To Catch What People Throw At You, Give a Little or You’ll Drop It

Football: Jets-v-Eagles, Sep 2009 - 16

Image by Ed Yourdon via Flickr

Sometimes it doesn’t serve us well to follow our instincts.

When I was little, I don’t know, maybe nine, I remember one of the many times Dad tried to teach me how to throw and catch a football on our front lawn, under the huge tree that seemed to always block me. Dad had played college-ball on scholarship at Duke University where he promptly blew out his knee; one of the many orthopedic problems he’s known. However, he still had his arm and his gentle way of making me feel like he really enjoyed lopping the ball over short distances with me and my awkward hands.

Catch the ball right here, into your arm like you’d cradle a baby.

Nobody needs to try that many times before learning that footballs are hard and pointy and hurt a lot when we catch them wrong. Purposefully putting my body in front of that spinning high-speed object didn’t feel safe.

Get in there and watch it the whole way make contact with you as you catch it.

My eyes were still shut when he said that. I was trying not to cry but I was pretty sure my fingers were going to look differently when I opened them.

Here came more less obvious instruction,

Let your arms and hands give a little, while you catch, closing down on the ball as you let it push you.

People throw all sorts of things at us in the space between “me and thee.” It can hurt to catch and even physically damaging. But counterintuitively, we need to catch like we are cradling a baby, get in there, and give way a little.

This isn’t always advisable but it refers to opportunities to practice presence. Not every interpersonal moment is such an opportunity. Nor will each true opportunity be received naturally or effectively. Those will improve with practice, or perhaps coaching or medical intervention.

The other day, Frida told me with some self-satisfaction about the long hoped for day when she stayed with her daughter during her daughter’s anger, rather than escaping. She gave space for her daughter to throw her pain around. Frida cradled her in her personal space long enough to receive and throw back. For Frida, what she threw back was the next effort of growth. That day we celebrated the presence she was able to offer her daughter and herself.

Now get in there Frida, let it come into you. Give way to some of the momentum or you’ll drop it, and cradle what you catch.

For Frida to do this, she owned her choice to find the presence and to do the work to gain the skill. As I am a medical physician of the brain, you might guess we worked on her illnesses. Frida stayed, received her presence in the company of her daughter – and we celebrated.

Self-Care Tip #284 – Give way to some of the momentum and cradle what you want to be present with.

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Grief Can Be Treasured At The Same Time That We Celebrate Life

Self-Care Tip #283 – Find the treasure in your grief while celebrating life.

Today is my daughter’s sixth birthday.  If ever there was a person who doubled the love she received, it is this chid.  She is all passion.  Yes, both ways, but that isn’t to judge.  Just, there is so little I can offer in words to describe her power of self.

They're asleep!

Image via Wikipedia

Tonight, we pushed two twin beds together so she and I could sleep beside each other.  Her sister slept nearby on another twin bed.  Her brother set his bed up in the closet.  (I know.)

If I wasn’t so tired, old and broke, I might be made vulnerable by times like this to having more kids.  Since that’s not going to change, these chubs are what we will stick with.  Happily.

My mind is turned toward God by this girl.  I somehow arrive in the moment praying when with her, perhaps for strength and patience or for humility and gratitude.  I learn from her.

Mommy, when I’m scared I talk to Jesus.

Often in times like this, I think of my niece, dead now six years, and how her parents and we wanted what was, what was stripped.  Still grieving and still living the life with us and in us, our braided thoughts and emotions easily lose their flow.

But today I have this clarity.  My niece is gone now six years and ten days.  Today my daughter is six years old.  Today I am sleeping with my three children.  Today I know that this is precious but this is not all we want.  We want what comes after our living years.  We want to let loose to Love the grief and the life; to untangle.  Not more.  Not less.  But we want.  We want what we have, now, although still in the unknown dimension of our forever.

In psychiatry, we are alert to grief that warps the ability to engage in life.  Grief that mars the connections of survivors.  Grief that becomes pathology, brain disease and a medical condition.  This grief disables and, for example, in the case of my daughter’s birthday today, would dissolve my ability to feel pleasure.

It is difficult to gain access to treatment as many of these survivors have ill opinions about medical care.  Such as; fearing medications will mute their connection with the deceased; mute their grief, or in other words, tribute/offering to the deceased; take away the personal punishment for surviving…

Questions:

  • What do you say to these weeping lives?  How can we de-stigmatize medical care for them?
  • How have you been able to treasure your grief and the life with you and in you?

Stop! Don’t Stop! – Affecting Our Practice Of Medicine and Other Agendas

Self-Care Tip #281 – Be aware of how your “Stop!  Don’t stop!” behavior is interfacing with your agenda.

One of the challenges in practicing medicine is the inevitable “Stop!  Don’t stop!” petitions.

stop & go

Image by Joseph Robertson via Flickr

It’s similar in a few ways to being a shoe cobbler who receives clients that don’t want her to use leather.  Ms. Cobbler spends 40-60% of her time with clients persuading them of her capacity to use leather, the objective and subjective evidence behind the use of leather and empowering her clients to wear their leather shoes despite public opinion.

This sounds silly and is not meant to be disrespectful to patients, including myself as a patient of physicians and my own difficulties being a patient.  It is only to describe the forces we are all working with when we work together in medical care – physician and patient.

Quenn came in reminding me of this.  Quenn was a 32 year-old married mother of three, who complained of trouble swallowing, sleeping and ability to feel pleasure over the past two months.  She had struggled with this after her mother died nine years ago, but the problems went away over the following year.  However nine years-ago, Quenn was not a mother.  Nine years-ago, Quenn could shake, stay in the house with the shades down, silent or crying loudly, not eating lying in bed for days and if she wanted, nine years-ago no one would know.  This time however, Quenn told me she was desperate.

I have to get better!  This time, I’ll do anything!  But please start with something natural.  I don’t want to get addicted!  I’m someone who never does meds.”

Quenn, why are you seeing me?  

This is challenging for everyone.  Together, the physician and the patient work with this influence on their agendas.

My brothers and I used to play a game on each other when we were kids.  Maybe you did this too.

Stop!  No don’t!  Stop!  No don’t! Stop!  Don’t!  Stop! Don’t! Stop! Don’t stop! Stop! Don’t!  Don’t Stop!  Don’t Stop!

And for some reason that was hilarious to us.  I like to remember this when I’m in the office and smile despite being played by the “Stop!  Don’t stop!” behaviors and emotions.

Questions:  How about you?  How are the “Stop!  Don’t stop!” behaviors and emotions playing on your agendas?  Please tell me your story.

The Growing Process Shifts From Shame and Fear to Friendship

Hello Friends.  Tonight ends our pilot run of the self-care workshop series.  Whoop!  Thank you for your support.  Very much.  The growing process, when in the company that we have here, shifts the experience form one of fear and shame to one of …well this:  friendship, with you and with our own selves.

One of our participants was kind enough to send me his recap,

Some of the points that were most important to me were:

  1. Going toward our temperament/the languages we use,
  2. Invest in your bank,
  3. Going against your intuition,
  4. The energy balance as illustrated by the triangle diagram,
  5. It doesn’t always feel good to perform self-care.
  6. categories in the bio…model and how they interrelate, i.e. biopsychosocial model.  (Smile.)

Pretty good! Huh?

This was written after our second week.  After tonight, we can add,

  1. Accountability for our flawed self doesn’t mean blame or fault.
  2. Our flaws become part of our opportunity for growth and personal presence.
  3. Self-awareness is a tool for,
  1. Understanding our agendas,
  2. Bettering our sense of presence,
  3. Freedom that is ours independent of our effort, morals, or any human quality
  4. A freedom that we want to fight for with everything we’ve got to preserve.  I.e., a freedom we can lose.
  • Using the biospychosocial model as a tool for,
    1. Understanding where our emotions and behaviors are coming from
    2. Understanding where emotions and behaviors of others are coming from – such as STIGMA

    I wish I had another summary from one of our participants rather than my own.  I can make this so much more complicated than it is!  I am learning.  I am flawed.  I am accountable.  I am not blamed.  I am in the company of friends, including myself!  Whoop!

    If I get another summary though from “someone,” I’ll pass it on for your perusal and comments.

    Again, thank you and until tomorrow…!  Keep on.

    Our Patient-Doctor Relationship Improved by Self-Care and Back At You!

    NICU Nursery

    Image by EMS Shane in Portland via Flickr

    I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

    Self-Care Tip #265 – Use your connections to help yourself and use your self-care to improve your connections (such as your patient-doctor relationship.)

    Damaged and premature, my niece was born needing help to live. Now, one year later, I am playing ball with her on the floor. Her intelligent smile, thriving body, and especially the lovely nape of her neck with that baby-curl of hair lipping up makes remembering her near death-dive into life surreal. I don’t want to remember it anyway. But when I can’t help myself, what I like to think of is how my brother and sister-in-law were treated.

    The clinicians at UCSD were unbelievable, my brother said. They included him in their decision-making and informed him of medical study results. If you don’t know, if you’ve never been sick or been in a medical setting otherwise, this doesn’t always happen. It isn’t traditional to share medical information directly with patients (such as x-rays, laboratory results, differential diagnoses, and to ask their opinion. Can you imagine?!  “…Um. Yes PLEASE! Can I be your patient!?” Sounds like fantasy.)

    I’ve also struggled to collaborate. Hovering over charts and laboratory results, many of us practitioners behave as if our patients were at any moment going to throw us into court. It’s embarrassing, even though the truth is, too many of us clinicians are stalked by litigious intentions, whilst the truly awful practitioners seem to sail away on unsinkable malpractice without pursuit.

    I have not enjoyed myself when I’ve done this. When I’ve acted suspicious of the very people I’m meant to team up with, work was not good for me. I don’t think my patients felt comfortable with the doctor-patient relationship either during those times. Hearing my brother talk about how he was treated has emboldened me to engage with more trust in the care I offer patients. Moreso, being friendly to myself has helped me be a better physician.  It’s tail chasing but with productive and enriching effects.

    Making a choice to choose trust and transparency with patients and clinicians, even being present with the fear, is self-care although high pressure. With people’s lives on the line, clinicians and patients know mistakes will happen. The self-care will grow our ability to forgive each other.

    My journey with self-care has brought me to see people differently. I look at them from the self-care angle. I look for those sticky bits where we can connect and collaborate. I expect things from them. I ally myself with their self-respect, with their intuitive desire to be friends with themselves. I am bored at work when I don’t do this. I am bored at work when my patients don’t do this too. Without self-care for myself and without my patient’s interest in self-care, medical practice becomes everything that the negative reputations advertise about the physician and the patient.

    Yes. My quality of practice has definitely improved.

    Who isn’t blessed when she sees the courage to face stigma, shame and bewildering illness? Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live, fights hard like my niece did and shows what that fight is worth?

    Who doesn’t learn from that? When someone loses her identity to the defacing ravages of disease but still knows she is worth the fight, like PattyAnne, working beside her is one of the best places in the world to be. For Me. It starts and ends with Me.

    Building trust in a patient or a clinician starts with us staying connected to others in our personal circle and along the ripples as the circle widens. We have to have a voice and hear their voice and we do this by maintaining a community of people.

    Connection is part of self-care for both clinician and patient. In the case of PattyAnne, (yes, she’s still in our story,) she could take an action toward her self-care with the intention of gaining stronger connection to her community and to me. She could ask herself about her intentions. In fact, we both would do better self-care approaching each other this way.

    Connection via the patient-doctor relationship is self-care and then back the other way too!

    It starts and ends with Me.

    Questions: Has your patient-doctor relationship been a friendly part of what you’ve given yourself?  What are some examples or in what ways have other connections you’ve chosen improved your self-care?  How has self-care inversely improved your patient-doctor relationship?  Please tell me your story.

    Introduction to Self-Care

    Questions:  How do we collaborate with our patients, or with our clinicians, to take action on behalf of health?  What can we as clinicians or patients do to teach, learn and practice the tenets of the field of self-care?

    Self-care is living consistently with the belief that the success of our health (emotional, physical, spiritual) begins and ends, not with “me,” but with “Me.” To teach and practice self-care comes when we understand that the essential self, the Me, is always worth fighting for, always worth the journey, always of value even in the throes of mental illness.  Here at FriendtoYourself.com, we work to define and teach self-care daily, we attack guilt, we stand up to shame, we live as we choose despite stigma and we work harder than we ever have on perhaps the hardest job of our lives.  Self-care is not weak but rather courageous.  It brings us to humble accountability for our lives, not seeking to erase our history but still reminding us that we are free to start over any time.

    I will be writing a series of blog-posts outlining self-care in which we will examine the tenets of self-care: self-knowledge, presence, moral neutrality, and connection. We will look at self-care as an essential practice for both clinician and patient, examining the ways in which a self-caring clinician may, in turn, provide better care to her patients, and patients take better care of themselves.

    Self-Care Tip #260 – Clarify what it means to be your own friend.

    By the way, check out a still unknown glorious writer at ASkirtAWeek.com.

     

    Self-Care As it Affects Your Professional Self

    Of the patients waiting at the Out-Patient Dep...

    Image via Wikipedia

    Self-Care Tip #236 – Think about what self-care is doing for your professional self.

    When speaking with managing editor of the Journal of Participatory Medicine (JoPM,) Kathleen O’Malley yesterday, I struggled to explain the presumed simple description of what effect self-care has had over the past many months on my professional self.  I realized that I hadn’t spoken much about that yet.  The words spilled out, messy and ungraceful.  I’d like to say it better so I’m going to try again, and then many more times.  Self-care has helped me be a better physician.

    I see people differently.  I look at them from the self-care angle.  I look for those sticky bits where we can connect and collaborate.  I expect things from them.  I ally myself with their self-respect, with their intuitive desire to be a friend with themselves.  I am bored at work when I don’t do this.  I am bored at work when my patients don’t do this too.  Yes.  My quality of practice has definitely improved.

    Who isn’t blessed when they see the courage to face stigma, shame and bewildering illness?  Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live when disease is damaging them, fights hard like my niece did and shows what that fight is worth?  Who doesn’t learn from that?  Who doesn’t want more?  When someone loses their identity to the defacing ravages of disease but still knows who they are, is for me, one of the best places in the world to be.

    Working harder on myself personally is working harder to improve myself professionally.  One healthy is another healthy Me.  Self-care has helped me find more pleasure at work because I know I am responsible about how I feel when I’m there.  I take care of myself when I’m there and then I’m able to give more to my patients because of it, including just being present.

    Being present is really a lot to get and a lot to give.  I sense this in my kids who want me to see them.  They call out for observation of activities; riding without training wheels, jumping super high, running in fast shoes, building awesomeness.  But those are code.  They want me to see them.  I just can’t do that when I’m self-neglected.  It carries over in all spheres of my life, including the office.  Who wants to consult a physician who is half asleep in the chair?  (Now if I need a nap, I just go all the way and sleep! j/k.)

    I know my self-care is participating in the practice of this kind of medicine with you.  I’m hoping to get better saying it.

    Questions:  What has self-care done for you in your professional world?  How has it helped you work better as a team-member?  How has it helped you receive better from others who have something to give – such as teach you or give directions?  Please tell me your story.