I recently returned from a week-long stay in Keystone, Colorado. I was there with a small group of physicians gathered to restore their voice to the practice of medicine.
How I got there was through a series of events I can only call synchronicity.
What I felt was a profound feeling of "coming home".
I showed up as all of me, in full color. My role was to listen deeply and expansively, and I chose to record what I heard in visual form.
It was as if everything I practiced was serving me in my service to this gathering. Each morning I woke early and rode my rented bike along the many trails around Keystone. I listened to the Snake River winding its way through the trees. I inhaled with awe each time I arrived at the vista of Lake Dillon. I clawed my way up a steep hill only to be rewarded with the jackpot of a stunning view of Breckenridge and beyond.
I had learned from these past few years of practicing self-care that these morning steps were my fuel for being present and thinking creatively. I knew what to do - even in an environment away from my familiar surroundings at home - because I had practiced them into new habits. I had my biking clothes, I was comfortable riding, and all I had to do was explore new roads and read new maps.
I also had my daily sketching and art journaling practice in place, something I started only within the last two years. I have experimented with many different formats and media, and I am comfortable drawing outside. On this trip, I brought a small Moleskine Japanese album with accordion pages. It fit in my small travel purse or pocket, and I carried a pouch with pen, markers, and water brushes.
On my morning rides, I often sketched a scene quickly in ink, filling in color later in the day or in the evening. I noticed what I noticed. I took note of the stories I wanted to tell. And by the time I got home, there were three or four panels that needed coloring, which I completed within a few days.
New experiences, new people, new places -- all of these fuel my creativity and keep me inspired.
I am grateful for the daily practices I cultivate at home, so I am well-prepared to stay open when I'm on the road.
For a frame-by-frame caption story of my Keystone travel journal, see my post here.
For an in-depth reflection on the contents of the physician meeting and its impact on me personally, stay tuned!
It has been fourteen years since I graduated from University of Michigan Medical School. I have journeyed far from the field of medicine, and yet my heart keeps hearing the call to return to my physician communities and share what I have learned. I simply cannot ignore my sense that the pain within our health care system - now felt at every level, including patients, physicians, and payors - is a resounding call to wake us up to our next stage of evolution.
It takes only a cursory scanning of the headlines of medical blogs like this one to get a sense for the unrest, the frustration, and the abundance of innovative practices emerging as a result of the rising sense of powerlessness among doctors. I left medicine immediately after receiving my MD, moving into uncharted waters after the Dean of Career Development at Michigan told me, "You're on your own. We can't help you with that." This was when, as a fourth year student, I announced I would be pursuing a career in venture capital.
I volunteered at a private equity investment firm - yes, I worked for no pay - and six weeks later, I was hired as an Associate. Within two years I was the youngest partner-level Investment Manager in the firm. No one told me this was possible. I simply would not accept anyone else's opinion of what I could or could not do. Especially after what I witnessed in my world of medical training.
One of my most vivid memories was on my Vascular Surgery rotation, where I was absolutely loving the concept of what we were doing - as intellectual masturbation material. But in practice, what I saw was my future laid out in the following scenarios. The second year resident, sick as a dog, showed up to work anyway, and, too weak to stand, lay down on a gurney in the OR while a case was going on. The third year vascular surgery fellow, a gentile Southern man, was in the middle of a lower extremity bypass graft and stepped out of the room. He lifted his mask, vomited into the scrub sink, and then reentered the OR to continue the procedure. This happened two more times within the same procedure before he completed.
Many of you reading this may be nodding and saying, "Yup. That's just the way it is. Suck it up or leave it." And my question is, "If you have trained yourself not to feel, what else might you be missing in your experience of other people?".
Later in the month, on a Saturday night call, we brought Mrs. X into the OR at about 10pm. This was hospital day 50-something for her. She had come in for a routine renal artery stent, and apparently had embolized into her IMA, killing off part of her gut. Her wound was infected, she developed multi-organ failure, and was kept alive, with an open abdominal incision, on a ventilator. She was unresponsive, and it was unclear, each day of the month we rounded on her, whether the family was aware of her prognosis. One day I spoke to her husband, and he told me, glossy-eyed, that the day before she was admitted to the hospital, they had played tennis together. He looked forward to the day they could do this again. What a far cry from the rigid piece of meat that was plugged into machinery and called "alive". I was confused, then, when we suddenly decided to bring her back to the OR to "drain her abdomen" or do something surgical, when there was no clinical evidence of any change in her status.
I will never forget the first snipping of the sutures holding her abdominal fascia together, as a wave of black liquid gushed out of her belly. We tried to catch some of it in a test tube to "send it for culture". As if we couldn't predict the lab report of "multiple anaerobic organisms not otherwise specified". Then, at around 11pm, our 63-year-old attending vascular surgeon walked in. He had street clothes on, and held a mask over his face. He leaned about ten degrees in over the body and said, "OK, I'm signing off". Then walked out.
We were left with closing her up, bringing this woman - not just a body - back to the ICU, and coming up with a story in our notes about what we did and why.
I moved on to a different rotation before she was ever pronounced dead. I wasn't there when someone had to break the news to her husband that they would never play tennis again in this lifetime. But I internalized a lesson in that month about the price of actually DOING what I LOVED. A door inside my heart closed, believing that my heart's desire - to do a job I loved, and to live a LIFE I loved - was simply not possible. I had to choose one or the other.
Since then, I have been a partner-track professional in a venture capital firm (again, something I was told would not be possible given my experience), I moved to California to follow my childhood dream of starting a violin school, built a successful six-figure business on my own from scratch, and then experienced the loss of that school through what I now see was burnout.
The gifts of burnout have been the rediscovery of my humanity, my desire, my creativity, my purpose, my own healing, and my love. I love empowering people and being co-empowered in relationships. I love seeing my ideas in action. And I love being the facilitator of true healing and transformation in people.
I have created a life in which I do what I love, and I am fully supported in the very uniqueness of my expressions of love. I have received trainings in life coaching, sound healing, traditional Thai massage, Breema bodywork, and Bio Optic Holography. I made a conscious transition from playing only classical music for thirty-plus years to improvising on my violin, voice, and other instruments. I co-created an acoustic rock duo with my partner-in-life, and we perform in public regularly. We live in a beautiful natural setting, among a community of people who value artistic expression, stewardship of the earth, and mutual support. I birthed myself as a visual artist, and have exhibited in a juried show during my first year as a painter. I have traveled the world and studied with the most inspiring people I have ever met in my life. And I share this with people, one-on-one, in groups, by phone and face-to-face.
I have avoided sharing the fullness of my learnings with physicians, other than those who happen to find me in their own internet searches. I have been hiding my joy. And now, even as I feel my fear of wading into shark-infested waters, I choose to bring my message to you. It is not necessary to settle for what others have told you is possible, or even for what you have defined in the past as possible. You are a creative force far beyond your current imagination.
I have followed the public and academic discourse on physician burnout and suicide, and I notice several things. First, the good news. It's being discussed and therefore legitimized as a "syndrome" in the eyes of the medical establishment. Not surprisingly, however, burnout is being "medicalized" as a diagnosis that must be prevented, eradicated, treated aggressively, and fought like a battle against a raging enemy among us. This is the medical mindset. It's how we were all trained to see the world - to focus on what's right and wrong, eradicate the wrong, and restore the system to its previous state if at all possible.
I have a different perspective. I see the experience of burnout not as something to be eradicated, shamed, attacked, or avoided, but as something to experience with full participation and curiosity. To see the depths of despair and loss as a form of structural tension within a system that holds great innate latent potential to launch a powerful trajectory in the direction of your greater mission in life. Yes, I believe your personal, specific experience of burnout holds the very keys to the fulfillment of your wildest dreams and desires for your thriving life.
Fundamentally, the process is one of remembering your love. Remembering your art. Remembering YOUR medicine. And LIVING YOUR MEDICINE. Yes, that means looking at yourself. Shining loving light - transcending right and wrong - on those experiences within you that require healing attention. When you have walked with courage through your own healing process, and you have touched the places within you that you did not understand how to love previously, you become your medicine. You embody the grace of healing, and you effortlessly deliver the level of care, compassion, and precision that flows through you as love.
If your heart says YES, please join me for a free introductory call to my new program for physicians, "Live Your Medicine", by registering here. Vote for your own joy, creativity, and desire by taking a courageous step on behalf of your own heart. And please reach out to any colleagues you know who may benefit from this discussion.
The Native American tradition speaks of each person's Original Medicine - that set of gifts that only you can offer the world with your particular life. I've always felt there was such a finality to the phrase "Original Medicine" - like I had to define the one thing I was here to do, or it would be lost forever.
This feeling would ignite the achiever in me, who would scramble to come up with a name, a brand, a package, a business, something very "put-together" that would create an image of how well I knew my Life's Purpose.
I've been doing some version of that for most of my life. But recently I've begun to discover a process I find much more alive, much more healing, much more in alignment with my own sense of unconditional wholeness. I call it "Live Your Medicine." It is the practice of asking, "What time is it now, for me?". It involves listening for what holds the most fear for me in this moment. And then summoning the courage to take action toward that in one small way. Again and again, revisiting and refreshing with each present moment.
It is reminiscent of Eleanor Roosevelt's words:
"You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, 'I have lived through this horror. I can take the next thing that comes along.' You must do the thing you think you cannot do.”
How often do we actually avoid - quite skillfully - the things that spark fear inside us? How often do we explain away these avoidances with elaborate theories, often quite impressive in their defense of our own status quo?
"Live Your Medicine" captures my emerging discovery that the true healing experiences for me happen whenever I do something that is utterly frightening to my mind's unquestioned beliefs. "Live Your Medicine" is an invitation to search inside yourself to find your edge, and to live in a way that develops your courage, rather than reinforcing old patterns, no matter how comfortable they seem.
For example, each morning for most of my life, I would begin with a "To Do" list - my responsibilities and things to get done. There was no reason for me to get out of bed beyond that list. It served as my purpose. There was no rhythm other than the methodical ticking off of items, showing up for scheduled activities, and getting through things.
Everything in my life changed when I made one seemingly small shift: I began my days differently. Instead of hopping out of bed and beginning to run after my "responsibilities" dutifully, I stepped off my bed and sat in silence, looking out a window at the sequoia tree stretching tall in front of it. I started with five minutes. I did yoga, not when the yoga studio scheduled a class, but when I needed it - sometimes first thing in the morning - and for the length of time my body required it - sometimes only twenty minutes.
Since then, I have maintained a practice of beginning my days with rituals that ground me in my connection to breath, body, and the earth. I am currently blessed with the situation of living just fifty steps from the beach. Most mornings I make the walk out to the bluff, and down to the sand where the birds pace along the water's edge. I wake up gradually, following the pace of the sun's creeping over the fog-covered hills to reveal the glistening surface of the ocean.
I notice, though, that even this ritual can drift into feeling of an "assignment" I give myself. I can fall back into a pattern of giving myself a job - even if that "job" is to start my day more kindly. My practice can harden into a set of rules that I must follow, or else be judged as something less than acceptable to myself. Not very kind!
My mind can turn any practice into a "To Do". It's just a repetitive pattern - a habit that was practiced for many years, and reinforced without questioning.
So my medicine is to "do the thing I think I cannot do". To be attentive to what that thing is, in this moment. And then do it.
I recently learned some simple restorative yoga poses from a friend. No need for the fancy bolsters, blocks, straps, and blankets that I've used in yoga studios. I can use pillows, blankets, and whatever else I have available. The experience is like floating - like my entire body is being supported, almost suspended, without any effort from my muscles. It's like being in water, without having to move at all.
And it's a totally ridiculous way to start the day! Which is why it's my medicine. Living MY medicine, at this particular point in my life, means having the audacity to begin my day by going into a state of complete surrender and relaxation. As if there is nothing to do, nothing to conquer, nowhere to be.
This is what living my medicine looks like for me, right now:
While my body floats in the feeling of being totally supported, my mind rests. It cannot feel fear in this moment of rest. And each moment I spend here, I train in courage. I look fear in the face - the fear that whispers a "To Do" list in my ear - and I do nothing anyway.
What's YOUR medicine right now? What time is it now for YOU?
Photo credits: Top - Randy Bales. Bottom - Lydia Puhak.
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There was a time when I believed - when I was totally convinced - that I could not take a day off.
Maybe it was the example of my parents, whom I saw work tirelessly every single day, never letting go of the responsibilities of their jobs, and never taking a day off unless they were absolutely required to (and by that I mean, being so sick they had to be admitted to the hospital).
Or maybe it was medical school, where I learned by working alongside residents and fellows who would regularly show up to work sick, because they "couldn't take a day off". On one rotation, I recall the vascular surgery fellow being so rundown from flu-like symptoms that he had to dash out of the operating room to throw up in the scrub sink during a procedure he was performing. I watched wide-eyed and took everything in, my mind drawing the conclusion that "people with important jobs can never take a day off".
I became determined to find work that would enable me to take a day off, and still be considered important.
The problem was, I really had no idea what was truly important to me. I had many concepts that had been implanted by messages from my family, from images in movies and advertisements, and from the culture in which I was living. "What's important" was a moving target, a reaction to whatever "everyone else" appeared to be doing.
Meanwhile, in my heart I knew that I wanted to make a difference in this world, to care about something genuinely, and to share my story somehow in this life.
But the only way I knew - based on what I had seen, learned, and been taught - was to put my head down and work.
I worked hard at everything I did. I didn't take many days off. When I did, I remember feeling an odd combination of freedom and loss.
"Who am I without my email inbox full of requests and my voicemail full of messages?"
"Who am I when I am not answering to anyone else?"
"What would I choose to do if I had an entire day with no obligations, no one telling me where to be or what I had to do?"
Questions like these would pop up in the few instances I let myself off the hook and took a break. The questions themselves brought up feelings of fear and confusion, because no one had ever asked them of me before. I had never dared take the time to find out what the questions might reveal, if I invited them into my life.
So I pushed them away, filling my time with work instead.
It was easier than grappling with the questions.
And yet I know now, looking back, that the times when I felt the courage - the imperative - to take time away from my routine and give myself a change of place, a change of pace, and a piece of open space to allow these questions to surface, have been food for transformation in my life. Had I not followed the instinct to "Just do it", I would not have been given the chance to watch my true story unfold, and so many of my genuine desires come into reality.
These days I am often approached by people for advice on career transition, achieving happiness or fulfillment, healing from chronic medical diagnoses, and how to get "unstuck" in life.
I listen, and I am always deeply humbled by the courage required to put our struggles into words and share them with another person.
I know that, being another human being, I never have the answers for another human being. To say that I do would only feed that part of our minds with an insatiable appetite for certainty and control - the same part that tells us we can never take a day off.
The coaching or healing or help or support I provide - whichever word you choose to describe the energy of being in the presence of divine acceptance of what is - is a practice of opening space, of giving permission to ask the questions that come up (no matter how much fear accompanies them), and celebrating the miracle of the unique journey we each take in this life.
So, can you really take a day off?
I don't know the answer for you.
But if the question interests you, why not try it and see where the answer takes you?
Have you ever sought someone's advice, and then realized halfway into the conversation that you really didn't want them to tell you what to do?
Or have you ever followed someone's advice, which never quite felt right to you, but they were in a position of authority or had done it themselves before, and you didn't know how to get out of it?
Have you ever wished you had more trust in yourself, and didn't need to rely so much on advice from other people?
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It's been ten years now since I've set foot in a traditional academic institution. Yesterday I stood inside the walls of a venerable one right here in my own backyard.
And it struck me that there is A LOT of "advising" going on at the formative stages of a lot of smart people's lives. A lot of people who are very curious, very bright, very capable, and very imaginative. But who just don't know. So they ask. They seek advice.
And what do they get? Well, what typically surrounds them in these places of academic prestige are a lot of people who got there by playing a certain game. They navigated a particular system, they overcame their own particular obstacles, and they achieved a certain status. Usually if they are in a position of enough authority to merit students' seeking their opinions, they've hung on to this status over a period of years. They've done the work of making all the right people happy in all the right places. They consulted the rule books, they found out what was expected of them, and they met those expectations.
They have seen the world through one particular lens.
This is perfect advising for someone who wants to experience life through that particular lens, and to find out what hoop is to be jumped through next. If you're asking, "How high must I jump?" and "Where is the next hurdle?", these advisors are perfectly prepared to tell you the answer.
But there's a different kind of questioning that occurs for all of us at some point in our lives. Perhaps even at several points in our lives.
Questions That Have No Right To Go Away
We come up against questions in our hearts, questions that ultimately ask us to test how much we trust ourselves, and invite us to grow into the next version of ourselves.
but frightening requests,
conceived out of nowhere
but in this place
beginning to lead everywhere.
Requests to stop what you are doing right now,
to stop what you
while you do it."
- from "Sometimes", by David Whyte
In these moments, some part of us actually knows the answer and knows what we must do.
The questions appear at the most inopportune times. We're "busy" doing something else. There's "not enough time". We're "supposed to" be focused on something we believe to be more important.
But the questions don't go away. They pull at us, beckoning us to pay attention to the part of us we'd rather be able to ignore.
It poses a dilemma. Should we go this way or that? Should we keep going as if everything is "normal" or actually stay with the question and listen to what it brings?
This is when we might seek advice from others.
And this is where knowing the difference between "advice" and "coaching" can save your life.
I've received a lot of advice in my lifetime. I can remember these pieces of advice quite vividly.
Some Advice I Once Received
For example, when I had made the decision in my heart that I would not be doing a residency after medical school, I started to do what all the career guides told me to do: informational interviews.
As I told people what I intended to do, I encountered a lot of advice. "Why don't you at least do an internship? Then you'll have more options, because at least you'll have a license."
These conversations never seemed that helpful to me, because I felt like my desires were being dismissed as naive, and that the risks I felt called to undertake were insurmountable (which I found insulting). As I continued to talk to more people, I heard more advice.
From one person: "Why don't you at least finish a residency in SOMEthing? You know, general internal medicine, something like that. Then at least you'll have the credibility of being able to practice something."
From another: "If you liked cardiology in medical school, why don't you at least get trained as a cardiologist? Then you'll have so many more contacts and you'll be able to get so much more done."
And another: "Well, why don't you at least practice for a few years, get some money and respect under your belt before you go off and do your little dream? Then at least you'll have experience."
And yet another: "Why don't you wait until you retire to do 'fun' things like following your heart and doing what you love? Then at least you'll have lived a full life before you go and throw it all away."
What I realized is that each of the people who gave me advice was only speaking from their own experiences and beliefs. None of them had actually done what I was going to do, for the reasons I was doing it. And none were actually helping me to listen to the voice of my heart, which was the one posing these questions.
I ended up listening to a lot of different advice and following no one's, instead creating my own opportunities through willingness and determination. I am forever thankful for my own intuition that guided me to follow something inside me, despite advice to the contrary.
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Fast forward ten years.
I've created many more opportunities by following my own intuition, and tapping that same willingness and determination, to move in the direction most aligned with my heart's greatest desire. Now that I have opened space in my life, space in my mind, space in my body, and space in my heart, to receive guidance, it just keeps flooding in. I don't ask people what to do. I don't tell people what to do.
I have since also lived the life of trying to gain fulfillment from seeing other people follow my advice. I thought I was doing the right thing, but I would always encounter an aspect of someone else that my experience could not comprehend, that my best knowledge could not penetrate. This was before I trained as a coach. I had no tools at the time to help other people access a deeper part of their own wisdom, to help them find the keys to their own locked doors. I was giving advice, where people were in great need of coaching. I just didn't know how to at the time.
Coaching Helps You Follow Your Own Advice...The Kind You've Ignored For Too Long In Favor Of Others'
The kind of reward I received from advice-giving pales in comparison to the nourishment that is provided by coaching. As a coach, I get to be free, gently observing the process of a person finally doing exactly what their hearts have always been telling them to do. I get to share in their moments of joy in discovering that the answers they sought outside for so long, in so many ways, were already inside them, waiting to be decoded.
In short, as a coach I get to watch people finally follow their own advice!
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There is nothing more beautiful in this world than to witness a person free themselves, and become enlivened by the light inside them, dancing to the music within them.
I recognize the feeling of a person's truest longing spoken out loud. I recognize the pain of staying silent and hidden for too many years. I recognize the joy of meeting yourself again, of looking yourself in the mirror with love and kindness.
This is not what comes from taking someone else's advice. This is true learning and growth. This is the drink of water I'd always been thirsty for, but never knew existed.
So the next time you ask someone for advice, listen to them very closely. And then ask yourself, "Does this feel more freeing? Or more constraining?" Any advice that does not bring you more alive in your heart is not advice for you to follow.
Follow your freedom. It is the voice of your divinity speaking to you.
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I love blog posts that start with "How To...". They are always so promising, and hold the anticipation of a wrapped present under the Christmas tree, or a package arriving on your doorstep after your recent online purchase.
"Oh I can't wait to open this! And finally SEE what's inside!"
And, just like Christmas, just like opening that package that you ordered online, there's that moment of not knowing, the moment of unveiling, the moment where your expectation rises to greet the present moment unfolding.
When it's unveiled, we deal with the match between our heart's desire - the image of what we hoped to see in that opening - and the reality right before our eyes. Is it everything you imagined? Is it "perfect" (meaning, does it match your idea of what you wanted)?
Or is it a letdown? An unfulfilled promise? A shattered dream?
Notice that whatever happens to be sitting in the box is completely neutral in this scenario. It just is.
And whether we create a Disney ending to this buildup, or whether we concoct an Elizabethan tragedy of epic proportions, is a function of our mind.
We can't stop thoughts. We can't control certain aspects of our mind's nature.
We CAN become the observer, the innocent bystander who sees it all but is often left out of the conversation.
When your mind is chattering, when you feel dissatisfied or unfulfilled, just stop and listen.
Instead of trying to solve the problem with the same mind that created it (thanks, Einstein, for telling us that this won't work!), listen to your thoughts.
Acknowledge what's asking to be heard.
Acknowledge any resistance you are putting up against that asking.
Acknowledge your desperate need to know right now.
Acknowledge your fear of sitting still and doing nothing about it.
Acknowledge your frantic chase to put an end to all the chatter right this minute.
Acknowledge whatever comes up for you.
When you've taken the time to give full acknowledgment, put it on paper, or speak it out loud. Find some way to express it, so you can experience the energy of your thoughts through your five senses. Give them an outlet. It doesn't have to be shared with anyone (but a blog sure feels cathartic sometimes).
And then notice how it feels just to give a little time to yourself and be heard.
So what about the promise of this blog post? To be exactly where you are, try including exactly the parts of yourself you'd rather deny, put away, or hide from the world. Give a little room to these voices, and you may even be pleasantly surprised.
I tried this today. I had to. I was facing a hurricane of thoughts competing for my attention inside my head, and all I wanted to do was lie down in a field of daffodils. I'm preparing for a "big" talk tomorrow at Stanford Medical School, and it's flooded my head with ideas. Deep down I know that the key to a great talk is being fully present to exactly what is going on in the room, doing all the preparation and then fully letting go in the moment. Here is a video blog with my process of getting to exactly where I am (it did feel a LOT better after giving everything a voice):
I recently noticed that I've been fighting against a lot lately. Fighting against complaining, fighting against frustration, fighting against fear.
How's that been workin' for me? Not so great.
Today I went on a hike and happened upon a field of daffodils...in February! Now isn't that amazing?
I stopped to appreciate the surprise of unexpected beauty. And I realized that by sending out the energy of "fighting against", I am actually becoming the very thing I wish to avoid or resist.
A few quotes come to mind. First, from Iyanla Vanzant, "If you want peace, be peace." In other words, don't walk into a room and shout at the top of your lungs, "BE QUIET!!"
Second, from good ol' Gandhi, "Be the change you wish to see in the world." In other words, don't fight fighting by fighting.
Third, from the Tao, "The softest of all things overrides the hardest of all things." In other words, don't try to overcome something powerful with more force. Soften your attitude towards it, practice observing and accepting it, receiving it without fear or need to defend yourself.
If you can actually get that far, you might notice that you already feel better, and the things you've been fighting against don't bother you so much after all. Try it today!
Identify something you've been fighting against. Name it. Say it out loud or write it down.
Now, get very still and breathe. It helps to be in a place that inspires your inner calm and allows you to listen only to the sound of your own silence.
And practice getting very, very soft toward that thing you identified. With each breath, see if you can get softer, gentler. See if you can experience the energy of appreciation toward that thing. Remember that all you are doing is sitting right there, breathing. Nothing has to change right now.
Here's my video blog while sitting in that field of daffodils earlier today. Appreciate your reality! Don't fight it....