Running through the pain

I’m not a runner. But I strive to be healthy (at times) and will jog every once in awhile, and it is generally awesome. Once I get past the puffing and into a rhythm, those endorphins kick in and I am soaring. One day, I was going at a good pace and suddenly felt a searing pain in my legs and was faced with a decision- do I run through the pain, or let up? I tried to push through for awhile but it really didn’t feel right and I finally slowed down for awhile that the pain settled down and I was able to finish my workout. Later, I was realizing that I probably had shin splints and taking the rest had been pretty crucial to not injure myself further. Yet, I had so much inertia that wanted me to ignore those pain signals and push through. Why?? I can’t help but think some of the values of the Culture of Medicine played a role.

The culture of medicine is strong and thick and hangs on you years after training has ended. Most of us come to the field because of our desire to help others, but the risk of losing ourselves in the process is substantial. 

We love the challenge of this work- flexing our cognitive breadth to limits we never imagined, learning more and more while simultaneously realizing the vast knowledge that still remains unknown to us. In the quest for understanding and becoming the best clinicians we can be, we easily put our needs on the back burner in service of others. We want the best for our patients, so we give our very best, sometimes until we have nothing left. We often find ourselves wearing our sacrifices like a badge of honor- going months without a vacation, responding to messages late in the night, saying yes to something even when you have no remaining bandwidth… 

We come to see the hard work as admirable, even if it slowly peels away at our morale and makes us lose pieces of our non-medical identity in the process. It renders us at high risk for burnout/moral injury, depression/anxiety, even suicide. Physicians are at least twice as likely as the general population to die by suicide. We lose about one physician a day to suicide here in the United States.

Isn’t it horrifying that those who are tasked to heal and keep us well are struggling so deeply? 

It is a scary situation we are in, that has only been amplified by the pandemic, and it can seem like an insurmountable problem. How do we heal the healers? How do we help make people feel whole again, and set healthy boundaries, and thrive in this vital work? I grapple with these questions regularly in my work as wellness director for my department. And for a long time, I felt like the world rested on my shoulders with this wellness quandary (which seems so silly, but I see now that it was my own baggage I carried with my taking ownership of too much and not accepting what was feasible for a single human). The fact of the matter is wellness is a team sport - we have to do our part to see our pain and not just run through it, and we also need our system to support us in not pushing ourselves to injury in the first place. (More on this in my “Putting the 'We' in Wellness” article for the San Diego Physician magazine.)

It’s a tough balance- finding the sweet spot between stretching our boundaries to learn, grow, and engage deeply in healing work, while also not depleting ourselves to the point of no return. And this is why things like peer support, engaged leaders, and evidence-based systems strategies can be the guardrails for us so we don’t try to walk that fine line alone. As with any complex health issue that I manage for a patient, I always say, you have to come at it from all angles to really get a handle on it. In this way, the synergy of multifaceted approaches can become an excellent strategy in the quest for well-being.

Casting off

Why is it that finishing something can feel so overwhelming? There’s something about closing the chapter on something that can be not only intimidating but practically instill dread in the procrastinating individual.

Case in point- I had been working on a simple scarf for my daughter for the longest- knitting a few rows here and there over the last year or two, wondering if it was long enough, and Harper finally said, “Mama can you just finish already?!” I hemmed and hawed and made excuses about how I didn’t really remember how to cast off (nothing a simple YouTube search couldn’t fix, of course). She literally created a motivational sign for me that said, “You Can Cast Off!”, prominently displaying it so I couldn’t avoid the task any longer.

So I sat down and finally finished the darn scarf. She wore it proudly and my guilt of this unfinished business quickly melted away. So why do I put myself through such misery- whether it’s the manuscript that hasn’t been submitted to a journal, unfinished clinic charts, an email draft to an old friend, or even a new blog post? I consider it remnants of a recovering perfectionist. Getting things *just right * sure got me far in my career in medicine, but maladaptive perfectionism is its own burden that can limit one in sending their thoughts into the universe. 

2022 is winding down and I’m looking at what intentions I hope to set for the new year. And I think I’ve got a good one- trusting myself to finish. We can’t let the fear of imperfection paralyze us from sharing things that are a little raw - because who  knows if those rough thoughts might impact someone else in a positive way? So here’s to finishing up, speaking up, and releasing a little goodness into the world in the process.

Embracing imperfect

 "Stupid Mama! I hate you!"

I can't deny that hearing those incisive words spill from the mouth of my 8-year-old daughter stung a bit. Sure, I'd certainly grown accustomed to some of this coming from my son who is younger and struggles with his own emotional dysregulation. But absorbing it from my daughter, who is so often calm, collected, and wise beyond her years, it was harder not to feel the impact.

Goodness knows I've been really working on self-compassion this year, which has helped me minimize my internalization of these challenges better than in years past. I do feel like I would have reacted more angrily in a previous chapter of my life when I had allowed myself to get particularly depleted and lacked the wherewithal to meet chaos with clam. But maybe I'm just a tad bit wiser and equipped with a more solid base of equanimity these days. 

I kept peace in my heart and watched her retreat to her room, seething. Several minutes later, she appeared at the door, locked eyes with me, and burst into tears as she fell into my arms. "I'm sorry, Mama -  you don't deserve to be treated that way..." She was horrified with herself, expressing how ashamed she felt in between sobs. I just held space for her, told her to breathe, and reminded her that she's human. We all get pushed to our limit sometimes and say or do things we don't mean. Truthfully, this used to happen all too often for me. But it was only through intentional reflection and action that I started to catch myself more and more, and did the hard work of repair - truly owning up to my mistakes.

The deep shame that my daughter felt with "acting out" really stopped me in my tracks, mostly because it reminded me so much of myself. We are so very alike, and I am all too familiar with the maladaptive perfectionism that I carried with me from youth into adulthood. To feel you can never mess up or disappoint others is a heavy, heavy burden to carry and it's something I have to consciously unload from my psyche on a regular basis. 

Visual cues help keep me honest. I have a keychain beaded with the phrase "embrace imperfect". Practicing this philosophy on a regular basis and modeling it for my children has truly been a game-changer in our household, empowering everyone to pause and acknowledge when we aren't showing up the way we hope to. In this way, we can continue the human journey of learning from our mistakes and growing in deeper knowing and connection.

Wishing you, dear readers, a salve of self-compassion to face the messy parts of yourself with a little more ease, embracing a growth mindset that helps you sail through the rough waters. It sure makes it a more pleasant journey.

Oh belly

Oh belly, what a complicated relationship we have had.

You cramped and cried out when our first little life in utero
    decided to prematurely take its exit. 
You grieved in this sorrowful vacancy
    and ached for what could have been. 
You glowed with pride in all your bigness
    when you miraculously grew babies into existence.
You hang here now, and I eyeball and squish you often,
    wishing you away.

I don’t stop to rub you with affection and say,
    “good job- it’s been a rollercoaster.”

I want to love you the way I love my babies.
    I don’t want to just tolerate you. 

I want to embrace you,
    and honor you for your service.

Be patient with me,
    as I learn to reconnect with you
    in more healing ways.

Mindful

to pause and savor bittersweet moments

that can shimmy underneath the

busy buzz of the day —

to truly taste each element to nourish

you from the inside out —

to sit in silence and feel peace, not fear,

in turning inward —

to settle into a bubble of peace that

brings comfort and clarity —

this is freedom

this is release

this is inner knowing.

the flare

sometimes it's easier to keep pushing through
to roll up the windows and hit the gas
and maybe your tires are almost bald
needle teetering on the empty line
oil change way past due
and there's a funny sound under the hood
but if you hum just right it blends into the background music.

and then the battery dies
and you're stuck with silence 
and stillness
and it gets a little cold at night
and you rummage in the back for a blanket
and wait for a jump.

but no one's coming
you drove so far and left everyone behind
the flashes through the window were a dizzying display
and now, it's just darkness
and you wonder how things got so worn
and you're tired, oh so tired.

but you remember there's one flare in your trunk
and you wonder if it's worth it
and a tiny voice says yes
and with a deep breath, you add a flame
and suddenly, you're not alone in the cold anymore.

you drive the speed limit now
and you watch out for the check engine light
and look out for stranded vehicles along the way these days
cuz this baby's got some mileage
and it's going the distance.

Fail Forward

Tears streamed down his cheeks with disappointment as folks laughingly declined his dandelions and found flowers he advertised as being "only five dollars!".

My son just wanted to have his own business, as he watched big sister successfully selling off her cookie inventory. I embraced him and tried to help him understand that the flowers unfortunately weren't nearly as appealing as the sweet treats. 

Suddenly something clicked in his little 5-year-old brain. He dried his cheeks and ran off to get some supplies. Before I knew it, he was churning out drawings and chasing after passersby, enthusiastically promoting his artwork for exorbitant prices, slowly bringing down the price until he hooked the customer in. One impressed individual even dug out a $2 bill for him to keep.

I've always been amazed at Ember's unfailing confidence - his ability to start up a conversation with a perfect stranger, his willingness to take risks, his sticktoitiveness, and his ability to be nimble when faced with adversity. I mean, let's admit it - it's hard to fail. It can make you want to hide in a dark closet and never come out. But some folks just have an uncanny ability to take it on the chin, dust off and get right back to it. Is it foolishness? Stubbornness? Denial? Or profound wisdom?

I think many of us could stand to learn a thing or two from this ability to switch gears and spin a failure into an opportunity for growth and greater knowing. For those of us who can easily struggle from analysis paralysis or let perfect be the enemy of good, it is a good reminder that if we aren't faced with disappointments or failures very often, we're probably not challenging ourselves or stretching our comfort zone enough. 

Of course it's a balance - you don't want to feel like you are constantly running ragged to meet some metric of success. It's important to have a foundation of self-compassion that allows you to return to a zone of safety when you feel too stretched. But it is fascinating to think about how much more innovation, and creativity might emerge in our society if people just gave themselves a little more room to fail forward. 

What can you do to push your boundaries and give yourself permission to discover and grow?

To be enough

When you look in the mirror, where do you first rest your eyes? Many of us go straight to the part we don’t like. 

And when you reflect on your day, the one negative encounter you have can completely wash out countless other lovely encounters that brought you joy and satisfaction. 

We obsess over our to-do lists and how we’re not living up to some set of expectations, but rarely take time to reflect on our ever-expanding “done” list.  

Why are we apt to be so self-critical? Is it a survival strategy to identify threats to our ideal existence? Is it an evolutionary trait to drive us towards growth and progress? Whatever it is, it’s a major problem that absolutely threatens our mental health, especially if we have perfectionistic traits.

So often we focus on the things about ourselves that we want to change, but how often do we really luxuriate in the aspects of ourselves that we want to hold onto? This was a charge in a writing workshop I recently attended, and I found myself strangely emotional. It was disconcerting that this practice felt unnatural and challenging. Why did this intentional act of self-love feel so unfamiliar and awkward?

When I challenged myself to lean into it and really extract some good to muse on, it was incredibly healing. Tears welled up as I gifted myself that moment of self-celebration. What a powerful act to take the time to reflect on the pieces of oneself that fill you with pride. 

And to take it a step further, when we can really embrace our whole, raw, perfectly imperfect selves with all our flaws and the messy parts, that is true empowerment. The words "embrace imperfect" dangle from my rear view mirror and constantly remind me of this need to cultivate rich self-compassion and heal the aching wounds of inadequacy. Imagine if we all gave ourselves the same love and nurturing that we invest externally. Can you be your own best friend?

I challenge you to look at yourself in the mirror and say, I am enough. It might feel strange, and you might not believe it at first, but you are a complete human being doing the best you can in this moment. And that is more than enough.

“A moment of self-compassion can change your entire day. A string of such moments can change the course of your life.” ― Christopher K. Germer

Pouring from an empty cup

I was so juiced to donate platelets today. It's long overdue - between full-time work in the pandemic, wrapping up two professional development courses, my assorted "extracurricular" professional activities, and parenting/family commitments, I've been spent. But it's pretty hard to ignore the worst blood shortage crisis in over a decade, so I felt inclined to do my part. I worked really hard to get caught up on my work so I could make it to the appointment. I even got a solo hike in this morning and was feeling good about doing something for myself before I did something for others. This was going to be great!!

I show up to the donation center, ready to go - my hemoglobin level was excellent but my blood pressure was a little lower than usual. I noticed I was feeling a little dizzy, and I was starting to realize I hadn't hydrated enough. I hoped, though, that I could push through - just like we do in the clinical sphere - see patients now, hydrate later - no way to get enough water in with the consistent masking that is necessary these days. They get me in the chair, I queue up my movie and am ready to go-- I think. But I sorta know it's not going to go well. The nurses scrutinize my veins, squeeze my arms with blood pressure cuffs, tell me to "squeeze 3 times and hold it" - tap tap tap, squint. They are not pleased. They check the other arm. They put heating packs on me to try to get the veins to pop. No dice. They didn't even bother trying to poke me - they could tell it wouldn't be successful. I was sent on my way.

DAMN. IT. I get in my car and feel the tears well up. Then, the inner voice - "Why are you being such a weirdo? You can always try another time." I guess what I was feeling was frustration and sadness that I couldn't be of help in a crisis. And some of the frustration was self-directed, because I definitely should have known better and ensured I had been drinking enough water and had adequate nutrition to participate. But we health care workers are often really bad at the whole self-care thing - it's a running sad joke in medicine. It's even more embarrassing because I am the Wellness Director for my department and try to strive to walk the walk for my colleagues. 

But it's time to set the guilt to the side and see this as the lesson I apparently needed to relearn, again. You can't pour from an empty cup. It seems so obvious, yet we sure do try sometimes. And while doing all the right things for our own wellness can feel overwhelming at times, it doesn't have to be perfection. Sometimes it's just going to bed when you feel tired instead of trying to power through a few more items on the to-do list. Or keeping a bottle of water nearby to sneak swigs in when you can. Or doing a 3 minute meditation in the car before you transition from work to home. These tiny moments can be cumulative and are a powerful testament to prioritizing yourself just a little bit so you can keep doing the important work that makes your heart sing.

"Self-care is giving the world the best of you, instead of what's left of you." - Katie Reed

Family Medicine - where health is primary

I’ve got you When you’re sick or well Through your joys and sorrows I’ve got you Your children, partner, parents From birth to death, I’m there.

I treat the whole person

You’re not “the diabetic”, but rather

the resilient person who lost 30 lbs

and picked up a love for cycling

after we found those elevated blood sugars

I’ll be there with you, tissues and all,

Through the bad news

And we’ll figure it out together.

We’ll celebrate the joys, too

Life’s accomplishments, love and family

I’ll catch your babies

Then fall in love with them along with you

High-fiving at those well child checks

Marveling at their growth

[it happens so fast doesn’t it]

We’ll share stories while

I remove that suspicious mole

Or insert an intrauterine device

Or deliver a steroid shot into that tired joint

I’m your partner in care

With you on your path to wellness

My head, heart and hands are my tools

I’m here for you.

I’m your family doc.

Social rounding

 social rounding

i had some time so i peeked in

on my patient on the wards.

he'd been having a rough go of it - 

in and out of the hospital,

his conditions getting the best of him.

in clinic, we usually focus in on 

these health issues that have

decided to make life difficult.

but today was different. 

we sat together for some time,

talking about our families,

the holidays, what's next in life.

we talked about what makes life hard 

and what makes life worth living.

i saw a bit of hope glimmering 

in those half closed eyes.

my heart swelled.

"thanks for the visit, doc,

you really helped me, mentally"

no, thank you, sir.

i needed this just as much as you.

a hazy arrival

"she’s anterior lip"

the words from the phone line
shock me awake
as i clumsily shimmy on some scrubs

it’s been a long few weeks 

peppered with sadness and heartache

coming off wards on the holidays 

in a pandemic surge.

i’m tired, but i need this.

“i have a baby to deliver!” 

i exclaim to an amused lyft driver

then take a few breaths. 

no rush, no stress

she’s a nullip, after all

she sleepily lights up when i arrive

epidural simmering

she’s labored down

let’s practice pushing

we talk about baby names and the weather 

in between contractions

it’s foggy on this uncertain morning

pairs of nervous eyes watch the fetal strip

from afar

the late dips give me pause, too

but i breathe, and i feel the progress

and i trust her process

with some more coaching, 

the pushes gain power and 

she rounds a corner

a student joins me for her first delivery

nervous but excited

hand over hand, we deliver the package

just as the fog starts to clear-

birth by fire

so many docs miss the beauty of this 

second stage

but i absorbed it all that morning 

with husband, student and nurse

cloaked in awe of the magic

a beautiful birth

a new family

a fresh chapter

a perfect antidote to so much grief

this is the power of our work

to attend to so much pain

but also connect in joy

this is family medicine.