Coming Full Circle

  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!

What Feeds You?

"When you touch one thing with awareness, you touch everything." - Thich Nhat Hanh

Since moving to the coastside community of Half Moon Bay three years ago, I've become more and more inspired by farmers. Specifically, local organic farmers and the ecosystems they steward. I am not sure how this evolution happened, but somewhere along the way, in the age of industrial farming and processed foods, in the trance of busyness that convinced me to prioritize my "job" over taking the time to feed myself well, I woke up to the way farmers are actually key players in the health care ecosystem.

For me, the past few weeks have included the following. On the first Saturday of May, my acoustic rock duo provided the live music for our local farmers' market. Our evolution from being loyal customers to becoming more active participants in the ecosystem providing this precious resource for our community has been a dream come true for the kind of musicians we desire to be. We play for tips, lettuce, strawberries, olive oil, bread, chocolate, a bit of cash, and a big dose of the love that comes from knowing we are feeding the community with our art and joy.

Two weeks ago, I became a member of my first CSA (Community Supported Agriculture). This means I signed up to get a box of locally grown, organic produce delivered to my door by a farm collective every two weeks. In each box is a note from Farmer Paul, with a poetic missive on his observations in the field, followed by some bullet points on "how to be a great and green member of the farm family". These two lines really hit home for me:

"Remember, you are not a customer; you are a shareholder in our farm.

Paying your bill is not enough. Owning a share means doing your share."

The "aha" for me was that I do have a responsibility. I was not just "buying" a box of food delivered to my door each week. I am now responsible for holding a piece of the thread. I am now a weaver of our local ecosystem. I am adding my voice to the chorus saying "Yes!" to locally grown organic produce, picked by hand, delivered by hand, and gifted to us all by the land. Do you feel that? We are gifted our food from the land. The land is not a factory. It is a generous donor and partner. And what we give to the land it gives back to us in multiples.

Several days later, I attended a lecture by Daphne Miller, MD, a family physician and author of the book, Farmacology: What Innovative Family Farming Can Teach Us About Health and Healing. Her curiosity about the relationship between her patients' health and the health of our soil led her on a global odyssey to visit small family-owned farms, as well as agricultural scientists and ecologists studying organic farming practices. The one-sentence summary of her talk was, "We are the soil." What we put into the earth, we put into ourselves. And what we put into ourselves, we also put back into the earth.

All of this has gotten me thinking more about both how we feed our world, and how we are fed by our world.

The thought seeds that take root in our consciousness create feelings which course through the cells of our body as chemical signals and are digested in each cell, creating our experience of life.

Imagine the gut - our digestive system - as the place where our feelings about the world are taken in, broken down and digested into the elements that fuel our entire being system of Soul+Body+Mind, driving our decisions and actions in the world.

Each of us is a mini ecosystem living within a sphere of progressively larger ecosystems - our bodies, our relationships, our homes, our families, our communities, our nations, our planet, and our cosmos. Mindfulness of food - what we put into our mouths - equals mindfulness of what we take in from our experience of life and what we perceive through our consciousness.

When we touch the essence of "WE ARE THE SOIL", we see that what we feed our consciousness we also feed to our world.

What are some things you can do now, in your world, to live more from this awareness?

• walk outside and breathe fresh air...imagine and feel the air feeding every cell of your body
• notice the products you choose that wash down the drain -- this eventually becomes part of our soil
• plant a garden
• walk barefoot in or touch actual soil or living earth
• vote with your dollars and support a local organic farmer in your area
• receive the sounds in your environment and notice how they are feeding you
• clean up your thinking...junk thoughts equals junk food
• love what you feel and trust your gut

Your mind may react to this list as being too simple to have an impact. But I believe we can each find our own way of remembering the ecosystems we are already part of. And when we remember, we touch everything in our world in a new way.

We can reclaim our position as owners again...not just customers, but holders of our own share in this web of life.

The Gifts of Burnout: An Evolutionary Wake-Up Call for Doctors

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.

AHA's "Simple 7"...Not So Simple After All

[singlepic id=285 w=320 h=240 float=center] The other night I read on the back of a friend's T-shirt the following list of guidelines from the American Heart Association (AHA)'s latest heart-healthy lifestyle campaign, called "Life's Simple 7":

• get active
• control cholesterol
• eat better
• manage blood pressure
• lose weight
• reduce blood sugar
• stop smoking

From my medical training, I recognized each of these 7 items as addressing the major risk factors for coronary artery disease and therefore heart attacks and strokes.

However, from my journey of learning about the connection between mind and body, and especially the ways in which our mind dictates the feelings, behaviors, and results we see in our lives, I noticed that these "Simple 7" are not so simple at all.

Four of the seven guidelines involve behavioral changes. Three of the seven can be addressed with pharmaceutical drugs but are also dependent on these behavioral changes in order to have maximum impact. These areas of behavior change - exercise, diet, weight loss, and smoking cessation - are typically the most challenging and frustrating for both patients and doctors in a preventive setting.

Why?

Because it's easy to read just two words - like "lose weight" - and to know what they mean. However, it's much more challenging to look at your own underlying thought patterns and the payoffs you are getting for behaving the way you are right now. If you weren't getting any payoff for keeping at your current weight, your mind wouldn't allow you to be at this weight. However, it takes some willingness and openness to really ask yourself what those payoffs might be. The answer may just cause you to want to change. Or it may send you running as far away from that answer as possible.

How many primary care physicians see their patients once a year, and give them this same list of seven "simple" recommendations, only to see them come back the next year with the same results or worse?

Before you start to beat yourself up over your inability to measure up to the AHA's "Simple 7" lifestyle improvements, let's look at each of them from a life coach's perspective.

"Get active"

What does this mean? On the AHA website, three suggestions are provided for "moving more". Parking farther away from the office door, taking the stairs instead of the elevator, and doing active fun activities with your children (including an endorsement for Nintendo's Wii).

OK. I can see the logic in each of these small steps. However, it takes energy to want to move. It takes space to even consider putting these small changes into a person's life. It takes a certain amount of inner freedom to even experience fun from doing activities with your children.

Why not look at the thoughts you have about yourself as you're driving to work? Or the thoughts going through your mind as you press the elevator button to go to your cubicle or office? Or the thoughts you hold onto after you get home and you're supposed to be "having fun" with your family?

I've learned that what we say to ourselves about what we do is a much more powerful motivator than what we actually do.

Our unexamined mind clutter is what prevents us from acting in the ways that we "know" we want to. No matter how many times we hear it, or how many suggestions we read, our actions won't change until we change our thoughts. It's the rare primary care doctor who has the training, capacity, and desire to delve into these issues with patients and find out what the patient really needs in order to change. Telling someone they will die early - and asking them if they want to see their children grow into adulthood - is a common strategy, but I'm skeptical that motivation by fear will work in the long term for developing the kinds of life-affirming habits we're talking about.

"Eat better"

What does this mean? "Better" is a term that translates differently in each person's mind when it comes to food. Learning what to eat, when to eat, how to select and prepare food, and creating the rituals around eating are all included in this idea of "eating better". With the typical grocery store offerings, it takes some education, innovation, and motivation to choose "better" foods and actually get satisfied from eating them.

Identifying what drives our food choices and eating habits is another journey into the thoughts behind our feelings and actions. Maybe we're choosing foods because we believe they represent love. Often it's an old memory of love. Maybe we're afraid to let go of those choices because we believe we'd be letting go of our ability to be loved. Maybe we watched a parent eat healthy, choose all the "right" foods, and die at an early age anyway, so we believe a story that "it doesn't matter what I eat, I'll die young anyway." Each of these is a thought that can be acknowledged and questioned, leading to a pattern of eating that comes from a deeper place of awareness.

"Lose weight"

This I suppose goes hand in hand with the two items above. But as Oprah's very public, decades-long journey has shown us, it is not so simple to simply "lose weight". On AHA's website, a great story of holistic life improvement, which resulted in weight loss, is highlighted on this page: "[Jennifer E.] changed her career, left unhealthy relationships, devoted herself to morning meditation, and began volunteering with a local women’s health initiative. Self-care became non-negotiable." Clearly, Jennifer's journey to health and wholeness involved more than losing weight.

I believe weight loss is a result of, not a means to, feeling better about yourself. There are many life coaches whose practices focus on weight loss as an entry point to total lifestyle enhancement.

"Stop smoking"

Again, two simple words, but a lifetime of effort, mostly failed efforts for people who do not address the underlying thoughts behind their smoking addiction. There is no question that the single most beneficial act that will improve a smoker's lifespan is to quit smoking. That knowledge doesn't stop the millions of smokers from continuing their habit.

Chemical dependency is one excuse; social stigma is another. The bottom line is we humans are powerfully driven by the content of our thoughts. And most of us have not been taught to observe our thoughts, or shown that we can train ourselves to believe different thoughts at any time during our lives, through practice.

Not So Simple...

I love that the AHA is acknowledging the whole person in their campaign to educate Americans about heart health. That our hearts are not "simply" the organ in the center of our chest that pumps blood throughout our system, that our vasculature is not "simply" a plumbing system transporting blood to our body parts. The AHA is attempting to get Americans to think about all aspects of our lives as contributors to healthy hearts.

What I see, as a life coach, is that ALL of our behaviors are driven by feelings we have in our bodies, which originate in our thoughts about the circumstances in our lives (never the circumstances themselves). A healthy heart is a symptom of living a balanced life, physically, emotionally, mentally, and spiritually. And a clear mind is a healthy starting point.

The "Simple 7" list is a good start for focusing on the most tangible areas of behaviors that impact our overall risk of heart disease. And with our health care system's current toolkit of interventions, drugs, surgery, office visits, and hospital stays, none of these factors will be significantly impacted in most patients.

Already there are physicians waking up to the fact that behavior and lifestyle changes are inadequately addressed in our medical system. If we want to have healthier bodies, we need to start by waking up to our own thoughts. It may be simple, but it's not easy. If you're struggling in one of these areas and don't know what to do, take a breath. Ask yourself, "What hurts?" and "Why?". And follow your thoughts to a treasure of information about what's motivating you. The medical system has trained patients to believe we are passive and largely ignorant about what's happening in our bodies. I believe we need to coach patients back to a greater connection with their own bodily wisdom - the wisdom we are all born with.

To live and feel healthier, you don't need a diagnosis. You need space to discover what's true for you, and the reassurance of knowing that you have the ability to create the healthy lifestyle you desire. It's that simple.