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.

singing bowl wisdom

I gifted my son a singing bowl for one of his Christmas presents this year. He can get revved up sometimes (I mean, don't we all?), and I was looking for new ways to help him reset. While it has been nothing less than adorable seeing him mesmerized as he creates sounds through the house, I had no idea how this small treasure would resonate with me so deeply, as well (no pun intended). 

My main experience with Tibetan singing bowls in the past has been when I've been practicing yoga or listening to a meditation. While the sounds were calming, I never really thought too much more about it, and certainly had very little experience with the concept of sound healing. As I have been working with my son to help him play his singing bowl, I've learned a few things along the way:

Be firm, but gentle - don't cling to the mallet too hard, willing the sound to carry

Take it slow - don't rush it as you swirl the mallet around the bowl

Let it in - let the sound envelop you and give you what you need

Try a different angle - if the sound isn't quite what you expected, angle the mallet differently and see what results

Let it build - sometimes the most powerful tones result when you just run the mallet around the bowl without striking

Balancing a steadfast approach with a little bit of give.
Fighting the inertia to rush through things.
Keeping an open mind and heart to fully embrace the experience.
Allowing yourself to be nimble with new approaches.
Luxuriating in a powerful (r)evolutionary process.

Friends, my intentions for 2024 have just fallen into my lap!

Resolutions may come and go - often, they are overly lofty or detailed, and easily forgotten. Instead, some people use certain visuals or mantras to ground them in what is important and true in life.  Similarly, setting intentions, and grounding them into a concept that is easily accessible, can be a powerful ritual. As a new year is upon us, I am inspired to channel this singing bowl wisdom into my daily life, and wish you all to find or hold onto that something that anchors you in your truth.

Make Your Mark

One of my favorite parts of the day is cuddle time in the evening with our kids as they are winding down for bed. Yawning and cozy, we reflect on the day that's gone and what's to come, giggle, and sing lullabies to each other. I know one day, this tradition will end and I am soaking it up as much as I can. Besides the joy of the oxytocin rush I get with these sweet embraces, I have also been inspired by some of the incredible wisdom that has emerged out of the mouths of these babes...

The other night, we somehow came upon a discussion on the meaning of life, and my 9-year-old said, 

        Maybe it's all about making your mark. 

I was shocked to hear such a profound commentary from my daughter and I feel like it so eloquently described a fundamental aspect of my vision statement for life. While I do feel that finding our joy in life is so crucial, I believe that an extension of that is the impact you choose to have on others as you pursue your passions. When we can follow our bliss and "make our mark" in a palpable and positive way, it can be so empowering for all involved.

It always throws me when patients tell me that some thing I said to them years ago significantly changed the trajectory of their health journey. I mean, we do our best to take care of patients when they come through our doors, but so often it feels that our impact ends there. Hearing these stories from patients is a reminder of the profound effect our words and actions can have, either for good or bad. This doesn't mean we need to walk on eggshells or overthink every single thing we say. On the contrary, when we can truly realize our self-efficacy and capacity for effecting change, we can help more folks take on seemingly insurmountable challenges, whether it is getting a chronic condition under control, facing the end of life with equanimity, or emerging from trauma.

I'll never forget when a patient told me after going through sexual assault that my words of encouragement from a prior visit echoed in her head and empowered her to fight back and save herself. Or the patient who finally quit smoking after the millionth time that I bothered him about it. Or the chronically anxious patient who finally found some peace when she realized her suffering and accepted treatment. These stories can easily become faded memories, but I am challenging myself to hold them in my heart more deeply, so I never lose trust in the power of compassionate presence. Just as these humans found hope and healing through connection, I, too, felt uplifted and inspired - in the human capacity for change and growth, and the part I could play in that process. This is one way that I make my mark. This is a fundamental part of my why. 

How do you make your mark? How do you want to have an impact?

Puzzling as Progress

So I decided to bust out a new 1000 piece puzzle two weeks ago for a fun family activity as the tropical storm was heading towards San Diego. I always associated puzzles with rest, mindfulness, and bonding with loved ones, so I was excited to get started. It was all fine and good at first, until my family members gradually tired of the extremely challenging work of getting the intricate pieces to come together, and they peeled away and busied themselves with other things. Then it became my project.

My partner regularly complained about how it was taking up too much room, and threatened to box it up when I was gone for a conference the following week. But when I came back, it was still there! He saved it for me. It seems like such a silly gesture, but suddenly I was filled with new resolve. If Cory didn't put it away, maybe he thinks I can do this thing after all. I found myself determined to prove that I could finish it. 

Every day, I tried my darnedest to make progress, but it was slow going. I felt the undone puzzle hanging over me, and it seemed weird how much I let it get to me. But it became obvious that the puzzle symbolized something more, reminding me of difficult things that I need to do that I tend to procrastinate or avoid. So every day, I spent some time chipping away at it. At first, I felt like I was barely making any progress. Then I found new approaches like focusing on identifying distinctive puzzle shapes rather than color patterns, or zeroing in on one section of the puzzle, which made me feel less overwhelmed by the more monumental task of getting it all done. I would mess with the lighting in the room or look at the puzzle from a different angle and sometimes that helped me find a path forward. Heck, the kids even joined in sometimes and helped me turn a corner a couple times when I was hitting a roadblock.

This simple puzzle ritual became an exercise in persistence and patience, and really forced me to just trust the process. I came to believe that I could really get it done and started to look forward to my solo meditative time as I slowly put the pieces together. Suddenly I wasn't checking work email after hours or obsessing over my to-do list. And when I did have to buckle down and do some work, I felt I had more bandwidth to complete other responsibilities because I had been committed to this "non-productive" downtime which naturally created some healthy boundaries between work and home. 

So, 13 days later, the puzzle is complete. I admired my work, and the finished product was missing two pieces - no surprise with two young kids and a playful cat at home! It made me smile and remember one of my favorite mantras these days, "Done, not perfect."

These are the lessons I've taken from what will be henceforth known as The Puzzle Project:

*Whether someone believes in you or not can easily sway your confidence, but in the end, faith in yourself is what will propel you forward.
*Embracing some flexibility in perspective taking can be a game-changer and support growth.
*You don't have to do it all alone - a little help from someone else can be just what you need to overcome a seemingly insurmountable hurdle.
*Creating space for creativity and play is a vital component of work-life integration.
*Release the pressure to be perfect and celebrate the good (enough).

We can do hard things! And have fun in the process.

Enjoying the Descent

I was coming down from a high of organizing and running the SDAFP symposium - it was an incredible event, if I do say so myself, bringing together almost 200 family docs for an extensive CME program that I painstakingly curated with the support of our Executive Director and Board of Directors. The energy of our community was invigorating!

Then it was right back into work the next day with some heavy emotional labor in patient care. And finally time to address some personal health issues that I had put off. Not to mention some clinic inbox issues had piled up - it was catch up time!

I was talking to my daughter as we drove up to the library after a long day. I was likely distracted by our conversation, my mental to-do list, and not to mention the emerging pain in my face after the lidocaine was wearing off from a minor derm surgery earlier that day. I cut in to the lot too early and hit the curb, busting a tire and cracking my steering column, rendering it useless and leaving us stunned. Thankfully we were safe, not hurt, and right where we were headed. I sent my daughter in to get her library books while I scheduled a tow through AAA. So many kind souls popped over to check in on me. I was pretty scattered at the time, but on reflection, I am so grateful to live in a community where people really look out for one another. And I'm so happy to have AAA and tow service within minutes at the touch of a button. And I know how lucky I am to have a flexible career where I can cancel clinic last-minute for an emergency and not worry about losing my job. I absolutely recognize the privilege I have of resources and technology so I can skate through a crisis relatively unscathed.

The next day, with my clinic schedule cleared and this unexpected gift of "free time",  I opened up a little bandwidth to understand what happened. Ater I Lyfted my kids to summer camp and made a plan with the local auto repair shop, I decided to take a mindful walk home. It involved scaling a sizable hill - I felt the burn in my legs and focused on my breathing while I huffed and puffed to the top. And when I got to the summit, I was able to pause and take in a beautiful vista of my town, framed by the Pacific Ocean, and found myself filled with a sense of peace and wonder. 

Then I got to enjoy an easy downhill trek as I descended into my neighborhood, and felt more ready to take on the many tasks at hand. It made me remember a simple truth - it is so important to challenge ourselves and stretch ourselves, but it is equally important to set aside time to replenish ourselves when we've been through some major things, so we don't get worn down.

I was so stretched and depleted, it's no wonder I put myself at risk of an accident. As my kind Lyft driver reminded me this morning, "we are not machines!" We are human beings who need to rest. I know this, I tell my patients this, I've written about this probably countless times, but sometimes I still forget to apply it to my life. Ideally we don't wait for crises to emerge to stop and take care of ourselves, but sometimes that's what has to happen to do the hard reset. And that's OK. We're fallible creatures, but we can learn and try to do better the next time. I do notice that I am better able to bounce back after mis-steps these days, leaning into self-compassion and curiosity to examine the situation with more clarity than in the past. And I'm able to access equanimity a lot more easily by finding strength through a gratitude practice when facing life's challenges. These tools have become a crucial part of my resiliency and a healthier growth mindset. 

So may we definitely climb the mountains, but may we also not forget to take time to enjoy the descent before tackling the next summit.