When a Thought Won’t Let You Go

We’ve all been there (yes, all of us). Something happens and we can’t stop thinking about it. It can be a complication, a misdiagnosis, something that happened in a toxic work environment, a failed exam, a harsh word. Not being able to let go of these thoughts means you are a normal person who cares… but it is not comfortable.

It will stop. At the time you are caught in the spiral of rumination, it seems unending. But it can’t and won’t last forever.

You are not your thoughts. There are your thoughts (and this annoying thought in particular)  and then there is “you”. Hold that thought (then see below).

Don’t make it worse by yelling. It’s human nature to try to push an uncomfortable thought or image out of your mind. But it doesn’t work. Yelling at yourself (in your mind) because you are not able to move past the thought/event makes it even worse.  

Get curious. Berating yourself makes it worse, but there is a way to disarm the thought and even make it go away:  

When the thought arises, just notice it. 

Wait….if “you” are noticing it, then the thought isn’t  “you”.

Exactly. 

Every single time the thought arises, say to yourself “I’m thinking about it again.”  But – and this is the most important thing – when you notice that the painful thought is back, you have to notice it without judgment.  Not… “I can’t believe I can’t let go of this thought.”…or “Something must be wrong with me.”… Just “There it is again.” 

Image from multiple internet sties

Mindfulness. The practice of noticing without judgment is called mindfulness. There are good data that an informal practice of mindfulness helps when we find ourselves with a thought that won’t let go. A daily practice helps even more. Set aside just 10 minutes and sit still. Just notice everything that comes up, acknowledge it, and don’t judge. Ditto for the next thought, and the next, and the next…

Here are some links if you’d like to learn more about mindfulness:

If you only read one thing about mindfulness, make it this book: The Miracle of Mindfulness: An Introduction to the Practice of Meditation by Thich Nhat Hanh

Headspace is a fantastic app to help you learn mindfulness

Mindfulness for Beginners from Psychology Today

National Suicide Prevention Lifeline 800-273-8255. You are precious. You matter. Call if you need someone to talk to.

Shoes to Wear in the Hospital (And Other Tips for Your Feet)

Working as a surgeon for as long as I have, trust me, I have learned the agony and ecstasy of foot care. After a long case or after 24 hours on my feet it’s the agony. But I’ve learned how to make my feet happy… and I’ve learned that it’s not that hard.

Photo credit

Shoes

The ideal hospital shoe has a wide toe box, is flat, laced (I’ll get to clogs in a minute), lightweight, slip-resistant, fluid resistant, and can be thrown into the washing machine. You can expect to spend around $100 for these shoes. Don’t get cheap shoes – spend the money!

Although many running shoes meet these criteria, my current favorite shoe is from Merrell, which has been a go to company for me for years. The other major contender right now for favorite hospital shoe among medical students and residents is All-Birds.

Even though I wear lace up Merrells most days at work, I love clogs when I operate. They let me back my feet out of them and lower my heels to stretch my calves.  I can kick them off and stand barefoot for a while if I need to change the pressure points on my feet. I had Dansko clogs for years, which are almost a tradition for surgeons, and then changed to Merrell clogs (which are pictured above)  Although they are great for standing, the problem with clogs is that your toes have to grip the shoe when you walk (or run to a code), which means they aren’t the best shoes for the rest of your day.

Here are some other options beside running shoes, Merrells, and All-Birds to consider. If you have tried these or have other shoes I should add to the list, please let me know!

Atoms – Great reviews and an amazing story about the owner of the company

Bala Shoes – designed by nurses with consideration for structural differences in women’s feet

Birkenstock shoes

Brooks Addiction Walker

Casca Shoes – This is an interesting company that offers custom fit and a variety of options

Clarks

Columbia Tamiami

New Balance Slip Resistant 626v2 work shoes

Timberland TrueCloud

TropicFeel

A note about high heels…

There is practically nothing worse for your feet than wearing high heels. (Sorry if you love them). If you wear them, please wear them only for special occasions and keep the heels as low as you can. If you are wearing heels in the hospital because it hurts to not wear heels, that’s a huge red flag and you need to really work on it.

Socks

When John Wooden, arguably the most famous coach in the NBA, starts the season by teaching his players how to put their socks on correctly, you can bet it’s important. Don’t skimp on socks. Buy good socks that fit well and take time to put them on correctly.  

Compression socks have the potential to change your life. Ok, maybe that’s an exaggeration, but this is one thing I wish I had started earlier in my career. It’s not clear that they do anything to prevent the occupational hazard of varicose veins, but boy do they make your legs feel better at the end of a long day.

Make sure you throw an extra pair of socks in your call bag. There is nothing that feels better than taking your shoes and socks off after 10-12 hours,  massaging and stretching your feet (if you have time) and putting on new socks before the second half of a 24 hour call. BTW, the same is true for shoes. Swapping out shoes (if you have two good pairs) is also really nice for your feet during a 24-hour call.

Foot stretching and massage – every day

A friend recently lent me this book which is written by Katy Bowman, with the help of 4 “goldeners” (all older than 70) about what they wish they’d known about caring for their physical wellbeing. Feet are literally the foundation of our musculoskeletal “chain” and unhealthy feet not only hurt, they can affect the function of your kness, hips, and back. Here is the routine recommended in the book to care for your feet. It only takes about 10 minutes and is something you will look forward to doing at the end of the day since it feels so good.

  1. Dorsal foot stretch. Put the top of your foot on the floor and stretch your toes and ankle. Hold it at least 30 seconds and repeat it at least three times. If you get bad cramps (which is normal if it’s tight) it just means you need to keep doing it. Let the cramp subside and start again.
  2. Sole of the foot stretch. Buy this foot massager (or one like it) right now! Stand on it to to stretch and massage every single square centimeter of the sole of your foot. You’re welcome.
  3. Toe circles. Grab each toe separately, pull on it a little and then move it in a circle (both ways) for several rotations.
  4. Toe stretches. Pull each toe away from each other (medial to lateral) then put your fingers between the toes and leave them there to continue the stretch
  5. Toe lifts. Lift your big toe first and work your way up to lifting the other toes as individually and as high as they let you.

As an alternative, if you want a guided yoga practice for your feet, check out this video from the amazing Adrienne Mishler.

Pedicures and Ingrown Toenails

Every time you take a shower, look at your feet with intention. If you have calluses use a pumice stone to take off the layers of dead skin. Don’t let your toenails get out past the end of your toes and never cut them in a curve like you do your fingernails. If you start to get an ingrown toenail, soak your feet twice a day, dry them well, and then wiggle dental floss under the corners of the nail. Leave the dental floss in place until the next time you soak and then put another piece under the corner of the nail. Continue doing this until the nail grows out enough to be cut straight across. Since toenails grow about one millimeter a month, plan on it taking at least a month.

By the way, if you’ve never had a professional pedicure, ask around to find a good place and try it. It’s not just for women, so if you are a man who has never tried this, step out of your comfort zone (no pun intended) and try it at least once!