Lessons from the Pandemic: Richard Rohr, Walking, and Lawn Chairs

It’s almost impossible during times of stress to be motivated to do hard things. For all but the most hardcore exercisers, ice cream just seems more soothing than running when you are emotionally exhausted (Right?). I’m no different. But, as much as I would like to think “later” will be ok to regain what I have lost in these months of being more sedentary than usual, I have begun to realize that I needed to get moving again.

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Enter Richard Rohr

I’ve been a fan of Richard Rohr for years. He’s a gifted writer with the laugh and smiling eyes of someone who has tapped into something I want to know more about. I subscribe to his weekly email, which this week introduced Jonathan Stall’s practice of moving “as a way to invite brave creativity.”

There is a lot to unpack in that idea.

What exactly would “brave creativity” look like? I’m not sure, but it sounded like something I, and I suspect all of us, need more of right now.

“We invite you, as able, to take some time this weekend to move mindfully through your local area.”

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I set off on a different kind of walk.

I grabbed my mask and headed out for a walk in my neighborhood, trying to think about this not just as exercise, but as something more. I read Jonathan Stall’s advice again:

  1. Bring something to jot ideas down while you are out, but more importantly, invite your “goals/pains/dreams”  to join you on this walk.
  2. Walk for at least 30-40 minutes
  3. Wear a mask if you get within 6-10 feet of anyone (respect for your neighbor)
  4. Start the walk with a sense of being open. “As you begin to move, seek the realms of wonder, of space, and of reaching high into what’s possible…”

Where did all these lawn chairs come from?

I’ve walked many times before in my neighborhood, and I’m an observant person.  But today, as I walked, I began to notice all the chairs on people’s lawns and all the swings, and “tires” hanging from trees. 

Were they always here and I didn’t notice them?

Are more people sitting outside now than before – even though it’s outrageously hot here in August?

Is this because of how much we all need (safe) connection to each other during the time of pandemic?

Are there actually more chairs, swings and tires because of how much we all need to hear birds, see trees and listen to the cicadas in the summer evening right now?

Next steps?

Yes, there will be next steps. This experiment led me to more questions than answers, but I had a real a sense of being taught, too.  

Try it?

Let me know what you see.

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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.

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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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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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,

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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Resolve To Be Kind

I’m not a great fan of New Year’s Resolutions in general.  Like all of you, I’ve made them and broken them more years than not.  But that being said, I do think the new year is a time we should pause and take account of where we’ve been and where we want our journey to lead us.  Or, put a different way, we can use the transition to a new year to think about who we are and who we want to become.

So instead of the usual resolutions to lose weight, drink more water, exercise, etc – here are three “resolutions” for medical students, residents and physicians that may be easier to keep this year. (If you aren’t in medicine, I think they still apply.)

Be kind.

Deliberately reset your intention to be kind with every encounter you have with patients or colleagues. Don’t forget to be kind to yourself, too.

 

Keep up with every day tasks so they don’t weigh you down.

Clean out your medical records, record your cases, prepare food for the next day… whatever it is that will free up time and emotional energy. Make a list of these tasks with check boxes and keep it on your phone so you can see it often.  Clear the list every night to start over for the next day.  Celebrate what you accomplished during the day and have self-compassion for the things you weren’t able to do.

 

Take care of yourself – physically, emotionally, spiritually.

Be deliberate in the choices you make to take care of yourself. Don’t get overwhelmed by the pressure of wanting to do it all.  Know that some days will make it hard to exercise, eat right, be still, etc.  That’s ok, but don’t give up.  Make sure you do something for your own wellbeing every day.

The gift you give to others through your career is special – remind yourself often of the amazing work you do.   Take measures to sustain your career so you can continue give to others and have joy doing it.

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I wish for you all a New Year filled with kindness, peace, and joy!

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Top 10 Holiday Gifts for Busy People (including medical students and residents)

What’s the best gift for a medical student or resident (or any really busy person)?

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Seriously, anything that frees up time for them is the best present you can give them.  If it supports their health or decreases stress, it’s even better!

Here are my top ten choices for best presents for medical students and residents – or any really busy person:

  1. A service or person to help clean their home.  Once a month?  Once a week? Any time they don’t have to vacuum or clean the bathrooms is a true gift.

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  1. An Instapot. I’ve long been a fan of pressure cookers, but the Instapot takes it to the next level.  This is my new favorite kitchen tool and it’s high on my list because it both saves time and increases healthy food consumption!

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  1. A subscription to Headspace. This might seem counter-intuitive since it adds a 10 minute task to their day… but there are data (and lots of testimony) that a daily mediation practice “expands time” by decreasing stress.

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

 

  1. If they live close enough to walk or bike to school/work, think about something that might help them combine that commute with getting some exercise. How old is their bicycle?  How about panniers to store gear on a bike? Would a great backpack help if they are likely to walk?  How about a gift certificate to a bicycle shop?

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  1. A gift certificate for Whole Foods or any place near them that has good, healthy prepared food.

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  1. Cookbooks with quick but healthy recipes like Thug Kitchen or Mark Bittman’s How to Cook Everything Fast.

 

  1. A Roomba vacuum cleaner. Plus, they may go viral with a cat on a Roomba video if they have a feline roommate.

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  1. A gift certificate to have their car washed and vacuumed every few months.

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  1. If they are a coffee drinker who spends time stopping at Starbucks, think about a really good coffee maker. I prefer Nespresso because the pods are recyclable (and the coffee is delicious).

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  1. 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? Make an elaborate certificate with something you could do for them and wrap it as a present.

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Good advice I have gotten over the years…

Dr. Jennifer Dietrich, who is the Chief of Pediatric Gynecology in the Department of Obstetrics and Gynecology at Baylor College of Medicine recently showed me a list of advice she’d been given in the past. It’s a great list, so I thought I’d share it! 

  • Give important emails 24 hours for a well thought out response.
  • Say yes to the things you want to do and that make a difference in your career.
  • Find time to protect yourself.
  • It is ok to say no sometimes.
  • Ask for help if you have reached your limit.
  • Try not to bring work home or at least confine work to the weekdays and weekends you are assigned to be on call/on service.
  • Make an appointment with yourself to exercise, relax, go out to dinner, etc.
  • Plan each year to go to the dentist, doctor, address medical needs and protect that time.

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