“Do you think it would be ok if I…?”

“We had a graduation celebration, but it was smaller than usual… only 20 people… and the older people just stayed a little while.”

“We meant to stay socially distanced… but you know kids.”

“God will protect me… I don’t need a mask.”

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Oh, how I wish this were over. We all do.

And it will end.

It will end, but what we have to grapple with now is how many of us will die unnecessarily before it ends… because the rest of us “had to get our hair cut” or thought this was some kind of political “hoax”… or just couldn’t be bothered.  

Because I am a physician, I have a lot of friends and family who call to ask some version of “Do you think it would be safe if….” I usually respond by telling them what I’m doing and then answer questions as they try to figure out the changes they need to make to be safe.

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I am in awe of how much we have learned about how the virus spreads in aerosols, how it stays on surfaces and how very infectious it is. We owe a huge debt of gratitude to the scientists who have tackled this pandemic with heart, mind and soul. This knowledge is guiding us, protecting us, and is essential to save lives.  

So, with gratitude for the science that has helped us better understand #COVID19, here’s what I tell my friends and family we are doing when they ask….

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Stay Home. We stay home unless it’s for an essential need. For example – we would go to the dentist for a painful tooth (but not for a routine cleaning). We have supported our local restaurants with pick up or delivery, but we don’t go to restaurants yet. When we do, it will only be outside and only if we are sure CDC guidelines for restaurants are being followed. There is no way we would go inside for a movie, rally, worship or other public gathering. The data are more than clear… large gatherings inside are the highest risk activities right now.

I get our vegetables from Pierre at a Plant It Forward farmer’s market sponsored by Dandelion Cafe. (I’m mentioning them on purpose because having these just picked vegetables has been a true gift!) But I have the rest of my groceries delivered. I ask the delivery person to put them on the step (by text). I wear a mask, and don’t open the door until they are more than 6 feet away to thank them. (BTW, they are doing amazing work to keep our communities safe – please tip often and as much as you can).

One of the questions I get asked about staying home is “but I’m young… isn’t it ok for me to go out?”. The answer is yes and no. Younger people are less likely to die or develop chronic lung disease from COVID19, but it’s not impossible. Here’s the real issue – If you end up infected with COVID19 you’ll infect people around you that are at high risk… and they could die or have horrible outcomes from the disease. Do you really want to risk hurting your grandparents or that nice guy at the store who always says “Hi” to you? Think about creating a “quarantine pod” as an alternative to going out to restaurants, bars and concerts… it’s not going to be the same, but it’s a good compromise to keep socially connected while being as safe as possible.

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Do it virtually if you can. If we are asked to run or be in a meeting, we do everything possible to make it virtual. If you are in charge of gatherings, this is an important responsibility. There is no reason to expose any of your colleagues or employees unnecessarily.

I’m an academic surgeon. I can’t do surgery virtually, but I can do a lot of clinic visits by video. I can do all my group teaching and committee meetings by Zoom. There is no moral justification to have meetings in person if they can be done online and I’m happy, as someone who can decide, to make sure my students and colleagues aren’t exposed to more risk than necessary.

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Socialize outside. If I am meeting a friend (or friends) I’ll only do it outside and only if we have discussed in advance how to manage the event. I’m excited that this weekend I’m going to an outside workshop that FAMHouston is facilitating to teach refugees how to grow vegetables in container gardens. These are my friends, so I really want to see them! We have established in advanced that we will meet CDC guidelines with everyone in masks and more than 6 feet apart.

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#WearYourMask. If I’m around anyone, I wear a mask, and I ask them to wear one – AND we stay at least 6 feet apart. The masks only come off if we are outside and more than 6 feet apart. It’s also really important to wear it properly! In particular, if your nose is hanging out, you might as well not have it on. Two other important things: 1) A face shield alone is better than nothing, but isn’t as protective as a mask and 2) the masks with the “breathing valve” aren’t worth wearing. Remember, my mask protects you. Your mask protects me. That’s why if we all wear masks we can stop the spread of COVID19!

Exercise with a mask available. When I’m outside exercising, I have a cooling mask (it is Houston, after all!) around my neck. As soon as I see someone coming towards me, I pull up my mask. I get a good 20-30 feet beyond them before it comes back down.

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Bring your own glass. I had a friend over for a glass of wine on the back porch not too long ago. They didn’t come through my house (and I would do the same for them). I opened the gate to the backyard, and they walked through my back yard to the back porch where I met them. They brought their own wine glass. We sat on opposite sides of the porch, 10 feet away from each other and had a wonderful, soul healing visit.

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Assume if someone else has touched it there is COVID19 on it. It’s a long shot, but what if… the UPS driver has COVID19 but is asymptomatic, coughs on their hands, picks up the package they are delivering … and now you pick it up. One inadvertent rub of the eyes at that point could easily mean an infection.

We put an old towel on a table and designated that table as “contaminated.” We put new packages on the table and immediately wash our hands. (If you work in an OR, you will understand this well… if you touch something contaminated you “rescrub” i.e. wash your hands before touching something else.) This sounds complicated but it’s not… if it’s just been handled by someone else, we assume it’s contaminated.

We have found that it’s easy to leave things on the table for 3 days before we open them (surprised us, too!). Obviously, groceries that need to be in the refrigerator are a little different (they get put in new plastic bags which go into the fridge). And, because three days may be long for some items…bottles of beverages get washed with soap and water before they go in the fridge.

Now, I have to be honest. A lot of new data are coming out that says we may be on the far end of safe with this. Some surfaces clearly are more at risk (like door handles), but things that get delivered are probably not really a problem. This is one to figure out your comfort level, stay up to date on the new info, and come up with a reasonable plan.

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I hope this helps.

Whenever I am tempted to say “just this once” … or fall into the trap of feeling like it can’t really be “that bad” to meet without masks, I think about how all my colleagues are putting their lives on the line to care for infected people… and how I would feel if I were the one responsible for their death, or the death of someone I know and love.

Be safe and take care of each other.

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Making Sourdough Bread as a Resident (or anyone with a crazy work schedule)

I just waved goodbye to a dear friend as she started the drive to her new residency – with a jar of “Tamar”, my sourdough starter* in her cooler. I was going to print some instructions to send with the starter, but decided it might be better to put those instructions here for her – and for all of you who have thought about making sourdough bread (but think you are too busy).

Why bother?

This is a legitimate question. What I’ve learned from making my own bread during the pandemic is that it’s more than just having delicious, warm bread to sustain you.  I won’t wax too poetic, but there are three reasons I think you should ponder baking your own bread:

  • A sourdough starter is a living thing who is there to help feed you
  • Making the bread is an act of self-care, a gift to yourself
  • This is a  profoundly slow and deliberate act. Mindfulness doesn’t get any better than this.

So, if you are intrigued, I’ve thought about this for a while and here is how I think this could work for residents – even during a crazy 80 hour week.

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Step 1: Get or make a starter

There’s a decent chance that someone where you work bakes sourdough bread. If they do, they will be delighted to give you some starter. It’s not a bad way to make some new friends and/or expand your circle of friends.

If you don’t find someone with starter, make your own. Sourdough starter comes from the bacteria and yeast that are in our environment so it’s a matter of mixing flour, water and time. If you want to help out some scientists while you make your starter, check out the NC State Sourdough Project.

Step 2: Understand the big picture

  • Sourdough starter is a living thing. You need to feed it once a week by adding some water and flour. Period. If you want to stop here and just have the starter around “in case” you decide to bake, this is all you have to do.
  • You are going to love the science of this. I’ll even predict you’ll end up using a scale to make sure your grams of ingredients are exact… but remember, as much as this will feel like science, its also how our ancestors made bread thousands of years ago. Don’t lose that perspective.. or that connection… when you bake.
  • It’s a four-step process with variations depending on the recipe:
    • Mix the 4 ingredients (starter, flour, salt and water) to make dough
    • Rise – long and slow. Overnight in the fridge, 2-6 hours on the counter. It varies by the recipe.
    • 2nd rise – usually. for 1-3 hours and in a container to shape the dough
    • Bake

Step 3: Find an easy recipe to start with so you don’t get overwhelmed…

Here’s a really easy first recipe:

  • Mix the dough (1 cup starter, 1.75 cups lukewarm water, 5 cups of flour, 1 tablespoon of salt)
  • Let it rise for about an hour then stretch it out and fold it onto itself several times. The recipe says repeat this once an hour for a total of three times, but you can skip the 2nd and/or 3rd times if you need to.
  • Put it in the refrigerator overnight.
  • Flip it over, seam side up into a bowl or loaf pan (to shape it) and let it sit for 2.5-3 hours.
  • Flip it back over (seam side down) into your pan, slash the top to provide a controlled way to expand and bake.

Step 4: Map out a schedule

Let’s say it’s Thursday evening and you are off on Friday. Here’s how this recipe might work for you…

  • Thursday when you get home, mix the dough. If you don’t have time to let it rise on the counter for an hour and stretch it, just put it in the refrigerator. (Trust me, it will work). Take the starter that didn’t go into the recipe, feed it, and put it back in the refrigerator.
  • Friday when you wake up put the dough in a bowl or loaf pan and let it sit for 2-3 hours on the counter. This will mold it into whatever shape you want.
  • Heat up your cooking container (dutch oven, oven proof pot, tray) as you preheat the oven.
  • Put parchment paper on top of the bowel and flip the dough out of the bowl onto the parchment paper.
  • Use the parchment paper to lower the dough into your hot cooking container.
  • Score the top and bake!
  • (Don’t forget to let it sit for an “hour” before you slice it… no matter how good it smells)
When you overproof dough (too long with too vigorous a starter) is gets REALLY liquid and REALLY sour. It isn’t worth trying to salvage it.

It’s an art. Everyone has bread that bombs.

Don’t worry! Just keep the starter alive, regroup and try again!

If you find you are having issues with getting a good rise, it’s ok to put some dry yeast in as “insurance”.  Poilâne’s famous sourdough includes it as part of the recipe, so it can’t be a “failure” in the sourdough world!

Comparing stater activation between white flour (dotted line) and whole wheat (solid line)

What to study next

If you are reading this, there’s a good chance you are Type A. You’ll probably get a notebook and treat this like a science experiment … like I did. Go for it! It turns out that even though sourdough bread has only 4 ingredients (starter, flour, water, salt) there are lots of variables that can affect the loaf e.g. temperature of the water, humidity in the room, etc. There is real joy in paying this much attention while creating something that is so sustaining. On the other hand, if this doesn’t make you happy, just make the bread!

Did I mention?… it’s not just bread…foccacia, pizza dough, pancakes… just wait until you find all the cool things you can do with sourdough starter and discard!

Blogs and websites that have helped me a lot

King Arthur Flour – Sourdough Baking: The Complete Guide  (Check out their blog, too)

The Perfect Loaf

Here are some of my favorite books so far (all links are to independent bookstores)

Artisan Sourdough Made Simple, by Emilie Raffe

Do/Sourdough/Slow bread for busy lives by Andrew Whitley

The Tassajara Bread Book

Poilâne by Appolonia Pouilâne

Starter Sourdough: The Step-By-Step Guide to Sourdough Starters, Baking Loaves, Baguettes, Pancakes, and More 

I wish you mindful baking and joy from your sustaining and delicious bread!

*There is a tradition of naming sourdough starters.

A letter to my car dealership – Your business scared me today (so I have some COVID19 advice for you)

As a longtime customer of your dealership, a physician, and a concerned citizen I wanted to reach out to you to talk about the experience I had today when I picked up my car. Please know that this is not an attempt to complain – it’s an attempt to explain – and hopefully make you, your family, your employees and your customers a little safer.

I woke up this morning excited I’d be getting my car back today! Since I realized I didn’t want to expose or be exposed to anyone that wasn’t necessary, I called ahead to pay online (thank you for making that possible!). But, once I got to the dealership… well, it just wasn’t safe.

I stood outside while someone went inside to start the process of checking me out … and here’s what happened – which is what prompted me to write you this letter:

  • I watched as one of your customers, who was clearly in at least two, if not more, high-risk groups walked up the ramp. She was passed by an employee coming down the ramp, who passed her shoulder-to-shoulder. The employee’s mask was on their face, but below their nose.
  • I watched as the service folks checked in two people who both had masks on properly (as did your employees). But they walked up to them and held out their hand to take keys, which meant they were within 2-3 feet of each other.
  • The service employee who checked me out came out with papers and then handed me a pen – which I suspect they had been using all day – and stood right next to me. When I shook my head and asked if there was another way to do this, they said “I can get you hand sanitizer”… and then “We know it’s coming again.”
  • When my car was returned to me, the employee who drove it up to me had a mask on – around their neck. The windows were up and there was no smell or sign of any disinfectant. They walked up to me (2 feet away) and reached out to hand me my key (which I put into a ziplock bag I had brought for this purpose).
  • As I was leaving, an employee walked by with their valved mask on… around their neck. Two strikes! These valved masks are being sold because it’s “easier to breathe” but that’s because all the air you breath out escapes… with the virus. So, they have no benefit at all.

Let’s break this down… and I hope this will help you and other businesses to think about this in a way that makes sense. We all want businesses to open – and stay open! So working together to prevent more spread of this deadly virus just makes sense. What’s making this hard for some people is how politicized this has become. But, it’s important to know that this virus doesn’t care how you vote or what you think. This is just medicine, science and common sense.  

The official CDC recommendations can be found here, but here’s how I would translate them for your employees i.e. what I would post somewhere if I were in your shoes:

Assume everyone you meet has COVID19

Unlike other viruses, you can be infected for up to 6 days before you feel sick. During that time, you can infect other people. Which means that everyone you meet could be infected… whether or not they are ill. If there is nothing else your employees remember, they should remember this.

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If anyone with COVID 19 coughs on their hands, touches something and then you touch it (followed by touching your face), you can become infected.

This is not the primary way this virus spreads but it can spread this way. (This is why it was so upsetting to be handed a pen.) I also wish the person who returned my car had a spray bottle of disinfectant with them. I sure would have felt better if they got out of the car, sprayed down the seat and steering wheel and then wiped it off. Oh, by the way, once COVID19 is on a surface (depending on what the surface is made of) it can last for up to three days. That’s why it’s so important to disinfect surfaces frequently and wash our hands after we touch anything that hasn’t just been disinfected.

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If anyone with COVI9 talks, yells, speaks, coughs or sneezes in a closed space, the virus can hang in the air for up to 3 hours. If you walk into that space during that time, you can become infected.

I can’t think of a worse closed space for COVID19 than inside a car! It’s true for any room, including your office space, but this is why I was perplexed when the person who returned my car didn’t have their facemask on. This is also why there is a “6 foot” rule and why we wear masks. (By the way, it’s not either-or, it’s both). We wear masks to protect others, not us… which means if we all do it, we’re are all protecting each other. (That’s also why you shouldn’t let any employee wear a valved mask) We stand at least 6 feet away from each other because the viral load will be much lower if we are talking to someone who is infected. By the way, the aerosol an infected person produces when they sneeze can travel up to 20 feet … and, remember, those viral particles can remain in the air up to three hours.

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Most of us will probably be infected eventually, but that’s not relevant.

I understand that in the face of such a terrible disease there is a tendency to just throw up your hands. I’m sure that’s why your employee told me “We know there’s another wave coming”.

But here’s the deal – every day we postpone any one of us getting COVID19 (or preventing it, if all goes well!) is one day closer to a vaccine.

With every day that goes by, we also understand more about COVID19 and how to treat it… so the odds of not needing the hospital, ICU, or morgue goes up.

For every case we prevent, we are actually preventing many, many more cases because of how this spreads.

There’s also the part about just being a good person; You don’t want to be the person who bends the rules, gets sick and then infects family, friends or customers.

You have a wonderful dealership and I will continue to be an enthusiastic customer. Your service is incredible, your employees are kind. Stay safe, stay well, and thanks for giving me an opportunity to share this information with you and for others.

Sincerely,

Mary L. Brandt, MD

Loving Us Back to Together

I have such sorrow, such a heavy heart. How, on the same day we mourn those who died fighting for our freedom should we have to mourn 100,000 mostly preventable deaths from #COVID19?

Link to video of the NYT front page

How can people justify gathering together like this party in Missouri?

Parties like this will almost surely lead to COVID19 infections…. and deaths. Probably not death for the people who attended parties like this one, but the death of their grandparents, their friends recovering from cancer, the doctors and nurses who see them and take care of them when they fall ill from COVID19.

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This is not hard. COVID19 is a very infectious virus that spreads between us when we breath, cough, sneeze or sing near each other. We just have to decrease the time we are together, the distance between us, and cover our nose and mouth when we are with other people if we want to protect each other.

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Disregarding the science behind how to deal with this pandemic is like standing in front of a burning building and telling the firefighters as they arrive that there isn’t really a fire.

There is a fire, friends. It will stop eventually, as we get better and better at treating and preventing the spread of COVID19, but for right now… our house is on fire.

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I recently listened to the first episode of Nadia-Bolz Weber’s new podcast ““The Confessional”. In that episode, she interviewed Megan-Phelps Roper who grew up in the Westboro Baptist Church. Megan’s “job” for the church, along with picketing synagogues, the LGBTQ community and the funerals of American soldiers killed in the Middle East, was to use Twitter to spread the hateful beliefs of the church. And boy was she successful.

But then something changed. Instead of being yelled at on Twitter by people who (justifiably) found the behavior of the Westboro Baptist Church abhorrent, she was befriended by someone who was kind to her. I’ll let you read this article, her book, or listen to the podcast, but through the kindness of her new Twitter friend she was able to have space to think without being judged… which led her to a place of love rather than hate.

As I thought about the angry responses to some of my recent Twitter posts, some of which I can’t even share here because of the language, I realized that “yelling”, in person or online never leads anywhere. If we are to get through this time together, and alive, we have to be kind to each other – in person and online. We have to see through the rhetoric and understand that anger often comes from a place of fear. We have to acknowledge that we are all afraid… and that we are all in this together.

Wear your mask. Stay home when you can. Stay at least 6 feet apart. And, please… be kind.  

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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.

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#CareForTheHealers – “Guard Your Spirit”

Taking care of patients in this time is beyond stressful. I’m keeping my eye out for anything that might help support healers of all kinds. This was sent to me today and I found it profoundly helpful. Take 5 minutes to listen to this amazing professor, pastor and friend.

This video was made for the students of Illiff School of Theology by Dr. Cathie Kelsey. Although the specific examples she uses are from the Christian faith, the practice she teaches in this video can use text from any religious tradition, or no religion at all – perhaps a poem, a quote, or an inspiring song?

The Importance of Ritual in the time of #COVID19

If you are a healer (which I think is much better than ‘provider’, right?) you are going to work afraid, and you come home afraid… which is completely normal. Being brave doesn’t mean being fearless, it means doing what is needed despite the fear.

But in this fearful time and with the incredibly important work you are doing, it’s important that your home becomes a sanctuary, a safe place where you can let go of a little of the fear.

Let’s start with banishing #COVID19 from your home.

I know that the chances you have any virus in your house is slim to none, but let’s start with a (literally) clean slate. If you don’t have one of the commercial products known to be effective against COVID19, mix up a dilute Clorox solution (4 tsp bleach in a quart of water). Put it in a spray bottle, use a rag, but clean all the surfaces in your home. Be deliberate, be excessive, be sure that you’ve gotten all the surfaces that you might have touched.

Then the ritual

When you come home from work, the first thing you should see is a sign on the door you enter. It should be a reminder that you are loved, that you are appreciated for your bravery and your work … and that the first thing you should do is wash your hands!

Take off your shoes

If you have on the shoes you wore in the hospital, take them off in the garage before you go into the house. You may want to consider having a pair of shoes you leave at the hospital, but what ever pair is on your feet when you get home, leave them in the garage or at the door.

Wash your hands

Without touching anything in the house, go to the closest sink and wash away the day. 20 seconds. Soap. All the surfaces of your hand.

Turn on some music

Whatever inspires or soothes.

Take a shower

This really isn’t about decontamination, it’s more about ritual. Wash off the day – literally.

I’s important that your home feels safe to you when you come in from doing the hard work of caring for others.  Following this ritual (or your own variation) will help sustain you.

Stay safe friends, and keep looking for joy. #EyesOpen

#EyesOpen

Like you, I’m surrounded and sometimes overwhelmed with the fears and anxieties of the COVID19 pandemic. The world seems so very fragile and vulnerable right now. This morning was tougher than usual for some reason. So…. I got out of my chair, put on my shoes and went for a walk trying to look, with eyes open, for things to sustain me, connect me and provide solace.

Here’s what I heard on my walk …

A virtuoso mockingbird singing to the world (and, I assume, a few cute nearby mockingbirds), six different languages from people walking near me (I love Houston!)… friendly “hellos” from almost everyone I passed (all more than 6 feet away)…

Here’s what I saw on my walk…

A magnificent tree that I had never really noticed before… a family rescuing a caterpillar from the street with a stick… small purple flowers in the grass… kids on bikes… a butterfly garden in a “pocket” prairie…

Here’s what I learned …

Fear is gone when gratitude is present. They can’t be present at the same time.

It’s therapeutic to spend a little time with your #EyesOpen, preferably outside.

If you are a healer, thank you for what you are doing and stay safe. I’ll hold you in the light.