Learning to Fall

My family recently joined a climbing gym, and it has been a fun outlet for all of us. When I first started, I was a little unsure of how it was going to go, as I don’t consider myself a very athletic person. Surprisingly, it was quite accessible as there are different levels of climbing you can challenge yourself with, and I found myself easily working my way up to the top if I grabbed the least challenging holds. Interestingly, I found it relatively easy to scale the wall this way, but it was actually the coming down that felt really tenuous. Suddenly the height felt so much more palpable. The most intimidating part for me was the idea of popping off the wall and letting the auto-belay kick in after a second or two before you slowly were let down to the ground by the mysterious contraption above. 

I found myself clinging helplessly to the wall and looking down at my 10-year-old daughter who had suddenly become my emotional support coach. She looked up at me with her big brown eyes and said “Mama, you can do this. Just look at the wall, not down, count 1-2-3, grab the rope and come off the wall.” Funny enough, she’s been testing herself with this very challenge the last week or two and worked up to it by slowly scaling up part of the wall, and releasing into the auto-belay at progressively increasing heights. She coached me to do the same thing, and it worked. By making the leap a little more achievable and less scary, I was gradually able to challenge myself into this trust fall of sorts and finally embrace the thrill of a transient sensation of free-fall. 

I had been so focused on the work of ascending before, but I realized that once I knew how to really fall, I felt so much more empowered to challenge myself to greater heights. Suddenly it felt so much less scary to take on the harder paths. I wasn’t afraid of falling anymore. Whether it was the auto-belay or my partner providing his counter-weight down below, I could stop catastrophizing the possibility of losing my footing and know that the worst that would happen would be a bit of a fumbling mid-air. And best case scenario, I finish an awesome climb and can celebrate with a joyful leap into the air and maybe a bit of a sloppy drop onto the mat and laughing embrace with my daughter. 

I see now that the more you can fall, the higher you can climb. This applies to making mistakes or facing “failures” along the way - if we’re willing to be a little vulnerable, take risks, put ourselves out there - the missteps don’t have to paralyze you, they become less scary and lose their power. As tough as this can feel in a field like healthcare where striving for perfection can seem like the gold standard, I’ve told my learners countless times that the mistakes we make as we care for patients can be some of the most powerful lessons and contribute to significant growth in our professional identity, strengthening the way that we show up for future patients. 

So I’m going to keep climbing, and falling, and learning and growing and having fun along the way. And when I might find myself faltering, I’ll be grateful for the ongoing inspiration from my small but mighty daughter.

Using our voice where we can

These days, it can feel overwhelming with all the changes and threats happening in our country with the current political climate. But I am grateful for ongoing dialogue with friends and colleagues who recognize that what is happening is not okay, and while it is easy to feel helpless, we do have agency to band together to address injustice that is unfolding. 

It was an honor to be able to collaborate with some dear family medicine colleagues through this op-ed in the San Diego Union-Tribune:

 

I'm grateful for the opportunity to share our perspective, and we're just getting started. First is making sure the public is aware of what is happening. Next is gathering a critical mass of folks to advocate for change. 

Looking forward to the California Academy of Family Physicians' All Member Advocacy Meeting next month to collaborate with other family physician colleagues and speak to our representatives about key issues affecting our patients and our work in primary care.

When we feel we are coming up against a wall in the impact we can make in certain issues within our exam rooms, it's time to break outside those walls to address the issue head on. While many of us in medicine feel that we aren't experts in advocacy work, it's important to recognize that we advocate for our patients all the time in our clinical work, and we can do this out in the world. We have to trust that with a little support from our village, we can take that same energy to advocate for our greater community. 

Chasing the sunset

On my evening flight from San Antonio back to San Diego, I found myself entranced by a seemingly endless warm color palette out my window as our plane chased the sunset. What a strange concept to gain time, to get a little something back in the time-space continuum, especially when life can easily can feel like an hourglass spending the grains of sand away. That image feels even more real at a time of so much loss and grieving - from the atrocities in Gaza and other war-torn countries to the natural disasters in the setting of climate change to the assault on science and evidence-based medicine to the threat of the basic human rights of women, immigrants, racial and ethnic minorities, and the transgender/gender-diverse community…

There is so much fear and uncertainty and so much at stake. 

It’s dizzying because there’s so much wrong right now, it’s hard to know where to turn. So maybe that’s why I clung to the practically infinite sunset - a bit of something beautiful and surreal at a time when things feel pretty ugly and unreal. 

Maybe that’s why I leaned even more into my MedEd conference this weekend, hugging kindred family docs who inspire and amaze me at the impact they make on their communities. And why I clamored together for community and resonated even more deeply with folx committed to gender health while beaming about the power of gender affirming primary care at the Transgender Healthcare Symposium.

I'm trying to breathe in as much self-compassion as I can these days as I send loving-kindness vibes to so many hurting. Staying connected to my people and leaning on my villages has been essential to keep me grounded at a time of such insanity. I still hold on to hope that maybe enough change makers can assemble to face the injustice unfolding in so many ways. Sarah McBride shared her hope that as we face the challenges of this new administration, that we see it as a potential slingshot moment:

"yes, we are pulled backward, but the pressure and tension of being pulled backwards ultimately propels us to destinations that we've never been before."

Time and again, I have felt the power of fierce optimism to be the essential fuel for resilience and commitment to advocate for what's important. So while we maybe can't quite shake some of the unsettling feelings of helplessness and despair at the state of our country right now, we can still do our best to channel our energy into the continuous pursuit of a better future. 

Heal thyself

I was wrapping up a refreshing session of vinyasa yoga and feeling pretty strong and grounded. The intention I had set for the class was, “Trust”, and I was proud that I had done just that and worked through some moves where I was able to push the edge a little while also seeking balance. I felt empowered but ready to rest.

The instructor guided us into pigeon pose, and I was thrilled to squeeze in a little hip opener before we settled into Shavasana. Little did I know that this would not be a simple time for relaxation. On my right hip things seemed pretty uneventful, but as soon as I settled into opening my left hip, I found tears quietly streaming down my cheeks. It was such a release. So often you hear stories about how we can hold stress and trauma in our hips, but I truly experienced it firsthand. 

I fell back on my intention: trust. I trusted that this was just what my body/mind/spirit needed at this moment, to surrender and allow myself a bit of healing. 

When we transitioned to Shavasana, the teacher said something that really resonated with me - 

“Take up as much space as you need.”

How often are we socialized to make ourselves small, to not be a burden, to put our needs before others? 

As I lay there, arms open, I felt light and free and unburdened. I luxuriated in this gift of occupying space for myself in a way that is healing and empowering.

I often joke with my patients that I feel like a better person when I practice yoga, and now that it’s finding its way back into my life again, I remember why- it truly is a healing salve for our physical, mental, and spiritual selves, helping to align and synergize these seemingly disparate identities to allow us to live more wholeheartedly and authentically. 

More than ever these days, I am realizing how crucial it is to engage in self-healing in whatever form it speaks to you. For years, I think I was waiting around for someone or something else to make me feel better, and it took me nearly 40 years to realize, that someone was me. I have the power to turn the same nurturing and compassion that I pour outward, to myself. And when I do, my replenished spirit has all the more to radiate to the world. 

Here’s to continuing to unabashedly make space for ourselves - to tend to old wounds, to embrace new growth, to connect with our truest selves.

Clarity in solitude

It's been a busy few months and I have had so much I wanted to share on this page. From 

educational outreach on LGBTQ+ health to 

insights from developing our compassion curriculum to 

inspiration from training in open dialogue to

excitement from a multidisciplinary collaboration on a new manuscript to

strengthening connections and brainstorming in my new role as GME wellness director to  

training up a wonderful cadre of resident/fellow peer supporters to 

collaborating with colleagues to fortify and safeguard FM education in the new med school curriculum to 

co-facilitating professional development in wellness-centered leadership with wellness colleagues to

heartfelt moments with learners and patients to 

precious moments with my children as they wrapped up the school year and extracurriculars and launched into the beautiful chaos of summer camp...

Well-- I'm tired, but the good kind.  I just know I need to do some stretching and cool down to integrate things after an intense period of growth and learning.

My heart and mind are full, and desperate to do some processing.

And the universe has granted me just that, as this week I have the home completely to myself as my two children have gone off to sleepaway camp and my partner tends to family matters out of state. 

I'm trying not to get an A in relaxing this week, nor am I gunning to catch up on all the things on my to-do list. I'm definitely looking forward to some restorative time and connecting with some parts of myself that tend to collect dust in the caregiving journey. More than anything, I know that a lot has happened, and sometimes it might seem easier to just keep on trucking when the pedal has been slammed to the floor. But everything has been pointing me towards the need to slow down and enjoy this ride more, so I'm putting on cruise control and giving myself some space to look back a little. And in that way, I know I can earn even more clarity about where I'm going. 

You can't be all things

On the surface, it can sound pretty exciting to be a full-spectrum family medicine physician and Associate Clinical Professor, Wellness Director for the Department of Family Medicine, Wellness Director for Graduate Medical Education, and Co-Director for the School of Medicine's new Compassionate Action and Real Engagement in the Community course. The reality:

~30 residents with varying needs and feedback on my teaching style and engagement

~75 faculty colleagues with a myriad of needs with respect to their wellness 

~150 medical students with varying opinions of our compassion course

~700 patients on my panel with a number of perspectives on the care I provide

~1000 residents and fellows with a myriad of needs with respect to their wellness

Every time I have to read through feedback, be it from colleagues or learners or patients, I can be so filled with dread. The fact of the matter is that I really want everyone to be happy and it kills me when people feel that their needs aren't being met. Whether I'm caring for patients or teaching and mentoring, I want people to feel supported, listened to, cared for. 

When you get feedback that you are too close for comfort, and try to back off, then you are at risk of being called disengaged. When you offer openness to feedback and co-creation, if you don't incorporate all the ideas, you can be seen as dismissive. It's a dizzying pendulum swing. 

In our efforts to try to be all things to be all people, our identity and values can easily become compromised. I am trying to keep that in mind as I forge a path forward with so many factors weighing on my conscience.

I know that I cannot be perfect, and given the privilege I have to be involved in the lives of so many people, there are going to be some unhappy people. And I have to be okay with that. It's just really uncomfortable. And I have to make up for it with more self-care and therapy and self-assurance that if I stay true to myself, I can lean on the inner compass to guide me forward as a leader, educator, and healer. 

I'm going to challenge myself with a little reframe - I'm so grateful that I am in a position to fuss over these "first world problems" and that I have the agency to have a seat at the table to use my voice and enact change. I just need to lean into personal resiliency a bit more so I'm prepared for the inevitable challenges along the way.

I appreciate those of you who made it through this vulnerability post which offered me a little catharsis at a tough time. If this struggle speaks to any of you out there in mentoring or leadership roles, know that you are not alone. And I'm happy to grab coffee or Zoom and decompress and strategize as we work through how we can show up as our best selves in our work. 

And just remember:

Maybe it all works out

I told my 9-year-old daughter that I was giving a talk tomorrow and was feeling a little nervous, and she said, “Oh, Mama. You say this every time you give a talk, and it always turns out fine.”

Holy smokes, y’all.. my tween dropped some solid wisdom helping me identify my cognitive distortion- 

The thought: You worry something won’t work out well
The reality: You’re always prepared and it always goes fine 

While planning for the worst has historically been a solid strategy for me that I’ve used to my advantage to try to stay at the top of my game, the mental load is heavy and it is so unnecessary.  What if, just maybe, it all works out?

Trusting my inner wisdom and experience is so much more freeing than anticipating the worst. And sometimes you have to hear the facts from someone outside of yourself to knock you back into reality. Yet another reason why I am such a fan of talk therapy and embracing some vulnerability with friends and loved ones to externalize the unhelpful thought streams that can take you on a wild ride.

Our thoughts can be our best friend, or our worst enemy. We can choose to embrace a self-compassionate voice of reason but often find ourselves enmeshed in the rants of a self-critical catastrophizer. It seems obvious what the default should be, but our negative bias can lead us down some scary paths.

So when I see myself starting to spiral, I try to ask myself, “Is this thought helpful? Is it true? What are the facts here?” And while that’s all fine and good if we are in the headspace to do this thought work, it’s also perfectly acceptable to just try to focus on releasing the unhelpful thoughts and just breathing and grounding yourself until you are a little more regulated. I find that I use these strategies with patients not infrequently, but only recently have I started taking the time to do it for myself.

Can you imagine the healing we could bring ourselves, if we gave more freely to ourselves all the goodness we pour out in others?

I've been crafting a session on self-compassion for our medical students, and it's been, well, damn hard - because I feel like I'm kinda bad at the whole self-compassion thing. But, as a thought experiment, the self-compassionate part of me wants to say...

Maybe you don't have to be an expert at this. Maybe you can just share your truth about the struggles of self-compassion. There is powerful learning in that, too. And maybe you can own some of the small wins that you've experienced in the beauty of self-compassion, because that can be accessible and inspiring to others. And maybe you can fall back on collective wisdom and encourage others to share their stories, because that is a strength you have, to build safe spaces for authentic presence.

Ack, even saying that last part, telling myself I'm good at something, feels weird. But a wise person once told me, keep doing the good self-care and self-talk - eventually it will feel natural and normal. It's only weird because it's not happening enough. 

May we all fill ourselves back up, trust our voice, and get grounded in our strengths to buoy us even in the hard times.