# To Those Whom Much Is Given…

96. everything is power-law distributed

97. everything is power-law distributed

When someone writes about 137 life hacks and two of them are a) identical and b) something you have never heard of, you can’t help but dive down that rabbit hole…

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So, what is a power-law distribution?

A power-law distribution is the statistical description of change that is proportional to the power of the change, in other words, change that is logarithmic, not linear. One of the classic examples of a power-law distribution curve is how income is distributed in society.

Although there are many uses for this principle in the world of finance and economics, power-law distribution can also serve as a mental model to help us understand ourselves, each other, and the world we live in.

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For those who are healers, or who are studying to be healers, there are three uses of this mental model that I think are particularly relevant:

3) Understanding inequities

I unknowingly wrote about power-law distribution when I explained the “forgetting curve” in this post: “How to Ace the NBME Shelf Exams, In-Training Exams and Your Boards”. I recommend you read the entire post, but the take home message is this: Cramming never works if your goal is learning how to heal. What works? Repeating information you want to learn at least five times in gradually increasing intervals (ok, you type A folks… get out the spreadsheet).

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The best time to plant a tree was last year. The second best time is today.

The power-law distribution also helps you understand why you need to start investing for your future – today.  The chart below is what happens if you invest \$100 a month starting as a new grad and keep doing it for 35 years (assuming a 6% return on your investment)

p.s. Here’s the website to do this calculation with different variables-  investor.gov calculator

This kind of “investment strategy” also works for exercise. Wow, do you gain strength and fitness fast at the beginning… and how sad that it only takes about six weeks to lose most of what you previously gained if you stop (both are examples of power-law distribution). Like financial investment, investing in your body with small “doses” of consistent exercise is the best strategy. For most of us who work in a hospital, the amount of walking we do at work is close to the recommended minimum for fitness (#GoodNews). Just accumulate a few more minutes at a higher heart rate (take the stairs, speed walk to the next consult, etc), add some body weight strength exercises like pushups, and you are good!

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Understanding Inequities

Investing for the future and how to hack your studying are important, but there is an even more important use for this mental model… It can help us better understanding the inequities in our society and in our work.

It’s easier to accumulate resources if you start with more. This principle is why young faculty members with limited mentorship or disproportionate service at home or at work end up not advancing. It’s why marginalized youth without resources to obtain education or connections struggle to break free from the cycle of violence and poverty. It’s why those who “have” (money, education, privilege) end up with disproportionate success (or access to care) when compared to those who started with less. Yes, there are exceptions, but they are just that… exceptions to the powerful force of power-law distribution.

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There are hundreds of examples of power-law distribution including the beauty of fractals like the pattern in this beautiful head of romanesco broccoli or the curve of a beautiful seashell. (It’s worth looking at the list… some of them are fun!)

Maybe Alexey Guzey is right…

96. everything is power-law distributed

97. everything is power-law distributed

# Why don’t we do the things that bring us joy?

All of us have a list of things we know we should do every day… and usually don’t. They shouldn’t be that difficult to fit into our day, but we somehow end the day holding our intentions and the struggle rather than the completed task. I’m not talking about the things other people need from you, or the requirements of jobs or school. I’m talking about the things that bring you joy (whether immediate or delayed), things that are really important to you.

Why don’t we do the things that bring us joy? The first step to conquer this paradox is to make a master list of the things that bring you immediate joy (e.g.prayer/meditation, reading, journaling, playing music, calling or writing to a friend you haven’t seen in a while, walking in nature, checking in with older relatives if it’s been more than a couple of days, learning something new, cooking for your family and/or friends) …and things that might be hard at the moment but will bring you joy in the long run (e.g. working out, organizing and cleaning your living spaces, working on a big writing project)

Once you’ve made this master list, acknowledge there is no way you are going to be able to do all these things in a day. It’s important to name these things, to make this list and revise it as new things are recognized… but it’s equally important to acknowledge that you are going to have to make some choices.  Pick what you currently think are the two or three most important things on this list and make a covenant with yourself that you will do them “every” day. The “every” is in quotes because let’s be real… life happens. Promise yourself that you will do these things every day, but give yourself grace for the occasional day when it’s just not possible.

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Next, pick a way to remind yourself and keep track of your progress:

Schedule them on your calendar. This is probably the best way to do this for most people, but you have to build in a “what if” plan. If for some reason you don’t accomplish it at the time you scheduled it, it doesn’t break the promise you made to yourself. Move it on the calendar, commit to doing it later, but don’t blow it off.

Keep a “routine checklist. This is separate from any other to-do list you create. This is for you. Not the things you have to do for other people, but the things you are doing for yourself, the things that add goodness to your days.

Morning is best (if you can). There is an adage in finance that you should pay yourself first. In other words, the first thing you do with your paycheck is to put money aside for investment in your future. Time is no different. Doing the important things first, the things that are just for you, is an investment in the day and your future.

The power of streaks. Put an X on a calendar every day, like Jerry Seinfeld or get the app that lets you put the Xs on a digital calendar. (There are other streak tracking apps, too.) Alternatively, create your own visual record of a streak with Excel or a Word document. The power of a streak is that you become more and more invested in not breaking the streak as time goes on.

Final thought. We are all busy, and we are all tired. This era, more than most,  is one of being pushed and pulled in so many directions and in so many ways. Take the time to identify the things that bring you joy. If that’s all you do, it will be a good start, because just making that list will make it more likely you will add joy to your days. When you are ready, make a real covenant with yourself, a promise that you will do the one, two or maybe three (no more that three!) things at the top of that list every day. And then, do your best. Give yourself grace when you stumble… and start over.

# Rethinking “Exercise”

I recently read a book that changed the way I think about exercise…for real. It not only provided scholarly (but very readable) insights –  it also made me feel less guilty about “not exercising” while giving me some new tools to think about caring for my body.

If you are in the 10% of people who exercise regularly without thinking about it, great. For the rest of us, here are my key takeaways from Daniel Lieberman’s book, Exercised.

Along with many other aspects of our daily life, exercise has been “medicalized”.

Every week in clinic, I talk to young parents who have been sent home from the hospital with instructions to feed their baby [xx] mls of formula every three hours. They set alarm clocks! They often end up feeding their baby when the baby isn’t hungry, and don’t give a little more when they know the baby is still hungry after they are fed. This is “medicalizing” food and it is not only silly, it can be harmful.

In our personal lives we medicalizing food (aka diets… which don’t work in the long run)…and we medicalize exercise. We have all learned the “dose” of exercise that is now recommended: 150 minutes per week of moderate exercise or 75 minutes/week of vigorous exercise (plus weight training twice a week). When you step back and think about it… really? The same “dose” for all of us? The same “dose” every week?

We evolved to be couch potatoes

The struggle to exercise is normal! We are fighting evolutionary pressure to not waste energy, to move only enough to take care of our needs and the needs of our community. Our bodies haven’t changed over the centuries. What has changed is our environment, which has become so efficient that we don’t have to move as much to walk through our day. So how do we fight back against our programing to be couch potatoes while honoring the need to keep our bodies physically healthy?

Just move (which you already do)

“… if you are a typical person who barely exercises, it would take you just an hour or two of walking per day to be as physically active as a hunter-gatherer. (p. 19)

The average healer in a hospital easily meets the goal of walking for more than an hour a day, Congratulations! You don’t need to “go to the gym” for another hour! There are other reasons to exercise (you will have to find a way to lift weights and stretch), so don’t take this as carte blanche to ignore your need to be fit, but quit beating yourself up for not “exercising”.

Stand up.

Sitting for prolonged periods is not good for you, primarily because it promotes the slow burn of mild inflammation. You don’t have to medicalize this, either, but don’t sit without breaks. Just stand up, fidget, walk to the water fountain… whatever it takes to move.

Play.

Breaking a sweat doing something you love is not only good for your body, it’s also good for your soul (and your sleep). Reframe! Find something you love to do that will let you break a sweat. (Note, the key word is “let”, not “have to”). If it’s outside, even better, but just go play.

# Gifts for folks about to start medical training – of any kind!

Every year about this time I put out a list of the best presents for folks about to start medical school, nursing school, physician assistant school or any medically related school … as well anyone “leveling up” to the next level of training in their field (i.e. internship, residency, fellowship, etc). This is my edited post for 2023. I hope it gives families and friends ideas on how to support the people they love who are learning how to heal.

The Gift of More Free Time

The everyday needs of a household can become oppressive if you are working 80 hours a week. And, because bathrooms need to be cleaned, and floors need to be vacuumed, this is time that takes away from downtime needed to recover from hard work.

Here’s a list of things that just about every healer or healer in training would appreciate to help free up time:

• A cleaning service. Hire someone to do a “deep clean” of their home once a month. Look on the internet for bonded cleaning services or call people who might know the best companies.
• Car washes. Who doesn’t love a clean car…. and who has the time to wash and vacuum their car?
• Roomba vacuum cleaner. One task taken care of!
• Someone else to cook meals (see below!)

• Instant Pot. The number one time saving kitchen appliance for busy people is the Instant Pot. My Instant Pot has fundamentally changed the way I cook – and has made it easier to eat well.
• Air Fryer. I’m a new convert to air fryers. 15 minutes to get wonderful roasted or air fried veggies is amazing! Hard to choose between this and the instant pot. There is an instant pot with both, but I’m not sure it does quite as good a job as an air fryer.
• Gift certificates for food. Do a little sleuthing and find a healthy grocery store near where they live. Other ideas might be a smoothie or juice shop, their favorite restaurant(s), or coffee shops
• Prepared meals. Most cities have small, local companies that deliver prepared meals to your door. That would be my first choice (support local!) but there are also national companies and do this, too. Most companies offer gift certificates which is probably the best plan to give flexibility between a subscription or a la carte ordering.
• Home cooked meals. If you live near, think about cooking a batch of favorite food(s) and putting them in single serving containers to freeze. You might also want to create a certificate for your personal “cookie/meal/soup of the month club” with a promise to deliver food once a month.
• A Good Cookbook. Mark Bittman’s cookbooks are all wonderful, but How to Cook Everything Fast is a particularly good choice for busy people.
• Vitamix. It may seem expensive for a “blender”… but this is much more than a blender. These are the blenders you see in professional smoothie stores. Smoothies become a lifesaver for busy healers. (The Vitamix also makes great soups, sauces, etc…..)

• Insulated Coffee Mug. Rounds in the morning often starts with “running the list” around a computer, often at “dark thirty” when the rest of the world is just thinking about getting up. Having good coffee or tea from home or a local shop that stays warm for several hours is such a pleasure. The mug of choice for just about everyone I know is a 10 or 16 oz Yeti tumbler.
• Water Bottle. No one drinks enough water at work in the hospital (and we all agree on this). Again, having a great water bottle that you can fill in the morning with ice water (and a slice of lemon if you like) makes the day better.
• Nespresso (or other) coffee maker. If they are a coffee drinker, a good coffee maker is key. Nespresso is my personal favorite, but be creative and look at all the options!
• Good coffee (or tea). There are local roasters in most cities, so rather than support the big chains, look for them and consider a gift of coffee.

For those who find solace and joy in good music (and isn’t that just about all of us?):

• A good Bluetooth speaker for their home or study space. I love the Klipsch The One II speaker I have at home, but I’m sure there are other equivalent speakers, including some that aren’t as expensive.
• Air pods or noise cancelling headphones
• A subscription to one of the many streaming music services like Spotify or Apple Music.
• Tickets to the symphony, ballet, jazz performances, or opera in the city where they live.

• Good mattress, pillows, sheets. How we sleep determines how well we function the next day, particularly in high stress jobs. Is it time for a new mattress? Is there a better mattress that might help? High quality sheets are usually a welcome gift, too.
• Light blocking curtains or shades. Post-call sleep is during the day and sunlight can interfere with sleep. Special curtains or shades to block the sun really help.
• A Weighted Blanket.
• Nothing Much Happens. This is a free podcast with the subtitle of “Bedtime stories for adults”. Since it’s a present, think about supporting this wonderful series with the very cheap subscription (which means you get the stories without ads.)

The Gift of Healthy (and not aching) Feet

Working in the hospital means a lot of time on your feet. John Wooden, probably the most famous basketball coach of all time, spent the first week of training every year teaching his players how to put on their socks…. because he recognized that if you didn’t pay attention to your feet, it would affect your game. The same is true in medicine.

• Comfortable shoes for the hospital which can be thrown  into a washing machine. High on the list are Atoms, AllBirds, and Merrells. I have shoes from all three companies and so, for some one like me (a surgeon) who walks and stands a lot, I can recommend these specific shoes! Atoms Sneaker, Allbirds Tree Runners, Merrell Encore Breeze, Merrell Antora 2 Rainbow,
• Good socks. Don’t go for cute, go for high quality, well padded, and functional.
• Compression socks. There is some debate about whether compression socks can really prevent varicose veins, but there is no debate that your feet feel better at the end of a long day when you wear them!
• Pedicures. Lots of women (and some men!)  have learned the joy of a professional pedicure for tired feet. Don’t underestimate the power of a gift certificate for  pedicures. But, as an alternative, put together a kit for home pedicures.

This might not apply to everyone, but most people who work hard know that they feel better if they exercise a little every day. But – a word of caution – tread lightly with fitness gifts since they can be misinterpreted as conveying a “need” to exercise.

• A bicycle. For many people a good bicycle can make it easy to add some exercise by commuting to work by biking instead of driving. Regardless, it’s a great way to get some exercise outside. If they have a bike they use to commute, you might think of some ways to make it easier such as
• A gym membership. You may have to do a little detective work to find the right gym that is close to where they live, but it’s worth it.
• New shoes. Runners are supposed to get new shoes every year or so. Give them a gift certificate from a running store near them, if there is one. Or, be creative and put cash in a tiny toy shoes and wrap them in a shoe box.
• Fitness equipment for home. Resistance training is important for all of us, regardless of gender or age. Although a bench and weights are part of the classic home gym, they take up a lot of room (and weigh a lot!). I’m a big fan of the TRX system, which makes a great present. Since it has become almost a cult among physicians during the pandemic, I have to at least mention Peleton as another potential fitness gift for healers and healers in training.

Massage and/or Spa Services. This, too, may take a little effort to find the right place, but this is a wonderful gift for stressed people.

Headspace. This might seem a little unusual as a gift idea, but I can’t recommend it enough. Meditation is discussed in most medical schools and hospitals as a tool to gain insight and recover from the depletion that is part of the work we do. The best way I’ve found to learn this practice, and then stick with it is Headspace, which is a great app. The first 10 lessons are free, but for a gift, go ahead and get the annual subscription.

The Gift of Time and Stories

Human beings heal their hearts and souls by telling stories. Although there are many stories your loved one can’t tell you (at least not the specifics) you can totally ask how what they are seeing and doing is making them feel. Set aside some time for a coffee or another beverage and ask – with intention – “How are you doing?” And then just listen. Don’t try to “fix” anything … just listen.

Along the same lines, think about a letter… yes, a handwritten letter or note. Maybe a long one for a specific holiday or birthday, maybe a series of shorter ones through the year. Imagine how you would feel after a particularly hard week if you had a letter to reread that talked about how proud someone was of you, filled with funny stories and words of support.

Revised March 6, 2022

Every year about this time, I try to put together a list for people trying to find the right gift for someone they know who is graduating from medical school.

If you haven’t heard of @medgradwishlist on Twitter, it’s an amazing grassroots effort to create Amazon wish lists for URM medical students with financial needs to help them get ready for their internship. This is a brilliant “pay it forward” initiative. I’ve been a Program Director and a Dean of Student Affairs and I know how many new grads finish medical school with enormous debt and empty bank accounts. The ~17,000 students graduating from medical school this year are about to start on the exciting – but stressful – path of becoming a physician. Not being able to afford the things that make that journey possible just isn’t acceptable. You can buy things on their list anonymously (or not). When you find the right thing for the right person, don’t forget to include some memories of your internship, advice, and words of encouragement!

If you are a student (or even a struggling resident) in need, please join this effort to get what you need. We are sure you will pay it forward to extend this support future classes! If you are a student who can afford to support others, please do. And regardless of whether you participate in #medgradwishlist or not, the following ideas will help with graduation presents.

I spent quite a bit of time looking at all the #medgradwishlists on Amazon, and I’m happy to share what I learned. In addition to their great ideas, I have some suggestions to add…

Instant Pot. This was on a lot of the Amazon lists, and I agree!!! II had to suggest one item to make life as a resident easier, it would be this. Several people asked for air fryers on their Amazon lists. I love my air fryer and use it all the time so please put it on your list if you think it will help. Just as an FYI, you already (sort of) own an air fryer since your oven set on convection does close to the same thing!

Someone to help clean and do laundry. I know you can’t put this on an Amazon wish list, but if you have a family member who either can do this for you, or pay someone to do this for you, it’s one of the best gifts you will ever receive.

Digital gifts to make communicating and studying easier. The single most important tool for an intern is their phone. If they don’t have a new phone that can reliably work with WIFi and cellular, this should be at the top of the list. A computer that works, has the ability to do streaming well, and is reliable is also key since it’s how they will study, write, and watch educational videos. They’ll want the flexibility of studying in a coffee shop (once we get COVID19 under control) or on their couch so make sure it’s a laptop and not a desktop computer.

There were some great ideas on the Amazon lists for items that aren’t quite as expensive as computers that you might consider as well: ring light for Zoom meetings, LED study light, lap top desk for your lap, iPad Pro, Apple pencil.I should add that buying a large quantity of pens to be “borrowed” by attendings would be a big win, too.

The kitchen (other than the Instant Pot). It’s so important to eat well when you work as hard as interns work (and to stay well caffeinated). There were some great ideas from my new colleagues on their Amazon lists including single serve coffee makers, pot and pan sets, nonstick bakeware set (if they are a baker!), wine opener :-), food storage bags and containers. A box or two of Kind Bars (my favorite) or other meal replacement bars is a great gift, too. And for the times cooking is just one task too many – Door Dash, Uber Eats, and/or Grub Hub gift cards are a great gift. One other must have… a Yeti mug to keep coffee hot during rounds!

Clocks and watches. We all have phones that can serve as alarm clocks, but an alarm clock that gently lights up the room is a much better way to wake up than sudden noise. I wouldn’t say an Apple watch is essential (and if you do a lot of procedures it might be easy to lose) but it is worn by a good percentage of docs.

USMLE3 study book. If you are a family member who is thinking about getting this as a present, you might also want to include a check for \$895 as a “bookmark” to cover the cost of registering for this exam.

Make your home a stress-free zone. If you are setting up a new home, this list can be really extensive. You’ll need to go home to a clean, happy space, so whatever you can do to make that happen is important. There were a lot of good ideas in the Amazon wish lists including self-cleaning cat boxes, pet hair removal brushes, furniture, shower curtains, towels, and a video doorbell. I’d add a Roomba vacuum cleaner to this list, too! BTW, a good TV is important, too. We all need to binge watch the Great British Baking Show as therapy sometimes.

Sleep. In this category I would include good quality pillows, a new mattress, light blocking curtains, white noise machines, and electric or weighted blankets.

Music. Most people fill their space at home with sound as well as light, so think about good WiFi speakers like Sonos and/or gift certificates for ad-free music services like Apple Music, Spotify, Pandora.

Health. Last but not least! The most important thing on this list in my opinion is a great water bottle since, particularly with masks on all day, none of us drink enough water. A new Sonicare toothbrush or WaterPik for dental health will be appreciated. Foot care is another important part of being a healthy resident, so consider gifting compression socks, new shoes for the hospital, work insoles and/or a foot massager. Anything that promotes or makes fitness easier is also a good gift – a new bicycle for commuting, workout gloves, free weights, resistance bands. You might also consider a meditation app like Headspace, or subscription to yoga classes on line.

• Scrubs. I noticed a lot of folx asking for scrubs. Nope – don’t do it! You will be required to wear the scrubs from the hospital since there are rules about them being washed in the hospital laundry. Ditto for things to wear under scrubs. You’ll get too hot, they get dirty, and they are against the rules in all operating rooms (and many hospitals)
• Textbooks. You are pretty much guaranteed to have access to a library where these books will be in digital format and free. These books are heavy! You aren’t going to take them to work and when you get home, you may have other things to read that take priority.
• Printers. Printers (and printer ink) are expensive and you just won’t use them. You are going to have to stay digital to really learn what you need to learn as a resident. Besides, if you do need to print out the return slip for Amazon, there will always be a printer at the hospital you can use!
• Black bag. If you are a family member thinking of getting one of these… don’t.

And finally…

For my new colleagues matching this month and starting your internship in June …

May your journey through this liminal time be as stress free and as joyful as possible. May every day as an intern bring you hearts to heal and hands to hold, new learning, and a sense of wonder and awe.

We are so happy you are joining us in this noble and sacred work!

# Lessons from the Pandemic: Richard Rohr, Walking, and Lawn Chairs

It’s almost impossible during times of stress to be motivated to do hard things. For all but the most hardcore exercisers, ice cream just seems more soothing than running when you are emotionally exhausted (Right?). I’m no different. But, as much as I would like to think “later” will be ok to regain what I have lost in these months of being more sedentary than usual, I have begun to realize that I needed to get moving again.

Enter Richard Rohr

I’ve been a fan of Richard Rohr for years. He’s a gifted writer with the laugh and smiling eyes of someone who has tapped into something I want to know more about. I subscribe to his weekly email, which this week introduced Jonathan Stall’s practice of moving “as a way to invite brave creativity.”

There is a lot to unpack in that idea.

What exactly would “brave creativity” look like? I’m not sure, but it sounded like something I, and I suspect all of us, need more of right now.

“We invite you, as able, to take some time this weekend to move mindfully through your local area.”

I set off on a different kind of walk.

1. Bring something to jot ideas down while you are out, but more importantly, invite your “goals/pains/dreams”  to join you on this walk.
2. Walk for at least 30-40 minutes
3. Wear a mask if you get within 6-10 feet of anyone (respect for your neighbor)
4. Start the walk with a sense of being open. “As you begin to move, seek the realms of wonder, of space, and of reaching high into what’s possible…”

Where did all these lawn chairs come from?

I’ve walked many times before in my neighborhood, and I’m an observant person.  But today, as I walked, I began to notice all the chairs on people’s lawns and all the swings, and “tires” hanging from trees.

Were they always here and I didn’t notice them?

Are more people sitting outside now than before – even though it’s outrageously hot here in August?

Is this because of how much we all need (safe) connection to each other during the time of pandemic?

Are there actually more chairs, swings and tires because of how much we all need to hear birds, see trees and listen to the cicadas in the summer evening right now?

Next steps?

Yes, there will be next steps. This experiment led me to more questions than answers, but I had a real a sense of being taught, too.

Try it?

Let me know what you see.

# Self care in the time of #COVID19

It’s so important, and so very hard, to care for yourself when times are tough. When routines are disrupted and fear and anxiety are present, our usual ways of caring for ourselves seem to (appropriately) fly out the window.  So, here are some ways to think about caring for yourself in the time of COVID19, whether you are working (at home or in the hospital) or isolated at home.

Connect with nature. Long after this pandemic is over, the earth will still be here and spring will continue to happen every year. Make sure you get a good dose of the smell of grass, the sight of a blue sky, the feeling of a cool breeze on your face at least once a day (but hopefully more).

Move. It’s normal that workout schedules are disrupted right now, but it’s not a good time to completely give up on your physical wellbeing. There is nothing good about being sedentary – not only does it make you feel physically bad, it also contributes to sadness and anxiety. A good, brisk walk outside may be the best “workout” right now since it combines movement and getting a dose of nature… but please make sure you practice social distancing and stay six feet away from everyone.

Eat well and enjoy good chocolate. You may be limited in your choices and your ability to get real food, but do your best. This is not a good time to succumb to the junk food as comfort food diet. Nor is it a good time to be overly restrictive. Splurge on small doses of the foods that make you feel comforted, but make sure it’s the best version of that food possible! Now is not the time for cheap chocolate… just sayin’.

Keep your spaces clean. Our homes need to be a safe sanctuary now more than ever, and that means we need to know they are clean. In addition to creating a ritual to enter your home, come up with a plan to keep your home neat and cleaner than usual. If it helps, what we’ve done is set a mindfulness timer to ring 3 random bells an hour when we are home. Every time it rings, we do one small bit of cleaning (or one set of an exercise) e.g. vacuum one room, clean the countertops, wipe off all door handles or do some pushups. What you lose in efficiency is made up for by breaking up an otherwise boring task and by the “surprise” of the random “request”.

Dose your news. We need to know what’s happening, but we don’t need to know it all the time. The human brain doesn’t like being continually bombarded with potentially dangerous information. It promotes the physiologic stress response and pushes us towards fight, flight or freeze… none of which are helpful in this time. I love Twitter, but I have to be careful right now… it can be an echo chamber of sadness and stress. The news I’ve found that is the most informative, most accurate and least stressful is the PBS News Hour.

Guard your spirit. Find a place and a way to keep your heart full, your #EyesOpen and your compassion alive. This is not a sprint… it’s clear we are in this new world of COVID for a while. #WeNeedYou so please protect yourself in body, mind and soul.

There’s still time!

If you have a medical student, resident, physician or anyone who is super busy in your family, here are few last minute gift ideas for you….

A Letter

I’m starting with this one because even though it’s obvious, we forget the power of stories in our lives to heal and support each other. Consider writing a long letter with stories about how they inspire you, when they decided on their career, funny events, etc.  Stress joy, humor… and gratitude.

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Spotify and/or Pandora without commercials

Many of us study with music, and most of us work (at least sometimes) with music in the background. These two platforms are currently the most used in the hospital. Being able to listen to the music of your choice without commercials is a great gift!

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InstantPot

Of all the cooking appliances and gifts, this one is the best for people who want to eat well but don’t have a lot of time. Even if you have to wrap the “IOU” (i.e. a picture of the InstantPot), it will be a very appreciated gift!

A clean home

No one likes to clean their home, but all of us need this!  Even if it’s a deep clean every 3 months for a year, this is a great gift for anyone. Although there are professional services you can find, consider contacting local places of worship or non-profit organizations who may know responsible individuals who need the work.

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This one might seem a little strange, but you’ll have to trust me. For anyone who is “too busy” this is an easy way to really stop – even for 10 minutes a day – and “refuel”. BTW, get yourself a subscription (or at least try the first 10 lessons which are free). You’re welcome 🙂

• A healthy grocery store
• A smoothie or juice shop
• Their favorite restaurant(s)
• Car wash
• Starbucks (or even better, a local coffee shop near them)
• Prepared healthy meals from one of the many companies that do this now
• Membership to the YMCA or a gym near them
• A new bicycle? (we never get too old to love this!)
• “Date night” certificates for movies, plays or music and a meal
• A favorite museum

Photo credit

# Happy New Year’s Resolutions!

Like most of you, my New Years resolutions in past years have been something like “Exercise every day” or “Eat fruits and vegetables with every meal.” And, I bet that you had the same experience I did… a few weeks of “success” and then they seemed to fade away. The problem with these kinds of goals are how they are structured. They end up being “either-or” goals … you are either able to do them or, more often, you miss a day (or two… or three) and feel like a failure.

I recently read a blog post by Ryder Carroll, the originator of the Bullet Journal which profoundly changed the way I think about goal setting and New Year’s Resolutions

It’s a simple, but very powerful concept. Set your goal as a destination… as a “lighthouse” in the distance, and then head in that direction every day. As Ryder Carroll explains, “When goals are lighthouses, success is defined by simply showing up, by daily progress no matter how big or small…”

So instead of the usual New Year’s Resolutions, pick a few “lighthouse goals”. Write them down and keep track of how you are doing (every journey needs a map). This can be as simple as one piece of paper for each goal, but I am such a fan of the Bullet Journal, I hope you consider using it.

When you get up every morning think about how to move towards your goal(s). If you veer off course, that’s part of the journey…. look up, find your lighthouse, and correct your course.  Every once in a while (maybe monthly?), look at the progress you’ve made and celebrate it! If, on the other hand, the goals you originally chose don’t make sense for you any more, pick some new goals, draw a new map and start over.

Potential New Year “Lighthouse” goals

• Be a better friend
• Write genuine thank you notes to people who have helped me
• Become more fit
• Eat real food for as many meals a week as I can
• Find out more about who I really am through meditation
• Keep a “stop doing” list
• Be better at my work through deliberate practice (practicing and learning the things I don’t like and aren’t good at until I’m better)
• Stay organized so I don’t waste time (and end up focusing on trivial things instead of what’s really important)
• Read things that bring me joy
• Learn about and use a Bullet Journal
• Find a community to support me
• Learn the names of as many people at work as I can
• Take the stairs as often as I can
• Make my living spaces enjoyable spaces
• Keep a journal to remember milestones and work out struggles
• Get good sleep as often as possible
• Learn Spanish (or any new language)
• Be on time
• Remember people’s birthdays and send a card
• Start the day with intention
• Appropriately limit email and social media time

# Holiday Gifts for Medical Students, Residents, Physicians and Other Busy People

Every year I try to post gift suggestions for the family and friends of people in medicine (and all other busy professions).  Here are this year’s suggestions!

Listen.  A great friend of mine told me once that human beings heal by telling stories. There are lots of stories in medicine that go untold, but I promise you there are stories. Listen mindfully, without judgment and without trying to “fix” anything. Start with “Tell me a story about something that amazed you”… and then take it from there.

Write a letter.  Write a “letter of recommendation”. Yes, I’m serious! Not a letter to “get” or be elected to anything, but a letter that shows you know who they really are and how amazing it is that they have dedicated themselves to something so important. Make it a love letter, a letter of support, a letter with family history to encourage them… but a real letter. Write it on a computer and then print it, or use some beautiful stationary and a pen, but create a physical letter that will sit on their desk. Put the letter in a special box (something you might add to from time to time with other short letters?).

Instant Pot. There are kitchen conveniences, there are fads, and then there is the Instant Pot. This has taken on almost cult like status among users for a reason. It’s a 6 in one device (pressure cooker, slow cooker, rice cooker, saute, steamer and warmer) that makes it easy to cook healthy food. For students and residents, the 6 quart basic Instant Pot does everything you need it to do, but feel free to choose one with more bells and whistles if you want.

A cleaning service. No one likes to clean toilets. And, if you are working 80 hours a week, housework takes away precious personal time to socialize, exercise or restore your batteries in other ways. If you are in a position to do so, see if you can make this a win-win by working with a church, refugee placement group or another social justice group to find someone specific who really needs this kind of work. Whether it’s a one time “deep clean”, a monthly clean, or weekly cleaning and laundry, any help will be a deeply appreciated gift. Another approach is to do a little “sneaky” homework – your loved one may have a friend who has already found someone wonderful who might need more work.

The Gift of Organization.  I have become a huge fan of the Bullet Journal. It is incredibly easy, very versatile and, I believe, a perfect system for medical students, residents and docs. (especially when paired with a list on your smart phone when you are separate from your Bullet Journal). Choose a good Moleskin journal and the new book by Ryder Carroll, who developed this technique, and wrap them together as a perfect gift. If you want to really make their day, include a package of good (but not too expensive) pens

A gym membership (and other related gifts).  It’s really hard to find time to exercise if you are busy, but it’s critical for mental and physical health. There are a lot of options here, but they need to be specific to the likes and dislikes of your loved one. If they are a runner, maybe a gift certificate for new shoes? Do they like spin classes? If so, check out where the good classes are near them. Same for yoga, dance, ice skating, tennis, swimming, etc. A membership at a YMCA ( if there is one near them) will give them access to weights, classes and often a pool. Would they commute to school/work if they had a good bicycle? Can you get them a new watch or fitness monitor that will help count steps and flights of stairs? Would an “on the go” exercise kithelp them?

A Meditation App.  I tell my students that if they can only pick one thing on the self-care list to choose, that this would be it. There are plenty of data that show the stress-reducing benefits of meditation. What is amazing is that if you have a meditation practice the other self-care is easier, too. This is a great tool to help meet the goal to be better and happier physicians.

Your time.Can you cook some meals once a month and put them in their freezer?  Do laundry? Bake cookies and mail them? Get their car washed every once in a while? Make an elaborate certificate with something you could do for them and wrap it as a present?

Need other ideas?  Here are links to some previous lists: 201720162014,