On the Twelfth Day of Christmas….

Did you ever wonder why Christmas is on December 25th? … or why we decorate pine trees if Jesus was born in the Middle East? To make the long story short (while begging forgiveness from my theology professors for the oversimplification), it has to do with the Roman Empire adopting Christianity as the state religion in the 4th century. When the Romans moved to conquer what is now England and Germany, the people they were conquering were more than a little reluctant to give up their celebration of the solstice and their understanding of the wonder of trees…. so the two religions “merged”, allowing these symbols to become part of the Christian tradition.

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And what about the 12 days of Christmas? Christmas (the religious holiday, not the shopping season) starts on December 25th and ends twelve days later on January 6th (Epiphany)… hence 12 days.

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As I thought about the holiday season, and the 12 days of Christmas, I came up with a different idea to celebrate this season… What if we all started a new tradition of donating a small amount to worthy groups for twelve days?  

I’ve listed twelve of my favorite charities below, but feel free to come up with your own. Even if you donate a few dollars to each one, you are celebrating the season of Christmas, Hanukkah, Kwanza and the Solstice in a powerful way.

  1. Doctors Without Borders (Médecins Sans Frontiers). This amazing group takes medical care into parts of the world where no one else will go. Their entire charter is worth reading, but they live by “observing neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance.”
  2. Your local food bank. Whatever preconceived notion you might have about hunger in America is almost surely wrong. So many families, Seniors and disabled folx rely on food banks. Make this year a time to learn more about hunger in America and donate to feed your neighbors.
  3. A local animal shelter. Kindness to animals is the mark of a compassionate heart.
  4. Neighborhood initiatives. Regardless of your own religious background, or lack thereof, mosques, churches, temples, and synagogues seek to help those in need. Find the places of worship in your neighborhood,  look online to see what good works they are doing, and donate to help them. Better yet, take your donation in person to meet your neighbor and thank them for their work.
  5. Donate to help fight discrimination and oppression. There are so many important groups working for justice, a particularly important mission during this time of conflict and division. Consider donating to the Southern Poverty Law Center, the Human Rights Campaign, RAICES, Human Rights Watch, the ACLU or other groups focusing on justice for all.
  6. Action Against Hunger.  This group spends 94% of the money they raise in 47 countries to “take decisive action against the causes and effects of hunger.”
  7. The National Alliance to End Homelessness. You can also donate to local shelters for the homeless, or programs like Healthcare for the Homeless in your town or city.
  8. Prevent Child Abuse America. As someone who works with abused children, I would also encourage you to donate to the chaplain program at your local children’s hospital. The chaplains see the specific needs of these children – but more often than not don’t have resources to provide meal vouchers, toys or clothes to help a family during these moments of tragedy and pain.
  9. Consider donating to a group that is working to stop climate change, or other groups that advocate for and protect our natural resources such as the American Bird Conservancy or the Nature Conservancy.
  10. Make sure an isolated senior has a visitor and food by donating to Meals on Wheels.
  11. Time. If you don’t have money to donate, make a commitment to volunteer with a local group to help others. “You make a living by what you get. You make a life by what you give.” ~Winston Churchill
  12. I am personally involved with FAM Houston (consider this my COI declaration!), a group that inspires me through their mission of “working for justice by building empowered community among refugees, immigrants, and local Houstonians.” Through building friendships and creating community they show that any light, no matter how small, is a miracle of love. If you are in need of a worthy group for your twelfth day of Christmas donation, please consider them!

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Last minute holiday gifts for busy people in your life

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!

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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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A subscription to Headspace

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 🙂

Link to Andy Puddicombe’s TED talk (the founder of Headspace)

Other ideas for gift certificates

  • 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

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Shopping for the Week (and Your Soul)

Whenever I can, I go to our local farmers’ market on Saturday morning to buy food for the week. There is the obvious benefit that the food is organic, healthy and fresh, but there are some other benefits you might not have thought about. First, there is something special about eating with the seasons. Right now is peach season and they are amazing… but they will be gone in a few weeks, to be replaced in the fall and winter with citrus fruits. Secondly, you learn the names of the people who raise your food – and they will recognize you after a few weeks of shopping with them. The farmers’ market becomes a social connection, created through food, that Is sustaining in a different way. Finally, the experience of the market itself is so different from the stress of the work week – bright colors, happy people, music, food trucks, etc.

Now what exactly did I buy? When I get home, I put all of the food out on my kitchen counter and take a photo. The task of taking the photo is just fun for me (I love the colors and how beautiful it looks) but, to be honest, I started doing this so I could remember what I bought. So the next thing I do is make a list from the photo.

First one home starts cooking! I use a program called Paprika 3 to plan the week. It includes a browser to look for recipes, a weekly planner to list when I’m (tentatively) planning to cook each recipe, and a shopping list. Even better, the app is shared with my significant other so we both have all the info.

Link to this website

So, what are we cooking this week? After trying different combos in the browser such as “okra and sweet peppers recipe” or “papalo recipe”, here is what our menu looks like for this week. There is never a week that we follow the menu exactly – and I think that’s really important. This is the destination, but not the journey! We swap evenings, trade lunches for dinners, whatever works for the week. Note also, that since we aren’t on call this weekend, we are cooking a lot on Sunday to have leftovers during the week.

Need anything else? I make a separate shopping list for the missing items in the recipes (if they aren’t in the pantry already) and go to pick them up at a nearby grocery store.

If it’s going to be a busy week, we get ready. Most of cooking is the preparation, right?  When you walk in the door exhausted at 7:30, it’s hard to have enough energy to cook. That magically changes if everything is already cut up and ready to throw in the bowl or pan. We’ll make stock from all the leftover vegetables peels and ends and spend some time cutting things up to have them ready.

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I hope this helps! It’s true for anyone who is busy, but medical students and residents have a particularly hard time finding the time to eat well. Give this plan a try… it will not only give your body the kind of food it craves (and needs)… you’ll be surprised at how it refuels you in other ways, too.

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What Medicine Needs to Know About Social Location

I want to share a concept I recently learned …

But first, a story.

A few days ago I was talking with a male colleague who is a leader in his department.  He is a good friend, so we often talk about a variety of things. He brought up the issue of equity in his department. He told me (and I wasn’t surprised) that he was working hard to make sure that there was salary equity for the women in the group. I asked him if they knew he was doing that.  He responded, after a pause, that only he and his second in command knew.

“You need to tell them.”

He paused and said, “That’s a really good idea. I didn’t think of it.”

So let’s talk about social location.

Each of us has a “social location” that is a composite of our social identities e.g. gender, race, sexual identity, etc.  There is usually a perceived (and totally constructed) “hierarchy” of these social identities. In the United States, at this moment, it’s pretty clear that the “dominant” social location would be: White, Male, Heterosexual, Cis-gendered and Able-bodied (I’m leaving it there without adding other social identities such as immigrant status, age, education… etc. etc.)

Here’s the main point I want to make.  If you are in the “dominant” social location (i.e. White, Male, Heterosexual, Cis-Gendered and/or Able-bodied), you most likely cannot “see” the location of others that are not “dominant”… even though you think there is no way you are less than supportive of people that aren’t like you.

Huh? 

David Foster Wallace probably describes this phenomenon best in his amazing commencement address “This is Water”.

“There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”

Let me give you some specific examples from the world of medicine…

  • When a Lantinx colleague walks into Grand Rounds and notices they are one of three people of color who are there, their response is probably very different than mine.  Being white is never something I’m aware of when I’m sitting in Grand Rounds.
  • When we, as leaders, only acknowledge Christian holidays on our calendars, and even worse, when we schedule important classes, tests, or events on Yom Kippur, Eid al-Fitr, or Dewali, we are not discriminating intentionally, but we are acting from a place of not “seeing” students and residents who are not Christian.

I think that’s why my friend didn’t realize how important it would be to let the women in his group know that he had their back. I also think it explains the genuine confusion of many leaders in medicine who truly believe they are equitable and fair … and who are then at a complete loss when they learn they somehow “stumbled” into acting in a way that differed from that perception.  

Here’s another wonderful fact. Once you learn about “the water” (i.e. social location) it will change everything…for the better. Because – once you see it you can’t ever go back.

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“Try to learn to let what is unfair teach you.”

David Foster Wallace, Infinite Jest

Anything Can Be A Prayer

I Happened to Be Standing

Mary Oliver

I don't know where prayers go,
     or what they do.
Do cats pray, while they sleep
     half-asleep in the sun?
Does the opossum pray as it
     crosses the street?
The sunflowers? The old black oak
     growing older every year?
I know I can walk through the world,
     along the shore or under the trees,
with my mind filled with things
     of little importance, in full
self-attendance. A condition I can't really
     call being alive
Is a prayer a gift, or a petition,
     or does it matter?
The sunflowers blaze, maybe that's their way.
Maybe the cats are sound asleep. Maybe not.

While I was thinking this I happened to be standing
just outside my door, with my notebook open,
which is the way I begin every morning.
Then a wren in the privet began to sing.
He was positively drenched in enthusiasm,
I don't know why. And yet, why not.
I wouldn't persuade you from whatever you believe
or whatever you don't. That's your business.
But I thought, of the wren's singing, what could this be
     if it isn't a prayer?
So I just listened, my pen in the air.

Simple way to log your cases

I just taught two of my residents an easy way to log cases without stickers, notebooks, cards (or any other HIPPA risky methods). They were all but jumping up and down with happiness, so I decided this might be worth sharing.

(For those that aren’t in medicine, this is a requirement for everyone training in a procedural based field in medicine.)

Step 1:At the end of the case, when you open the computer for the orders and notes, highlight and copy the patient info at the top of the screen.

Step 2:   Open your Outlook calendar. Every institution gives you an Outlook account for your email and (even if you haven’t found it yet) this has a calendar, too. Hospital and medical school Outlook accounts are password protected and HIPPA compliant. (It would be a good idea to double check at your institution, but I haven’t found one yet where this isn’t true).

Step 3: Create an “appointment” for your case.

Paste what you copied from Epic into the “note” portion of the appointment. It will look like the green box in the image below.

Copy the name and MRN to the subject line of the “appointment”

Add the attending’s name if it’s not in the info copied from Epic.

Step 4: To officially log your case, open the ACGME site in a window next to your open calendar. Copy and paste the information from your calendar to log the case (isn’t that better than typing all that info?!?!…. you’re welcome!)

Step 4b: Put an asterix by the patients name in your calendar entry to show that you logged this case.

Hope that helps!  If you discover any important tricks or shortcuts to add to this system, please contact me or comment below!

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

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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

  • Learn more about compassion and practice it
  • 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!

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Photo credit (and article on the Art of Empathetic Listening)

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. 

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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?). 

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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.

 

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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. 

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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,