We Give What We Can

This week, I struck out during my attempted platelet donation. I was all settled in, ready to watch my guilty pleasure - the season finale of Stranger Things - but the machine kept alarming because the "draw" arm was not cooperating. My nurse rallied a couple more staff members to try to secure more reliable access, bur unfortunately it was not meant to be. My vein had clotted and there was no path forward to donate that day.

There was a funny sense of disappointment I felt in not being able to successfully give. Maybe it was imagining the kiddo with cancer I couldn't help, or maybe it was the physician/caregiver in me who felt I had failed in living up to the needs of the community as we face a chronic shortage of platelet products. I mean, it wasn't my "fault" per se, but I reflected on what I could have done differently to set myself up for success - hydrate better? Said no to the rare beer I allowed myself to enjoy the day prior? Eaten a more substantial meal that morning? I mean, yes to all of those things, but also none of us is perfect. I had to give myself at lest an A for effort for showing up that day with the intention to give.

That being said, I do appreciate that this act of service is a unique experience that very concretely demonstrates the adage, "you can't pour from an empty cup". I've been constantly reminded of this with the large bruise left behind on my antecubital fossa...

Sometimes it's getting back to basics - eat, drink, rest. I tell my patients this all the time - but if you aren't fulfilling your basic needs, you're no good to anyone. So this was a clear reminder that sometimes you need to say no to someone else so you can say yes to yourself. The fact of the matter is that this week, I was overcommitted, which is my natural predisposition to be fair, and my body said no even though my mind wanted to say yes. 

I try to teach my kids (and patients) the power of listening to your body. We spend so much time in our mindspace that sometimes it takes some extra intentionality to drop in to our bodies and honor our physical needs. It's a practice and I'm grateful that when I have really invested in myself thoroughly, my physical cup is literally overflowing and I have some extra "liquid gold" to share with those in need.

Who knew that being a platelet donor would be the ultimate strategy for overachieving me to stay accountable to my own self-care?? To give, and see your donations fanning out across the country to folks who need it most, is a beautiful feeling. And sometimes it is the extra push I need to make sure I'm prioritizing my own health, so I can continue sharing this gift. 

If you are well and have some bandwidth to join the *super cool* club of blood donors, check out redcrossblood.org. 

Finding Connection in Stormy Times

When I was working on the wards during a recent rainstorm, the power at UCSD Hillcrest hospital went out. Of course the hospital generator had kicked in, so emergency power kept all the essentials running, but walking the basement floor to stay shielded from the downpour was eerie, to say the least…

Fortunately the FM wards team was invited to huddle up in the ED doc box (the work room for emergency medicine physicians) for our table rounds. We were grateful to share space with these folks whom we usually only overlap with briefly for handoffs on hospital admissions. It was such a gift to be able to get a better glimpse of the day-to-day of our emergency medicine colleagues while we reviewed our own census together. One of the EM attendings and I laughed together about getting to see this other side of each other’s services - enjoying the hilarious contrast of some of the abbreviated presentations in the acute setting (e.g. “dog bite - antibiotics - fine”) compared to us pontificating on some of the ways we family docs tailor our care to meet the needs of our patients (“let’s be thoughtful about how we order the diuretic regimen for this frail patient”).

In academic medicine, our institutions can be large and mighty, but often much too siloed. Having the opportunity to intermingle with other disciplines can be both insightful and build empathy and stronger connections between teams. And undoubtedly this better mutual understanding can strengthen our collaborative working relationships while improving patient care.

I can think of so many times where realtime interactions with my colleagues in other disciplines really enhanced not only the quality of patient care, but just felt good. Remembering that we’re all working together to help folks feel better can really fuel our sense of purpose and remind us that we are not alone in this sometimes grueling work of healthcare.

Looking forward to sharing more thoughts on this important theme through an interdisciplinary panel on collegiality in the workplace as part of “I’ve Got You” week. More to come!

Moving Beyond Burnout

When we are hurting, we might find ourselves a little withdrawn as we turn inward and tend to our needs. Truthfully, this was crucial for me to do some of the work to truly heal. But pain easily becomes suffering if we can’t share it and process it. And as I get a little more distance that affords the perspective to really learn from the journey, I feel more ready to share my story now. Hoping others can benefit, because I know my experience is not unique. 

Grateful for the opportunity to shine a light on the often veiled and depersonalized view of burnout and mental health issues in healthcare, alongside a dear friend and colleague, Dr. Ami Doshi.

The Burnout Over Burnout podcast, c/o Symptom Media - Mental Health Education & Training

Silence can be deadly. May we fight the stigma and empower folks to seek help and support one another, helping to build the strong wellness culture we so desperately need in healthcare.

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.