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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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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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,

You’ll never buy stock again

This may be one of the easiest kitchen tricks I’ve learned in the last few years.  I haven’t bought any stock since I figured this out. It saves money, but more importantly, this stock tastes MUCH better than anything you can buy.

Step 1:  As you peel, chop, and otherwise use any vegetables for recipes or salads, save all the pieces you would normally throw away.

The vegetables that help the most with umami (and make your stock great) are the classic mirepox (carrots, celery and onion), garlic bits, and mushrooms.  There are a few vegetables you should avoid using for stock. Some vegetables will make the stock bitter or impart a strong, very specific taste that may not work in some recipes (e.g eggplant, turnips, cilantro, ginger). If you happen to be someone who buys Parmesan cheese with a rind, those rinds are wonderful in stocks. If you use fresh herbs when you cook, make sure you throw the stems in the stock. 

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Step 2:  Keep a big ziplock bag in the freezer and toss the washed bits you saved into the bag.  When you drain beans, tomatoes or other vegetables from cans, put the juice in the bag, too.

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Step 3:  When the bag is full, put the frozen vegetable bits in a big pot with water to cover them, bring to a boil and then simmer for about an hour.

 

If you have an Instant Pot, you can make stock in less time.  I don’t add salt while making the stock because it lets me season the dishes I make to taste.

 

 Step 4:  Freeze the stock you don’t use in a day or two.

 I usually freeze my stock in 1-2 cup plastic containers.  Alternatively, use freezer bags if you want to take up less space in your freezer (Push the air out of the bags and lay them flat on a cookie sheet to freeze).  Another trick is to freeze the stock in ice cube trays or muffin tins and then put the frozen stock in freezer bags.

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In addition to recipes, use this stock instead of water when you make rice or grains. Thaw your stock in the refrigerator (if you remember) or in the microwave (if you don’t).

We eat a mainly plant based diet, so I only make vegetable stock.  If you eat meat, you can save the bits from the meat or fish you cook – or ask your butcher for stock worthy bones and add them to the vegetables to make great chicken, beef or seafood stock.  If you want perfect chicken or beef stock, you may have a bit more work to do… 🙂

Enjoy!

 

 

Hate cooking but want to eat better? (By the end of this post I bet you buy this app!)

It is hard to eat well when you are a medstudent, resident or busy doc (also true for busy people not in medicine  The key to eating well if you are busy is planning.. but it takes time.  As I’ve written before, here are the basic steps that you need to follow to eat well if you are “too busy to cook”.

  • Use a calendar to organize which days you need to have dinner ready
  • Find the recipes you want to cook
  • Fill in the calendar with what you will take to work for lunch and your planned dinners.
  • Make a shopping list.
  • Shop once, then follow your plan

To follow these steps, I’ve used the internet to find recipes, Evernote to map out the week, and Grocery IQ for the shopping list.  I’ve gotten pretty efficient, but it’s still takes a non-trivial amount of time… and who has that kind of time, right?

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And then I read Jane Friedman’s post “My Must-Have Digital Media Tools: 2018 Edition” and I saw this…

I was skeptical, but I downloaded it.

Here’s the bottom line… this app is “expensive” ($25).  But I promise, even if you are medical student without much money, it will be the best $25 you’ll spend this year.

Here’s why – this app takes the five steps listed above and puts them all into one place.  It not only makes it easy to choose recipes, plan your week and shop, it almost makes it fun.  Here’s how:

Use a calendar to organize which days you need to have dinner ready.

Start on the “meals” tab and put notes in for your week.  If you share cooking with a significant other or roommates, you can share the account with them so everyone is (literally) on the same page.

Find the recipes you want to cook and put them in the calendar for the week

Click on the browser tab to find new recipes.  As you gather recipes in the app, it becomes your  own personal “cookbook” which is searchable by category, name, or  ingredients.

Fill in your calendar with what you will take to work for lunch and your planned dinners.

This was the first moment I knew I was really hooked.  All you do is drag and drop the recipes you want into the appropriate day.  Wow.

Make a shopping list and go shopping.

This is when I was completely sold.  When you pull up the recipes you’ve chosen, there is a little “hat” icon at the top:

When  you click this icon EVERYTHING IN THE RECIPE appears in a shopping list.  Unclick what you don’t need and repeat for all the recipes.

Because this app is on your computer and your phone, just take your phone with you to the grocery store.  As you pick up the item, click the box next to it and move on to the next item. If you are sharing the app with your significant other or roommates, anyone can add to the grocery list or unclick things they have bought.

 

 

Here’s the official website for Paprika: https://www.paprikaapp.com/.   Enjoy your healthy eating!!!!  Try this plan (instead of the bagels, pizza, peanut butter and other “free” foods in the hospital) for a week or two.  I promise you’ll feel better, learn better and have more energy to take good care of your patients.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How to Succeed in Clinical Rotations (and residency, too)

Today I have the incredible joy of talking to the medical students on our rotation.  No agenda, just a conversation that they requested for some “advice”. They just started their surgery rotation last week and it’s their first rotation.  First rotation, beginner’s mind, unbridled enthusiasm… it is so wonderful!. I decided I would come up with what I wish someone had told me at the beginning of my rotations…

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Be mindful, deliberate and excited about learning.

This is probably the most important piece of advice I can give.  Clinical rotations are often a whirlwind of work and you can be swept away without realizing it. Residents can ignore you, people can be cranky, patients can be difficult… and in the midst of all this, you are expected to learn to be a doctor.  You have to stay in charge of that mission, no matter what is happening around you.

Take a little time to reflect on why you are doing this and what kind of person/doctor you want to become.  When times get tough (and they will) hold on to it.  If it helps you, come up with a slogan to repeat, keep on a piece of paper in your wallet or on your wrist

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Learn about the practice of mindfulness.  Mindfulness has been shown to be effective in decreasing stress and may help to prevent burnout.  It’s not hard to learn, but it’s hard to master … which is the point of a “practice”. (e.g. the practice of medicine)

Learn to keep a “beginner’s mind”.  When I was a student on core medicine I had a senior resident that showed me what beginner’s mind looks like.  It was 2am and I was tired.  We were seeing a gentleman at the VA hospital for his diabetes, hypertension and some electrolyte abnormalities.  I presented the patient to the resident and then we went to see him together.  He had a rash, which I thought was so insignificant that I didn’t even include it in my presentation.  But, instead of scolding me, this resident got excited.  Yes, you read that correctly, 2am and excited about a rash – because he didn’t know what it was. (This next part will date me, but it’s a great example to make us grateful for the access we have to information now).  He called security and had them open the library.  We spent a wonderful hour looking through books – like a treasure hunt when we were little kids – until we found the rash in one of the books.  We were laughing, excited and couldn’t wait to get back to start the appropriate therapy.

 

Understand what you are going to learn (the big picture)

On every rotation, you will be given a list of learning objectives.  By all means, know them, study the things listed and make sure you know them (they will be on the test).  BUT… please realize that diseases don’t stay conveniently siloed in a single specialty so this is not learning “surgery”, it’s learning about how surgeons approach a specific disease you will see elsewhere, too.   You also need to know that what is listed as learning objectives today may well be obsolete tomorrow  (if they aren’t already).

You have chosen a career that ethically demands life-long learning.  That means that one of the most important skills to learn is how to develop a system of learning that you can use in medical school, residency and later in practice.

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Develop a system for lifelong learning now

Learning is iterative.  You will learn broad concepts on each rotation along with a “fly over” of the entire terrain of the specialty  You will need the information you learn on your surgery rotation on your medicine rotation when you are consulted on a patient with an ischemic leg who needs surgical treatment, or on your pediatrics rotation when your patient with a pneumonia develops an empyema.  If you choose surgery at your career, you will read and learn the same topics throughout your residency (and after) but with increasing depth.

The practical points on how to develop a system to learn during your rotation are here: How to Ace the NBME Shelf Exams: How to Ace the NBME Shelf Exams, In-Training Exams and Your Boards, but the key points are summarized below:

  • Remember it’s school.
  • Make a list of all the topics in the textbook.
  • Breathe deeply. You are not going to read every page in the textbook in addition to your assigned reading.
  • Create a schedule to SKIM every chapter
  • TAKE NOTES. All the time.
  • Figure out how to store your notes so you can find them in the future
  • Go through your daily notes in the evening and then store them in your system
  • Review, review, review

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Take care of yourself.

Pay attention to ergonomics, diet, exercise and sleep.  Most importantly, take care of yourself emotionally and spiritually.  You can’t learn or serve others if your tank is empty.  Come up with what is important for you and make a list.  Seriously.  Make a list of what you find helps you stay on track and then check it off every day.  Look at it before you go to bed.  Celebrate the things you did and don’t be hard on yourself for the ones you didn’t get to.

Don’t forget to take a “Sabbath” every week.  True time off is critical for recovery from this stressful work.

If it gets too hard, seek help.  It’s a sign of strength, not weakness, and most (if not all) of the people around you have been there.

We have the most amazing job on earth.  When the administrative issues or political conflicts get to you (and they will), just remember – you get to take care of another human life with the goal of relieving their suffering.  What could be more important than that?

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