self care

 

The issue of self-care came up for me several times this past week.

First, there was a writing prompt that asked:

"What is your self-care practice?"

This was a multiple choice question. The answers included: journaling, mindful movement (such as yoga or qigong), meditation, listening to music or podcasts, and reading. I chose meditation because I practice daily, and it helps keep me steady and strong, calm and compassionate. But later, on a path through the woods, I realized that walking is my go-to self-care practice. Walking in the woods, or near a stream, or by the lake. In the mountains. On the beach. Walking is a mindful and meditative practice for me. I like to think it helps keep me healthy. That it strengthens my bones. That it keeps my mind active and engaged. It promotes physical, mental, emotional, and even spiritual well-being.

"Walk as if you are kissing the Earth

with your feet."

~Thich Nhat Hanh~

In her book, "Welcoming the Unwelcome," Pema Chodron phrases it a little differently. She asks:

"When things are really tough--like you're scared, you're lonely, you're angry, 

everything's falling apart, during difficult times--

in what do you take refuge?"

Do you try to avoid the situation, or distract or comfort yourself by streaming Netflix, by overeating, or by turning to alcohol or drugs? To gambling? To sex? Do you make up stories that justify your anger, or jealousy, or disappointment? Do you dwell in self-pity? Blame? This is not self-care at all.

"Be good to yourself.

If you don't take care of your body

where will you live?"

~Kobi Yamada~

Self-care came up again when I was talking with a colleague who has been struggling with depression. Not sleeping well. Not eating well. I posed this question:

"If you had a patient who was struggling the way you are,

how would you care for him?"

He responded by saying he would prescribe an antidepressant, and something for sleep, and he would recommend therapy. Meaning, he would take good care of his patient, but he wasn't seeking the same good care for himself. 

Do you take care of yourself? Do you believe in extreme self-sacrifice such as foregoing meals, exercise, or sleep in order to do your job? Do you suffer in silence? Do you have trouble concentrating, or making decisions? Are you in pain?

Self-care is a reflection of self-love, and self-respect. It is gentle, patient, and compassionate. If you wonder how to practice self-care, think about caring for a new puppy or a newborn baby. Then show yourself the same attention, concern, kindness, and joy. You'll feel better, and you'll be healthier, too. 

"Whatever is good for your soul,

do that."

~author unknown~

jan

the willing suspension of disbelief

 

The word "disbelief" has taken on new meaning for me.

"It is now life and not art

that requires the willing suspension

of disbelief."

~Lionel Trilling~

I used to associate disbelief with wonder and awe, with brilliance or great beauty. It meant I had come upon something beyond my wildest imagination, or ability, or awareness. A book, or a work of art, or a piece of beautiful music, perhaps. I wanted to know who created it. Who wrote it, or composed it, or painted it? Always prompting a surge of envy.

For example, I nearly abandoned my desire to write in retirement when I read "Talk Before Sleep" by Elizabeth Berg, the story of a dying woman and the friends who kept vigil at her bedside, written with wisdom and humor. 

I envied the author. I ached to be able to write that well, but I didn't believe it was possible. It shut me down until the thought occurred to me, "If others can write well, I should at least give it a try." With that, I beat back my own disbelief, and I got to work.

Natural beauty is another source of wonder-struck disbelief for me...

"Keep close to nature...

Wash your spirit clean."

~John Muir~

Yosemite

...as is music, with chord progressions, harmonics, and orchestration that would never come to me. Heart-aching, spirit-lifting, soul-soothing sounds of wonder and awe that inspire reverent disbelief.

What are some of the things that bring you to amazement and admiration? To disbelief?

"Suspend, for a moment, your disbelief 

and encounter once again

the sense of wonder you knew

when there was...magic!"

~Andrew Lord~

Now-a-days, unfortunately, disbelief has a more ominous edge. 

It brings to mind the growing horrors of war in Ukraine and in the Middle East. Who thought we would ever witness such violence against children, women, and the elderly? Such cruelty. Such suffering. 

Unbelievable.

Who thought our democracy was in jeopardy when we believed it was infallible? Who hasn't greeted the deception, lies, and arrogance of our leaders with utter disbelief. 

"Truth will always be truth

regardless of lack of

understanding, disbelief, or ignorance."

~W. Clement Stone~

Disbelief can be the harbinger of beauty, wonder, and delight...or it can tether us to fear, deceit, and rancor. The willing suspension of disbelief can lead to a whole new perspective on life as we understand it. It invites us to embrace what is real and true.

"You have to let it all go...

fear, doubt, and disbelief.

Free your mind."

~The Matrix~

jan

a grand cosmic light show

Lokah Samastah Sukinho Bhavantu~

May all beings everywhere be happy and free.

 

I'm curious. Do you believe in prayer? In miracles? In magic? What do you think about this?

A friend of mine is being treated for one of those oppositional-defiant cancers that tend to elude treatment. His initial CT scan several months ago already revealed metastatic disease. Two weeks ago he finished his first four cycles of chemo. Last week, he underwent a follow-up scan to see if it was working. 

"You must find the place within yourself

where nothing is impossible."

~Deepak Chopra~

As he was being scanned, four of the holiest women I know were on their knees in prayer for him. His wife and children, friends and family lifted him in prayer, as well.

Because prayer doesn't seem to work very well for me, I sat cross-legged on a rock at a nearby lake, took a couple of slow, deep breaths, and released the growing tension in my chest and throat. I let go of the customary misgivings and preferred expectations I have cultivated my whole life, and I waited. 

This is what came to me:

"No mud, no lotus"

~Thich Nhat Hanh~

A grand cosmic light show. Shower after shower of glittering white light lifting upward, then fading away like falling embers. Like dying cancer cells. I tried to imagine what this would look like on a CT scan. A short circuit somewhere in the system? Electrical interference of some sort? I smiled to think of the chaos that would ensue, the doctor, in his excitement, calling his colleagues over to see what was happening, all of them stunned. Baffled. Mystified.

"Even the smallest shift in perception

can bring about the greatest healing."

~Joshua Kai~

Two days ago, his wife called me with the results of the scan.

"It's gone," she said. "The scan was clear. There was no sign of cancer anywhere."

Wait. What?

She hailed it as a miracle, and attributed it to the grace of God, to all the prayer that had been lifted heavenward that day.

As a physician, I would have voted for the efficacy of modern chemotherapy, but I really wanted to believe our noble universe had something to do with it, or, as quantum physicists believe, that our minds can shape reality, or that there is some other benevolent force at work. Synchronicity, or destiny, or just plain good luck.

 "We are never more than a belief away from

our greatest love, deepest healing, 

and most profound miracles."

~Gregg Braden~

When it comes to healing, what do you think? Is God in charge of it? Does prayer have the power to heal? I know a lot of people who are certain it does.

Can meditation bring about healing? I'd like to think so.

Or is it the sole result of effective therapy? 

We may never know, but one thing is certain. Whether it was the hand of God, or the power of prayer, or the dazzling light show that helped this time, we witnessed a mystery that left all of us stunned. Baffled. Mystified.

Or perhaps we created one.

"The wound is the place

where the light enters you."

~Rumi~

jan

what it means when your doctor sounds a little miffed...

I was contemplating what to write about this week, when this story unfolded right in front of me.

True story:

A friend of mine was awakened in the middle of the night this week when her son called from college to say he was having chest pain. He'd been diagnosed with mononucleosis a week earlier, and was feeling worse and worse. He ended up calling 911 and going to the hospital in town while she jumped out of bed, packed a bag, and embarked on the five-hour drive to her son's bedside..

By the time she got to the ER, they had already ordered a chest Xray and blood work. Her son's d-dimer level was elevated, so he underwent a CT scan of the chest to rule out a blood clot in his lung. It showed pneumonia, instead. He was admitted and started on two powerful antibiotics and a blood thinner.

His mother and I exchanged frequent texts the next day as I attempted to answer her questions...without being too critical of the level of care her son was receiving. I explained what the elevated d-dimer test meant. That it doesn't necessarily portend a blood clot. That infectious pneumonia by itself can raise the level. That, in this case, the blood thinner was a precautionary measure. 

"Nobody cares how much you know

until they know how much you care."

~Theodore Roosevelt~

My friend wanted to know what else she should ask the doctor when he came in. I asked if they'd done any other testing. Sputum cultures? No. Cold agglutinins? No. Follow up Covid testing? No. Was his doctor aware that he'd just completed a full course of antibiotics for an ear infection that had complicated his mono? No. No one asked. Did anyone ask about vaping? No. 

"The most important part of the story

is the piece of it you don't know."

~Barbara Kingsolver~

Did the doctor come in to see his patient, a new admission? No. It was Friday afternoon, and he wasn't planning to make rounds.

My friend did manage to get him on the phone, however, noting that he sounded slightly miffed when she put my questions to him. Nevertheless, shortly thereafter, there was a flurry of activity as blood was drawn and cultures were obtained.

The thing is, no one took a thorough history to begin with. If they had, they wouldn't have prescribed the same antibiotic he'd just finished. 

If they'd submitted sputum cultures when he was admitted, they wouldn't have prescribed a full course of inappropriate (aka. "shot gun") antibiotic therapy. 

I explained to my friend that I'm "old school" in my approach to medicine. This means more than simply obtaining the patient's history, performing an examination, ordering tests, and recommending treatment. It involves explaining what is happening every step of the way, and the reasoning that goes into our decision making. It means sharing our expectations for the patient. Even our fears. It means responding to theirs.

It involves not just the patient, but the people who gather at his bedside because they care about him. Because they love him. When we treat a patient, we treat his family and friends, as well. They need to understand what is happening and what to expect. They deserve our attention. They need our consideration, compassion, and support, too.  

The overwhelmed physician may suggest this is what we have nurses, social workers, psychologists, pastors, and family and friends for. In today's health care culture, you can get away with this. You can focus on the bulleted lists in the electronic medical record and leave the rest of it to your staff. You can apply what you know about medical and pharmaceutical technology without really knowing your patient. He will still heal. But by disengaging yourself from your patient's psychological, emotional, and spiritual life, and from his family and friends, you sacrifice your connection with him. Unless you include them in his care, you disconnect him from his support system. From his caretakers. 

This can leave all of them with fear, uncertainty, confusion, and dread when what they need is engagement, support, and understanding.

"A kind gesture can reach a wound

that only compassion can heal."

~Steve Maraboli~

Things eventually worked out for my friend and her son. He is home now. The cultures nailed the diagnosis, and the antibiotics were changed. He has a trusted PCP who will monitor his recovery. It's time to let the healing begin.

"The good physician treats the disease.

The great physician treats the patient who

has the disease."

~Sir William Osler~

jan

PS: I'll be off the grid at Kripalu Center for Yoga and Health in Massachusetts this week. I expect to come back heavily meditated...

imagine helping someone else heal

 

If you have been toying with the idea of writing about your personal experience with illness or injury, but you haven't made time for it, or you can't find the words to get you started, you should probably consider starting small. Not with your open heart surgery or your traumatic brain injury, but the time you twisted your ankle in the backyard, or sliced your finger with the kitchen knife. You remember it, right? How much it hurt. How you had to call in sick that day, and trek over to ER for an Xray or stitches.

You worried about missing work. You dreaded seeing your bill. You berated yourself for having been so careless, or lazy, or stupid (not that lack of intelligence had anything to do with it). You apologized profusely for inconveniencing your spouse and coworkers. Perhaps you missed your child's soccer game or dance recital that day. You felt so helpless. You swore you'd never let it happen again. 

Not a healing thought among them.

"An injury is not just a process of recovery.

It's a process of discovery."

~Conor McGregor~

The severity of the injury wasn't the issue. The trouble started when you surrendered to anxiety, frustration, and anger. You blamed yourself, and went on to punish yourself for it. You sent discouraging and judgmental messages to your body when it was doing its best to heal...

...which, if you had been paying attention, would have amazed you. While you were carrying on about how stupid and careless you were, your blood stream rushed coagulation factors to the site of your cut and stopped the bleeding. Fibroblasts made their way to the ligaments in your ankle, and went to work repairing them. Naturally occurring chemicals flooded your system to reduce the pain. 

"Your body's ability to heal

is greater than anyone 

has permitted you to believe."

~HEAL Documentary~

Instead of chastising yourself for causing the injury, you could have been cheering yourself on. You might have rested instead of pushing yourself to carry on as usual despite the pain. You could have redirected the energy you wasted on self-reproach, bitterness, and embarrassment to self-care and self-acceptance. You could have been an advocate for your own healing, if only you had known you had the ability, and the power to do it.

If, as many of us now believe, you can participate in your own healing, or hamper it, imagine the role attitude, intention, optimism, and hope play in healing after a heart attack, a paralyzing injury, even a bout of severe depression. Imagine loving and tending to the needs of your broken body. Your ailing spirit. Your elusive dreams. 

Now, imagine helping someone else heal.

"We are stronger in the places

we have been broken."

~Ernest Hemingway~

jan

an invitation to heal

 

Listening is a critical skill for health care providers--for doctors, nurses, and therapists in every field. All day long we listen to patients as they tell us their stories...their symptoms, and the timing, severity, and course of their illness. We organize and record the facts in order to arrive at an accurate diagnosis and formulate a treatment plan. 

Deep listening adds another layer of connection with our patients. It involves more than just getting the facts down. It requires us to remain open-hearted, receptive, attentive, and nonjudgmental in each and every patient encounter. It is the key to accurate diagnosis and to healing. It is not, however, an easy skill to acquire or to sustain.

"In deep listening, we listen

with the sole purpose of helping

the other person feel heard and accepted."

~Thich Nhat Hanh~ 

 

In his book, "The Road Home," Ethan Nichtern describes some similarities between deep listening and mindfulness meditation. Deep listening involves sustained awareness, intention, patience, and compassion. As such, the deep listener encounters some of the same obstacles that trip us up during meditation: 

• DISTRACTION: Attention is difficult to sustain because we are distracted much of the time. Linda Stone ("The Attention Project" at https://lindastone.net/) coined the phrase "continuous partial attention" to describe the difficulty we have sustaining focus. Our minds are constantly darting from task to task, from issue to issue, from patient to patient, or simply drifting from one thought to another. We divide our attention between the story the patient in front of us is telling while worrying about the next difficult case, or the results of the tests we ordered on the last patient we saw. Not to mention the emails and text messages that are waiting for a response. Just as we do during meditation, we need to acknowledge the fact that our attention has wandered and return to the present moment.

• FEAR: Another obstacle is the anxiety that can arise during the patient encounter. We worry about getting behind schedule. We worry about making a mistake or missing the diagnosis. The patient's story may trigger a memory from our own experience that reminds us of a painful ordeal we thought we'd put behind us. Suddenly, our hands are shaking and our heart is racing.

• INTERJECTING OUR OWN STORY: In an effort to identify with the patient, we may be tempted to interject our own story into the conversation. Perhaps, like the person sitting in front of us, we, too, have lost a child or struggled through chemo and radiation. We want to share our experience with her--what helped us get through it, where we turned for support, how we coped with side effects. This attempt to create connection and identification can backfire if our story is not what the patient wants to hear, if he is not ready to hear it, or our experience does not accurately reflect his story.

• OFFERING ADVICE: This, of course, is what we do all day long. We order tests, prescribe medication, recommend diets and exercise programs, and make plans for follow-up. The sooner we get to this, the sooner we can move on to the next patient. The problem is that we run the risk of intervening too soon, before we understand the patient's whole story, or worse, before the patient is ready to listen to us.

"The biggest communication problem

is we do not listen to understand.

We listen to reply."

~Stephen Covey~ 



When the patient tells us his story ("the history of the present illness"), he offers us a glimpse into his most private thoughts and feelings. He makes himself vulnerable...literally and figuratively naked before us. We elevate and dignify his presence when we receive his story with an open and non-judgmental heart, when we are attentive and responsive to his needs, and when we respect and welcome his offering.

"The most precious gift

we can offer anyone

is our attention."

~Thich Nhat Hanh~

Deep listening embodies compassion, empathy, and equanimity. It relieves suffering by providing the storyteller with a safe, nonjudgmental, receptive listener. It is an invitation to heal.

jan



how to know when you need help

 

If you are a healthcare provider in any field, or a caretaker for someone...because it is your profession, or because you offered to help out, or because circumstances forced you into the role...you know how hard this kind of work can be. You know what it feels like to do your job when you're exhausted, hungry, scared, unsure. You know how stressful it can be when you're running behind schedule, or you're asked to work an extra shift. It can be hard to make time for your family and friends with everything your work requires. You sometimes miss your kids' games and recitals. You miss family celebrations and holiday gatherings. You do your job even though you're not feeling well or you're in pain. Or when your bladder is full.

"You must find the place inside yourself

where nothing is impossible."

~Deepak Chopra~

We all understand this. We accept it, and we choose it. It is hard at times, but this is what I think is harder. It is harder for me when someone I care about, someone I love, is struggling, and I can't be with them to lend a hand.

"I cannot do all the good the world needs,

but the world needs all the good I can do."

~Jana Stanfield~

I was reminded of this last week when my brother went into the hospital for some pretty scary tests because of a complicated assortment of medical conditions. I couldn't be there with him because he lives far, far away. Which left his wife to manage by herself.

A long time friend is navigating treatment for cancer on her own. Also, far away.

My son's dog ran out of steam this week, leaving us with broken hearts. 

Impotent: how you feel when you are kept from providing care, or support, or encouragement to someone you love, when they need it most. You feel powerless. Helpless. Empty.

"We can't help everyone,

but everyone can help someone."

~Ronald Reagan~

Which is why we need helpers. This week I had to take a step back and turn the care I longed to offer over to other people. My brother's wife stayed with him in the hospital day and night all week long. An old friend of hers stayed at my friend's side during chemo and stood by to offer whatever support she needed at home. My son's girlfriend stood by him with comfort and compassion.

I called. I sent cards. Flowers. Whatever I could. Nothing, really.

"Do all the good you can,

by all the means you can,

in all the ways you can,

at all the times you can,

to all the people you can,

as long as ever you can."

~John Wesley~

This is a reminder to accept all the help you are offered.

jan