You're in charge of you

Some people turn to alcohol, recreational drugs, or overconsumption of food as a way to fire their dopamine reward pathways. My issue? I'm a recovering workaholic. 

Well, let's be honest - I still work way too hard, but I can't deny how much my work gives me joy. To be there for people during some of the most vulnerable parts of their lives - from welcoming a baby into the world to holding space for someone thinking about leaving this world - it is an incredible privilege. It's truly rewarding to be this anchor for folks - but it's a double-edged sword, as we can take on so much and not see ourselves buckling under the pressure.

It's easy to make yourself last when everyone/everything else is consuming your attention. Caregivers, I see you! I am on a constant journey of figuring out boundary setting and recognizing my limitations as a human being. It wasn't until I started treating my self-care like work - with scheduled exercise, recuperation time, and healthy lifestyle goal-setting that I started feeling like I had some efficacy in my own life and wellness. Weirdly, I think I kept waiting around for someone/something to hold me accountable to get myself in gear. Who/what was I waiting for? 

At the end of the day, you have to remember that you are in charge of you. No one else can make you decide to give yourself rest, nourish yourself, heal from trauma, or optimize your well-being in general. I think so often we de-emphasize it in this work-obsessed world we live in because there aren't deadlines around our lives. I mean, one day we do die, but we all assume it is far away, that we have all the time in the world. But that's never a guarantee. Sometimes horrible things have to happen to us to really reorient - whether it's losing a loved one, going through a major personal health issue, or having our lives upended in some major way. We can't fall prey to the assumption that there will somehow be time in the future. Because what if there isn't?

We don't have to let a morbid obsession with our mortality guide us, but I do feel that if we are able to wrap our minds around the inherent impermanence that is our lives, sometimes this can help us stay in better alignment with what truly matters. Mindfulness and meditation can keep us more grounded, humble and grateful, and I am striving to make that more a part of my life. By conscientiously plugging into our existence more and taking time to reflect on what matters, we can be true to our north star and also have just a little more impetus to take steps to ensure we are doing what we can to stick around in this life.

Here's to continually learning and growing on our own wellness journeys!

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.