Desolation cries for company

Desolation cries for company

There was a new bounce in his step. Mr. Stefani stood a little straighter, and his face expressed an almost smile. Intriguing.

I had treated elderly Mr. Stefani, suffering progressive heart failure, for approximately a year. It was an exercise like table tennis. I told him how important it was to take medications on a regular basis – he kept forgetting. I told him it was important to avoid salt in his diet – he said he was a poor cook and it was easier to heat up instant meals. I told him it was important to get out and be part of social activities – he said he didn’t have a family, and didn’t really care.

“Why care?” he said.

He was sick, and, as he put it,

“What was there to look forward to in the beginning of each day anyway.”

This is a common story. When people develop heart failure, proper food and self-management of the condition is as important as taking correct medications. This may make a difference between being able to manage the disease at home or several hospitalizations in a year, ending up in the nursing home. Elderly patients, especially men, who do not have family support, are faced with a “triple whammy.” There is no-one who cooks proper food for them. Wham! No one reminds them to take their medications. Wham! And no one motivates them to want to live better and longer. Wham! Wham! Wham!

So what had happened to Mr Stefani?

After we went through these preliminaries –

“Have you been more short of breath?”

“No.”

“How much can you walk?”

“About a block.”

“Are you taking your medications?”

“Yes.”

“Are you keeping away from the salt?”

…we finally arrived.

“Yes, much better now,” he announced, “I have a new friend who cooks for me”.

Well, in all fairness he had said, “I have a new girlfriend.” I just interpreted it as a “new friend”. He went on to explain that there was now a young woman in her late 20s living with him, and she had taken over his kitchen and was helping him out in general. Hmmm. I wasn’t sure if I should ask anything further, something along the line of “Where did you find her?” However, Mr Stefani was more than happy to explain.

“I was driving along the road one day, and there she was, standing on the edge of the road. I stopped and asked if she needed a ride. She said she had nowhere to go. I asked if she wanted to come home with me, and she said yes. That’s how it happened.”

My patient seemed happy. His grooming was better. His feet were no longer swollen. I suggested that he bring his new friend to his next appointment.

The next appointment came in 6 weeks. Mr Stefani walked in with a young woman who beamed at me. I started asking questions about his health. Yes, he was feeling a lot better. She proudly presented his medication list. He told me how she was after him to walk every day. She told me how she had changed her Chinese-style cooking to be salt-free. He told me how he helped her look for a job.

There were questions I didn’t ask. Was she really his girlfriend? Was she an illegal immigrant? Was she hiding from someone? What did she get out of this arrangement? Was he paying her?

Looking at the two people in front of me, these questions all of a sudden did not seem so relevant. People at their heart need connections, and those two had found one.

Endless Rhythm by Robert Delaunay

Endless Rhythm, by Robert Delaunay

 

Self-care Tip: Be open to human connections wherever they occur. It may just save a life – yours or someone else’s.

Question: Have you made a connection with a person that was unexpected? Was it challenging? Fruitful? Embarrassing? Eye-opening? Tell us your story.

 

Introducing our new co-author at Friend to Yourself

Finally!

I’ve been hoping, asking, looking, waving awkwardly in the hospital hallways, trying to find someone who would join me in this great blogging experience with you on self-care. And, finally.

Please join me in welcoming Dr. Helme Sivet! You will love getting to know her, and she will love, as I do, sharing space with you. Keep on.


Screen Shot 2017-05-17 at 3.04.34 PM

Helme Silvet, MD, MPH, FACC
Loma Linda University School of Medicine
Chief of Cardiology, Jerry L. Pettis VA Loma Linda Healthcare System

Hello!

 

My Blog Journey

Sana (or Dr Q) and I have known each other for two decades or so (and yes, we have lived that long). We have spent hours talking about what makes us excited to be physicians, what gets us up in the morning, and what makes us upset. Finally, we decided that it was time to share some of these thoughts together. Taking care of self is a principle that we both try to teach our patients, but also practice ourselves in order to be effective parts of our families, communities, and humanity. The goal of this blog is to attempt both from the, perhaps, somewhat unique perspective of biology, and medicine as the starting point to self-care.

My Professional Journey

My medical experience started in the “old country” behind the Iron Wall – I grew up in Estonia and graduated from medical school there. After the Soviet Union opened its borders, I made my way to the U.S. and finished an internal medicine residency at Loma Linda University and cardiology fellowship at Brigham and Women’s Hospital/Lown Cardiovascular Center. Starting in 2003, I have worked at the VA system as a cardiologist. Along the way, I also graduated with an MPH degree from Harvard School of Public Health. I am passionate about making people get better – this includes preventing, treating and managing heart disease as a cardiologist – but also helping my patients make sense of their life journey. One cannot treat and prevent disease without caring for the whole person.

My Life Journey

Between my two sisters and myself, we have lived in 5 different countries – this has made for interesting holidays! Seeing different parts of the world up close has given me plenty of experience, but has also come with a certain sense of displacement. It has been a continuous struggle in my life to figure out where I fit in the wide world in general, and in my little microcosm of a world in particular. In this context, it has been fascinating to learn different things from different cultures, and observe how people with different life experiences can effectively communicate with each other. And I noticed that somewhere along the way, my quest for truth and knowledge is giving way to a quest of understanding and compassion.

Disclaimer

The thoughts on this blog are my own and do not represent entities I belong to in a professional capacity. The stories that I tell are true in principle but the details may have been changed to protect people’s privacy. The blog is not meant to offer professional advice or treatment advice for specific medical conditions; the goal is to share ideas, general principles and stories of a personal journey.

 

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.

You Are Allied, Chosen and Of High Value to Our Efforts In Self-Care

Squirrel

Image by nsavch via Flickr

I remember starting with my research team about eight years ago. Some of the terrain between then and now returns like a welcoming committee every time I consider a team venture.

My research team and I have learned a rhythm and trust in each other’s talents that constitutes much of the travel pleasure experienced. However, knowing that their excellence is “behind” me, in front, and surrounding has been much of my medium for improvement. It has taken a lot for me to get this far, not absconding what we still hope for. What obstruction a colleague is when they lose their interest in growth. I am thankful they allow me multidimensional space to change, know my flaws and relax to know theirs. The ability to gift this to someone takes a lot of bank.

One of the beauties of having had received this type of gift once, is that it improves our vision to know where we might find it again. You readers have chosen me to work with but I have also chosen you and this is why. You have bank. Thank you for being persons of such high value.

When someone wonders about our talents, they are simultaneously wondering about our flaws. Standing under such scrutiny takes courage, I admit, but courage is improved by a sense of safety. Thank you for being safe. That takes bank.

I am a teacher. I am very good at teaching about emotional quotient, emotional and behavioral insight and interpersonal exchange. I am very good at teaching efficiency and perspective to achieve that. I am a Jedi in intuiting emotional milieu and harnessing that information into the goal at hand. I can do this for others, as well, with empathy and speed. I am talented.

Now. Surely when put this course way, and with your growing familiarity with me over the past one and a half years, you have some knowledge about my flaws. I am inspired that you believe more in my brilliance than in my Achilles. I am inspired that you ally yourself with me to make sure that my flaws do not kill me off and thereby kill the self-care work we endeavor together. That takes a lot of bank.

Your bank is more than you were given in your gene-purse. Your inheritance does not account for your long hard work on the continuum of growth. That is from intersecting personal dimensions that include things like in-process God-deposits, choice and more choice.

It is said that wealth begets wealth of which you are a rich example. Your riches are blessed, just as the men who did not bury their gold. I am happy to be with you, who are getting more bank. I am smart enough to know that after the shower, I will find something in my benefit. Ruth knew that of Boaz. Pond fish know that about the rain. I know that about you.

We are at a turning of seasons now, when creation takes stalk. Like so many squirrels, brown bears, tree frogs and you, I am glad when my pantry and borough reflects that I have a team, (allies to my desire and labor to be a friend to myself,) who are safe and rich and want Me. Wow. That is what they call, “Bank.”

Questions: How does it feel to know that you are known as, “Money-Bags?”

How do you choose allies to your self-care venture?

How has your sense of safety affected your ability to invest in yourself?

Please tell me your story.

Self-Care Tip – Remember that you are chosen and of high value.

Reworking Choices With Your Physician as Part of Your Team

What do you want? 

It is one of my challenges as a physician when someone comes to see me for reasons I’m not able to accommodate.  I can’t validate them.  I can’t tell them what they want to hear.

What can I do?  Help them “realize” that they came to see me for another reason.  Another way to say it is to help them “choose” another agenda.  A part of them realizes their need for help; they came.  A part of them believes I am a person that can help; they came.  A part of them.  A part that I and the patient are responsible to find and shift agendas deliberately or by any wiles possible.

Hands touching

Image via Wikipedia

We are an unusual team in this.  How often do you find another so awkwardly paired?  Yet these are some of my best patient-doctor relationships.

What do you want?

When there is a meeting up, a connection and everyone is working for the same “want,” both presence and movement are natural responses.  It’s like we’re standing still in the moment, senses taking it in, and moving all the while.  The process of moving itself brings pleasure and healing.  It is not always about arriving.  It is not always what we think we want.

Self-Care Tip – Enjoy your re-choices and what you will get from them.

Questions:  Have you every found yourself being “helped” to have a different agenda that improved your presence and movement in your personal journey?  Please tell us your story.

Getting or Giving Bad News Without Fear

Slalom skier

Image via Wikipedia

I was reading an article on awareness of obesity the other day telling us that many times, people don’t know they are obese until they are told by someone else.  Ouch.  Pass the Band-Aides.  But it aired our need to stay connected, speak up, and listen.  It also prompted me to reflect on mental illness.  How often I’ve sat with someone’s emotions-history in my hands, looked at them and realized they didn’t know.  They were there, emotions bleeding all over the place but didn’t grasp their injury.

Um, excuse me ma’am.  Let’s apply some pressure on that and get you some help.

Bloody news like this reminds me of my friend Jack.  He was waterskiing with my brother and I when we were college’ish-age.  Jack was not so capable on the water, although he wasn’t afraid.  As you probably know, three is the perfect number for waterskiing – one to drive, one to hold the flag when the skier is setting himself up, and then of course the skier.  Any more and there are way too many polite smiles and way too much advice for the bobbing body in the water.  Jack was working on his slalom moves, thrilled with his progress and after about the third fall, was still ready for another go.

Hit it!

Our boat, Rosewater, eased him out of the water and he was up.  Jack has a way of celebrating like no other.  He whoops and yells and his whole body joins in.  And so he was in his happy place, up on a single ski, unconcerned with the world at large.  It was lovely.  Until the wake of that other huge boat threw him down and his face slammed into his spectacular single ski.  Up he came and we just looked at him, quietly at first.  Jack paddled up to the boat and wondered if he should try again.

Um, sorry Jack.  Let’s apply some pressure on that and get you some help.

Jack had a huge gash, copiously bleeding all over his face and he had no idea.  He was wet already, cold from the water and didn’t feel a thing.  I still feel the creepies skittering up my arms and chest thinking about it.

When we told Jack, he was a little unbelieving.

Are you sure?  Is it bad?  I think I’m alright.  It’ll wash out and I can try again….

Oh there wasn’t much pleasure in telling him the bloody news.  Generally there isn’t that much pleasure in telling someone they are fat or suffering from mental illness either.  It’s the follow-up to that statement where the fun comes in.  The hope that we link the first punch-line to.  Good news is, …along comes the second punch-line.  Hope.  And presence.  Being with someone where they are at, as they are, and with patience doesn’t mean leaving him in the dark, bleeding out.

The reverse is true of course as well.  If we don’t stay connected with others, we may lose the opportunity to see ourselves through their eyes.  It is an opportunity.  When we are with someone we trust, respect and think see’s us as the precious thing that we are, it is.

Self-Care Tip #195 – Stay connected with others and listen without fear – something good is coming.  Be a friend to yourself.

Questions:  How do you deliver “bad news?”  What is the best way you’ve ever been given “bad news?”  Please tell me your story.

The Achilles In Us All – To Our Own Demise

Cover of "Troy - The Director's Cut [Blu-...

Cover of Troy - The Director's Cut

Self-Care Tip #188 – Don’t avoid the obvious to be a friend to yourself.

Have you ever watched someone make a bad decision?  Probably, if you’ve watched anyone.  We all do make bad choices.  But a really bad one?  One that when you hear it going down, you can almost feel the hair on your neck point south.  We ask ourselves why no one stops them.  We perhaps have tried to reason, to force, to pull favors to buy them away from this choice.

If you do this, ….

Maybe weeping some.  Maybe they’ve done this same variety of bad choice before; many times perhaps.

The problem is bigger than our own selves of course.  The people in our wake, being tumbled about by our bad choices, these people suffer.  It’s irresponsible.  Sure.  Those tumbled people are responsible for there own self-care too, but they aren’t responsible to accept us back with open arms when we drive our boat over them.  We don’t connect that the reason they are back there bobbing in the water is in part because we don’t have insight into our behavior.

Brad Pitt played Achilles in the movie Troy, Directed by Wolfgang Petersen.  If you remember, he died in the end.  Movie critic, described what killed him well.

Achilles is moved by love of glory and knows that he will die young if he pursues it, but his reputation is all that counts because all he is a warrior and the best one, at that.
Self-care includes stopping the kill that our own “Achilles heel” is making on us; i.e. that (or those) big thing(s) that everyone else but us can see that in the end will kill us.

Carl Jung describes the inferior function of someone’s personality type as their Achilles’ heel.  Myers called this the shadow.  It is the part of us that has the least amount of conscious awareness (otherwise known as insight.)  This is the part of our temperament that we are not comfortable with.  Although it may strengthen with maturity, it can be the death of us if we don’t take it seriously.  We will always have it, true.  But with deliberate effort and with working no harder than what self-care has already proven to be (the kind of bleeding effort that makes us plead “Mercy!”) …then we can grow.

Then perhaps after performing the hardest work of our life, we may be fortunate enough to die from another reason in the end.  🙂  We also may be fortunate enough to have people in our lives who feel safe with us.  People who feel they can trust that we will treat the precious connection between “Me and Thee” responsibly by taking care of ourselves.

Questions:  How has your Achilles been influencing your life?  How have you helped yourself to stop avoiding “the obvious?”  Please tell me your story.