Monday, November 24, 2014

Checks and Balances

I haven't done one of these posts in a while, so I figured I'd share with you a few things that have interested me lately:

(In the interest of self-care, I've been trying to put the electronics away at night)

  • I've been into walking recently. I started out wanting to walk an hour every day this month, but the weather and work schedule haven't always obliged. Nevertheless, I have managed to fit in at least 30 minutes of low-level walking most days. Just as sleep forms the base of the self-care triage pyramid, simple walking should be the cornerstone of physical activity for most people. Furthermore, this Mark's Daily Apple article makes the case for walking as therapy and stress-reliever.

  • This great interview with Elizabeth Dunn, the co-author of the book Happy Money, reminded me to continue my practice of simplicity. Her five core principles of spending for happiness (buy experiences, make it a treat, buy time, pay now/consume later, and invest in others) are good advice for all of us this holiday season.

  • Are you taking some vacation days this winter? For many people, days off are not accrued and will reset in just a little more than a month! See the sobering statistics of why Americans don't take all their vacation and try to find a way to take the rest of yours!

  • And just for laughs, check out this very funny spoof on the DIY "hacks" articles you see all over FB and Pinterest. #1 is my favorite. Enjoy, and happy Thanksgiving!

Monday, November 10, 2014

A Month for Gratitude

Pumpkins on one of the last days at the farmer's market

It's November, and Thanksgiving is almost here. November is always a good month to reflect on the things we are grateful for, and frankly, I need the "gratitude practice"...

I recently underwent yet another IVF procedure - a multi-egg stimulation and retrieval - because all of my banked embryos from that previous egg retrieval last winter when I briefly ended up pregnant have now been used up. Without success. To be honest, it's been a hard several months of disappointments, for which I was NOT mentally prepared. After undergoing this more involved and invasive type of IVF procedure again (the frozen embryo transfers are easier), I maintain what I've said before here and to everyone that has asked me about it: the physical experience of IVF is seriously nothing compared to the psychological experience of IVF.

Not the most fun way to spend a day off. At least it's only a 22 gauge.

Sparing lots of details, the point is that I have been feeling a little bit lost. But I'm finding my way back through gratitude. I plan on doing a "gratitude challenge" by journaling about at least one thing that I am thankful for each day this month. This practice has been discussed extensively on the internet, in books, and on social media. Although I had never done this before, I imagined that it will provide a great reminder of what matters most.

I began my exercise of gratitude awareness this month by focusing inward, and I wanted to share with you the first two items in my gratitude journal:

I'm grateful for my mind. Sure, it may have a hole in the bottom of it that was plugged up with a bubblegum-sized piece of fat from my belly 3 years ago, but I must admit that despite its current pituitary deficiencies, my brain has served me quite well. I recently had to write a mini-bio about myself for a chapter submission to a book, and as I was writing it I realized all that my brain has accomplished for me. It solved many engineering problems, in school and on the job. It completed research projects and a Master's thesis. It got me into medical school, through medical school, through residency, and to the point of being a board certified medical specialist. That is pretty amazing, undisputed stuff. And it's helped me make good decisions in my life, about lots of things... too many things to list here.

I'm grateful for my body. I recently heard an interview with movement specialist Katy Bowman in which she made a distinction between "exercise" and "movement". Exercise is one little piece of what is movement, which is one of the elements that constitutes optimal body functioning. This also includes, she pointed out, very basic and overlooked but important things: the ability to eat, to digest, to sleep, to eliminate waste, to have sex, to get pregnant, to stay pregnant, etc. Yes, I know those last couple of things in that list are currently missing for me, but I'm doing pretty well otherwise. And I am reminded (if I allow myself to be) of these gifts every workday as I see patients struggling with one or another of these vital elements.

Thank you for reading today about my thanks. Have you ever done a "gratitude challenge"? Was it helpful? What are you thankful for right now? Share it here or on Facebook!

Thursday, October 30, 2014

Introvert or extrovert? Recognize when you're "out of your element."

Me traveling upstream

Are you an introvert or an extrovert? This question has been discussed in books, articles, and social media recently, as the answer can affect big factors in our lives: how we conduct business, the success of our relationships, parenting style, and what kind of job we would be most happy doing.

The conventional thinking of an introvert as "shy" and an extrovert as "outgoing" is too superficial. It is actually more appropriate to describe an introvert as one that gains energy from solitary activities, while an extrovert is one that gains energy from being around others. The opposite on both sides is true; introverts tend to lose energy from being in crowds, while extroverts lose energy from being by themselves. Of course, none of us exhibits traits on entirely one end of the spectrum between introvert and extrovert. Sometimes introverts do "extroverted" things like go to parties or give speeches, and vice versa.

But are you one of those people who regularly does something (for work or otherwise) that's "out of your element"? Are you an introvert working in sales, are you an extrovert who programs computers, etc.? I definitely lean toward the introvert side of things, but I am not always out of my element at work. Because the workdays are so varied, being an anesthesiologist requires a balance between introversion and extroversion. Sometimes I care for only one patient in a long case, quietly monitoring and administering anesthesia for the entire workday. A true extrovert could find that type of day particularly draining. Conversely, on a day with six quick cases, I have to be constantly "on" when interacting with multiple patients, nurses, surgeons, etc. I go home feeling a bit more fatigued on those days, and the last thing I want to do is go to a dinner party or a meeting. These opportunities sometimes arise, but often I end up saying no to them. (Having an introvert for a husband helps!)

In the book Quiet: The Power of Introverts in a World That Can't Stop Talking, Susan Cain gives an example of a beloved professor. Despite being a classic introvert, he is well known for his engaging lectures. He gives these lectures in the mornings and the afternoons, but in between, he must retreat to a silent place to "recover". At one point, he was asked by a superior to spend his lunch hour in a recurring meeting, but he declined, citing some sort of made-up need to research ships in the harbor (i.e., go sit in the park alone).
That's good self-care! He knew himself well enough to realize that he required silent time to recharge and thus should not sandwich in another activity that was clearly out of his element. This would cause both undue stress and degeneration of the quality of his lectures. If you lean toward one personality type and you are frequently performing activities that are on the other side of the spectrum, then you are going to need extra self-care and de-stress opportunities during those times. How this is achieved is up to you. What's in your black bag?

Don't know which type you lean toward in the first place? Check out Cain's 12-question quiz on her website. There are others out there in a similar vain, and you can always take a Myers Briggs test (as I discussed here) as well. This excellent Fast Company article summarizes the differences between the types and gives advice on how to care for introverts vs. extroverts (more from a management perspective, but could be applied outside of work situations).

Does this change how you think about something important that you regularly do or participate in - your work, a hobby, etc.? How do you recover when these pastimes are out of your element? Share your thoughts here!

Monday, October 13, 2014

Self-Care Triage

If you've ever had the unfortunate experience of a visit to the ER, then you or your injured party were involved in triage. Maybe you sat there waiting to be seen, wondering why others were called back before you. If your reason for showing up in the ER is less serious than another person's, you will be be seen on a lower priority. This is the concept of triage: the natural prioritization of who and what needs to be addressed first.

With the multiple responsibilities and roles we fill in life during these seemingly shorter and shorter days, it is imperative that we learn how to triage our own self-care. Recently, I was asked by a group of young female medical students to provide some practical tips for self-care. One of them said, "We know we should try to achieve some balance, but no one ever gives us real-life tips on how to do so. I don't know where to start." This prompted me to share some concepts I've had in my head, organized by priority. Following the theme of simplicity in my Four Realms of Balance (Work, Home, Community, and Self), I chose four basic categories of self-care for my triage: Sleep, Nutrition, Exercise, and Leisure Time.

Sleep. Sleep, which arguably could be lumped into such self-care categories as "rest" or "leisure", definitely deserves to be a pillar on its own. It is the base of the pyramid of needs, a most important factor... such that all other attempts at self-care will suffer if sleep is inadequately addressed. Check out this Tedx Talk by Dr. Kirk Parsley on America's Biggest Problem if you don't believe me. The reality is that many of us will suffer periods of sleep deprivation, either due to work or childcare or other personal reasons, at various points during our lives. And during these challenging times, sleep should be priority number one... above proper nutrition or working out or any other self-care items. In other words, it would be better to eat garbage and not exercise but sleep extra than it would be to have nutrition and workouts dialed without good sleep habits.

The goal should be to get at least 7 hours per night. Of course there will be nights, such as on a call shift, that this will not happen. In that event, every attempt should be made to take a decent nap during the day. And no strenuous exercise should take place! This will merely have a paradoxically negative effect due to increased stress levels in the body. What if your profession involves shift work? This is difficult but can be managed. This blog post by night-shift pharmacist Michelle Tam is one of the best I've read about taking care of yourself while regularly working nontraditional hours.

What to do if you must nap at odd hours or have a hard time falling asleep when you should? Make yourself go to bed EARLY. Figure out when you need to wake up and get into bed 8-9 hours before that. Stop looking at the blue screens of TV, phone, or computers at least an hour before you want to fall asleep. If you must look at the computer, install f.lux. Wear a sleep mask. Make your room as dark as possible. Turn up the fan or air conditioner (or turn down the heater).

Nutrition. Without getting into political discussions about food choices or macronutrient ratios, the most broad-based, simple and effective piece of advice I can give here is to eat real food. Basically, 80% of the time you should be eating things that are made at home and/or do not come from a package, restaurant, or vending machine. No matter what your preferred diet (vegetarian, paleo, high protein, low fat, etc.), your food should be as unprocessed as possible. Experiment with some simple meals and go-to snacks that you can bring with you to work. Also have some "emergency" real food on hand for when you get stuck at work late or on-call. Examples of this would be a bag of raw almonds, dried fruit, hardboiled eggs, cans of tuna or salmon, or even an energy bar with minimal ingredients (Larabars are pretty good in that sense).

Exercise. Many people list "exercise" as one of their favorite ways to care for themselves. However, too much or the wrong kind of exercise can actually be detrimental if things like sleep are not optimized. Being in the higher and yet smaller end of the pyramid, exercise should be modulated based on how well you are doing with your sleep and nutrition. Just like you can't fake a good night's sleep, you can't "out-train" a poor diet or poor sleep habits.

Now, some people are just not athletic or do not enjoy to exercise. Nevertheless, I maintain that "exercise" is a pillar of self-care for us all, as long as you re-frame it to encompass a broad spectrum of low-level activity to all-out intense sprinting. What is the type of exercise we should all be doing the most? WALKING. Most of us are capable of it, and if we are not, there exists a similar low-level alternative. And all the walking you do during your day can add up to quite a workout! What if it doesn't because you sit all day at work? Try parking in the remote parking lot, taking short desk-breaks, walking at lunch, taking the stairs, etc. Build your exercise base with walking and fill in the rest with what is appropriate for you. (The topic of exercise deserves its own triage pyramid... a subject for another future post!)

Leisure Time. The rest of "you time" should be made up of things that bring you enjoyment. Not sure what those things are? Well, then you should spend some self-reflection time figuring out what makes you tick! What are your simple pleasures? What kind of personal maintenance activities (baths, massage, creative time, meditation, etc.) do you require to feel good? Take a look back at the Resilient Clinician self-care questionnaire for inspiration and have some go-to ideas.

My triage may seem a bit daunting, but it's actually very simple. When faced with a choice over how to fill a particular period of time, think of the pyramid. I use it constantly in my own practice of balance; I may have planned to weight train or go bouldering after work, but if I woke up from a bad night's sleep or work was particularly stressful, I will skip it... or maybe just go for a walk! How about you? How do you prioritize self-care?