learning to let go

 

If you practice meditation you know how hard it can be to quiet your mind while sitting in silence. Our minds like to be busy--thinking back on things that have happened, thinking ahead to what awaits us, guessing, planning, judging, fretting--when our goal in meditation is to let go of all those thoughts so we can remain calm, mindful, and compassionate.

"What lies behind us

and what lies before us

are tiny matters compared to

what lies within us."

~Ralph Waldo Emerson~

When our minds wander during meditation, we are encouraged to simply acknowledge the interruption and refocus on the body. When thoughts arise, we label them "just thoughts" or "just thinking" and move our attention back to the next breath--in, out, in, out. Letting go of intrusive thoughts helps mitigate the impact of negative emotions such as anger, anxiety, bitterness and resentment that may have a strangle hold on us.

This, I believe, is a practice we should all embrace. 

We are accustomed to labeling our own negative thoughts as "voices" we hear. It's an interesting metaphor. We are advised not to pay attention to the voices of negativity that discourage our creative efforts...voices that insist we're wasting our time, that we have no hope of success, that our work is meaningless or inferior. Voices that make us feel guilty for indulging in something we enjoy when others are so hard doing real work.

The voice of a parent might come back to us...something about taking life seriously, earning a decent living, or keeping up appearances. It might a teacher or boss or co-worker, all of them with your best interests in mind as they scatter aspersions and dissuasions and conventional expectations along your path as if your journey weren't difficult enough without them.

"Tell the negative committee

that meets inside your head

to sit down and shut up."

~Ann Bradford~

The point is that those negative voices are just thoughts. Just echoes from the past, not worth arguing about. They are opinions, and they do not have your best interests in mind at all. Banish them! Return to the breath. Or take a walk. Or call up a friend--someone who encourages you and supports your dream. Someone who understands how hard this is and respects you for trying. Someone whose friendship isn't invested in your success or wealth or fame.

Do whatever it takes to stay on the optimistic side. Turn your attention back to the truth:

"A negative mind will never

give you a positive life."

~www.pixilatedbelle.tumblr.com~

When we choose to pursue something as fleeting as a creative urge or as elusive as a dream, negativity is intrusive. Think about it. Meditate on it. Learn to let it go.

For more on writing and meditation visit my friend Madhu Wangu, at

 http://www.madhubazazwangu.com/about-mindful-writing/ .

She's the expert.

jan

tell your story with your whole heart

If you were asked to write a piece for a narrative medicine journal, which story would you choose to share?

If you're a healthcare provider, would you tell us about a difficult or tragic case you cared for? They are sometimes the stories that stay with us the longest because of the way they affect us. They highlight the frustration we feel when our best efforts fail. The uncertainty we encounter when the patient gets worse despite our best efforts. The shame and guilt we shoulder when a patient slips away. 

I could write about the young mother we lost during childbirth, and what we told her husband when we presented his healthy newborn daughter to him in the aftermath. Forty years ago. Or I could tell about a patient who planned to commit suicide by ingesting rat poison (which we could have treated...) but instead, accidentally drank a mislabeled bottle of hydrochloric acid. He died in a medically induced coma as the contents of his thoracic cavity dissolved away. Stories that we embody because they are dramatic and unpredictable and unfathomable.

"O, what an untold world

there is in 

one human heart."

~Harriet Beecher Stowe~

On the other hand, I might choose to tell you a humorous or happy story, like the one about the resident who smuggled his puppy into the ER one night so he could stitch up the cut on his pet's back leg. I could tell you about the surgical resident I worked with who orchestrated his own hernia repair under self-hypnosis. No anesthesia, thank you very much. Or I could describe what it felt like to see a patient open his eyes for the first time after six weeks in a coma...three days after his family arranged to bring his dog to their son's bedside in the ICU.

"Dog is God

spelled backwards."

~Duane Chapman~

I could tell you about a normal delivery, a successful operation, a cancer survivor. 

And you? What story would you tell? 

"Tell your story

with your whole heart."

~Brene Brown~

Perhaps you're not in the business of health care at all. Maybe you're the patient. Perhaps you can tell us what you thought the first time you smelled cigarette smoke on your doctor's breath. It may have offended you when he asked you whether there were guns stored in your house, when he asked you about drug and alcohol consumption, or about your opinion on vaccination. You thought he was being judgmental or critical when he was simply inquiring for your own safety and well-being. You may have resented him for it...until he showed up at your mother's funeral even though she wasn't a patient of his. What did you think then?

Maybe you are healthy and strong. Tell us what went on in your mind when the home pregnancy test you ran came back positive. Or negative. What were you thinking the first time your wobbly toddler scraped his knee, and you had to clean it up and put the bandage on it? Tell us about the chances you have taken. Unprotected sex? An unbuckled seat belt? A bike helmet collecting dust in the garage? 

Oh, you have a story to tell, all right!

"Write about what disturbs you,

what you fear,

what you have not been willing to speak about.

Be willing to be split open."

~Natalie Goldberg~

There are millions of untold stories burning holes in the veil we wish to hide behind. We are so sure we have nothing new or important to say, when in fact our shared stories connect and empower us, and ultimately help us heal. 

"Telling our story does not merely
document who we are.

It helps make us who we are."

~Rita Charon, M.D.~

jan

the scariest thing

If you are a healthcare provider, you should be scared. If you are a healthcare consumer or a patient, you should be terrified. If you require prescription medication, or physical, occupational, or speech therapy, or you require mental health services, if you are raising children or caring for an aging parent, you should be afraid.

"A healthy person has a hundred wishes,

but a sick person has only one."

~A.G. Riddle~

We should all be worried because the people we depend upon to protect our health and well-being have been dismissed and replaced with people who have no training, or knowledge, or experience in medicine. We are losing the experts we need to develop the drugs that we use to manage diabetes, hypertension, and heart disease, infections, and cancer. To monitor and manage public health threats. To protect our children. To man suicide hot-lines. The list goes on...and on...and on. Jobs have already been lost. Staff, dismissed. Offices, closed.

We should be worried because research into advanced techniques and treatments will cease as the grants that fund medical research disappear. People who are enrolled in clinical trials will be abandoned and lost to follow up.

It's scary to imagine what will happen to people who will no longer be able to afford health care. To people who won't be able to afford their medication. To people who will lose the benefits they need for mental health treatment, substance abuse recovery programs, and protective services.

Measles cases are on the rise. People have already died. Unnecessarily. Drug-resistant tuberculosis is on the rise. HIV prevention has taken a hit.

"Not everything that is faced can be changed,

but nothing can be changed

until it is faced."

~James Baldwin~

It's all very scary. Heart breaking, actually. But this is the scariest thing of all:

WE ARE ALL FEELING HELPLESS TO PREVENT

THE GUTTING OF OUR HEALTHCARE SYSTEM!

All the phone calls, all the letters and emails, all the demonstrations that we have traditionally relied upon to make our thoughts and feelings known to our leaders--our frustrations, our anger, our disbelief, our fear--are falling on the deaf ears and blind eyes of the people we depend upon to lead us into the future. 

"I am not afraid of an army of lions

led by a sheep.

I am afraid of an army of sheep

led by a lion."

~Alexander the Great~

No one seems to know what to do. Or where to begin. Or how to go about it. Perhaps they simply lack the backbone to take a stand against what is happening. Or, they lack the courage to begin.

What will you do to protect your patients? To support the research, services, and human decency that you dedicated your career to? 

While you think about it, try this: 

Extend a simple kindness to someone.

Do something that will make the moment just a little bit safer, easier, or happier for someone.

Smile at or with someone.

Feed someone.

Hug someone, or if that's going too far, hold someone's hand, or wave to them.

Be nice.

In other words:

"Do what you can

with what you have

where you are."

~Theodore Roosevelt~

Something will come to you...

jan

writing to heal

 

Some time ago, I talked about the ACE (Adverse Childhood Experiences) Score and how childhood trauma can cause epigenetic changes in the young brain that trigger an overactive inflammatory response. This has been shown to lead to disease states in adults, such as autoimmune conditions like lupus and rheumatoid arthritis, heart disease, diabetes, stroke, depression, and PTSD-like anxiety and reactivity. Luckily, epigenetic changes can be reversed. Healing is possible.

"What is the source of our first suffering?

It lies in the fact that we hesitated to speak.

It was born in the moment when we

accumulated silent things within us."

~Gaston Bachelard~

Among the practices that have been shown to promote epigenetic healing is writing to heal. Researchers at Carnegie Mellon found that the simple act of writing and reporting on an emotional state had a significant effect on the body's physical state. It improved measures of immune function even in patients battling life-threatening diseases. It reduced markers of the stress response by lowering the heart rate and blood pressure. It lowered rates of depression, addiction, anxiety, and PTSD. The damaging effects of ACEs can last a lifetime, but they don't have to. 

"I write because silence is a heavy weight to carry.

I write to remember.

I write to heal."

~Andrea Gibson~

Bernie Siegel, MD, uses "writing to heal" in his workshops. He prompts students to write on the topic of  "why you love yourself." Then he asks them to write about why they might want to end their lives. They are usually surprised to see that the compilation of pages they have written about why they should commit suicide is many times greater than the collection that considers why they should love themselves. Whether their stories are about emotional pain or physical pain, Siegel encourages them to break the silence that has been wreaking havoc on their minds and bodies all their lives without their awareness or understanding.

In another study, one group of participants was asked to write about a personally traumatic experience for 15 minutes daily for four days in a row, while another group wrote about an emotionally neutral topic. The first group reported improved mood, improved memory and sleep, reduced pain, fewer intrusive negative thoughts, and reduced blood pressure compared with the second group.

It is hypothesized that writing exerts its positive physiological effects by reducing the levels of inflammatory substances that accumulate when traumatic or painful thoughts and emotions are denied, repressed, or otherwise silenced. Acknowledging, describing, and releasing those feelings through writing may allay anxiety, reduce stress, and promote healing.

Hence, my interest in the practice of narrative medicine.

If you would like to give it a try, or if you want to offer this tool to your patients, here are a few general guidelines for getting started:

• Find a time and a place to write without distraction or interruption.
• Try different modalities, such as writing long hand in a journal, tapping it into your laptop or phone, or dictating and transcribing your story.
• As you write your first draft, do not worry about or let yourself be sidetracked by correcting grammar, spelling, or usage.
• Forget what you imagine others will say about your writing.
• If what you are writing about makes you increasingly anxious, set it aside. Focus, instead, on self-care. Take a walk outside. Take a nap. Have something good to eat. Call a friend. Return to writing when you are ready.

"Self-care is a divine responsibility."

~Danielle LaPorte~

The simple act of putting our stories into words can help us heal both psychologically and physically. When we share our story with others, it can help them heal, as well. And isn't that what we are here to do? To help others heal?

"The healing that can grow 

out of the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

jan

five succinct bullets

Last week, Elon Musk directed all federal workers to submit a list of five things they had accomplished at work in order to justify keeping their jobs...or risk being fired. A few days later, they were advised to ignore the order. Then, without explanation, they were redirected to comply with it. Needless to say, this resulted in total chaos. In fear, anger, and confusion. 

"...use this as an opportunity

to shine and show off what you do

in five succinct bullets."

~Elon Musk~

I'm retired, so obviously, this doesn't apply to me. Still, I thought it might be fun to try it (tongue in cheek...). So, here it is:

1. When my plans for the weekend fell through at the last minute, I decided, instead, to drive to Pittsburgh to surprise my son who was celebrating the first year anniversary of his very own craft brewery, CoStar Brewing. Check it out at https://www.costarbrewing.com/. I think it pleased him when I showed up unannounced.

2. I spent either an hour in meditation or two hours walking in the countryside every day.

3. I read. I'm reading "Coming to Our Senses" by Jon Kabat-Zinn in preparation for a meditation retreat with him later this year. It's a big book! It'll take a while for me to get through it.

4. I woke up early to enjoy the sunrise.

5. I fed the birds, squirrels, and the deer out back with the "good" (meaning "expensive") birdseed every day. 

Granted, this might not be the type of activity that would impress Musk, but it serves to keep me balanced and relatively calm in spite of the chaos. It helps me stay in touch with reality even when it scares me. It keeps me sane, unlike some people I know...

"When something is important enough,

you do it even if the odds

are not in your favor."

~Elon Musk~

jan

 

make me care

 

The art of storytelling is as old as the spoken word. It entertains, informs, and connects mankind across culture, race, and creed. It has the power to heal, and in medicine, it can be a life-saving skill.

Most people enjoy reading or listening to stories at their leisure. The health care provider, on the other hand, listens to stories all day long because it's part of his job. This is how he obtains the "history of the present illness," perhaps better described as the "story of the present illness." It forms the basis of all that follows: performing the physical examination, tracking down the diagnosis, and formulating a treatment plan.

The clinical encounter begins when the health care provider takes the patient's history. He listens for specific details that lead him to the diagnosis. If the problem is pain, the provider wants to know where it's located, and whether it's sharp or dull, steady or throbbing, constant or intermittent. He wants to know how long the patient has had the pain--for a day? For a month? For years? What makes it better? What makes it worse? These details guide him through a maze of possibilities.

"The shortest distance

between a human being and the truth

is a story."

~Anthony de Mello~

The problem is that patients don't know what the provider needs to hear. They don't arrive at the office prepared to rattle off a list of relevant signs and symptoms. It's the provider's job to ask about them, but he only has so much time to get to the bottom of the patient's problem. Nowadays, the written or dictated clinical note has been largely replaced by the electronic medical record (EMR), so rather than listen to the patient's history, the provider navigates his medical record with a series of clicks that pull up an array of bulleted lists, complicated charts, and sketchy details. This is intended to expedite what has been ruthlessly abridged to a ten-minute office visit.

Because time is limited, doctors often redirect the patient who appears to be getting off track or is slow coming up with answers. In fact, one frequently quoted study found that physicians interrupt and redirect the patient when they are as few as 18 seconds into the interview. Frequent redirection leads the patient to believe that what he wants to say isn't important or relevant, so details go missing.

This is a problem. Healing, or failing to heal, occurs in the context of a person's relationships with his family and friends, his surroundings, expectations, and perceptions, as well as his emotional, psychological, and spiritual life. If the patient is denied the opportunity to tell his whole story, part of him may never heal.

"Healing yourself is connected to

healing others."

~Yoko Ono~

Let's say, for example, that the patient presents with abdominal pain. He answers all of his doctor's questions. The pain has been present for four days. He describes it as constant. It started in his upper abdomen, but now it radiates into his back. Eating makes it worse. In fact, the patient says he hasn't been able to keep anything down for the past twenty-four hours. After a focused physical exam and a few tests, the physician correctly diagnoses the problem as acute pancreatitis. But that doesn't explain why the patient develops a headache, has trouble keeping his balance, and becomes confused the day after he is admitted to the hospital.

What the doctor doesn't know is that the patient has been drinking heavily because his wife walked out on him recently. In fact, he blacked out a couple of days ago and woke up on the floor next to his bed. He didn't mention it because he was busy answering the doctor's questions about his abdominal pain. So, the doctor missed the small subdural bleed his patient sustained in the fall until days later when he had his first seizure.

This scenario highlights an important problem. Obtaining an accurate and thorough medical history takes time. Given the imperative to see more patients faster, the provider may have little time to explore the details of the medical history with every patient. Perhaps he's running behind schedule, or an emergency interrupts him. In some cases, the patient can't bear to disclose the sorrow, or fear, or shame that underlies his symptoms, so he doesn't mention it. It takes time to invite, enable, and encourage some patients to share the story that brings them to the office in the first place.

"Storytelling is the essential human activity.

The harder the situation, 

the more essential it is."

~Tim O'Brien~

When the patient is constantly redirected in order to satisfy the provider's agenda, important parts of the story may be overlooked. This reinforces the importance of hearing the patient's full narrative. When we reach into their cholesterol laden hearts to understand why they are poisoning themselves with food, we need to know more than what they are putting into their mouths. When a patient is noncompliant, we need to consider what he is afraid of, or angry about, or grieving over. When we allow the patient to speak, we may discover that the reason for this one's fatigue, or that one's intractable headache is end-stage disappointment, or anger, or shame that has festered for years.

Only then can we help them heal.

"The greatest story commandment is:

Make me care."

~Andrew Stanton~

jan

bipolar tendencies

If you weren't downright bipolar before the November election, you might be tending in that direction now, torn, as we are, between fear, dread, and uncertainty...and the bravery it takes just to make it through the day. Between periods of chaos, and moments of peace. Between utter despair, and a faint glimmer of hope. Between anger and gratitude. Sorrow and surrender.

"I'm not bipolar.

I've just had a bipolar life

foisted upon me."

~www.healthyplace.com~

We are only a few weeks into this, and there is no end in sight. How will we make it through? And who will we be when we come out on the other side?

"Life can be like an emotional roller coaster

with its ups and downs.

What matters is whether you are keeping

your eyes open or closed

during the ride..."

~Ana Ortega~

Like our eyes, it is important to discern whether our hearts are open or closed to this journey. How are we coping? In Buddhism there are four fundamental practices that are designed to open the heart: lovingkindness, compassion, empathetic joy, and EQUANIMITY:

"Equanimity: 

mental calmness, composure, and

evenness of temper,

especially in a difficult situation."

~from word-struck~

As Jack Kornfield puts it, "Equanimity arises when we accept the way things are." He doesn't suggest we give up in the face of adversity, or we passively embrace or simply succumb to whatever comes our way in life. He doesn't encourage denial, or indifference, or surrender. He means we acknowledge reality, and reflect deeply on the truth. Then we act out of lovingkindness, rather than giving way to our habitual tendency to judge, blame, retaliate, or cling to resentment and anger. This is not an function of the intellect, a decision we make, or a promise we commit to. It is a practice. A process. A way of life.

"When you find your center

you will not be drawn to someone else's storm.

Instead they will be drawn

to your peace."

~Becky Bro~ 

What if you could find a way to get off the emotional roller coaster that takes you nowhere? Wouldn't you gladly abandon the path that leads you in circles, up the same steep hills, down the same scary slopes, around the same predictable curves, again and again?

Imagine what it would feel like to escape the anger, fear, and confusion that habitually repeat themselves in your life. To tear up the ticket that gets you through the gate to envy, shame, and despair as we head into our uncertain future.

What if, instead, you could be steadfast and strong? Peaceful and calm. Wise and reflective. What if you could bring the whole bipolar ride to a grinding halt? 

How would you do that? What would it take? Who will you become?

Remember this: Teachers abound. You can begin now.

As Poe put it:

"Deep into that darkness peering,

long I stood there,

wondering, fearing, doubting, dreaming,

dreams no mortal being

ever dared to dream before."

~Edgar Allan Poe~

jan