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.

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.

Just write

In medicine, we soak up so much suffering on a daily basis. Sure, there is a lot of joy and connection and laughs and inspiration. But the number of times I have felt a patient's trauma in the core of my being is innumerable. The cumulative grief and pain is too much for any human to bear. So we have a few options - 

1. Box it up. Compartmentalize. We all have to do this to a certain extent in a busy work day. We can have a really difficult conversation with a patient on hospice and then have to head into a well baby check, all smiles. But some people continually keep all the hard emotions buried down deep, hoping they will never come out (spoiler alert: repressed feelings often rear their head at the most inopportune times).

2. Feel it all. Have no boundaries. Lose your sense of self. Simmer in the pain of sympathy and notice it creep into all the corners of your life. 

3. Process it. This can look a lot of ways, whether it's a Balint group, therapy, meditation, creative arts, or writing. 

For me, writing is a critical elixir to stay healthy and whole as a healer. When I face hard times with a patient, and I feel the pain gripping my heart in unhealthy ways and sending me on my way to option 2 above, I am called to write. In this way, I can search for understanding in the midst of the suffering, even if it is just trying to make sense of my feelings. This ritual helps me ground myself in a deeper wisdom by metabolizing the pain in my own reflective process.

I have started a tradition of giving journals to my learners, encouraging them to write about their experiences in medical school as a therapeutic outlet, and also to be able to remember some critical moments that might otherwise fade into a distant memory. Many have told me how powerful it has been to journal during such a demanding time of their lives. 

Journaling might not be for everyone, but I do feel that creating space for oneself to process the heavy stuff in medicine is pretty critical and an accessible antidote for cynicism, numbing, and emotional exhaustion.

And I have found it so meaningful to take it to the next level by sharing my story and remembering the common humanity of so many of life's challenges - but more on that another day.

For now, find time to just write. You won't regret it. 

Moving through uncertainty

I was on a solo road trip recently to a conference and at some point on the journey, I was met with a dense fog that cloaked the highway for several miles. It was disconcerting and disorienting, and forced me to zero in on what was right in front of me. The little that I could see had to become my guiding point, and it took a lot of present-moment awareness to stay focused on the path forward, even though it felt very uncertain. 

I tend to be a very future-oriented person, so leaning into contemplative practices like meditation and mindfulness have forced me to embrace some discomfort to see things a different way. I find comfort in planning and looking forward and what’s ahead, to feel more sure in the present moment. But sometimes in life, we will get mucked up in some things that are unclear, dynamic and unexpected. And we have to reorient and ground ourselves in what we do know, even if it doesn’t seem like much. When there isn’t much extrinsic information, we have to go inward to our intuition to guide us. That comes naturally to some more than others, but certainly we can all practice sinking into our inner knowing more often. As social beings, we easily can look outward for guidance on which way to go, but sometimes that takes us on a very different path than we would have chosen for ourselves.

Eventually I did make it through the fog and was able to breathe more easily as I finished up the trip on a nice sunny stretch. It was a little scary, but I was grateful that I trusted myself to move through the uncertain path. I found that it put me in a helpful mindset as I embarked on the wellness conference, trusting my voice more to speak up and connect with new people. When we get comfortable with the unknown a bit more, it really can empower us to meet it with grace in our daily life.

Stuck in knots

Have you ever tried to untie a knot when you are in a hurry or stressed out?

It's super frustrating, isn't it? What ends up happening? You keep tugging and making it worse. 

Silly example - I was trying to undo a tangled up necklace recently when I was running late for something. It was a ridiculous few minutes of struggle until I gave up and told myself that that wasn't the time to do it. 

It's only when you force yourself to slow down and methodically work through a seemingly impossible problem that it starts to unravel the way it should. The old adage is, when you walk into a code blue in the hospital, check your pulse first, then check the patient's. You have to be able to turn inward and settle in to the right frame of mind to show up and do hard things. 

I am reminded of this again and again when I don't give myself space to just be - whether it's meditation, journaling, yoga, or being fully present with loved ones. When you're feeling depleted, it's easy to get caught up in unhelpful thoughts peppered with guilt and worry around unfinished items on the to-do list, unrealized aspirations, self-criticism, and even hopelessness and overwhelm. It can be a vicious cycle of trying to busy oneself to avoid a shame spiral of inadequacy - but it's the same useless coping strategy that keeps us angrily tugging at knots that won't budge. 

But when I allow myself to turn inward with loving kindness and trust that I have what I need and that I am truly enough, even when I feel stuck in knots, that is a powerful act of self-compassion and healing. I think that's why contemplative practices are so radically effective - they ground us in the important stuff while softening even the most formidable obstacles.

So next time you're faced with a knotted mess, put a little trust in yourself to meet it with equanimity. And if you feel like you can't at that moment, sometimes stepping away to get into a better headspace is the right move. Regardless, tough times are inevitable, but how you support yourself in facing those challenges is what really matters. 

Still flowering

I recently received some anonymous feedback wishing for me to "create better boundaries" in my scope to focus more on my "areas of passion". I found this both shocking and saddening and have been reflecting a lot on this perspective. Is the era of the full-spectrum family medicine physician ending? 

I find it disappointing that some folks feel we need to "specialize" in something within Family Medicine. The truth is, having great breadth to my practice as a "comprehensivist" is my passion and I am specializing - in primary care for all ages. To have a day that can involve a well child check, OB visit, joint injection, counseling a patient struggling with depression, and a heartfelt discussion on end-of-life wishes, all while teaching a couple medical students the tools of my trade - that's pure joy for me. Sure, it's exhausting as heck and I need time to replenish myself when I get home, but I'm getting a lot better at filling my cup back up so I can keep pouring for others. 

I'm a fairly open book about the human issues I deal with - from working full-time while parenting two young children, to navigating a neurodivergent household, to struggling with self-compassion and taking rest, to healing from childhood trauma, to embracing a queer identity that many folks don't understand or acknowledge. I own this authentic approach because I know I'm not the only person living an imperfect life and trying to find my way through. I trust that vulnerability builds connection. But it does also risk the fact that others will make judgments based on what they see. I accept it and have no regrets.

Maybe this person also saw me juggling a shocking list of commitments in medical education and scholarly work as an academic physician - this year alone, I'm president of the San Diego Academy of Family Physicians and busily coordinating our annual conference, completing the Sanford Compassionate Communication Academy Fellowship, serving as Well-Being Educator for the American Academy of Family Physicians and Wellness Director for UCSD's Department of Family Medicine, disseminating important findings from wellness work through scholarly channels, mentoring students and residents in their own research endeavors, developing a new FM clerkship and compassion curriculum for the School of Medicine, envisioning care workflows to better meet the needs of gender-diverse patients, and not to mention all the teaching at the med school and with our residency program. 

Believe me, my resident/student evaluations often come in late and sometimes chart notes stack up (especially if I have to stay home with a sick kid), and I always manage to submit work *right* under the deadline. But the important stuff - like being fully present with my patients in the exam room, helping my learners continue to grow in their clinical identities through teaching and actionable feedback, supporting my colleagues who are going through tough times, and spending quality time with my family -- the human stuff, I think I'm doing OK.

I have been transfixed by my son's pumpkin plant that's been growing in our home. It's easy to get distracted by some of the wilting leaves and not notice the ever-lengthening vine that is starting to flower. But that's life, isn't it? Sometimes things have to wilt a little in the juggling game of life, but if we stay true to what matters, we can still find ourselves flowering. It's a delicate balance and I'm constantly fighting a momentum towards overwork and overcommitment, but I can say with certainty that this busy woman is focusing on her passions. And there's much more to come.

Breathe, and notice

I recently attended a “roll and release” class at a yoga studio, using massage balls to release tension. I was so pumped to work out some of the kinks in my body, but little did I know that some life philosophy was coming my way. As I settled in on my mat and tried to maneuver awkwardly over one of the spheres, the instructor encouraged us to go slow, breathe, and notice. 

Go slow. 

Breathe. 

Notice.

Those simple but wise words started turning over in my head and have become a mantra for me this past week. 

Sometimes when we are going through hard things, we are so focused on feeling better and getting away from discomfort that we don’t take the time to understand what is truly going on. Maybe it’s because we fear what we might find… but the fear and avoidance often turns out to be much worse than meeting our pain with curiosity. There’s a famous saying, 

Suffering = pain x resistance.

I really don’t want to avoid my pain- more and more as the years go on, I realize the wisdom and power that has emerged in times of pain when I just.. opened to it. More on that later.

So during the class, I really made a point to compassionately seek out my trigger points and meet them gently with a little pressure and patience. With time, there was release and I found myself feeling more open, nurtured and grateful. 

By meeting our pain points with an open-hearted tenderness, we  can achieve greater understanding through this focused introspection. And maybe, just maybe, we can also prevent the deep scars of avoidance that inevitably emerge when we turn away from it.

The power of primary care, mentorship, and wellness

It is truly an honor to assume the role of President of the San Diego Academy of Family Physicians this year. This is my acceptance speech from the Installation of Officers event.

It is an exciting time to be stepping into the SDAFP presidency role, with new opportunities as we enter a period of new normals. As we find ourselves armed with more resources to continue forward in the fight against COVID, we also might find ourselves feeling more empowered to connect with others and restore a sense of community that was strained these last 3 years. I’m hoping that SDAFP will begin to host more social events again for those looking to reconnect or meet with other family docs in San Diego. I hope we can come together more often and build up old and new bonds with awesome FM colleagues across the county. 

Now, I take this privilege of representing all of you very seriously and am very open to hearing ideas from folks on where we want to use our momentum this year. From my point of view, I have three main areas I’m hoping to focus on: increasing awareness of the power of FM, strengthening the primary care pipeline through mentorship, and increasing focus on physician wellness.

It is one of my passions to spread the magic of Family Medicine to current and future physicians and the general public- anyone who has seen my posts on social media knows that I unabashedly post on the regular about my #FamilyDocJoys. I think in general we are all too humble about the incredible feats we pull off in our lives as clinicians, educators, scholars, advocates, and so much more. It is such a joy to publicly brag about all my favorite people in our specialty who are moving mountains, and I encourage you all to join me in this collective uplifting of colleagues and the beauty of the work we do. Don’t be shy! What we do is awesome and we need to talk about it more!

Another area ripe with potential is building a stronger pipeline into our specialty - and I’d argue that effective mentorship is crucial to help achieve that goal. I’ve been communicating with the rising FMIG leaders at UCSD SOM and it just further reinforced to me that if we can create some powerful links with students earlier in their education, we have the capacity to connect more amazing future docs into FM. Whether it’s speaking on a panel for National Primary Care Week, or simply getting a cup of coffee with a couple students, putting a face to the work we do can be so powerful. The risk of primary care erasure is palpable across the country and while we need to advocate for strong primary care education in med schools (something that we are actively working on at UCSD), we are all capable of making an impact on the individual level with every student we meet.

Lastly, I’d like to make a few comments about another passion of mine- physician wellness. I have served as Wellness Director for UCSD’s Department of Family Medicine for the last four years, and have seen the power of institutional investment in primary care and its impact on physician wellness. I was also fortunate to be a part of the AAFP’s Leading Physician Well-being program, which has provided additional insight that I hope to share with our members. I hope I can inspire colleagues to employ innovative strategies to support their wellness during an especially challenging time in health care. I have felt the potential for individual and systems approaches to revolutionize our care delivery, our working relationships, and our quality of life. This openness to seeing and practicing things differently is so crucial as we continue the movement to improve physician wellness in our specialty and in our lives.

Whether it’s leveraging social media to raise awareness, writing resolutions or lobbying on issues impacting our work, mentoring students and residents, or advocating for what we need to thrive as family doctors, we have a tremendous capacity to make an impact and shape the future of our specialty. I know I don’t need to overstate this because you all get it, as enlightened and empowered folks doing the good work both in the exam room and out. So I encourage you to continue using your primary care power - inspire others to explore leadership and advocacy and amplify the important work we do. And I am so excited to be on this journey with you.