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?