Doctor, no offense but I don’t want to see you

Doctor, no offense but I don’t want to see you

It was already close to the end of the workday in my clinic but there was still a new consult to see. It was the usual – a recent heart attack with diabetes, metabolic syndrome and hypertension. Pardon me, I meant to say – there was a new patient named Mr Lowry with the above-mentioned medical conditions.

I went through the chart quickly – some of the medications could be further optimized, blood pressure could be better controlled, the weight would have to come down. I asked the patient the usual questions – no, no recent chest pain; yes, he can walk for couple of blocks until his knees start hurting; yes, he quit smoking; no, he has not been able to lose weight. Mr Lowry answered the questions readily enough though he did not offer additional information or ask questions.

I asked him to take off his jacket and get on the exam table for a quick physical. As I leaned closer to help him push the T shirt up to listen to his heart, I could see there was writing on the shirt. I could only make out the word “today” as the shirt was riding up on Mr Lowry’s generously sized belly. “What’s written on the shirt?” I asked, curious. I received the first smile of the visit, and Mr Lowry pulled the shirt down so I could see. I DIDN’T WANT TO BE HERE TODAY, the shirt read. As I puzzled, my patient burst out laughing. “This is my hospital shirt”, he explained. “I wear this to all my doctor visits. My wife knows that it needs to be washed every time I have an appointment”.

The smug joke masked a deeper truth – my patient was trying to set his own narrative for his medical appointments. He didn’t want to be “recent non-ST-elevation MI, diabetes, obesity”. He was “Mr Lowry who doesn’t want to be sick”.

There is something freeing in naming the negative emotion. It is now out there and identified. In regards to Mr Lowry, it made it easier for me to find the motivation for lifestyle change – “you need to take your medications, lose weight, etc – so that you don’t have to see me anymore”.

Over the next day, I kept going back to the shirt. Is it somehow more powerful to elicit a negative emotion rather than positive one? Politicians certainly know that fear moves people to vote more than a desire for a positive change. The generic “you should exercise to be healthy” is less motivating than “you should exercise so that you wouldn’t get a heart attack”. It is especially motivating if the heart attack has already happened once – now the fear has teeth. When I ask my patients what is the most important thing I can do to help them, the answer often comes in negatives: “I don’t want to be short of breath”, “I don’t want to be tired after walking 10 steps”, “I don’t want to be in the hospital”, “I don’t like the hospital food”.

Few weeks ago, Mr Herkel was admitted to my hospital service. He was an epitome of a healthy 53-year old – slim, fit, didn’t smoke, exercised regularly. Part of the reason he had kept himself healthy was his bad genetic lottery – most of the men on his father’s side of the family had already had heart attacks or died by his age. And now, when he had developed chest pain that refused to go away, he anxiously checked himself into the emergency room. The type of chest pain he had was not especially worrisome – but due to the significant family history, we did a thorough workup nevertheless. His careful lifestyle had counteracted his genetics – the tests showed no heart disease. Mr Herkel’s relief was palpable. “No offense, doctor,” were his parting words, “but I sure hope I will never have to see you again!”

As for Mr Lowry, I am waiting for him to come back one day with a different T-shirt. The one that says, I DIDN’T NEED TO BE HERE TODAY.

Screen Shot 2017-07-09 at 3.39.52 PM

Self-care tip: Sometimes, a powerful negative emotion may be a motivation for positive changes in your life. But you have to name the emotion first and evaluate it. Be smart.

Question: Have you had a negative emotion change your life for the better?  Tell us your story.

How do I become a friend to Me? Start with seeing.

magic mirror

“I like the way he sees me.  I have a lot of trouble seeing myself.”

Madge really had it going, as far as I was concerned.  In this one statement, she is insightful.

Juxtaposing being able to see into oneself with the self-declaration of not being able to see, is ironic.  It is lovely, like going toward anxiety to diminish its power over us.  It is complex, as are the many hues of gray.  A beautiful weed.  Great weakness.  Useful trash.  It is a pretty great irony to come to that place of wisely recognizing how little wisdom we have.

We have trouble seeing ourselves. Part of what makes it so hard to be friends is that doing that is like shaking our own hand.  When we try, we are a purse flipped inside out.  The crude insult, “Her head is stuck up her own a–!” comes to mind.

Many like bullet points to give a, “How to.”  For example, look at Yahoo!

How to buy, store, and cook watermelon

Cook watermelon.  I know someone is saying, “Made you look.”  And maybe when I say, “How to see yourself in these moves,” someone else is swirling their eyes.  But, as I am not about to say that I know better than Yahoo!, here’s my try:

1.  Origins, (God)

2.  Brain health

3.  Community

4.  Admit limitations

5.  And a big magic mirror

Mirror, mirror, on the wall, how do I see Me?

Maybe my list is out of order and maybe it is not a perfect step approach into the soul.  So be it.  Editors of Yahoo! feel free to instruct.

Madge, in one statement, covered community and limitations.  It was nice to be in her space.

Self-Care Tip:  How do I become a friend to Me?  Start with seeing.

Question:  How do you become a friend to Me with your site?  Please tell us your story.

The Process Of Coping With Triggers Such as Anger Includes Awareness

Two people in a heated argument about religion...

Two people in a heated argument about religion when Mahmoud Ahmadinejad spoke at Columbia University. Click the audio button found above and to the left to listen to them. (Photo credit: Wikipedia)

Self-Care Tip #132 – Awareness comes over and over again when you are a friend to yourself.

A reader posted in response to yesterday’s blog, When Someone Is Afraid Of You, You Don’t Have To Be Afraid Of Them. Just Be,

Sometimes it feels like any negativity dirties me up forever. I have a really difficult time dealing with any of the more negative emotions…. I am not sure how to “just be” with respect to those emotions…it always feels like anger whittles away my soul. Any ideas for coping through the times when we get really angry?

Taking care of ourselves requires awareness.  Just seeing it for what it is.  Being tuned in.  Having that degree of knowing.  Insight.

Awareness is sort of like “I love you’s.”  When we hear them, we might need to hear it again 5 minutes later.  There are no available stock options.  If the love doesn’t keep coming, than problems start.  Same with awareness.  We restore our own awareness how best we can, over and over again.  It slips and when new feelings come up, it may seem like it never happened.

My dad came over a week ago and spent the day with me and the kids.  The joy of just being able to spend a whole day with him was unique.  It was a different company than when he visits for an hour or on a timeline.  This day was all ours.  He left his car, and his cell phone behind.  He rode with me and the kids, sans detractors.  We were relaxed together.  Present.  There was a lot more time of just sitting quietly doing our thing but sharing even in silence our own selves.

Today he called, “To check on the tribe.”  He reminded me that it had been “just” a week since we spent that time together.  In my business of filling cereal bowls, the office, picking up dirty kleenex, training our dog where to poop – our time with Dad seemed like a long time ago.  I told him half jokingly, “Dad, we aren’t a bank account.  You have to keep coming.  You don’t accrue interest on what you put in.”

So is our own self-care.  It’s not that we are starting from scratch every time we take a bath.  It’s more that when we get into the flow of caring for ourselves inside and out, it becomes a regenerating, constantly investing rhythm that may at some times take thought and at others just happen because that’s who we’ve become.

One step of coping is that regenerating, repeating, purposeful process of awareness.  Our reader’s question about coping with getting angry put simply, requires awareness.  Because coping is soooo much more than just that, I’m sure it is too simple but it’s a start.  From there, come other bits of coping.  But without awareness, hmm.  Not much is going to happen.

Question:  What is your process of coping with triggers such as anger?  Do you think about it or is it cued subconsciously?  Please tell me your story.