To put it simply, this weekend in Charlottesville, Virginia was terrifying.
Being fairly removed from most public news, choosing to forgo TV and traditional news outlets in order to preserve my sanity, I wasn’t prepared for what I walked into Saturday morning in the streets of the town I call my home.
As I parked and walked along the downtown mall, with the hopes of seeing my friends at our local farmer’s market, I was hit with an unwelcome wave of negativity and confusion. One scan of the surrounding area revealed people dressed in all sorts of strange clothing, carrying posters and displaying various instruments, flags, and other memorabilia I didn’t fully understand. Something was happening and my heart was confused, aching and hurt. Turning the corner from the downtown walk, I soon discovered that there was no farmer’s market, not a single tent, none of the familiar faces I had come to love and know as family.
Suddenly, with only mere seconds of warning I was drawn to a crowd, screaming and running for what appeared to be their lives. It was chaos.
Still somewhat removed from this disturbing commotion I started running back to my car, parked at the local family medicine clinic I had known to be a place of healing, of acceptance, of love.
As I got into into my car, my eyes were drowning, ready to close and process what they just saw.
Keeping my eyes closed, I fled from these disturbing images and I prayed like I had never prayed before.
God I know not what evil and hate is happening now, but may you protect all those wishing to stand for peace and drive away those confused with intentions to hurt.
Racing away, I drove back home to my girlfriend’s apartment.
But, before I could even begin a conversation, my eyes were directed to a cell phone screen, watching a video showing violence breaking out in the streets I had previously walked upon in peace for so many years. The video then turned quickly to utter horror as it showed a car driving head on into a crowd of civilians.
I didn’t know what to think.
This was happening in Charlottesville.
Who were these harbingers of hate, these white supremacists rallying to “Unite the Right”?
And who were these counter-protesters?
Why was there so much anger? So much hatred?
I stopped and hugged my girlfriend. Holding her with every ounce of love remaining in my heart.
The two of us, an inter-racial couple trained as physicians to be healers of the physical form, were now being called to be healers of a brokenness nowhere to be found in any medical textbook.
Silent, just resting in each other’s being we didn’t need to use words to say what was in our hearts.
What does the moment require of us right now baby?
Without hesitation, looking into each other’s eyes, we grasped hands and started to pray.
Silent, in meditation, we breathed to pray, and prayed to breath.
On the surface,
I, a white Christian man
She, a black, spiritually unifying woman
Just meditating, praying, and asking for peace.
What the white supremacists stood for was hatred and evil.
They as people, however, were not hatred, they were not evil.
They were just people, confused, and emotionally disturbed people.
What the counter protestors stood for was unclear, but what ensued in their presence was only more hurt, anger, and unintentional hatred.
They as people, however, were not hatred, they were not evil.
They were just people, trying to defend values they held dear.
Both just people trying the best they could with their current understanding to defend their values and beliefs.
Despite traditional thinking otherwise, we are not actually our words, we are not even our actions.
We are simply people blessed with the freedom of choice, capable of love, and capable of hate.
We are people, not actions, not words, just people.
Pondering further, escaping the chaos of the present moment I wondered:
What if no one showed up for the supremacist’s march? What if we had all simply stayed home, and went about our normal, joyful day, pausing to pray for those confused and in need?
Or better yet, what if we had walked, jogged and played in our city without passing a second glance at those matching for hate?
To me non-violence is not a path of ignorance or turning a blind eye to hate, but one of stripping hate of its weapons, leaving all those carrying such hurt naked and bare of their power to generate fear, create violence. and hurt beyond measure.
Ask any mother what is the best way to defuse a child’s temper tantrum gone off the rails?
Do not engage the child.
Let them yell, let them scream, let the emotion flow.
But do not engage what cannot be engaged.
We are not slaves to fear.
We are not slaves to hurt.
We all have the choice to stand for love, and unfortunately this weekend, many stood for hatred, and some inadvertently engaged an evil, giving it precisely the weapons and control it desired.
I have many friends who disagree with my stance of non-violence, of non-engagement, of staying home to meditate, to pray, but I also have many friends who did precisely as I did, holding safe spaces for prayer as the evil went marching.
They are all my friends. All truly amazing people standing for shared values of compassion, inclusion and acceptance. They all have my love.
For love you see is all we really have.
Going forward, my girlfriend and I will continue meditating and praying for healing so that the confused and hurting hearts can be filled with love, so that those hurt in the violence can hopefully be healed from these acts of misunderstood hate and so that there can finally be peace.
A black woman and white man.
We, as two human beings
Seeking to share our love
With all those open to receive it.
For as the great Martin Luther King Jr most eloquently professed,
“Darkness cannot drive out darkness; only light can do that.
Hate cannot drive out hate; only love can do that.”
Love we will Dr. King.
Love we most certainly will.
When looking back to my childhood days I notice that death was always next to me, starting with a classmate suffering from cancer. One day she did not come to school. We were told that she was very sick and I wanted to visit her, but was not allowed. As a child I did not understand why I was not allowed to visit her. Suddenly, she had disappeared. Over the next few years, I had to learn that death was always near, as two classmates committed suicide and another one came back from holiday with a serious infection and died. I began to fear this being which takes away people with whom I had shared some parts of my life. No announcement and suddenly they were gone. Like many of us I tried to avoid thinking about death.
Several years later, the topic popped up again, silently, but with insistence. Nothing had happened, I just had a little voice in my head telling me that someone who is facing a terminal illness and who is at the end of his life, should not be alone. So I started a two-year training in which I learned to accompany people suffering from a severe illness or to support people in grief. During this training I noticed that I was interested in two things: the last weeks of a person time on Earth and the necessity to bring the topic of dying back to the table in order to help us both lose the fear of death, or at least most of it. After listening to a speech by a German Professor in Palliative Care I realized that this is what I was supposed to do.
In my opinion, Palliative Care is a very important part of medicine. You see the human being as a whole, you see their needs and you do not try to do everything to keep the person alive. Quality of life before prolongation. Sometimes less is more! Three years ago, with the fire was now burning, I started as a volunteer in one of our hospitals. Once a week, I held a little café with another volunteer. Offering food was the opener for a conversation. I did not know that this would become a path of deep learning, of ups and downs, of joy and pain.
My first day came and I was very nervous and had to take a walk before entering the ward. My heart was beating and I had a lot of questions running through my head: Will I be able to do this? Am I able to decide between compassion and suffering? How do I find the right words? Can I stand the suffering of others?
My first patient was a nice old man. Most of the time he was sleeping and he held my hand. I was glad for this start, it was easy, just to be there, knowing I did not have to do anything, I did not have to find the right words, I just had to be there, holding the hand of someone in need. Every time he awoke, he smiled at me and said “I am still there“ and I smiled back and said “yes.” He spent several weeks with us and one day he did not want to hold my hand anymore and I thought to myself “Ok, you are ready to let loose too.”
My first lesson during this time was to understand that there is no perfect age or time for dying. We had a young man of 37 in the first room and this old man at nearly 83 in the last room and between these two men there was only “WE WANT TO LIVE.” I am grateful for this first lesson, as I think it is important. We often agree that an old person is allowed to die because he or she has already had a life but we cannot stand the death of a child because this child had no chance to live a full life. Are we allowed to judge in this way? Who is telling us that because of the age of the person that they have really lived and who knows if the child has already learned a great lesson in such a short time?
During the next year I had to understand that everyone has his own way to cope with his illness and with the fact that life is running out. During my training I had to go deep into myself. I had to look at death from different perspectives. My fire was burning and I often was too afraid that my inner fire could burn the patient and I became quiet. At the beginning, my idea was to talk with people about death, to find pictures with the patient which took the fear away. I have learned that through the intense discussion of the topic I was able to conquer my own fear and I could now accept death as part of our life. And now? Only a few people start the conversation about their coming death, their concern, their life. A lot of them still deny their illness or are not able to talk about it. This lesson was painful, very painful. I could hardly bear it and it was more difficult for me than visiting a patient with a deformed head due to a tumor. I was often frustrated, and in a way, also demotivated. I did not see my role as someone just bringing coffee to the room, I wanted to help the patient to find peace with the dying process and to learn from him, his life, his regrets. One day, I realized that I was not with the patient and his needs, but was stuck in my own needs and from this moment something had to change.
I believe one of the problems of our society is being silent when someone is talking about death. The fear that someday this life will be over over is too big and we try to run away from it. In Western society we believe that we can conquer everything and have to learn that one day this life will be over, it is not a choice. “You have to leave and you can’t stay.” We have to face it. This was the lesson I should learn. I see life as a good bottle of red wine: You fill it and when the bottle is full you close it with the cork - bottle and cork belong together, so life is nothing without death, right?
Sometimes I hear that patients are told “We cannot do anything anymore” and then I have the impression that they give up. I feel sorry for these people that they allow someone else to judge the worth or purpose of their lives. Of course, it is not the same anymore, but there is always a way to live, different, but to live. Palliative Care is able to do a lot today to reduce pain, nausea etc. and I also like to take care of the spiritual needs of a person. One of my most impressive patients was a 34 year old woman with brain cancer. We got to know each other in hospital and when she went to a hospice I visited her there. Usually, I do not do this, but in this case I had a good feeling and at the end the gut feeling was right. She told me that at this age she felt too young to die and from that moment on she took everything she was able to get.
She had wonderful colleagues who came every day after work. They went with her to the cinema and we had so much fun. There was always laughter in our room that the nurses always wanted to stay with us. They brought food, her favorite Polish dish: Piroggi, and we sat together having dinner, strangers who had become friends. She told me that she did not know that her colleagues liked her and she was astonished to feel this love at the end of her life. I sometime had the feeling I was in a movie watching these people having fun in the room and crying outside.
Eventually, the day came and she could not leave her bed anymore, she had nightmares and saw it as a personal failure that she was not able to fight with death anymore. Her death was not easy to take. I was always afraid that someone would touch me in a way that I couldn’t bear. But I have learned that I am stronger than I thought.
I cried a lot, I saw her everywhere, but then I told myself it is ok. This young woman left a big footprint in this world and I see a story behind this young death: the fact that she taught us to fight until the very end and we shouldn’t stop because someone tells you that you are not able to heal.
As regards to dignity, I met a woman who had been suffering from cancer for four years. She was fed up with her illness and the ups and downs. She wanted to die as soon as possible. We had a small conversation. She was very clear what she wanted, her children did not know about her illness and from one moment to the other, she was quiet and we sat together for some time in silence. She did not believe in God or something else, but when I left the room I asked her if I should ask God for his grace to release her. With tears in her eyes she nodded and I said, ok I will ask him this evening, which I did. I was very touched by her and that we only sat together and it was ok that no one had actually spoken. I realized that for her everything was clear said and words were not needed anymore.
During the last three years I have met so many amazing patients for whom I share the greatest appreciation. Some people say “I could not do this, how can you stand it? How are you still doing this?” I guess one reason is that I have learned to accept death as part of life and to see people relieved of their suffering also helps a lot. When people die it is often a relief. I know that it is hard to leave this life behind but in the end everyone does it and you see that the ones who fight so much can actually turn away from relatives, loved ones and life, going their last way.
Sometimes, I am proud of these people – no one really understands it – but I see how difficult it is and when they are able to do it, they do not have to suffer anymore and they have grown through their illness. This gives me trust that I can manage it, too. You can fight against it, but one day, this is for sure, the time has come and you see that you will lose this fight. It is the usual way we all have to go, when the little bird spreads its wings and flies.
Of course it is not always that easy. I once came into the room of a young woman. Her mother was with her. I looked at her and had the feeling death was not far away. I offered my service and the mother accepted the cake. I went to the kitchen, came back and the mood had changed totally. She shouted at me that she does not like my damn cake, it is awful and I saw in her eyes her pain. I had the feeling that the daughter could hardly breathe because the mother did not let her. I was too inexperienced and noticed that I was not able to find the right words and talked nonsense. So, after a while, I left the room. I was shocked. Later on I met the mother on the floor, we looked each other deep in the eyes and I tried to tell her that everything was going to be ok and I could feel her pain. The daughter died two days later. There was a lesson in noticing my own limitations. Until today, I could not cope with these, but now I am at peace with what I can offer.
During the first year of training, I watched myself very carefully. I noticed everything, my reactions, my own fear and today I am grateful. Today, I know when it is too much and I need to stop. But to be honest, this does not happen very often. Patients often say “You are giving us your time, go home, you have a private life” and when I tell them that they are my teachers, that I learn so much from them and their experiences they always look at me in wonder and disbelief. For me when I see a smile of a patient or when someone touches my hair because he is not able to speak anymore gives me the strength to continue working. This is what everyone of us can give to other people around us who are in need. Active listening, compassion and showing that we are Genuinely Interested in them is all we really need to do.
Being a volunteer in the field of Palliative Care has helped me to see what is really important. I take care of my own life. You never know when your time has come, so live the moment. I do not procrastinate on the things which are important to me and I know that I have to love my life in order to balance my work as a volunteer with my private life. I would not do this without all the wonderful people I have met. Because of their stories I am able to help others who find life these days very challenging. I am grateful for this experience.
The grim reaper does not frighten me anymore, I see his sickle and know that if you open yourself to this topic you can learn from life and learn from death and most importantly, appreciate the gift of life in the place.
If you haven’t already, check out Part I of this series: My Guide for Caregivers When Your Loved One is in the Hospital to get caught up on the first five tips!
6. Seek Out Supportive Services
Many hospitals have Integrative Medicine Consult Services, providing services such as Reiki, Music Therapy, Art Therapy, Acupressure, Therapy Dog visits and basic relaxation/stress management support. I have just started to connect with the Integrative Medicine Consult team as part of my health system and have made an effort to advise my patients/families of the available services and ask if they would like such services during the course of their stay.
Spiritual counsel is also readily available. Nearly all hospitals have trained chaplains, who are more than happy to work with you and your loved one during their hospital stay. People can often be afraid to ask or unsure if the available service will match their personal beliefs, but chaplains, no matter their personal affiliation or beliefs, are specifically trained to be vessels for universal spiritual healing, being present with you and your loved ones no matter the differences that exist between your family’s beliefs and those of the chaplain.
And lastly palliative care services can be an absolutely life saver. Life saver you say? Yes, palliative care is not simply symptom management at the end of life. It is alleviating the burden of symptoms, providing spiritual and emotional support and directing care towards the most patient oriented of problems at any stage of life. In Episode 006 of my podcast: A Medicine Mind: Wisdom and Well Being, I spoke with Jonathan Bartels, one of my most impactful mentors and one of the leading experts in palliative care, and I encourage you to check out this conversation to hear how Jonathan seeks relieve suffering in those most in need, and when the time calls for it, to support patients and families through the transitional process of death and dying.
7. Academic Medical Centers Can Be Your Friend!
I know my joke in Part I of this series about facing the army of white coats is somewhat of an exaggeration, but I recognize that being confronted with so many people at one time can be quite overwhelming, Having studied at the University of Virginia School of Medicine, I saw many patients and families expressing uneasiness (or frank refusal) with regards to medical students and residents taking part in their care. While at first glance you may feel your loved one will be better off with less (or more experienced) clinicians involved, I can assure you that there are many benefits to having a true team of caregivers at very different stages of training.
While this is my personal bias and driven from my experience as a student caregiver, I encourage you to seek out the medical students and speak with your team of nurses. Residents, Fellows and the Attending Physicians are often burdened with lots of work (and not that medical students and nurses aren’t), but medical students and nurses can be your gateway to more personal discussions, story-telling and really digging into what is troubling you and your loved one. And through these lengthier and perhaps more vulnerable discussions, the student and nurse can become an additional advocate, speaking to the broader team about new ideas, needs and history garnered from you as the caregiver that otherwise may never have reached the surface. Medical students are eager to learn and nurses understand the holistic needs of the patient often better than anyone and while neither may be completely “running the show,” they can be tremendous advocates for you and your loved one.
8. The Use of Outside Medications/Supplements
Now I will preface the following statements by saying this topic is very institution dependent and potentially controversial, BUT, in general, if you as a caregiver bring in a loved one’s supplements and certain home medications in clear labeled containers, hospital institutions and staff will allow and want you to take such medications. Is your loved one currently taking some curcumin, methylfolate and a combination of adaptogens? Bring them with you in the containers and express your desire for your loved one to be supported by these herbs and supplements. If the primary provider is uncomfortable with the products that you wish to provide your loved one, than ask to engage in a mutual discussion seeking understanding clarification and intentions behind their use, but I strongly advise you to NOT hide and keep such products secret as certain products do have known negative interactions with medications and the potential negative effects can be quite devastating.
I will commonly search Mytavin to look at possible nutrient depletion in my patients based on their current medications.
For institutions with access, (The Institute for Functional Medicine is one) one can get also get access to Natural Medicines Database in order to examine available data about natural products, possible adverse drug interactions, and nutrients that can be depleted while taking certain medications.
I cannot and am not going to give you recommendation for specific supplements, but I will provide some options to consider that are generally well accepted at most institutions and can be quite beneficial as part of a healing regimen
9. Ask Questions and Engage in Shared Decision Making
It is your right to ask about the role of certain tests, medications or procedures in the course of your loved one’s healing. Those of us desiring to be more integrative in our approach can easily tune out to invasive tests or drugs just by their label, but you must remain open and inquire with your team as to their reasoning and logic behind the overall care plan. Ask specifically about each medication- how does it work, how might it help, what are possible adverse effects and risks, what are the alternatives, how likely will my loved one benefit and what it the expected magnitude of this benefit?
Ask about lab tests, following up on results as you desire, ask for printed results or copies. Ask similar questions about the reason behind certain labs, what is the perceived benefit of this test and what exactly does the result mean? Usually it is not so cut and dry as disease or no disease. And most importantly inquire into how such testing will change or improve treatment for your loved one.
10. Protect the Microbiome
I left this for last because it is arguably the most important and perhaps the least well understood in acute hospitalized medicine. As we come to understand the vital role for maintaining a balanced and diverse microecology of bacteria, viruses and fungi on many of our body surfaces and organs, we see that antibiotics are not a silver bullet even in the most appropriate of circumstances. Recommendations from recently compiled data and systematic reviews are beginning to echo the importance and efficacy of probiotic supplementation during courses of antibiotics and in the healing period in general to prevent adverse effects and difficult to treat hospital acquired infections (1,2).
An example of such data is a recent review from the American Academy of Family Physicians summarizing the currently available and broad research on probiotic supplementation for various gastrointestinal conditions.
A sample from the conclusion:
“There is high-quality evidence that probiotics are effective for acute infectious diarrhea, antibiotic-associated diarrhea, Clostridium difficile–associated diarrhea, hepatic encephalopathy, ulcerative colitis, irritable bowel syndrome, functional gastrointestinal disorders, and necrotizing enterocolitis. “
“Probiotics are safe for infants, children, adults, and older patients, but caution is advised in immunologically vulnerable populations”
Of particular interest is the high level of evidence supporting probiotics in preventing antibiotic associated diarrhea, infectious diarrhea and in the prevention of C. Difficile, a rather terrible intestinal infection often acquired during hospital admissions involving extensive antibiotic treatment.
It is important to recognize that probiotics are not for everyone including the critically ill, septic or otherwise immunocompromised. There are numerous case reports of probiotics entering the bloodstream (likely due to intestinal permeability and dysregulation of mucosal barriers) and causing serious blood infections.
That being said, most institutions have pharmaceutical grade probiotics that can be given in conjunction with antibiotic treatment, but not all doctors and staff may be entirely aware of their availability. You can be an advocate for your loved one to ensure that a discussion regarding the use probiotics during a hospital stay occurs and that the right steps are taken to help support your loved one’s microbiotic ecosystem and overall health.
There is even emerging research now regarding the use of probiotic based cleaning solutions to minimize antibiotic resistance and decrease total hospital associated infections in inpatients (3). Who knows how we will be “cleaning” hospital surfaces in 5 years time?
There are many other ways besides probiotic supplementation to support and “protect” your loved one’s gut ecosystem. Incorporating fermented foods and prebiotics as tolerated in a palatable and easily digestible forms can be quite helpful to support the gut ecosystem. Focusing on our other key lifestyle factors including sleep and stress management will also help to regulate the intestinal mucosal barrier and maintain a diverse and supportive environment
I hope this has been a helpful guide and introduction into integrative and supportive care for those requiring hospitalization. Hospitals will never be perfect, but we can all make greater efforts to support our patients and our loved ones through the plethora of means available in order to remove obstacles to cure, and in the end, promote flourishing and joy for all.
1. Probiotics for Gastrointestinal Conditions: A Summary of the Evidence
2. Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis.
3. Impact of a Probiotic-Based Cleaning Intervention on the Microbiota Ecosystem of the Hospital Surfaces: Focus on the Resistome Remodulation
My Guide for Caregivers When Your Loved One is in the Hospital
Hospitals are strange places. We come to them seeking healing, yet routinely uncover only more barriers to wellness. Yes, hospitals are not ideal.
A few weeks back I discussed aspects of my approach with hospitalized pediatric (and adult patients) during the course of the overall healing process.
This week, however, I wanted to address and provide some practical recommendations for CAREGIVERS when it comes to supporting and healing your loved ones during a hospital stay.
As I said before, the modern hospital is not the ideal place for most to begin the healing process and it can be quite challenging to incorporate fundamental ancestral, lifestyle, and integrative healing principles into one’s care in such a place. However, with present awareness, an open mind, and some helpful guidance (hopefully from a few of my tips) your loved one can recover quickly and be restored to optimal health and avoid some of the potential harms of being cared for in the modern hospital setting.
To start things off, I think it is important to recognize a disappointing, but purposeful observation.
1. Hospital healthcare workers, trainees, and students are often overworked, sleep deprived and frustrated by numerous internal barriers to providing personalized holistic care.
This is not an excuse. I repeat, this is not an excuse. It is simply a statement of observation, but one that we must first accept in order to begin a therapeutic relationship as a caregiver. We can all be stressed, tired, burned out, fatigued, depressed, etc, and we must realize this simple truth in order to more fully accept all individuals. As healthcare providers, we seek to understand and meet the needs of our patients, no matter the circumstance, and as caregivers we seek to be present for and to tend to the needs of our loved ones as we perceive them.
Problems often arise when the perceptions of the patient’s needs from the caregiving party are vastly different than the perceptions of those of the hospital staff (example: the physician is stressed and worried about the patient’s elevated Creatinine- a marker of kidney function, while the family is worried that their father hasn’t slept well in 3 days). Where this gets really troublesome is when both sides fail to acknowledge the relative burden of “caregiving” as either the physician or family caregiver, and fail to accept the other’s current state of stress or worry.
We recognize as providers that we will see patients in their most vulnerable and worried states, but what is often not acknowledged, however, is that as a patient or caregiver, you too may see a doctor, a nurse, a respiratory therapist or a patient care technician on perhaps one of their “worst” days as well. We all have rough days and sometimes they will overlap.
But we won’t know unless we ask, and we cannot fully embrace other’s pain unless we seek to fully accept their ability to be hurt, tired or relatively broken.
Now, from a place of acceptance and understanding we can move into some more accessible tips for cultivating the best relationships with your loved one’s care team.
2. Be Available
Hospital rounding and schedules are often incredibly busy, with only minutes to spend with certain patients and families. It can often be confusing as a caregiver, being present during all of your loved one’s stay, as to why all of these strange people wearing white coats come at one time and then never come back when you actually want to talk.
It is not a perfect system by any means, and once again I make no excuses, but it is a present reality.
Ways to negotiate this system as a caregiver:
Rather than demand or ask the doctor or nurse to return to answer your questions and address your concerns at specific times available to you, offer a range of times in which you will be around and willing to talk. Afternoons are often variable in the afternoon and a good start for finding free time, but as a caregiver if you express to the team in the morning that you would like to speak more about your loved one’s care, suggest a range of times to your doctor and see if you can find a mutual time. Providers will be more than happy to speak over the phone or in person if they do not feel stressed my demands they are unsure they can meet.
Additionally, demands can be perceived as threatening- consciously or unconsciously and as such, healthcare workers may be less willing to return to see your loved one if they have perceived you to be demanding, a burden or a challenge to implementing their care plan.
3. Optimizing Sleep
Hospitals are notorious for being difficult places to sleep: alarms, vital sign checks, early morning rounds, you name it- it is challenging. What can you do to address this?
1. Ask the team or nurse if they can skip overnight vital sign checks. For example ask if they can do there final vital sign check at 10 PM, skipping the 2 AM check and checking again at 6 AM providing a full 8 hours of uninterrupted sleep.
2. Sleep aids such as Melatonin are a part of most hospital formularies and have been found to be quite helpful in maintaining normal circadian rhythm structure in patients. It can also be helpful in minimizing the potential for your loved one to become disorientated or delirious. 3 mg’s taken an hour or two before bed is a reasonable starting dose and as mentioned before available in most hospitals.
3. Try to promote a normal sleep wake cycle by engaging in activity during the day and avoiding excessive day-time napping. Yes, we need sleep to recover, but we also need well entrained circadian rhythms for optimal hormonal release, wound healing, etc. Excessive daytime naps may make up for “lost sleep,” but they are not the best solution. See the first two tips in this section for associated recommendations to combat excessive daytime sleepiness.
4. Building a Nutritious Diet
Okay this could be a long answer, but to put it bluntly, hospital food is often not the greatest. The food available in the cafeteria, while perhaps different than the food available to patients, is also often not much better. This is certainly an area needing improvement and I recognize the challenges of trying to choose between putting diabetic patients with heart issues on the “cardiac carb consistent diet” that includes orange juice, muffins and sugar laden yogurts or the low carb diet that consists of “scrambled” eggs, skim milk and bland oatmeal. Not ideal indeed.
A simple, but time-intensive solution is to bring in homecooked food. But you say, “I shouldn’t have to do that! The hospital should have nutritious food.” Yes, you are right, but unfortunately the hospital is neither ideal nor reliable.
Some foods that can be quick to prepare for your loved one include:
5. Supporting Stress Management
Anything you can do at home, you can do at the hospital!
Amazingly I have been able to cultivate a solid and diverse practice thus far during my residency training and spend much time helping my patients and caregivers with mindfulness practices to support healing. As a caregiver, explore the hospital asking about quiet spaces, green spaces or spaces for prayer or meditation. If your loved one is able, take them to such spaces, spending time outdoors in green spaces, or to places of warm light, free of relative noise and chaos.
I will not get into specific practices here, but some great exercises I use with my patients who spend much of their time in bed are basic relaxation and breathing exercises as well as progressive muscle relaxation. Technology can be a great friend too, using headphones to listen to calming music, meditation sequences or natural ambient sounds.
These practices are arguably the most important part of your loved one’s healing, even more so than a nutritious diet and restorative sleep. I say this recognizing the hospital is full of numerous environmental exposures and burdens to remaining joyful. I have unfortunately seen many patients become disillusioned, acutely depressed and simply overwhelmed with the lack of control in the hospital setting. And perhaps even more troubling is bearing witness to the acute loss of meaning in one’s life while wearing a gown. Hospital time is not real time, and hospital exposures are not normal exposures, and as such we need to recognize the tremendous need to cultivate spiritual, emotional and mental well being through the course of a loved one’s hospitalization in order to mitigate the negative effects of such exposures.
Tune in next week to read Part II of the Caregiver’s Guide, and in the meantime, please practice and share these ideas with all those in your life. Leave a comment or share an email with your thoughts from this post. We love to hear from you!
I believe in evolution. I believe in God. I believe in natural selection. I believe in a spiritual oneness behind all things. I believe in things that are easily “explainable.” I believe in things that may never be proven.
Like all beings, I simply believe.
Belief is a powerful tool and as I shared last week, belief in the abstract sense can be quite beautiful and lead to a meaningful, fulfilled life.
A little excerpt:
Belief is knowing that something can happen
Faith is knowing it someday will
So I enter into today’s discussion on belief and faith, acceptance and approval by simply reminding us that the realm we are about to enter is one of belief, of rationalization and of creative conjecture.
Not of undeniable fact or proven truth.
Simply of belief
I am medical scientist and a faithful Christian.
These aspects or descriptions of my being inform all others and cannot be excluded or addressed alone.
One cannot exist without the other, one is not “immune” to the influence of the other and most importantly they can both exist together without contradiction.
We must start to realize this fact of interactive belief so as to avoid unnecessary conflict, miscommunication or unfiltered anger towards others when seemingly different and challenging beliefs arise. Otherwise we will invariably walk down a road of needless suffering, guilt and damaging resentment.
Simply put: We must recognize our beliefs and our perceptions and see others for their beliefs and their perceptions.
We must accept others as they are, and realize that by fully accepting or loving someone you do not have to agree or approve of everything they do or of everything they believe in.
You just have to accept them.
Genuinely and completely accept them.
This is not easy, I know.
We strive for “acceptance” and approval over many other true needs and often confuse one for the other.
And yet, despite our desire to gain acceptance, we are often reluctant to offer acceptance to others, or even more tragically, to fully accept ourselves.
We seek approval when we do not need it.
We do not provide acceptance when it is all we really need.
We desire and seek approval in order to “feel accepted,”
when in reality we never needed approval to “feel accepted” in the first place.
So what does acceptance look like?
Or perhaps more importantly what does acceptance feel like?
Acceptance is freedom, it is peace in the moment, it is knowing there is no such thing as judgement. It is being deeply connected to and touched by another human being.
Acceptance is believing, acceptance is empowering, acceptance is relieving to a world of anxieties.
Acceptance just is.
How about approval?
Why do we often get these two confused?
Ever feel hungry when you are actually thirsty or tired?
Ever feel angry when you are actually just lonely and isolated?
It is easy in states of heightened emotion with “uncontrollable” environmental burdens to cross-contaminate the emotional waters and for the mind to start telling itself a story that is actually quite untrue.
How do we combat this?
Here is a simple exercise I have created and practiced to help in these moments of emotional distortion or potential confusion.
First, as with most things, take a pause:
Three simple breaths
They don’t have to be deep, they do not need to follow a special pattern.
You just need to pause and know that you are breathing
Know you have taken three purposeful breaths
Then from this place of reflection, repeat this series of phrases or mantras
I am vessel for acceptance.
I fully accept others as they fully accept me.
I greet others with openness and seek nothing but acceptance.
I am independent of other’s approval and seek not to obtain such recognition for its sake alone.
And if moved by your own spirituality or faith you can repeat these phrases
I have been accepted and graced by God, my divine, and I will offer such acceptance to others knowing they too, have God’s precious grace.
For I did nothing to receive such grace, and will never need approval to fully accept it.
I am working to be an accepting vessel,
remembering I never need approval to accept others and myself
for in reality
It is only when we start looking for approval
That we forget that we were and will always be
As I am currently completing my first rotation in Pediatrics as part of my Family Medicine Residency training, I thought it would be an opportune time to discuss my approach to holistic pediatric (and even adult) medicine. Over the past few weeks, I have seen numerous children in the hospital and outpatient setting. From the 2-hour newborn to the 18 year-old struggling with a complex psychosocial situation, I have been quite impressed with the depth of knowledge required to be a pediatric hospitalist and general pediatrician.
I often joke with my brother's girlfriend, who is a veterinary technical assistant, that being a doctor should be simple, you are just responsible for one species. When it comes to taking care of kids, however, the idea that they are all Homo sapiens somehow is just too hard to believe. Developmentally complex, children can be categorized by certain physical and cognitive milestones, but in reality, this is just a snap-shot reflection of the person he or she currently is, and may have no bearing on the adult he she will eventually become.
Nurturing and caring for our youth is something near and dear to my heart. Having grown up with all younger cousins, I literally saw the growth of my relatives from diapers, to tricycles and rec soccer, to finally graduating high school and moving on to college. I currently have been serving for almost 2 years in my local church’s Children’s Ministry, teaching, learning and growing with elementary age kids, seeking to further a relationship with Christ and live a joyful, playful and overall meaningful life.
If I were to tell you that the most important part of their physical maturation was constant oversight from a pediatrician during well child checks, sports physicals, the occasional visit during a tough cold, or the acute visit for that really weird rash, you might think this to be a grand overstatement. But take a closer look at this thought, and what you might find instead, even when we start to consider the acute illness requiring hospitalization, is a relationship of trust whereby the pediatrician, hospitalist or family physician is able to nurture the growth of a child, simply by being a positive presence, someone who genuinely and deeply cares.
It has become very obvious to me, that even in the hospital setting, that many of my discussions revolve not around specific aspects of a particular illness or presenting complaint, but on how a kid is doing in life. What sports do they play, are they involved in dance or art, how much are they sleeping, do they have any problems with their diet- too much candy, food intolerances, not eating enough vegetables, binging on ice cream and Chinese food, how was life at school, do they have close friends, if they have siblings what is their relationship like, have they been able to travel to another state or country, what do they want to do when they grow up, what was the coolest thing they’ve done in the past week?
To me, taking a history is so far removed from asking about quality, duration and onset of pain, or reciting a laundry list of questions for a complete review of systems that I sometimes even forget where I am even working. Even when these components are required as part of a complete medical encounter, I will always seek to inquire about total well-being: social, spiritual, physical, and emotional.
I will be the first to admit that I have previously worked extensively with a psychologist, seeking to improve my overall well-being, digging deeper into my weaknesses and fears, and making sense of any thoughts or doubts that would swim through my mind. While this relationship worked for me, it may not be right for you, but what I encourage of everyone is to find that person in one’s life with whom these types of discussions can occur, completely safe, secure and free of judgment. It certainly does not have to be with a trained psychologist or even a family member or friend, the arrangement and sense of true acceptance are all that matter.
Expanding from this encouragement to pursue and develop an open and supportive relationship in one’s life, I have thought more and more about my many pediatric encounters, and it has become entirely clear, that perhaps, such a dynamic and supportive relationship is being shaped without the child, family or doctor even being aware of its supportive construction. Through thoughtful and meaningful interaction over a period of time, a general pediatrician or pediatric hospitalist can become a trusted presence in a child’s life such that the child can actually begin to cultivate a greater sense of positive well-being and adopt new self care practices to hopefully prevent future illness.
Taken to the hospital setting, one can begin to see the potential for truly impactful change during a period of serious illness and relative stress. No one wishes to be in the hospital, and I would argue that the only thing people want more than to leave the hospital is to never come back. As such, I realize that the hours, days and potential week spent in a hospital can be a monumentally productive time where a vulnerable child and family can become much more willing and engaged to learn why their child ended up in the hospital in the first place and what exactly can be done to prevent any future hospital visits.
But learning and prevention take time and effort. If a doctor is only willing to perform rounds and get the “EMR” completed without a second or third visit to speak with a family, much of this potential growth will never be realized. I can certainly say that overall workload and EMR obligations make this type of care more challenging, but for someone just 3 weeks into learning how to be a pediatric hospital MD, it is indeed possible, it is simply a question of priority, awareness and mindful intention.
Have I been able to engage in such discussions with all of my patients and families- of course not. Could I be doing more- certainly. But what I realize and want to convey to you is simply knowing YOU CAN. Whether in the hospital, on the sports field or general clinic YOU CAN. We CAN. We ALL CAN. We can be the positive presence a child and family need to heal, grow and open, allowing them to share all of their worries or when they are hurting or when things get tough.
It’s a fact of life that we all want to be happy, healthy and remain free of suffering. Sometimes, however, illness, negative thoughts, and unexpected life events can cause upheaval in this balance. While I always hope to have people in my life that I can turn to when times are difficult, I ultimately want to know that I have the tools and personal resiliency myself to face any challenges, all the while, knowing I have a support team waiting in the wings to catch me should I stumble.
Being a pediatrician or pediatric hospitalist can be so much more than simply being the “kid” doctor. We can empower kids as their families to be owners of their health and vitality. As I have said many times before, the hospital is all too often the home of sick care and the outpatient clinic the home of chronic band-aids. I am never one to discredit the value of hospitals, and certainly do not want to come across as someone who sees hospital care as completely dysfunctional, I merely want to suggest that there is an alternative when it comes to how we use our time, where we direct our energy and what we actually offer as supportive resources.
Will the hospitals of today ever become holistic acute care centers incorporating lifestyle medicine as their foundation, allowing patients to sleep on regular schedules, eat whole and nourishing food, engage in communal connection with others whether in play, spiritual bonding or simple conversation, discover practices to help reduce stress and support resilience, all while additionally having access to specialized technology delivering appropriate and cost-effective acute care when necessary, I have no clue. Maybe we need a replacement for the hospital all together? Once again, I have no clue.
What I do know is this: as health care providers, we must open to cultivate a relationship of positive intention no matter the patient’s circumstance or environment for healthcare delivery. We must be in it for the long term supportive relationship even if it appears we will be only a part of this person’s life for 2 days. We must care and love our patients enough to show them how to heal, to become resilient, and to forever flourish. While the specialized tools at my disposal may be drastically different in the hospital setting versus the outpatient clinic, the space and intention I hold will always be the same, and guess what, lifestyle medicine will always be accessible. Always.
To close I give you the essence of my intention when delivering medical care to all.
Remove the obstacles to cure, educate individuals about new ways of living this most precious life, support people as they navigate such challenging obstacles and engage in a relationship founded on love.
Remove, Educate, Support and Love.
This is my purpose, this is my mantra,
This is my life.
To Be or To Do, That is the Question
If you’ve read some of my previous posts, you have probably picked up on the fact that I speak quite frequently (in perhaps a slightly philosophical and abstract manner) about the importance of reflection and savoring moments of simply “being” in order to fully flourish and thrive in the service of others. Those that know me quite well would probably share that I am quite active in “doing:” writing, researching, serving my community and just recently beginning work as a family medicine resident.
I do a lot. And honestly, I am likely doing too much.
But how do I get so much more accomplished now than when I previously spent more “quantitative” time engaged in “doing” activities without a single second devoted to meditation or a purposeful pause?
I wish I had a strictly logical or rational answer to this question, but the truth, such an answer escapes me
What I can say, however, is this:
We need being, and less doing, to actually do more.
Let’s get one thing straight, there is not and will never be “enough” time in the day for us to satisfy all of our desires or complete all the work (no matter how selfless) we initially planned to accomplish.
In fact, the more you attempt to schedule doing in your life at the expense of time to rest and simply be, you will slowly begin to do less and less, and feel less satisfied even when you have theoretically accomplished “more.”
Rather than start an entirely philosophical discussion trying to make sense of this concept of balancing doing and being, I propose, instead, that we extract practical meaning from this dichotomy of being and doing by addressing two simple, yet surprisingly profound ideas.
From these two statements, it becomes quite clear the we can consciously and unconsciously pursue doing rather than being because we perceive it to be the easier task when it fact doing may actually be beyond our capacity and downright impossible.
Choosing to do because we have “learned” it is likely easier and more rewarding than simply being when it fact, in a particular situation, we may not actually have the means to do anything.
Any situations come to mind where you felt helpless or rushed and tried to do something in order to fill a space or that void of discomfort?
To give a practical example, ask any EMT or Emergency Room doctor about Advanced Cardiac Life Support: the algorithms and process for attempting to resuscitate someone after a cardiac arrest, and what of all the things that are a part of this relatively complicated algorithm actually save lives?
If you guessed the drugs, you are unfortunately mistaken.
Yet, with all the research done showing no actual benefit to the administration of nearly all drugs administered during a cardiac arrest when compared to well performed basic life support including compressions and, if possible, a timely and fortunate electric shock from a defibrillating device, we give the drugs anyway.
Doing because it seems easier than being, even when doing cannot actually be done.
I reiterate this amazing truth in order to bring clarity during those moments of uncertainty, fear or doubt.
No matter the situation,
WE WILL HAVE ALWAYS the capacity TO BE,
but very often
WE WILL NOT HAVE the capacity TO DO.
Yet, paradoxically, it is precisely in the moments where we cannot do, that we choose such a path because simply being seems impossible or entirely unthinkable.
Why exactly during these most difficult of times do we struggle with the decision to do rather than to be, when in reality, there shouldn’t be a decision to make at all?
Now that my friends, is a question worthy of a philosophical discussion.
Have a wonderful week.
A New To-Do List
What if your “To-Do” List looked something like this?
1. Give/Receive 5 hugs
2. Smile at a stranger
3. Tell a friend thank you for simply being a positive presence in your life
4. Share one home-cooked meal with a close friend or family member
5. Eat 4-5 servings of vegetables
6. Write down three things in a gratitude journal
7. Spend 5 minutes in silent reflection
8. Read two pages of a spiritual text
While our Standard “To-Do” lists will certainly include practical objectives like buy groceries, wake up at 8 o’clock to finish a term paper, send the confirmation email/memo for the meeting at the end of the week, take out the recycling and trash- why can’t our lists also include a few things from the alternative list above?
Understandably, we cannot just add things to the Standard “To-Do” List and hope to feel completely nourished without the singe of burnout at the end of the day, so what on the Standard “To-Do” could you possible replace? remove? modify?- making space for something, perhaps, a little more nourishing? What if the 8 things on your list were non-negotiable, like drinking water, putting on your clothes for the day, sleeping? What if you had a calendar on your fridge where you could check off such things at the end of the day, reflecting on how you felt as you completed things on your Nourishing “To-Do” List.
We understand that this is a somewhat artificial construct/simulated exercise, but allowing yourself to see “sharing your love with others through the gift of five hugs” on the same level as “drinking and eating to live” can be a profound experience, one that may change how you choose to spend your time, how you connect with others, and, ultimately, how many things you actually get done.
How do you relate?
In continuing our thoughtful explorations into how we interact and connect with the world around us, we ask another thoughtful question: How do you relate? We, as human beings, are relational by nature, seeking to connect with much of our environment. From relating to a friend or a close family member who provides us with that safe space to be our genuine selves, to connecting with the sunset as it casts its beauty across the open water, we are not restricted in our capacity to connect by any definition of what is considered “alive.” We yearn to appreciate and understand our world, whether it comes in the form of people or animals, trees or books, art or music, theater or smiles, everything is accessible to our willingness to connect.
Just as our relational nature can provide us with the opportunity to experience a joyful life, it can also lead us into an unfortunate state of suffering. From drowning under an overwhelming burden of work to feeling acute sadness following an unexpected tragedy, there is no guarantee that our relational nature will bring only happiness to our hearts.
It can be tempting during these times of great sorrow, challenge, or tremendous frustration to turn away from your relational nature, choosing a path of insulation and isolation to weather the difficult circumstances. And while it is important for us to attend to our needs in these trying times, it can become all too easy to slowly fall away from the things that bring us the most joy. Subtle and insidious, this process can be difficult to spot, often occurring in secret despite the most conscious vigilance.
While it may be the perceptive guidance of a close friend that finally leads you to see your fall from your distorted relational being, it is you and only you who can discover the people, activities, scenes and pursuits that bring you the most joy.
We started this discussion asking “How do you relate?,” with the ultimate desire to reach perhaps a more intriguing question “How do you create?” - create the space so that you can genuinely relate, giving and receiving by your nature innate, knowing the present moment to be the one and only gate, for peace to be free and love to tempt fate.
When was the last time you created suffering for another?
Yes, when was the last time you created suffering for another?
Not the most joyful thing to think about for sure, but a concept and idea that certainly deserves a place in our conscious awareness.
Come up with your answer, yet?
No worries, it's a challenging question.
And I wouldn't expect you to actually have the answer, for in all reality, you are probably completely unaware of the last time your words, actions or energy actually made another suffer.
Kind of hard to recall something when you weren't consciously aware of it in the first place, although even this statement is beginning to lose truth as researchers further explore the realms of latent infantile memories.
Tangent aside, while you may be entirely unaware of the last time you inadvertently hurt someone, you are likely equally as unware of that last time you filled someone with joy, hope or love.
And you thought that statement was supposed to make me feel better?
Yes, just give me a couple seconds to explain.
Smile at a passing stranger lately?
Donate T-shirts to a church clothing drive?
Say thank you to the individual bagging your groceries?
You may never and will likely never know how such words or actions impacted these individuals, but you don't have to, you just to need to know that you planted seeds of possible joy with the most meaningful of positive intentions.
You don't have to know the outcome!
For in truth, we cannot control or dictate someone's response to our presence, our words or our actions.
We just can't.
We can however, take ownership and responsibility for our own actions and words.
Take responsibility for our energy, our intention, and our response to conflict.
As I have come to see it, we really only have occasional and variable control over one thing: creating and maintaining conditions most likely to promote our flourishing and relieve our suffering.
Occasional and variable control over the conditions
MOST LIKELY to promote flourishing and relieve suffering
Ever buy someone a book only to discover they read it 2 years prior?
Ever invite a friend to a party only for your friend to meet another individual at the event with whom there was a recent significant conflict?
Ever offer to help cook Thanksgiving dinner for your overstretched mother only to be met by the words:
“Of course not, that is my job you shouldn't worry about anything, just stay out of the kitchen.”
We cannot control the outcomes of our actions or someone's reaction to our words, so stop trying.
It's just not worth it.
Instead, we can pour ourselves into a mindful process of awareness, intention, clarification and reflection, all with the genuine desire to create joy, relieve suffering AND remain unattached to the eventual outcome.
1. Cultivate awareness of another's needs, emotions and current perceived stresses.
Do the same for yourself
Identify any incongruences or unmet needs that could cloud your judgement or distort your intention
2. Set your intention and make it clear, but not challenging to the other party(ies) involved.
If directly communicating use non/violent and open language to further appreciate and understand another's intention.
Use phrases like:
Help me to understand...
Is there anything important you would like me to know?
Is there anything else you would like to say or for me to know?
3. Ask for clarification
Invite the other individual to share their thoughts, worries and current needs
Use phrases like:
I want to make sure I understand what you are feeling and needing right now.
I want to make sure I fully understand what you just told me.
Offer and allow them to explain even when you feel you do not need any more clarification.
4. Reflect back on your actions, your interactions, and your word choices over the past day.
Was there a moment that felt off?
Where you were feeling hurt, lonely, angry or tired and subsequently acted/spoke solely from this place?
Were there any conversations that just didn't go quite right?
We can ask all of these questions without fear of self-loathing or negative rumination, knowing that it is through these questions that we can grow a greater awareness of the present moment and the needs of others.
The Distilled Process
We can strive to use non violent language, to appreciate and better understand others, to openly give within our capacity and to acknowledge when we are carrying negative energy or acutely creating tension.
If you can do all of these things each and every day, no matter how minute, you can be satisfied knowing you are doing everything within your control to create and nurture a space intended to bring joy and not suffering.
Creating space with the best chance of instilling joy and relieving suffering.
So I guess that question: “When was the last time you created suffering for another?” can be replaced by a much more practical, relevant and answerable question:
Am I holding a space with the greatest likelihood for instilling joy and relieving suffering?
And that my friends, is actually a question we can ask and hope to answer.