Get in shape, meet new friends, AND help the environment?
Screengrab photo from here which I learned about here
Spogomi is a new “sport” where teams of people compete to pick up as much litter as they can in a specified time period.
“Some 53 million tonnes of plastic waste and 4.5 trillion cigarette butts are discarded on streets and landscapes globally each year. Japanese runner Kenichi Mamitsuka began scooping up some of them on his morning jogs in 2008, and soon hit on the idea of gamifying his public-spirited act to raise awareness of littering.” From this article
Cash to pay to talk to your doctor after hours?
“My father was on the phone for a long time with the nurse in his primary care doctor’s office working out a challenge with the timing of his various medications. They accidentally got cut off, so he called back… just after 5pm. The phones had been automatically transferred to the answering service and he was told that if he wanted to talk to someone he would have to pay in cash.”
I asked a few questions to make sure I had heard the friend telling me this story correctly (since I couldn’t believe what I had heard…)
Have you experienced this or know someone who has?
The size of life
I hope you enjoy this amazing work as much as I did. Thank you Neal Agarwal and Julius Csotonyi!!
It’s a hard morning in the world today, a morning that follows a series of hard mornings. I feel like we are being inundated with surplus suffering, that our world is carrying so much pain. But as much as we would like to look away, it’s not what this moment calls for.
We need to nurture hope.
Last year, Rebecca Solnit wrote this essay about the despair many of us are feeling.. .and what to do in response to that despair. She helped me understand how to respond to feeling overwhelmed by darkness, how to reclaim our agency so we can shine light into the world.
Hope is a discipline, not a feeling. Which means, like all disciplines, it can be nurtured by specific practices – telling the truth, showing up, being angry (and using that anger appropriately), courage, and using stories to restore ourselves and our communities.
Tell the truth. We don’t have pretend things are ok or try to gloss over the horror of blood on a beach after a celebration of light, in fact it’s a disservice if we do.
When we choose hope we become part of the movement that boldly looks hatred in the face and says out loud “Not this.” When we choose hope, we hold space for others so they, too, can begin to see the possibility of change.
Show up, don’t give up. Presence is far more powerful than most of us give it credit for. Choosing to not look away is a form of presence. So are vigils, cards written to console, protests, prayers, and quiet petitions.
First of all, hope does not mean saying this is not bad, and it does not mean saying that we can defeat it. It just means saying we will keep showing up. That we will not give up.
Be angry. Rebecca Solnit quotes Rev. Dr. Renita J Weems who reminds us that “rage is a form of prayer” because rage is not primarily about anger, it’s about the love and care that underlies that anger. Use the anger as fuel to carry out what love demands of you.
“The true soldier fights not because he hates what is in front of him, but because he loves what is behind him,” GK Chesterson once wrote, explaining why it’s so easy to lose sight of the prime mover that is love.
“Make your mind an independent republic of hope.” This may be my favorite of these disciplines. Human beings are hard-wired for fear. We can’t change our primitive (and protective) fears…but we can choose to override them. Said a different way – We can let ourselves be “colonized” by fear (which is almost always what lies beneath hatred and anger) or we can courageously choose to be “an independent republic of hope.”
“Hope it’s not something you’re born with, it’s something you make. It’s something you decide. And then it’s something you do. You get up every morning and you make it again. The next day you put it on just like you put on your shoes.”
Study the heroes. Remind yourself (and your fearful brain) that there are teachers of hope we can emulate. It’s not just about looking for masters of hope… There are heroes of hope everywhere. By all means read about the heroes of history, but don’t forget to look for small acts of heroism, too … acts of kindness or courage, signs of solidarity, courage in the face of oppression.
We learn who we are and our place in the world by telling stories. There is none more familiar or beloved than the hero’s journey, the tale of one who bravely decides to go into the unknown. It is a universal narrative, spanning time and culture. Yet as the spiritual writer Henri Nouwen once observed, “the most personal is the most universal, the most hidden is the most public, and the most solitary is the most communal.” Hearing another person’s courageous journey, we can’t help but consider our own.
Lay up stores of love, care, trust, community and resolve. The practice of hope, of refusing to give in to despair, requires great care. There are times when the darkness feels overwhelming, times when we all need to be able to access our stores of spiritual nutrition and support. Take care of yourself, build genuine community, and keep your moral compass in good working order for the times you will really need it. Make it a practice to collect stories of love, care, trust, community, and resolve, stories you can return to when your reservoir of hope runs low.
Not long ago I saw a post by someone on Bluesky (which I can’t find now) that said we should reread books that “break us open”. I just finished this truly remarkable translation of the contemplative classic, Practice of the Presence of God by the 17th century monk, Brother Lawrence. It “broke me open”, and I’m already halfway through my second reading.
Although Brother Lawrence and Carmen Acevedo Butcher are both from the Christian tradition, I am convinced that the practical contemplative practice of “Turning to Love” that is described here can be reframed only slightly by those who are of other traditions (or none).
Practice of the Presence offers new ways of seeing that surpass our sometimes tense and either-this-or-that mindsets. And my work with this translation seeks to honor and share his positive, open-hearted wisdom.
Carmen Acevedo Butcher
On Oranges, Satsumas, and Not Taking Common Things for Granted
Thanks to my mother-in-law (who asked me this question at Thanksgiving) I got to do a deep dive into something I hadn’t really thought about.
The history of citrus begins around a billion years ago as Algae developed from cyanobacteria and photosynthetic eukaryotes… followed by what we would recognize today as land plants which evolved around 400 million years ago. The family of land plants that evolved into the first citrus plant probably originated in Southeast Asia, specifically in the southeast foothills of the Himalayas. What we recognize now as the three “ancestral” citrus fruits, the pomelo, the citron, and the mandarin, evolved from this original, profoundly acidic (and therefore inedible) citrus fruit.
The three ancestral fruits evolved, in different genetic combinations, into the citrus fruits we know today.
I recently was invited to a meeting where a group of residents and educators were tackling the topic (and reality) of resident fatigue. We started by reviewing the ACGME Program Requirements. When it comes to mitigating fatigue, the ACGME requirements are (in my words):
Teach residents and faculty how to recognize fatigue, why it’s dangerous, and how to mitigate it.
Make sure there are adequate places in the hospital to sleep when residents are on call.
Arrange for alternative transportation for residents who are too tired to drive home.
They also list some strategies for mitigating fatigue; “…strategic napping; the judicious use of caffeine; availability of other caregivers; time management to maximize sleep off-duty; learning to recognize the signs of fatigue, and self-monitoring performance and/or asking others to monitor performance; remaining active to promote alertness; maintaining a healthy diet; using relaxation techniques to fall asleep; maintaining a consistent sleep routine; exercising regularly; increasing sleep time before and after call; and ensuring sufficient sleep recovery periods.”
All of these are great ideas, but it’s important to realize that there is an assumption behind them which is that fatigue is physical, and mostly the result of sleep deprivation.
As someone who survived surgical training prior to the 80 hour duty hour regulations and who practiced for a long time, I know from personal experience that although sleep is foundational, there are a lot of different ways to be tired. It is true that physical fatigue, particularly sleep deprivation, is the primary reason residents, practicing physicians, and other healers are tired. But it’s not the only reason. Saundra Dalton-Smith, MD has thought deeply about this, and thinks there are seven different kinds of tired.
It should be obvious, but it’s worth stating – to get to the top level (where you can achieve your full potential) you have to start at the bottom. If you are hungry, thirsty, or scared you aren’t ever going to be able to give or receive respect and appreciation. And without meeting the four levels of need below the top level you won’t be able to fully show up to heal patients and contribute.
I think most of us would agree that the soul crushing fatigue that comes with recurring moral distress is worse than the fatigue of a non-stop beeper when you are on call, which is worse than the fatigue you feel after an hour charting in the medical record.
So I took Shapiro’s model and asked this – What if fatigue can be thought of as a hierarchy? If the model makes sense, like Shapiro’s work, it should be able to guide us as we work to mitigate fatigue for our trainees.
It’s a draft, but a new idea I think is worth exploring. Let me know what you think.
What a fascinating journey this morning as I travelled 1500 years back in time (via the internet) to this medieval portable altar.
On my first roll of the digital dice on this website that randomly links to other websites, I arrived at a database of portable medieval altars, created by a historian whose research interest is “portable devotion”. Lots to think about here…
“Socializing” an idea
I suspect the word has been around for a while, but I learned that “socializing” has become part of “business speak” in medical centers and hospitals, as in… “Go socialize that idea with them first.”
It turns out this new vocabulary is just a new way of describing what great leaders have known all along…you don’t know what you don’t know.
“Socializing” a new idea starts with determining who might want to “veto” your new idea and then meeting with them, not to persuade them, but to learn from them. With each meeting you learn more which lets you refine the project and, at the same time, allows your organization to evolve with you.
The best thing I learned is that the concept now referred to as “socializing” came from the Japanese concept of Nemawashi (根回し)… “Nemawashi literally translates as “turning the roots”, from ne (根, “root”) and mawasu (回す, “to turn something, to put something around something else”). Its original meaning was literal: in preparation for transplanting a tree, one would carefully dig around a tree some time before transplanting, and trim the roots to encourage the growth of smaller roots that will help the tree become established in its new location.” (Wikipedia)
There are lots of people who spend nights in the hospital to care for others… physicians, nurses, techs, and many others.
Especially for trainees who work long hours, eating well when you are on call is not easy. There are usually few (if any) options available in the hospital, and when you are exhausted it’s hard to prepare and bring your own food.
But eating well is really important …. not just nutritionally, but emotionally as well. Here’s a link to the system I’ve found works the best, but deciding that Diet Coke, graham crackers, and cereal are not major food groups is the critical first step.
p.s. I post recipes that meet the “pizza rule” (less time to cook than it takes to order a pizza) on Bluesky, Facebook, and Instagram with the hashtag #CallFood.
p.p.s Here’s the recipe for my breakfast tacos (which are also the best 2am #CallFood you will ever have).
Sometime in the early1900s a surgeon performed colectomy for a patient who suffered from schizophrenia. Post-operatively, not only was the patient’s colonic pathology cured, but it appeared that their schizophrenia was as well.
Not too long after, another surgeon noted the same thing… he had operated on a patient with schizophrenia who was less psychotic after removal of part of their colon. These two anecdotes became a theory… which led to a large number of schizophrenic patients undergoing removal of their (healthy) colons.
This doesn’t make sense, right? Except that it turns out that major trauma (like a big operation in the early 1900s!) can lead to a temporary relief of psychosis in some patients with schizophrenia. In other words, it probably would have been just as effective – and just as temporary – to induce a high fever…which was also a form of treatment for schizophrenia in the early 1900s. (Ebaugh et al., 1938)
There’s a parable here, one that helps us navigate dangerous, unproven theories that are proposed by (usually) well-meaning people …
Portrait of Baynard Holmes in 1889, from Wikipedia
In the early 1900s there were many well-respected physicians who thought schizophrenia was caused by “autointoxication”.1 Baynard Holmes, Professor of Surgical Pathology and Bacteriology at the College of Physicians and Surgeons in Chicago, was one of them. His foray into the surgical treatment of schizophrenia was personal; His son Ralph had his first psychotic break as a second-year medical student. Holmes abandoned his other academic work to concentrate on “curing” schizophrenia. He first published a paper showing that schizophrenic patients had delayed transit in the colon and hypothesized that stool “stuck” in the cecum was therefore the cause of schizophrenia.(Holmes, 1920)
Holmes operated on 22 patients, creating an appendicostomy to flush the stool out of the colon.(Noll, 2006) There was a 10% mortality rate… and one of the 2 patients who died was his son, Ralph.(Davidson, 2016)
Henry A. Cotton, Sr, was another authority who promoted, and took advantage of, the autointoxication theory of schizophrenia. He was a psychiatrist who oversaw, and then performed (!), colectomies on over 200 patients with schizophrenia. He reported a success rate of over 80%…. and a mortality rate of 25-30%.(Davidson, 2016)
In 1923, a group of physicians did what needed to be done from the beginning – a randomized controlled trial. Not surprisingly, there was no difference in outcome between patients treated with surgery and those who did not have surgery.(Kopeloff & Kirby, 1923)
It took a long time for these dangerous operations to stop, despite the proof that they didn’t work. We can only imagine how many hundreds of patients underwent this futile and very dangerous procedure before it was finally abandoned. In today’s world of rapidly available communication it takes 17 years for new evidence to change clinical practice. (Morris et al., 2011) We can assume that in 1924 it took longer than that. In addition, there were physicians (like Henry Cotton) who ignored this new data and continued to remove healthy colons from schizophrenic patients because they personally benefitted from doing the operation, either financially or because of their reputation. (Davidson, 2016)
You may add to this list, but I think we can start with these…
We can be blinded by our desire to end suffering (especially if it’s someone we love)
As human beings, our desire to heal can limit our ability to be objective about outcomes… which is why we have clinical trials (and the scientific method).
And finally (and unfortunately), there are charismatic but evil people who take advantage of people who are afraid and/or suffering.
By the way, there are remnants of this theory still with us today in the form of “detoxificaiton” of the body by cleaning out the GI tract with diet, purging, and/or enemas. (It still doesn’t work…)↩︎
Davidson J. Bayard Holmes (1852–1924) and Henry Cotton (1869–1933): Surgeon–psychiatrists and their tragic quest to cure schizophrenia. J Med Biogr. 2016;24(4):550-559. doi:10.1177/0967772014552746
EBAUGH FG, BARNACLE CH, EWALT JR. PSYCHIATRIC ASPECTS OF ARTIFICIAL FEVER THERAPY. Archives of Neurology & Psychiatry. 1938;39(6):1203-1212. doi:10.1001/archneurpsyc.1938.02270060093003
Holmes B. Dementia Praecox: The Insanity of the Young. Dementia Praecox Studies: A Journal of Psychiatry of Adolescence. 1920;3:105-138.
Kopeloff R, Kirby G. Focal infection and mental disease. Am J Psychiatry. 1923;80:1490191.
Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-520. doi:10.1258/jrsm.2011.110180
Naumann DN, Marsden MER, Brandt ML, Bowley DM. The Bouffant Hat Debate and the Illusion of Quality Improvement: Annals of Surgery. 2020;271(4):635-636. doi:10.1097/SLA.0000000000003623
Noll R. Infectious insanities, surgical solutions: Bayard Taylor Holmes, dementia praecox and laboratory science in early 20th-century America. Part 2. doi:10.1177/0957154X06059446
Sahil Bloom shared this image in a recent newsletter, along with an explanation of how Ohtani used the “Harada system” to become the superstar he is.
The chart Ohtani created as a freshman in high school to meet his goal of being drafted 1st in the Nippon Professional Baseball League.
The story of the Harada system is delightful. It was developed by Takashi Harada, an junior high track and field coach in Osaka, Japan who realized that his young athletes needed more than just drills and strength training to succeed (in all ways). He developed a system for them to define their own goals and actions, and then used it to take his last place team (out of 380 schools!) to 1st place – a position they held for 6 years.
Our ability to pay attention is how we accomplish the things that are important to us, whether it’s being one of the best (if not the best) baseball players in the world like Shohei Ihtani, or finishing a book that has been lying fallow on a computer for too long (Mea culpa).
Thinking about how to better pay attention led me to this post, which summarizes and shares a 4 minute video from Daniel Pink with his 5 step plan to improve our ability to pay attention👇
Set a baseline
See how long can you read a book until you are distracted
As you add steps 2-5 (below), repeat to monitor your improvement
Eliminate distractions
Make where you work a “no phone zone”
Close tabs and anything else on your computer that might distract you
No notifications on any device!
Create a focus ritual
It doesn’t matter what it is, but it matters that it exists
“It’s like hitting play on a playlist your brain already knows.”
Take breaks and move
“Think of your brain like a toddler… It melts down if you don’t give it snacks and naps.”
Reconnect attention to meaning
Take the time to articulate the “why” of what you doing
And how do we promote elevation, which sounds like just what we need in our society right now? According to Nancy Davis Kho, it’s by developing an ongoing practice of gratitude.
“Research published in 2015 in Frontiers in Psychology found that an ongoing practice of gratitude basically rewires our brains to reward us for the positive perceptions we have of the people around us. That begets more gratitude and “elevation,” a lovely scientific term defined in a 2000 article by social psychologist Jonathan Haidt as “a warm or glowing feeling in the chest [that] makes people want to become morally better themselves.” Pour me some elevation, barkeep, and make it a double!”
Every year at Thanksgiving, I make my great-grandmother Sallie’s cornbread recipe. She and my great-grandfather were “dirt farmers” who lived in Oklahoma during the depression. This bread, some beans, and vegetables from their sustenance garden (if there were any), was all they had for dinner most nights.
As I mix the ingredients for this cornbread (and then use it to make stuffing), I can’t help but ponder their life…how hard it must have been and how, as my ancestors, they made my life possible.
I don’t want you to just sit down at the table. I don’t want you to just eat and be content. I want you to walk out into the fields Where the water is shining and the rice has risen. I want you to stand there far from this white tablecloth. I want you to fill your hands with mud, like a blessing.
-Mary Oliver
Mix together with a big spoon
1 cup cornmeal
1/2 cup flour
1 tsp soda
1/2 tsp baking powder
1/4 tsp salt
Make a large “hole” in the middle of the dry mixture with the spoon
Beat one egg with a fork, add 1 tablespoon of oil (which is what my great-grandmother used) or melted butter (which tastes better IMHO) into well in the middle of the dry mixture and mix with a fork
Add 1 cup of buttermilk
Let rise while heating the oven to 450 degrees (about 10 minutes) with your cast iron skillet in the oven.
Gently whip the batter down with a fork
Pour any excess oil from the pans into the batter and then pour the batter into the hot cast iron skillet.
Bake 20-25 minutes (until a toothpick or knife comes out clean)
So that’s my great-grandmother’s recipe (and yes, the photo at the top of this post is of her and my great-grandfather). This recipe makes the right amount for a weekday dinner but it doesn’t make enough for Thanksgiving. So I did the math to make enough for everyone (and the stuffing, and breakfast the next morning!) If you don’t have enough cast iron skillets, no worries. Use muffin tins, cake loafs, whatever you have.
The recipe is the same but starts with melting a stick of butter in the microwave (It’s supposed to be 7 tablespoons but a stick of butter = 8 tablespoons and I can’t imagine a little extra butter hurts!)
Dry ingredients:
One bag of cornmeal (2lb)
3 1/2 cups of flour
7 tsp of baking soda
3 1/2 tsp of baking powder
2 1/2 tsp of salt
Wet ingredients:
7 eggs
“7” tablespoons of butter (see above) – or use oil if you prefer
“7” cups of buttermilk – the batter should pour but not be thin
If you don’t know about the amazing Kate Bowler… you’re welcome! Her take on the “secret of life” (yup, for real) is one of the best I’ve ever heard. (Click on the image to hear it)
“Tiny plastic pellets called nurdles – each about the size of a lentil – are washing up on Texas beaches in alarming quantities. These pre-production plastics are the raw material used to make everyday items like bags and bottles. But when they spill during manufacturing or transport, they escape into the environment, becoming one of the most widespread sources of microplastic pollution.”
This is a scary situation I knew nothing about. These little pieces of plastic “act like tiny sponges, absorbing toxic chemicals such as pesticides and heavy metals”. So it’s not just that we take in microplastics by eating fish that have confused these objects with food, we also consume the poisons the nurdles have absorbed.
A reminder that forest bathing is wonderful (and so easy)
I spent some time yesterday in a park near my home and, while there, decided to try the Japanese practice of shinrin yoku, known in English as “forest bathing.” (Which is therapeutically known as sylvotherapy!)
It’s a practice that involves all five senses, one by one, intentionally…
Listening to sounds, birds, insects, wind in the leaves
Touching the ground, the trees, and the leaves.
Smelling flowers, plants, the dirt
Seeing plants, birds, animals, clouds..
Tasting by breathing through your mouth
If you work in a hospital or another building, a small green area or a single tree will suffice.
We have powerful tools on our digital phones, particularly in medicine. But the relationship with our phones is complicated…and not always beneficial.
The first time I ever came across the word alexithymia was in this New York Times opinion piece about digital phones by Steven Barrie-Anthony. As a physician, I love learning new clinical words with Greek roots – in this case “a” for not, “lexis” for words, and “thymos” which means “feeling” or “spiritedness”. Alexithymia (a word invented in 1970 by psychotherapists), is also known as “emotional blindness”, and means not being able to recognize your emotions.
Dr. Barrie-Anthony noted that the “vast majority” of his patients were experiencing an “alexithymic fog” due to the “gravitational pull” from their phones and social media, a condition that affected “the most important aspects of who they are, their relationships with others and how they move through the world.”
Do we really have agency when we get pulled in by the gravitational force of our phones? For our non-work related time, we pick the app…but then we fall into the dopamine feedback loop of whatever game we’re playing, or algorithms that are foundational to social media.
I think it matters more that I’ve realized, and not for the reasons I thought:
Being used by the tools of the digital world is different from using them as tools because it separates us from our authentic emotions.
“One constant I’ve found is how technology brings a kind of alexithymic fog — alexithymia being the condition of having difficulty identifying or being able to express one’s emotions. This isn’t universal, and the emotions we’re pushing away aren’t always the same. But it happens in a startlingly consistent way.”
To tackle the problems of technology we have to return to our emotional lives for their own sake, and not always leap to doing or changing or fixing. This is the only viable pathway if we are to remain in touch with our humanness and to preserve love, empathy, emotional and spiritual richness, and the capacity to create art and music that reflect our inner lives.
I have yet to experience awe in the digital world.
“When medieval Christians gathered in cathedrals, the soaring architecture and stained glass were designed to lift their thoughts toward the divine. The shared narrative included an image of the good life that directed one to love their neighbor as oneself. Today’s digital architectures are designed with a different purpose – to keep our attention firmly earthbound, focused on consuming content and generating data. The “infinite scroll” isn’t just a design feature; it’s a spiritual technology that trains us to value quantity over quality, novelty over depth, reaction over reflection.”
