Growing Life

I have had a “dry spell” in my writing – a time when my metaphoric pen ran out of ink, and I couldn’t replenish it.  My ideas were all focused on family needs and transitions, my counseling practice, and more recently, learning the personally and professionally exciting field of neuroplasticity, how the brain changes itself, and how that can be applied to eliminating persistent pain. 

Now my thoughts and desires turn, again, to the traditional preoccupations of spring.  I am planting my garden, choosing plant starts and seeds, following the sun through the day to see where it lingers most, and planning where each plant will (hopefully!) be able to grow and produce its vegetables, fruit, or flowers. 

New Year’s Resolution

 

Tradition asks us to use the onset of the New Year as a time to make resolutions for changing our behavior for the better in the coming year.  In fact, making – and breaking – those resolutions is the topic for conversation and news articles every year at this time.

I actually get this opportunity twice a year: January 1, with everyone else, and in the fall during the Jewish holidays of Rosh Hashanah and Yom Kippur, with others of the greater tribe.  One would think that I would get used to it, perhaps even good at it – that somehow my resolutions, like the bare root trees of winter, would ground themselves in the fertile soil, and grow strong and leafy, signaling my success to everyone.

Instead, I find myself revisiting the same basic resolutions twice a year (at least!), though the context and details may vary slightly. 

So, again, it’s January, and I plan, over this next year, to take better care of myself and to put myself and my own needs, first.  Just writing that I will “put myself first” makes me so uncomfortable that I feel compelled to add, “most – or more- of the time.”  Then, feeling that I have chickened out, I go back to the stronger statement, and say “yes, I will put myself first.”

Why is this so hard for me that I must resolve, over and over again, to make these particular changes in my life?  The concept is not foreign to me; as a physician, I advise my patients not only to take care of themselves first, but how to do it.  With this advice, I have told my favorite parable (“Reflections”), familiar to all who travel by airplane, where, at the beginning of each flight, the flight attendant tells the passengers “In the unlikely event that the cabin should lose pressure, and the oxygen masks are released, put on your own mask first, before you help others who need assistance.”

What would it mean for me to put myself first?  Certainly, it means prioritizing behaviors and activities which make me strong and diminish pain, decrease stress and make me happy.  These include exercise, regular rest, meditation, creative expression, and attentive scheduling.  In reality, I actually do these things, but not consistently and not enough.

So it is ironic that I have counseled innumerable people, my patients, through these same lifestyle changes.   The results are varied - often people make at least some changes, but sometimes they don’t.   Perhaps most of them, similar to my own experience, do take on practices that help them focus on their own health, but can too easily get derailed by the needs of others.

Our personalities, experience, and training influence the direction of attention.  Some of us tend to turn our attention first to those around us who are in need.  As a woman, a mother, and a physician, my natural predisposition to notice and attend to those in need became more compelling.  It is what I tend to do first.  It becomes automatic. 

The antidote to automaticity is mindfulness.  When we notice our thoughts and feelings as they occur, we can recognize that we have options, and choose what to do in that moment.  In choosing, we do not react automatically, but thoughtfully.  If I plan to go to the gym and exercise, but before I leave my daughter tells me her computer isn’t working and I need to fix it so she can do her homework, my automatic response would be to try to fix the computer because her homework seems more important than my workout.  But if I stop and examine my options, I realize that this is the only time today I could go to the gym, that my exercise is very important, that she could clean her room first, or hand-write her work for now, and that I can easily look at the computer when I return, while I rest after exercise. 

We don’t usually think about heroes as making choices to care for themselves.  Heroes traditionally care for others at the expense of themselves.  Yet when we examine the qualities of heroism, we find courage, steadfastness, and the ability to make split-second choices which save lives.  The hero does what is right, regardless of the expectations of others. 

Sometimes we find the qualities of heroism inside ourselves, and apply them to situations which do not seem like the stuff of legends.  Still, they are the same qualities, which we use on a micro-scale every day.  With them, we do things to save our own lives, a little bit at a time.  In the Jewish tradition, the person who saves one life saves the world.

Reflections

There are times when we stop doing and focus on being.  We spend time with ourselves looking inward instead of outward.  For physicians this is unlike most of our lives, in which attention, focused primarily on the needs of others, drives us in an often hectic schedule in which any reflection must be fitted into other activities.  

 

Thus we have short times for thinking when we are driving, as we walk from one room to another, as we eat lunch, or in the moments of blessed peace in the bathroom.  When we do think, it is still likely about others, about our work as detectives in figuring out just what is wrong and how can we fix it.  Sometimes we wonder if we are doing the right thing, or if there is anything else we can do, or if we have made a mistake.  Sometimes we agonize over a mistake. 

 

Physicians are trained, sometimes severely, to not think about ourselves.  In training, we learn to turn away from our own needs for sleep, food, exercise, emotional support, and time for reflection.  We are supposed to be available to work long hours (the number of hours is now regulated, which was not the case when I was in training) no matter what we personally feel.  In one extreme example, when I was an intern, the senior resident on call took care of the emergency room in the small community hospital, and the back-up physician was a faculty member who was on call to come in to the hospital when he was needed.  One night when I was on call, I went into the resident lounge and saw the senior resident sitting on the sofa with an IV in his arm and a bag of fluid dripping into his vein.  He was ill with a stomach virus and was so dehydrated that he needed the IV fluid to be able to stand up.  I was shocked and asked why he was doing that, and was told that the particular faculty physician (who felt that residents should work under any circumstances) refused to come in to the hospital, and had told him to use IV fluids and go back to work.  The senior resident felt that he had no choice but to do what he was told and kept working.  In this way, we acquire the habit of putting our own needs last.

We learn that to serve others, we do not think about ourselves and turn our lives to “doing.”  We are tremendously busy; it takes a lot of everything we have to care for our patients.   And yet we have so much to think about.  When we do stop, and be with ourselves, it takes time to move the focus in, to sit with our breathing and feel the boundaries that delineate who is “me”. 

When I stop to think of myself as body-mind-spirit-together, to consider “me”, I create and reinforce a pattern of self-care that spreads out to nurture the wholeness in those around me, including my patients.  I believe that when we can see the wholeness in people, and let them see that we see them, they are strengthened and can more readily find their own wholeness.  Here is where healing begins.

Another way to think about this is the airplane analogy (one of my favorites - it may come up again).  Every time you get on an airplane, you are told that in an emergency, if oxygen masks are released, you are supposed to put your own mask on first, before helping the person next to you. 

Many traditions help people stop their usual activity and go inward to care for their wholeness, sometimes during particular holidays, others suggesting more frequent practices.   Many people find times for reflection that are unrelated to any traditional practice, and can range from quiet time going fishing, running, doing music or arts or crafts, cooking, or sitting in the sun.  I find quiet time for myself in music, meditation, and increasingly, in writing.

In my tradition, this is the Jewish New Year, Rosh Hashanah, the day the world was born, and the Days of Awe, Yom Kippur, in which we stop everything to be with ourselves.  This is the time of reflection, when each of us asks ourselves “How did I do last year? Where did I stay on track?  Where did I miss the path?  What do I need to do in order to find the trail and start again?  Where am I going?”  And as a physician, “How can I be aligned with the path of service and still care completely for myself?”

And so I am reflecting also on the qualities of heroism, and what we do when we focus our attention inside. The physician is considered a hero for saving lives.  But most of us don’t save lives in that dramatic way every day.  I wonder if this process is part of what allows us to continue to persevere, to move through our lives with courage, to act from selflessness that actually is based on self-knowledge of our own wholeness.