“What’s Your O-Ring?”

I grew up with this image on the wall.

Preventable disaster.

Space Shuttle Challenger has been on my mind lately. Last week Hector Carrillo did a live recording from Florida, experiencing cold temperatures there like the rest of the country. I attended six nightly online creativity workshops organized by Erin Mallon, narrator, writer, and podcast host. I now feel a familiar, swelling creative energy akin, in my metaphorical mind, to that housed in solid rocket boosters. Talking animatedly with Friend Donna the other day, I brought up Challenger and she asked me why, for such joyous and productive excitement, I choose a metaphor that’s one of the greatest tragedies of a generation?

Huh. Fascinating.

At first I thought it was just because Challenger was such a quintessential and iconic image of the space program in general, and growing up with rocket images all over the house [Ba worked for Lockheed Martin on the Shuttle Payload Integration Contract, he told me tonight when I requested a photo of the photo from home], I just pulled on those memories as convenient analogy. I had not ascribed any conscious meaning or relationship to the shuttle’s ultimate demise. I was ready to shrug off Donna’s question as peripheral to my creative journey. She prodded me gently, though, to engage some cosmic curiosity and explore further. Speaking of comic: Today, January 28, is the 38th anniversary of the Challenger explosion in 1986. 

For those too young to remember, the night before Challenger launched from Cape Canaveral that January day, temperatures dipped far below freezing. Engineers at Morton Thiokol, manufacturer of the O-rings that served essentially as gasket seals for the rocket boosters, advocated strenuously to delay the launch. They knew that temperatures that low would stiffen the rings, making them contract and fail, causing fuel leakage, uncontrolled combustion, and inevitable disaster. Bob Ebeling sounded the alarm first. Despite his and his colleagues’ presentations and advocacy, NASA elected to launch, and seven amazing people lost their lives.

Eventually Donna and I got to the bottom line Challenger question for my creativity and writing: ”What’s your O-ring?” OH, SO fascinating! I spent the next 24 hours and a good portion of my morning pages (21 consecutive days as of today) yesterday processing… I bet more insights emerge this week and beyond. Thus far it’s mostly more questions and a few vaguely related ideas, that apply to more than just my book project:

Where is there vulnerability where stability is assumed and taken for granted?
How can I detect it? Where are alarms sounding that I ignore because I don’t want to delay something that I want or expect? What realities am I denying to advance an agenda, but that put that very agenda at risk for abject failure because I deny them?

Booster energy as book energy: What happens when it leaks or emits inappropriately, and under which circumstances? What would that look like? Is it already happening?

Conditions and consequences: The parameters for normal function in the body are remarkably narrow. I have always marveled at how a person can not only survive, but function highly for prolonged periods, with multiple systems operating wildly outside of those parameters. Nature compensates automatically, elegantly. But there is always some cost, and compensatory mechanisms can only last so long before the system crashes. So for my writing, what are ideal and acceptable conditions for creative work to occur and thrive? How can I establish and maintain those conditions, monitor for derangement, and adjust accordingly? What costs are worth paying, for what reward and value, for how long? How can I know when I need to delay or even abort? 

The O-rings were only one part of a highly complex and integrated machine. Each part of any system has its own unique parameters of function, and is also inextricably linked to every other part. Derangement and compensation in one part inevitably affects the whole of parts in predictable and yet nuanced ways. How elastic is each part’s accommodation capacity, within and outside of its normal functional range? When function is impaired, what complex domino effect does that create, with what consequences for the whole system?

This post feels oddly satisfying in its total lack of conclusion. Truly, I can live the quesiton(s), as Rilke admonishes so eloquently. I look forward to what insights emerge in time, especially as I continue to release streams of consciousness in writing each morning. This week I will practice letting go of attachment to outcomes, and attend to habits that make my desired outcomes of high creativity and connection more likely: bedtime, morning light and writing, regular exercise, sitting with uncertainty.

Let’s see what happens!

Walking the Talk: Leading Indicators

The most perfect gift from Donna. xo

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

Instagram, @shaneeastreads, 1-3-2024

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.