The Unforced Rhythms of Grace

Although I follow my ancestors’ spiritual path, I have incredible respect for the varied traditional paths my friends follow…and for those who follow no specific spiritual tradition. This post, which is the text of a sermon I gave today, does not and should not imply anything beyond my desire to share… and to lift up love where ever we find it.

“But to what will I compare this generation? It is like children sitting in the marketplaces and calling to one another,‘We played the flute for you, and you did not dance; we wailed, and you did not mourn. For John came neither eating nor drinking, and they say, ‘He has a demon’; the Son of Man came eating and drinking, and they say, ‘Look, a glutton and a drunkard, a friend of tax collectors and sinners!’ Yet wisdom is vindicated by her deeds.”

 At that time Jesus said, “I thank you, Father, Lord of heaven and earth, because you have hidden these things from the wise and the intelligent and have revealed them to infants; yes, Father, for such was your gracious will.  All things have been handed over to me by my Father, and no one knows the Son except the Father, and no one knows the Father except the Son and anyone to whom the Son chooses to reveal him.”

 “Come to me, all you who are weary and are carrying heavy burdens, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.  For my yoke is easy, and my burden is light.” Matthew 11: 16-19, 25-28

This week’s Gospel reading is a complicated but rich text, particularly if we take on the challenge of trying to really understand what Jesus is teaching here. 

At the time he delivers this lesson, Jesus has finished his instruction of the disciples, delivered the sermon on the mount, and has started to travel to different cities to teach and proclaim his message. Things are getting a little intense… John the Baptist is in prison, and Jesus is starting to be labelled as a trouble maker by the authorities. 

Christ and John the Baptist, Emmanuel Tzanes, between 1650 and 1690

The verse has three parts that at first don’t seem that connected… It starts with children in a marketplace, moves to infants who are wise, and ends with yokes and heavy burdens. 

The first part of the verse, the children in the marketplace, starts with this: “What comparison can I make with this generation? They are like children shouting to others as they sit in the marketplace, ‘We piped you a tune, but you wouldn’t dance. We sang you a dirge, but you wouldn’t mourn.’ 

I had a lot of questions after reading this, but the biggest one was this: Who is Jesus talking about when he says “this generation”? Who are these people Jesus compares to children (and not in a good way) who refuse to participate, who reject the other children inviting them to take part in the joy of dancing and the grief of mourning? 

The verse continues with this: For John came neither eating nor drinking, and they say, ‘He is possessed.’ The Chosen One comes, eating and drinking, and they say, ‘This one is a glutton and a drunkard, a friend of tax collectors and sinners.’ 

John was an ascetic. He fasted and lived without other comforts for spiritual reasons. But what’s important for our understanding of this verse is that the prophecy he proclaimed was a threat to the status quo, to the power of the religious leaders of the time. So they declared his fasting as a sign he was possessed by a demon. 

Jesus wasn’t an ascetic. He loved a good meal and no matter what table he sat at, everyone was welcome. But they didn’t like that, either… so they called him “a glutton and a drunkard, a friend of tax collectors and sinners.”

From this we know that “this generation” doesn’t join in when they are invited to dance and mourn… and not only do they refuse that invitation, they badmouth the people inviting them. But we still don’t know exactly who “this generation” refers to because it’s left intentionally vague. Jesus doesn’t specifically call out the religious leaders who were protecting their religious authority. He also doesn’t call out the followers who went along with those leaders because they thought the way of least resistance was easier. 

He just says “All y’all” (which means we are included) by referring to them as “this generation”.

The take home message here is that the religious leaders, political officials, and people who just wanted to keep their heads down to avoid trouble didn’t want to have anything to do with John and Jesus… because the message they were spreading was dangerous. It threatened to overthrow the status quo, to pull the rug out from under power… their power.

You’ll notice there is a gap in the gospel reading today… verses 20-24 aren’t included. I won’t read them all, but I think Verse 20 is important: Then [Jesus] began to reproach the cities in which most of his deeds of power had been done, because they did not repent.” 

Let’s read that again – Then [Jesus] began to reproach the cities in which most of his deeds of power had been done, because they did not repent.” 

It’s right there! Jesus’ acts of healing, teaching, and caring were “deeds of power”. That’s why the folks in power were so afraid of Jesus, why they slandered him, and why – ultimately – they crucified him. 

But here’s the punch line, how Jesus ends his teaching about “this generation”… After he describes the slurs being used against John and himself, after he shakes his head at the “children” in power who were not understanding what was happening, he says this: “Yet wisdom is vindicated by her deeds.”

But he leaves us hanging… He doesn’t explain what that means. He doesn’t tell us who wisdom is (although we suspect it is Jesus). No, the next thing that happens is that he prays…

Then Jesus prayed, “Abba God, Creator of heaven and earth, to you I offer praise;for what you have hidden from the learned and the clever, you have revealed to infants. 

Unattributed photo from TikTok

An hour or two after a healthy baby is born, there is a magic hour or so where they behold the world they have arrived in. For that hour, they are wide-eyed and have an extraordinary expression on their face that is a combination of wonder, curiosity, and deep peace. They look around as if they can’t believe the wonder of what they are seeing, of this gift they have been given. I’ve never seen that expression on any other human face, of any age. (The closest I’ve ever seen is the face of the Dalai Lama and his friend Bishop Desmond Tutu when they are laughing with each other, but even then – it is not the one time holy gaze of a newborn infant.)

I don’t think we have words to describe the wisdom Jesus is talking about in this verse. 

I don’t think it’s verbal at all. 

But I think we all know it.

I think the wisdom Jesus is referring to is given to us when we are born, a wisdom that is reflected in the brief moment of wonder when we behold the world around us with inexplicable joy, as we experience God’s unforced rhythms of grace for the first time. 

This gift of wisdom isn’t just a birth-day present, we all still have it. This gift, this grace, is within each of us at all times and in all places… we just have to remember that it’s there, a gift from the Holy Spirit. 

It’s this particular kind of wisdom, this grace, that I think is the focus of the last part of today’s reading. 

 Come unto me, all ye that labour and are heavy laden, and I will give you rest.

 Take my yoke upon you, and learn of me; for I am meek and lowly in heart: and ye shall find rest unto your souls.

(Sometimes the poetry of the King James Version is just what the occasion calls for.) 

Last week we had a special service to guide us in the practice of lamentation. We lamented together, and we learned about the need to bear witness to the heaviness we all carry, especially in these times. 

Take my yoke upon you… 

When we hear the word “yoke” we appropriately think of the heavy wooden crossbeam used to attach two oxen together, to let them pull a heavy load together… 

There have been so many days I had to lean on this verse… The days I had hard conversations with grief filled parents, the days I was so exhausted I didn’t know if I could carry on… But even then, even when I found solace in these words, I couldn’t help but wonder….. Why, if I’m already carrying a heavy load, would the answer be to add more weight to my shoulders? Why would I want to add a yoke, even if it was the yoke of Jesus?

The answer to that question is (literally) lost in translation.

In the 1st century, when Jesus spoke these words in Aramaic, when he told his followers “Take my yoke upon you” it had a much deeper meaning, one that they would have all known… because the word Yoke referred to the teachings of a Rabbi, the specific way a rabbi guided you in the “difficult but joyous task of obedience to the Torah”.

Every rabbi had their own yoke, their own unique interpretations and teachings that their students were expected to live by… and Jesus was no different. 

What was different was how he described what we can expect if and when we take his yoke upon us.

Take my yoke upon you, and learn of me; for I am meek and lowly in heart: and ye shall find rest unto your souls.

Jesus says “follow me” at least 12 times in the Gospels. I’ve always seen that in my head as like following someone on rounds in the hospital (sorry, but it’s true)… walking physically behind them, trying to follow in their footsteps, having them lead me to the next place I need to go. 

Eugene Peterson’s translation helps us better understand this verse and what it really means to follow Jesus… what it means to put on his yoke: “Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace.” 

Today’s gospel lesson comes down to this: 

Following Christ doesn’t mean what we usually think of when we say we are going to follow someone. It’s not about traveling behind Jesus, walking in his footsteps, having him lead the way… 

Following Christ means walking with him, beside him in lock step – because we are yoked to him. 

Following Christ means working with him to help co-create God’s kindom on earth. 

Following Christ means watching him, learning from him, imitating him … in other words, striving to be true disciples of Christ.

Walk with Christ.

Work with Christ.

Follow Christ.

And you shall find rest unto your souls.

Amen

Sermons are meant to be heard. If you’d like to listen to this one, here’s the link (the sermon starts at 29 minutes)

World Cup Joy

I’ve become enthralled with World Cup soccer. This 39 day-long event feels like a blend of the Super Bowl (in intensity), the Final 4 (because the underdogs have a chance) and the Olympics (because it’s world-wide) and I can’t get enough of it…

Yes, I know there is corruption and that FIFA takes corruption to new levels. I know what happens in our cities during the World Cup is not all good. I’m not going to ignore these horrors or pretend it’s otherwise. But there is another lesson I’m learning watching the matches (and the celebrations before and after) – It’s possible for us to be tribally attached and globally connected at the same time… and feel joy from both. 

Source

As much as I am enjoying the matches and the wild fan celebrations, it’s the pre-game ritual that has particularly captured my attention.

It starts with unfurling a huge national flag for each of the two nations on the two halves of the pitch. Then another banner – a circle with an image of earth and “FIFA 2026” , is unfurled in the center of the field.

Source

And then there’s a procession – led by a child… who picks up the ball for the match from a pedestal as they enter the stadium to carry it to the center of the field, the referees walking just behind them.

They are followed by the two teams who merge from two lines to walk into the stadium side by side, each player holding the hand of a child…. boys and girls with all colors of skin who are all very serious (except for when they grin when they forget that they are supposed to be serious). 

The happy Providence RI kids chosen to walk out with Scotland

The players gather around the blue midfield circle together as the two national anthems are played

And then the game starts.  It’s intense, it’s stunning athleticism, it’s everything you want in a sport… but (mostly) without the rancor that seems to accompany national identities in the world today.

Players help each other up.

They applaud each other’s teams and the fans at the end of the match.

The fans are exuberant, flamboyant, and passionate… Without being obviously vindictive or mean. The crowds are huge, and loud, and boisterous… and there has been virtually no violence.

From where I sit, it looks like the cities of North America have been invaded with joy. 

Source

Turfgrass, 48 cuisines, and Grief in the Wind

World Cup Grass

Who knew?… There are “grass gurus” (Led by Dr. John Trey Rogers, Professor of Turfgrass Management at Michigan State University) who are responsible for creating perfect turf for the World Cup. 

Dr. Roger’s team custom engineered grass for every stadium (including the indoor NFL stadiums that have never had grass on the field) which was grown on different sod farms in the United States and shipped to the stadiums in the last few months. 

Source

Seeing the world through food… (at least 48 countries in the World) 

“I can’t really say why I decided to cook, or otherwise procure, a dish representing every nation at the World Cup, except that I thought it might be kind of fun…”

Tim Murphy

In this article Tim Murphy recounts his family’s attempt to cook (or procure) food from each of the 48 countries “by eating, more or less in order, through the 12 groups of four teams who will meet in the tournament’s opening rounds.” The Houston Chronicle made it easy for those of us who live in Houston by creating a list of 48 restaurants where you can find the cuisine of the competing countries. And check out this blog that teaches kids why cooking is a lot like playing soccer!

Source

Grief is in the wind…

On a more gentle note, I was touched by two different stories I read this week, both having to do with grief and the wind. 

A  little over 25 years ago Gus Guadagnino hung a windchime from a tree on the property he owned adjacent to the Suncoast trail near Spring Hill, Florida in memory of his mother. Other folks did the same and now there are over 100 different chimes hanging from the tree. 

It must be a incredible experience to stand under this tree on a windy day… 

Source

The second story was about “wind phones”, old fashioned, disconnected, rotary phones placed in isolated, natural places that people use to “talk” to someone they have lost.

“Here they can say the things left unsaid. Wind phones offer a setting for the person to tell the story of their grief, to reminiscence and to continue to connect to the person who is gone.”

Taryn Lindhorst
Source

If you are missing someone, I wish you solace and gentle healing…

Is it Ageism or Is it Time to Stop?

I was asked to give a talk with this title several years ago for the annual meeting of the American College of Surgeons. I was surprised at the enthusiastic response then, and more surprised at how many times other folks have asked me to talk about this topic since. I had a friend recently ask me if there was a link to the talk that they could share with others. It wasn’t recorded (that I know of), so I’m posting the slides here. I think they are mostly self explanatory, but if you have any questions, please let me know!

Buy the Ice Cream

I hope it’s still true, but for many years the neurosurgery service at the hospital where I worked had a wonderful ritual. Every time a neurosurgery resident performed a case for the first time, they were sent to the cafeteria to buy ice cream for the entire team.

Ice cream (especially Blue Bell Vanilla…. IYKYK) is joy in a container, joy that can be expanded by using the simple and ancient practice of a blessing. Judaism has a long history, and many resources for blessing the routine moments in life, including a blessing for the first time something is experienced. You don’t have to be religious to adopt this practice – you just have to find how to acknowledge and appreciate the moments that inspire joy, awe, and wonder.

The power of this practice is amplified by writing them down, which is why I think it’s important for everyone learning to be a healer to keep a journal. There are many reasons a journal helps make sense of your experiences, but being able to relive these “first time” experiences years in the future will surprise and sustain you in ways you can’t imagine now.

So spend a few moments recording what happened, who was there, and how you felt the first time you hear a murmur, the first time you cry with a patient, the first time you see the miracle of birth, and the first time you bear witness to a family’s unimaginable loss. Look for first times that maybe aren’t so obvious, too, like the first time you meet a famous teacher, the first time you walk into a new hospital, the first time you get to park in the “good” parking spaces.

But most of all, record the moments you never want to forget… like the first time you hold a newborn during the magic hour when they are starstruck, looking around with open eyes and wonder (the most peaceful expression you will ever see on a human face).

So buy the ice cream for the first case.

And then … write down how blessed it made you feel.

Instructions for living a life: Pay attention. Be astonished. Tell about it.

mary oliver

AI vs. Polymaths, The Shape of the Universe, and Using Caffeine to Study

Is AI the ultimate polymath? 

Merriam-Webster defines a polymath as “a person of encyclopedic learning”, but that doesn’t seem to really convey the wonder of a true polymath.Because polymaths (at least the ones I’ve met) not only know a lot about a variety of topics, they are also passionate about them. You never feel that they have an obligation to study or a “goal” to learn…They usually convey a joy of learning (combined with extraordinary intellect) that leads them to their “encyclopedic learning”. 

Source

The universe is flat and may be shaped like a Pringles chip

This article explains why cosmologists (who study the cosmos, not makeup) are sure that the universe is flat. What they aren’t sure about is which of the 18 possible 3D flat shapes best fits what they currently understand about the universe.

How to best “use” caffeine to stay alert

Caffeine is a pleasure and, for many, almost a necessity. But caffeine can be a double-edged sword if you don’t understand how to use it to help with fatigue, sleepiness, and a need to study for exams!

Although this piece is directed primarily at medical students and residents, the information applies to everyone who uses caffeine to stay alert.

Caffeine effects on spider webs, from the amazingly detailed Wikipedia article on caffeine

p.s. I used AI to generate the banner image above.

1+1+1 = 3 = 1?

Artist Unknown

Disclaimer: Although I still follow my ancestors’ spiritual path, I have incredible respect for the varied traditional paths my friends follow…and for those who follow no specific spiritual tradition. This post, which is the text of a sermon I gave today, does not and should not imply anything beyond my desire to share… and to lift up love where ever we find it.

When the day of Pentecost had come, they were all together in one place. And suddenly from heaven there came a sound like the rush of a violent wind, and it filled the entire house where they were sitting. Divided tongues, as of fire, appeared among them, and a tongue rested on each of them. All of them were filled with the Holy Spirit and began to speak in other languages, as the Spirit gave them ability. Now there were devout Jews from every people under heaven living in Jerusalem. And at this sound the crowd gathered and was bewildered, because each one heard them speaking in the native language of each. Amazed and astonished, they asked, “Are not all these who are speaking Galileans? And how is it that we hear, each of us, in our own native language? Parthians, Medes, Elamites, and residents of Mesopotamia, Judea and Cappadocia, Pontus and Asia, Phrygia and Pamphylia, Egypt and the parts of Libya belonging to Cyrene, and visitors from Rome, both Jews and proselytes, Cretans and Arabs—in our own languages we hear them speaking about God’s deeds of power.” All were amazed and perplexed, saying to one another, “What does this mean?” But others sneered and said, “They are filled with new wine.” Acts 2:1-13

Artist unknown

Today is Pentecost Sunday, which marks the end of the Easter celebration and the beginning of what we call “Ordinary Time” in the church’s calendar. 

(By the way, that’s ordinary as in ordinal… days we count…. Not ordinary as in mundane)

The first half of the liturgical calendar tells the story of Jesus – starting with Advent and ending today, with Pentecost. The second half, which starts tomorrow, tells the story of the people of God, the story of the community of believers that was born on Pentecost over 2000 years ago. 

Source

It’s not a gentle transition… 

Before we enter Ordinary Time, we leave the Easter season with (literally) a bang… with wind and fire. 

Let’s listen to today’s lesson again, this time from Eugene Peterson’s translation of the Bible…

When the Feast of Pentecost came, they were all together in one place. Without warning there was a sound like a strong wind, gale force—no one could tell where it came from. It filled the whole building. Then, like a wildfire, the Holy Spirit spread through their ranks, and they started speaking in a number of different languages as the Spirit prompted them. 

There’s a lot to unpack here, but let’s start at the beginning… “They were all together”… 

Who is “they” and why were they all together? 

A little further in Chapter 2 of Acts, Luke tells us who “they” refers to. It’s the 12 disciples plus 120 other people who became believers because they had seen the risen Christ during the 40 days he walked among them. 

So that’s who “they” refers to… but why were they all together?

The word Pentecost is derived from the Greek Pentakonta, and means “fiftieth”.

“Pentecost” is the Greek word for Shavuot, the Jewish festival that celebrates the gift of the first fruits of the harvest and the gift of being given the Torah at Mount Sinai. It’s a festival that happens 50 days after Passover (hence “Pentecost”). Pentecost, like Passover, was a pilgrimage festival  – which meant everyone travelled to be together to celebrate. That’s why they were all in one place, to celebrate Pentecost… that and the fact that 10 days earlier, at the time of his Ascension, Jesus had told them not to leave Jerusalem.

It had been only 50 days since Jesus’ execution..  But the 12 disciples and the 120 new followers weren’t grieving… 

They knew Jesus was alive, raised from the dead…Because for 40 days after his resurrection Jesus appeared over and over to not only the disciples but to many others. Scripture tells us that he appeared to more than 500 people on one occasion (1 Cor 15:6) and that he gave “convincing proofs to many other people” (Acts 1:3)

At the end of those 40 days, 10 days before the festival of Pentecost,  Jesus ascended into heaven… but not before preparing his followers for what would happen on Pentecost. 

“When they were together for the last time they asked, “Master, are you going to restore the kingdom to Israel now? Is this the time?” 

Jesus answered,  “You don’t get to know the time. Timing is the Father’s business. What you’ll get is the Holy Spirit…” The Message

Which brings us to the bang… the wind and fire

I suspect you learned the weird math of Western Christianity like I did.  You know… the 1+1+1 equals 3 which equals 1? It didn’t make sense then, and it’s still hard to understand for me now. 

Let me share some thoughts from Richard Rohr that may help:

Not exactly One, Christian mystics and teachers attempt to explain, and yet perfectly One; not exactly Three but yet Three… No wonder it took us three centuries to even find a word to describe such a nonsensical image of God. Note this for now: the principle of one is lonely; the principle of two is oppositional and moves you toward preference; the principle of three is inherently moving, dynamic, and generative.

One is lonely.
Two makes you choose.
Three is a community.

The mystery of the Triune God helps us understand that God is not “something or someone”, God is community, relationships, connection… “inherently moving, dynamic, and generative.”

Richard Rohr also reminds us that when we try to describe God, Christ, Holy Spirit, or even Love with words, we will never do it well. As he puts it “All theological language is an approximation, offered tentatively in holy awe.”

All theological language is an approximation, offered tentatively in holy awe.

richard rohr

It’s so hard to come up with words that let us grasp mystery… so we use images and metaphors. We talk of wind, fire, and water… as we grasp at trying to understand the majesty and mystery of a triune God. 

But maybe it’s not as hard as we think…. 

Maybe it’s as simple as this

God for us, we call you [Creator]
God alongside us, we call you Jesus
God within us, we call you Holy Spirit 

richard rohr

Which brings me back to today’s scripture…

Without warning there was a sound like a strong wind, gale force—no one could tell where it came from. It filled the whole building. Then, like a wildfire, the Holy Spirit spread through their ranks, and they started speaking in a number of different languages…

God-within the disciples and those who had seen the risen Christ was ignited and “spread like wildfire”.  God-within spilled out in the words they spoke… and not just any words – words in a number of different languages…Words that let everyone there hear the Good News in their own language. 

Words that let them understand. 

Words that connected each one of them to each other and the mystery of Divine Love. 

Pentecost, Gisele Bauche

It was so loud, so crazy, that the people who ran towards them to see what was going on thought they were drunk. 

Today’s verse is followed by a sermon by Peter explaining that these people weren’t drunk… they were fulfilling prophesy. He walks them through the prophesy and then retells the story of the execution of Jesus on the cross and his resurrection from the dead, ending with “Therefore let the entire house of Israel know with certainty that God has made him both Lord and Messiah, this Jesus whom you crucified.”

We are then told that the people listening to Peter were “cut to the heart.” and began to beg him to tell him what they should do. 

He told them to repent and be baptized.

The text continues with these words…  “They were convinced by his arguments, and they accepted what he said and were baptized. That very day about three thousand were added to the number of those converted.” 

The Church was born.

There have been ~70 generations of human beings since that moment. 

Which means.. 

It is highly probable that one of your biological ancestors was there… 

And it is certain that at least one of your spiritual ancestors was there. 

…Because we are part of an unbroken chain of spiritual inheritance kept vital and alive by the roaring wind and tongues of fire of the Holy Spirit present within us and around us … then, now, and always…. 

God for us, we praise you and call you [Creator]

God alongside us, we praise you and call you Jesus

God within us, we praise you and  call you Holy Spirit 

And all God’s people say…

Amen


Claire Tabouret’s design for one of six stain glass windows depicting Pentecost for Notre-Dame cathedral

Sermons are meant to be heard. If you’d like to listen to this one, it will be posted here.

ACHOO Syndrome, El Niño, and #CallFood Granola

ACHOO syndrome

ACHOO may be one of the best acronyms for a physiologic condition I’ve ever seen. It stands for  Autosomal Dominant Compelling Helio-Ophthalmic Outburst. The ACHOO syndrome refers to the inherited trait of sneezing when you are suddenly exposed to bright light (like walking outside into bright sunlight). It’s also called photoptarmosis (from the Greek phōs, “light” and ptarmós, “sneeze”)

Interesting trivia about the ACHOO syndrome

  • It affects 18-25% of the population
  • Aristotle wrote about it in his Book of Problems
  • It’s probably caused by a minor cross wiring between the Trigeminal and Optic nerves

Source

El Niño

Today’s New York Times had an informative (and somewhat scary) article about the weather phenomenon called “El Niño”. 

El Niño is the name given to powerful shifts in Pacific Ocean winds and water temperatures that can drastically transform global weather patterns. Over the centuries these natural patterns have sparked epic droughts and heat waves, and have intensified epidemics.

NY Times

Yikes.

If you want more information, sign up for NOAA’s monthly “diagnostic discussion” here

#CallFood Granola 

I cooked this recipe for the first time this week and, in keeping with my promise to add more topics to support students, residents, and busy docs, decided it was worth sharing. Start with the basic recipe and then change it to your taste (I’m adding some whole almonds and cashews next time).

Take a bag of this granola with you when you are on call to mix with yogurt – or just grab handfuls when you need some healthy calories. 

p.s. I substituted olive oil for the vegetable oil which was delicious and probably a little healthier

p.p.s. If you do the math, this is incredibly cheap compared to commercially made granola, granola bars, or other grain based snacks

p.p.p.s I have used #CallFood for years on social media (Bluesky, Facebook, and Instagram) as a hashtag for recipes that don’t take long to cook, taste great, and are healthy (In case you are looking for more suggestions.)

Gifts for Healers

Source

I started this newsletter/blog years ago as a way to support trainees (medical and other students, residents, and fellows) as well as colleagues. If you’d been here for a while, you’ve probably noticed that my interests have expanded and so have the topics I write about! The expansion of the topics represents a new season in my life and the cool idea I got from Austin Kleon that you should write a newsletter directed to the people you want to meet.

But here’s the thing… trainees and practicing healers are high on that list for me! So I’ve decided that I’ll return to some posts directed at those very special people… like today’s post on hints for people who want to buy you presents. Feel free to forward them the link :-).

In an attempt to educate family and friends (and an interesting way to organize what would otherwise be a somewhat boring list), here’s a look into the average day of a medical trainee. (I’m using a surgery intern as my baseline, but with some variation this schedule applies to just about anyone training to be a healer.)

Wake up too early

“Dark-thirty” is the classic time trainees have to wake up. No matter the actual hour, it’s always early…and it’s hard! Everyone uses their cell phone as an alarm, but some need a bit of extra help…

Caffeinate

If you are a someone who loves the kick start of caffeine in the morning, you need a way to do this well.

  • An easy coffee maker like Nespresso (and/or gift certificates for the coffee)
  • Gift certificate to a local coffee or tea shop (I personally try to find one that’s not Starbucks…)

Drive to the hospital

  • A gift certificate for car washes
  • A small car vacuum, trash bag, or other accessories to keep their car a little neater

Meet the team, run the list, make morning rounds.

(From the time I asked my team at the hospital to take the pens out of their pockets so I could take a picture of them)

The “scut” (i.e. to do) list is almost always on paper, which is a great opportunity for the perfect pen….and a second (or third cup) of coffee or tea that stays warm until the end of rounds;

Head to your assigned task for the day (OR, procedural suite, clinic, inpatient care)

Comfortable shoes – the link is to a post with my favorites, but there are always new, great shoes that come onto the market and are quickly adopted by people who have to stand on their feet all day. Ask for the latest!

Good socks – I swear by Bombas, but the key concept here is to not skimp.

Spend an inordinate amount of time entering data into a computer

Overhage JM, McCallie D Jr. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters: A Descriptive Study. Ann Intern Med. 2020 Feb 4;172(3):169-174.
  • A subscription to one of the streaming music services (to get rid of the commercials while you are listening to music)

On a good day, eat the food you brought or bought

Photo by Mary Brandt

It’s cheaper, healthier, and more efficient to bring your own food.

On a not so good day, grab calories on the run

A busy call day means you may not have time to stop. But you’ll need to refuel!

  • Boxes of healthy (minimally processed) pocket sized food like Kind Bars (or equivalent)
  • Small bags of nuts, boxes of raisins, etc.
  • Be creative – mail or deliver a monthly “subscription” of homemade or bought “pocket nutrition”

Afternoon rounds

See above (for morning rounds) – minus the caffeine.

A “Something or nothing” workout

Exercise is ESSENTIAL for so many reasons… but we tend to have an “all or nothing” default when it comes to exercise. We plan a 30-minute stop at the gym on our way home… but then we are 10 minutes late out of the hospital… and then the traffic is bad… so we decide not to go at all. The key is to do something (anything) rather than abandon the workout all together, to shift from “all or nothing” to “something or nothing” as your mindset. Here’s a few gifts that might help in that endeavor…

  • A membership in the gym that’s closest to them (or better, ask them to tell you which gym will work the best for them)
  • A bicycle (if they live close enough and this might be a good way to commute)
  • An eBike (if they don’t live that close)
  • New running shoes
  • TRX (or other home fitness equipment)

Some studying

Link to How to Succeed in Residency: Studying

This is exactly the same as exercise! It’s not necessary to complete a review of a topic every day, but it is necessary to study every day. (I’m serious… otherwise you have missed the big memo about life-long learning and being a professional!)

  • A good desk and an even better chair
  • Computer upgrade
  • A second monitor

Some decompression, socialization

This is essential. Downtime with music, visiting with friends, taking a walk outside, or whatever works for you are necessary to reset and heal from our work.

Dinner at home

Source

Cooking at home for busy folks has to meet the “pizza rule”* – but it’s more than worth it. Cooking for yourself is a great way to care for yourself, eat better, and have leftovers! Fortunately, there are a lot of ways to hack eating well so you don’t find yourself repeatedly getting food delivered (or eating too much fast food)

*Whatever you decide to cook has to take less time to prepare than it takes to order a pizza.

Sleep

Sleep is foundational.

Sleep is foundational.

Sleep is foundational.

(Yup, repeated on purpose. Everything is harder if you haven’t slept well… thinking, moving, your mood, your interactions, and maintaining your health.)

Don’t skimp on the things that make it easier to sleep well.

  • A good mattress, sheets, pillows
  • Light blocking curtains or shades
  • A weighted blanket
  • Sleep mask
  • Ear plugs (can also be used for loud concerts!)

And some miscellaneous gifts that don’t fit into this schedule!

Let me know what else I should add to the list!

Diagnosis, Discernment, and Birding: Part 2

A few weeks ago one of those “scary” messages popped up on my car’s dashboard screen. 

Source

Next step – get on the internet. 

It turns out that the key thing is to look at the grille shutter to see if there is anything stuck in it. If it’s stuck open there isn’t a problem. If it’s stuck close it’s still not life (or car) threatening unless the engine overheats. Sounds straightforward… but, you have to know where to look. 

Since (of course) we were over 200 miles from home when this happened, we went to the local dealer and asked if there might be someone who could look to see if it was stuck open or closed.

“We’d have to run a full diagnostic scan first.”

“But we just need someone who knows where to look to just look.”

“We can’t do that. There aren’t any technicians available and they require the scan first.”

(At this point we decided to take our chances and assume it was open)

“You know, we are both doctors…”

He interrupted to say “So you know how important CT scans are!”

I smiled and said, “Not if all you need to do is pull out a splinter.” 

from The Making of a Diagnostic Mind by Alexandra Sifferlin

The art of diagnosis in medicine starts, very importantly, with the story. It’s actually astounding how often that will make the diagnosis. At the very least, it narrows down the possibilities. (which we call “the differential”). 

The physical exam is next, to refine the differential diagnosis and guide you in deciding which tests to order. Even if the triage team has ordered the tests first (like in a busy ER) it’s still very important to go through these steps in order, starting with a “blank slate” so you don’t fall into the trap of the many ways our brains succumb to bias (especially anchoring bias).

Designed by John Manoogian III

What makes this process, the art of diagnosis in medicine (as opposed to my car) unique is the intent. Because we always go through this process for someone else. We make a diagnosis as the first, important step in healing another human being. 

Photo by Mary Brandt

Birding is about healing ourselves

We don’t “diagnose” a bird when we go birding. There are some similarities – We look at “field marks” and listen to the songs the same way we collect data from a patient. We also create a “differential” i.e. the list of birds that fit our findings. 

But there’s is one big difference – the intent. Birding is not something we do for someone else, it’s something we do for ourselves. 

Photo by Mary Brandt (on the way to High Island via the Bolivar Flats)

There’s a reason so many people flocked (no pun intended) to parks during COVID to take up birding for the first time. It’s a focused way to be outside and experience a little bit of forest (or lake, or field) “bathing”…to connect with sounds and sights that resonate on a soul level.

Anyone who birds a favorite park over and over knows intuitively why they keep going back: It just feels good. Being in nature—pausing in it, sitting with it, discovering its wonders—brings a sense of calm and renewal.

audubon magazine

Discernment is about healing the world 

And then there’s discernment, which comes from a different, deeper intention. 

“Discernment” implies more than than just identifying a bird or making a diagnosis. We discern the difference between right and wrong, the correct path in our career, which of two important choices we should make … in other words, discernment helps us find our way in a moral or spiritual sense. Which is why discernment can be is a spiritual practice based on “noticing the movements within your heart and soul — your desires, thoughts, emotions — and identifying where they are coming from and where they are leading you.” 

Source

Compassionate action emerges from the sense of openness, connectedness, and discernment you have created.

Joan Halifax