The Mindful M.D.

Moving Day

Moving day is for reflection on what gives me value. 

Keeping:

• desk, chair (4), bench, table, bed, clothes (33 items), computer, ipad, table, food processor, coffee maker, art pieces (5), shoes (3), wood handled antique silverware, dutch oven, 15 books. 

Is there a way to test items in my life for value?

If i pick it up will it make me happy? Have I used it in the last 1 month? Is it fostering growth? creativity? community? connection? or contribution?

It is difficult to quantitate, mostly it is just a complex intuition. 

 

Let. Things. GO. if you cannot see the value added!

Last Day Level 2

Last days at work always polarize me. It was the best, it was the worst. 

This was my last day as a chief resident. This was my last day as a resident. This was my last day. 

In the final meeting of the peer review committee on which I sit, we looked over one of my cases. A gentleman was divericulosis we admitted, tanked up and sent home. We made an error. We assumed that he would tolerate his home dose of a certain medication. This was the wrong decision. He represented the next day with dizziness and low blood pressure. It was multifactorial as he was bleeding again, however, his medication misadventure could have and should have been prevented. 

Time for some Critical Self Reflection:

What did I do well?

• The diagnosis and treatment of his primary problem was appropriate. 

What did I learn?

• Hospitalized folks, often are not taking or will not tolerate their home doses of medications. 

What will i do differently?

• Run the medication list with the patient before discharge and if there are medications that can cause side effects related tot he primary diagnosis, consider just starting at half dose or holding until the PCP visit. 

tough year, tough day. Mistakes are great teachers and are opportunities, not the result of personal failures. 

Fathers Day

My penultimate day at work is less than climactic.

Really just thinking about why my father was such a good dad.

My gratitude for his support (all types) is overwhelming right now. On the eve of the biggest trip of my life, I think of how he made this trip possible. He made this life I live possible and he is the main reason I am doing as well as I am.

Thanks Dad,

You da' man.

Critical self reflection and mindfulness

Self reflection is the key to growth. 

However, what are the ways and whom are the models for this?

I think the most I learned this year from a CSR perspective was around my patterns of choosing the easy path, especially when I do not know the answer. My initial reaction when this occurs is to hide, flee, or lie to prevent shame and being seen as not knowing. This reaction is complex and not my fault. We are cultured from the time we start medical school to hide when we do not know, so that our ignorance hidden. The easy path when i do not know is to hide, to send a letter, to run away from uncertainty. 

Moving forward, my only goal is to seek the power of the pause. The power to have a split second of freedom from my habitual reaction. This is how change will occur. I also need to accept that I am both enough and fallible. Acceptance and the pause are the twin engines of growth. 

 Also, 

At the end of the day:

My journal has these questions:

1) What did i do well today?

2) What did I learn today?

3) What can I do differently tomorrow? 

 

 

Fear Setting and Tim Ferriss.....

These are the notes I just took on Tim Ferriss' latest Ted Talk. Check it out.

 

 

"We suffer more often in imagination that in reality." "Easy choices, hard life. Hard choices, easy life." Gerzy P. We need to do the hard things first.

 

The premeditation of evils:

Visualize the worst case scenario.

 

What if I...? (whatever is causing fear and anxiety,

Define: (worst things if you take that step..)   Prevent: (how can I decrease the likelihood of X happening)    Repair: if that happened, what can we do to repair

 

Has anyone else every figured this out?

 

What are the benefits of partial success if you attempt?

 

The cost on inaction? what is the actual cost?

If I avoid this, what might my life look like?

emotionally,  physically, or financially?

Anticipation and presence

I am ready to leave. We are blasting out of Denver in 3 weeks, but I love Denver and we have good friends. How can I enjoy these last few weeks in a great city with great people and not be constantly living in the future?

 

Use your sense Daniel-son.

 

On Learning....

Useful external feedback is elusive.

This year was hard. I flamed out hard after my last attending month.  After I finished in April, I found it hard to even make myself go into work. After a while, I started deprioritizing relationships as I went. This was a necessity for me to even maintain some level of functioning. I did not exit these relationships well. Mostly, it was just email silence. Relationship mismanagement led to a wake of dissatisfaction and distrust in my path, eventually to a climatic meeting last week.

Two major learning points from this whole process:

1) I have a burnout pattern: I withdrawal to the bare minimum. I start dreading hard work and challenges though these are the reasons I went into medicine and begin to take the easy road. My integrity is sacrificed on the alter of survival.

2) I need feedback to learn, but quality, constructive external feedback is hard to come by as a professional.

 

How am I going to move forward?

1) Identify mentors.

2) Recognize my burnout warning signals.

3) Set up self feedback loops based on values and expectations.

4) Set up mentor based accountability for these feedback loops.

 

Learning is iterative and mistakes and burnout are the best teachers.

 

From Recognition to time....

“Mindfulness gives you time. Time gives you choices. Choices, skillfully made, lead to freedom. You don’t have to be swept away by your feeling. You can respond with wisdom rather than habit and reactivity.”

Came across this quote today. It is interesting to think about the relationship between time and choice. I spend the majority of my day in reactive mode. Reactivity is habit in response. I think the power of pause or time as suggested above is the power to change your life. The power to listen and watch as opposed to acting out of habit. Within the pause is the power to eat one less marshmallow, or drink one less beer. 

 

How to Be Massimo?!

How can I deface the generation before me? How to provoke change with the old gaurd?

 

Ask yourself what the sacred beliefs of our profession are?

1) Memory and intelligence are enough

2) Mistakes are only fodder for my growth

3) The same systems of education will serve the new generations

4) Expert clinicians are born

5) We can do it alone

6) If you work hard enough, you will be osler

 

Just a few to break into pieces.....

Start with how to learn...

 

Tough times and passing memeories.

Memory and mind. Concept and Belief.

These are the connecting forces that give us the blueprint of the world. The way we move through the world is dependent on our memories, concepts and beliefs. Shaped by experiences and labels associated with these experiences.

Yesterday, I had a hard meeting. With people I care about, telling me things I knew, but did not want to hear. My vision of myself was not a shared vision. I was living in a world of self deception.

Why do we do this? I will tell myself all is well as a defense mechanism. It is a way to move forward.

After the meeting though, I see some new things about myself. My clear values system is a strength and a weakness. I write off people and tasks that I don't perceive to matter. However, these actions have consequences, people are hurt and I do not want to leave a wake of destruction in my path.

The path is clear sightedness, gentleness and openness. BUT sometimes, you need others to give you the clearest sight.  

Events are events. It is how relate to them that matters.

All events are "passing memories." Pema C.