of my first patients in practice, who came in with the nasal balloon:  Your patience and trust will humble me forever.  The emergency room doctor had placed the balloon for a prolonged nosebleed.  He instructed you have me take it out.  I had never seen such a device before, much less deflated and removed one.  You let me examine it, think it through, and finally just cut the tubing with scissors.  We bonded over that and you continued to teach me about collaboration and sharing between patient and physician all the while I knew you.

To all whom I encountered in those early years:  There are too many of you to name, too many to acknowledge fully.  But every one of you helped make me the physician I am today.  With each new meeting now, each applied principle and physical exam technique, I thank you and honor you, my esteemed teachers.