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Gifts for Healers

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

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

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

Wake up too early

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

Caffeinate

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

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

Drive to the hospital

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

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

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

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

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

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

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

Spend an inordinate amount of time entering data into a computer

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

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

Photo by Mary Brandt

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

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

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

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

Afternoon rounds

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

A “Something or nothing” workout

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

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

Some studying

Link to How to Succeed in Residency: Studying

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

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

Some decompression, socialization

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

Dinner at home

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

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

Sleep

Sleep is foundational.

Sleep is foundational.

Sleep is foundational.

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

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

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

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

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

Diagnosis, Discernment, and Birding: Part 2

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

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Next step – get on the internet. 

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

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

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

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

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

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

“You know, we are both doctors…”

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

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

from The Making of a Diagnostic Mind by Alexandra Sifferlin

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

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

Designed by John Manoogian III

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

Photo by Mary Brandt

Birding is about healing ourselves

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

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

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

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

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

audubon magazine

Discernment is about healing the world 

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

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

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

Joan Halifax

Mac and Cheese to Heal the World, the Awe of Space, and Spring Migration

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I love it when I discover someone working hard to help heal the world. The byline of Dadbriefs.com, where Slade Wentworth shares his work, is “Food. Fun. Fatherly Wisdom. Recipes for Resistance” – which perfectly encapsulates this funny and inspiring site.

Check it out. It will make you think, it will make you smile, and it may propel you into the kitchen to cook something wonderful for your family and friends. 

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There’s something deeply American about mac and cheese. It’s comfort. It’s family. It’s the thing you make when you want everyone around the table to feel safe and cared for…That’s exactly the feeling I want for every kid sitting in a classroom in this country. Safe. Cared for. Set up to succeed.

slade wentworth

Here’s another wonderful site to add to your list if you need a daily dose of awe (and who doesn’t?) …

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Astronomy, as nothing else can do, teaches men humility.

Arthur C. Clarke (1917-2008):

It’s the beginning of spring migration in the Northern hemisphere. At its peak there will be hundreds of thousands of birds flying over you, mostly at night. 

Birdcast.org is a wonderful site from the Cornell Lab of Ornithology (also the makers of eBird) that provides data and tools for you to wonder (and feel wonder!) about this beautiful spring event. 

“may my heart always be open to little birds who are the secret to living”  

e. e. cummings

Medicine for hard times, Al dente music, and Pasta heresy

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Medicine for your soul 

Music, poetry, and art can be medicine for unsettling, violent times. Take a moment to seek beauty today (and every day). It will help to settle your soul in the face of what we are all experiencing right now.

Free access to 60,000 works of art in the National Gallery. They also have a wonderful Chrome extension that randomly chooses a piece of art to display anytime you open a new tab on your computer.

Poem of the day from the Poetry Foundation

#CareForTheHealers, a playlist started during COVID but that seems appropriate now, too.

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Al dente pasta

Today’s delightful trivia… Barilla has Spotify playlists for each type of pasta they make that can be used as a timer for that specific pasta. 

While we are on pasta….

Since good food (and especially pasta) can also be good medicine… Have you discovered this technique? 

You can cook pasta in the sauce (or just a little water) without having to boil a huge pot of water.

Click here for the recipe – Jamie Oliver’s one pan pasta al limone

Click here for the recipe – Single Skillet Spaghetti

Joy is an Act of Resistance

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“Where there is cake, there is hope. And there is always cake.” 

Dean Koontz

Hard times call for sweet things, particularly if they are easy to make and really, really good. This week I had a small culinary epiphany… Clafouti, (which is one of my favorite desserts ) is a cousin to the delicious dessert known as a Dutch Baby as well as a new favorite dessert of mine (and Christopher Kimball), Pan de Elote.

What they have in common is that they are all “blender cakes”.

Here’s the basic blueprint – a little bit of flour (of your choice), some eggs, some liquid, a sweetener (as much or little as you want) and various flavorings. They all go into a blender before being poured into a pan to be cooked.

So easy.

So fast.

So delicious.

You’re welcome!

Here are the three blender cakes I’ve cooked and can attest to…

This is my favorite clafouti recipe. Clafouti is traditionally made with cherries, but berries, pears and other fruits work well, too. I often add nuts (usually slivered almonds) as well.

Source (and a different recipe for Dutch Baby pancakes)

A Dutch Baby is almost identical to a clafouti in terms of the ingredients, but you add the fruit afterwards. Here’s the NY Times recipe for a classic sweet Dutch baby. You can also make a savory Dutch Baby if you are looking for a fast dinner.

Photo source – https://muybuenoblog.com/mexican-skillet-corn-cake/

And then there is the life changing, amazing Pan de Elote or “Mexican Corn Bread”. (which has nothing to do with the cornbread most of us know). My favorite recipe for Pan de Elote calls for fresh corn, but frozen or canned work well, especially for those of us who don’t have a lot of extra time to cook.

Here’s a few more blender cakes that look easy (and fast) that are on my list to try!

Whole orange blender cake (yup, skin, seeds and all). It goes without saying that whole lemon blender cake exists, too.

Vanilla blender cake is basically a sponge cake, but most recipes say it has the moist crumb of Japanese sponge cake (which is not at all a problem!)  Adding fruit like peaches or bananas is an option, too.

Photo source

Bolo de Cenoura (Brazilian carrot cake) No carrot grating required, usually topped with chocolate… what could go wrong?

It’s not just dessert… Joy is an act of resistance.

Photo source

Ash Wednesday (for those who practice and those who are curious)

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It may have been different for you, but as a child Lent was never explained to me in a way that made sense … and I had lots of questions: 

  • What is a Liturgical year??? (I grew up in a Protestant church so this was never really explained)
  • Why 40 days? (except it’s really 46?)  
  • Why do we call it Lent? 
  • Why “give up” something? (And why is chocolate always on the list?) 

The Liturgical Year

Like the seasons,the structure of Christian (and most other religious) worship follows the solar year. Not surprisingly, the Christian calendar has its origin in the Jewish calendar, which revolves around the Sabbath (the origin of our week) and Passover (once a year in the spring, which set the annual cycle of a year).

From before the time of Christ, the GraecoRoman world kept Saturn’s day (on what we now call Saturday) as the first day of the week. Since no other origin can be traced for the seven-day cycle, it would appear that they adopted the week from the Jewish system. The Romans did not, however, name the other days of the week definitively until the third century of the Christian era.” (The Liturgical Year – It’s Story, 2000) 

Prior to the 4th century, there was no “liturgical year” as we know it now… there was only Easter (which like Passover, has a date decided by the lunar calendar). The very early church (the first 200 years) fasted to prepare for Easter, which is the practice that led to subsequent Lenten practices. 

Shared by Deacon Art Bass on Facebook

The origins of “Lent”

In 313 CE Constantine, the emperor of Rome, announced that no longer would Christians in Rome be persecuted. In fact, having seen a vision of a cross on a shield in battle, he converted to Christianity and made it the official state religion of Rome. (And, as we say… the rest is history)

Prior to that time, it was not easy to be a follower of Christ. In 217, Hippolytus described what it took to become a Christian. “After being carefully screened, candidates were admitted to a three-year period as “hearers of the word.” As well as attending their own sessions of instruction, they were permitted to be present at the liturgy of the word, but not for the prayer of the faithful or for the eucharist (II, 16-19), participation in which is the privilege of the baptized members of the community.” (The Liturgical Year, Canadian Conference of Catholic Bishops, 2017)

It was only after three years of intense study and discipline that new Christians could be baptized – which always took place during the celebration of Easter. This was not a trivial decision. Those who chose to follow Christ during the first 3 centuries risked persecution, torture, and even death.

 From Three Years to Forty days

It’s not surprising that after 313, when persecution of Christians was no longer permitted, that more people sought to join this new religion. It’s also not surprising that a) baptisms still took place on Easter and b) you still had to commit to study and discipline before you could be baptized. 

After the time of Constantine, however, the Church found itself in a world that was less openly hostile. Converts flocked in. Gradually the strict discipline of the catechumenate, which had been a three year process, was abbreviated to be totally encompassed in the six weeks of Lent. (The Origins of the LIturgical Year, Talley, 1991)

Why 40 days? When the Council of Nicea met in 325 CE they decided to formalize the preparation to match the recorded 40 day fasts of Jesus, Moses, and Elijah. 

Why Sundays are not included.

Sundays are considered a celebration of Christ’s resurrection, so they aren’t considered part of the 40 days of Lent (which is why it is actually 46 days)  

Why do we call it “Lent”?

Easter and Passover both occur during a window of dates that fall in the late spring (because they are based on the lunar calendar). The word “Lent” means spring: From Merriam-Webster dictionary. The origins of “Lent” are from the “Middle English lente springtime…from Old English lencten; akin to Old High German lenzin spring”

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If you are Christian (and especially if you have a Lenten practice) I hope this helps you understand why this isn’t about giving up chocolate. (Seriously). For those who follow other paths, I hope this will shed some light on some of the practices of those around you, practices that we don’t usually talk about.

Sourcehttps://christinesine.substack.com/p/spiritual-practice-clean-monday-shrove

p.s. About the ashes… Ash Wednesday is always 46 days before Easter. It’s a practice that was established during the 9th-11th century so there would be a clear beginning for Lent. It’s based on many Biblical texts about ashes being a sign of repentance. 

p.p.s. I’m not an expert… so if you are, please let me know what I’ve omitted (or misrepresented).

Passive Learning in Medicine

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Medical training is based on active learning – studying textbooks and articles, listening to experts, seeing patients, setting up procedures and then performing them, reading images, looking at slides. This kind of learning is straightforward – You do the task, get feedback (in a variety of ways), and then adjust to improve. 

I’ve never really thought about passive learning in medicine … until I learned about this recent study from the Institute of Neuroscience at the University of Oregon that clearly showed that passive exposure improves active learning (at least in mice).

Based on my experience as a medical educator, that rings true for medical students and residents, too. Watching experts do a procedure over and over won’t ever replace learning to do the same procedure – but it does seem to be a habit embraced by superstar medical students and residents (in addition to their deliberate and very active learning).

“The core insight here is appealing precisely because it’s so easy to act on. Passive exposure costs almost nothing. No extra willpower, no additional scheduled practice time, no special equipment. You just need to put yourself in contact with the material you’re learning.” 

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How can you add a little passive learning to your day (in addition to rereading and highlighting notes or listening to a recorded lecture)?

Just listen. The ideal way to take advantage of the didactic courses in the first two years of medical school (and subsequently in clinical rotations and residency) is to engage actively with the material during the lecture. (Yes, I’m serious… and here is how to do it). But if you find yourself unable to really engage it turns out that “just listening” (i.e. being a passive learner) isn’t a complete waste of time. You can also attend departmental Grand Rounds or other interesting lectures as a first year medical student (Most of them are before your classes start or during lunch). You won’t understand much… until you do (which is always exciting!) . You can find a list of these lectures on every hospital and medical school website (Here’s an example from Baylor College of Medicine). These are public lectures so you won’t be out of place. If anything, they will be delighted there are basic science students interested enough to attend. (p.s. there is often food, too…)

Just watch. “Shadow” in the first two years of medical school…ask senior students or residents (who will ask their attendings) if you can watch surgery, follow someone in clinic, or go on rounds with a team. When you are on a rotation, “just watch” surgeries that you aren’t assigned to (which is a lot easier in minimally invasive procedures because you can watch it on a screen). The same goes for “just watching” a pathologist looking at slides, or a radiologist reading images, etc. You can also take advantage of YouTube to “just watch” videos of procedures, how to do a physical exam, etc, etc. 

Passive exposure will never replace active learning (a really important point!) but just watching and just listening aren’t a waste of time… and may help make active learning a bit easier.

3.5% of us is all it will take (plus some words to soothe)

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“Nonviolent protests are twice as likely to succeed as armed conflicts – and those engaging a threshold of 3.5% of the population have never failed to bring about change.” (Robson, 2019)

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Take care of yourself

“There are no more ancient bookends than sunrise and sunset.  For millennia we have lived between their cycles.  We have come to internalize their rhythm.  Unconsciously we are aware of them even if we do not see them.  My ancestors taught that it was important to acknowledge these daily transformations: the promise of a new beginning and the invitation to a deep rest.  Hope and peace.  We live in the balance between sunrise and sunset.  We live between expectation and fulfillment.  I will greet the sun when I first see it and I will embrace the night when it comes quietly to claim me.  I will search for wisdom between the bookends of time.”

The Rt. Rev. Steven Charleston

Walk With Me

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This is the text of the sermon I was to give today. Like many churches in the path of this weekend’s severe winter storm, we cancelled our in-person services to keep each other safe. 

The text for these thoughts is Matthew 4:12-23, and, in particular, these verses: 

As he walked by the Sea of Galilee, he saw two brothers, Simon, who is called Peter, and Andrew his brother, casting a net into the sea—for they were fishers. And he said to them, “Follow me, and I will make you fishers of people.” Immediately they left their nets and followed him. As he went from there, he saw two other brothers, James son of Zebedee and his brother John, in the boat with their father Zebedee, mending their nets, and he called them. Immediately they left the boat and their father and followed him. Jesus went throughout all Galilee, teaching in their synagogues and proclaiming the good news of the kingdom and curing every disease and every sickness among the people.

The video at the end is meant to be played as an integral part of the sermon. 

The Calling of Peter and Andrew, Duccio, 1308-1311

“Follow me”

When Jesus spoke these words roughly 2000 years ago, he didn’t say them in English. I know that’s obvious, but it bears repeating. Jesus spoke Aramaic with his family and friends. He was able to read Hebrew, which was the language of the temple, and he spoke Greek, which was the common language of the Roman Empire (which is why the gospels were written in Greek). When the gospel according to Matthew was written, “akoloutheō” (ah-ko-loo-THEH-oh) was the word used for “follow”.

Akoloutheo is also the root of the English word “acolyte”. That association may help us understand what Jesus actually meant when he said “Follow me” because an acolyte is “a person who attends or assists a leader”. Its modern use is mostly related to the church; Acolytes are the people you see every Sunday preparing the communion table, lighting the candles, and carrying the cross. 

In other words, when Jesus said “follow me” to his first disciples, it wasn’t a metaphor. It meant “walk with me, assist me, attend to me”.  This sense of “hands-on” following is also present in the English word “follow”. In Old English the meaning of the word “follow” was to “accompany”. The word most likely evolved from the proto-Germanic word *full-gan, or “full-going”.

Understanding this etymology helps us with today’s reading. Because if “following” Jesus means to accompany him, to be “full-going”, to be completely invested, it’s asking for something more than most of us learned growing up in church. Because following Jesus is not just about “giving your life to Christ”, it’s about walking into the world led by a radical way of being that completely upends powers and principalities. It’s about full-on, hands-on, joy-filled discipleship to bring the kindom of God to earth as it is in heaven.

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Of course they dropped their nets and left everything behind. 

When Jesus said “follow me”, he was clearly instructing Simon, Andrew, James, and John to travel with him towards the kindom of God… But it also meant they could walk away from oppression. 

Fishermen on a Boat. Fresco from a House Located Near a River Port of Rome. 131 AD.

Fishermen in the first century Rome weren’t what we think of today. They didn’t own their boats – and they didn’t own the fish they caught. Both their boats and the fish they caught belonged to the Emperor of Rome. When they hauled in their nets, the biggest fish went to high ranking Romans. Any remaining fish that could be sold were sold to make money for Rome. As a result, fishermen in first century Rome were as low in the social order as tax collectors. They were just collecting fish for Rome instead of coins. 

Of course they dropped their nets and left everything behind. 

They assisted him, attended to him, learned from him as he “went throughout all Galilee, teaching in their synagogues and proclaiming the good news of the kingdom and curing every disease and every sickness among the people.” 

Word spread quickly. Crowds began to gather.

People then, like now, were hungry for good news, sick of being oppressed and frightened, desperate to be healed. They lined roads to welcome him and sat in crowds gathered to hear his teaching. They offered places for Jesus and his disciples to stay and provided them food.

James Tissot (1836-1902), “The Multiplication of the Loaves”

Can you imagine what that would look like? 

It’s actually not that hard to imagine…because right now, in our country, there are crowds gathering to hear similar good news, crowds lining streets and gathering in schools and in churches to hear profound teaching on how to bring peace into our lives and the world.

For those who might not be aware, a group of Buddhist monks who live in Fort Worth left their home in October on a Walk for Peace. They are walking 2300 miles from Fort Worth to Washington DC… not to protest but to carry a simple message, one that resonates with the teachings of Christ – Peace is within each of us, a peace that passes all understanding… a peace that can heal the world. 

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Amen (May it be so.)