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What you will find below is an email I sent to the incoming class of medical students at the University or Virginia School of Medicine back in August 2017. To say I remember how all the words came into being would be a frank lie. It was, indeed, a bit of a spiritual experience. While most of you reading this introduction are not medical students or have no affiliation with medicine or medical training, my intention of sharing this message is ACTUALLY FOR YOU. Yes FOR YOU. Because, let’s be honest I already shared it with the medical students. So why am I sharing this with you? Humanity's language of caring is universal and while the words below may have been initially intended for my medical colleagues, there is a meaning and message embedded that is meant for every soul interested to explore its mystery. So if you are willing and curious, let’s start the exploration together. Welcome to Charlottesville and the UVa SOM! By now you have probably received an epic number of emails and are perhaps overwhelmed with all of the information being thrown your way. It's okay. It's completely an entirely okay. You are also probably also wondering now who is sending us this random welcome email? My name is Rob Abbott and am a first year family medicine resident with VCU Shenandoah Valley in Front Royal, Va having just graduated with the UVa SOM Class of 2017. With those details out of the way I can tell you who I really am. I am a student, a human being, a medical trainee just like you, seeking to relieve other’s suffering all the while serving something greater than myself. It is hard to imagine that just some few years ago I was spending time in the anatomy lab (the old, not so clean and nice one) identifying brain structures with my classmates and learning all of the amazing biochemical machinery necessary to make ATP from 1 molecule of glucose. And while time does go quickly, it also doesn't. 4 years is a long time, and for some like myself who took 5 years total, it is even longer, and for others doing PhD and research work it can take a decade or more. It's a long time. Thinking months and years ahead is wonderful (even if it seems like graduation is so far away) and having an intention and vision for yourself is incredibly powerful, but the future is not years ahead. The future is actually just the summation of the present- what we do each and every day. Want to be a kind and compassionate physician? Be kind and compassionate each and every day. Want to eat more vegetables and less processed food, eat a couple vegetables and put down the doritos each and every day. Yes, these may seem like obvious or silly examples, but they are remarkably relevant and true. In a more abstract sense, I like to think that we are all people transitioning between states of “being,” “becoming” and more “being”. If we simply remain in states of transition, expansion and growth ("Becoming") or thinking about who/what we want to become (skipping the challenging becoming process and going straight to some "new" state of being), we completely miss the present moment, our current state of being, the opportunity to enjoy the present and simply be. Medical school will be full of opportunities to become- you will be evaluated constantly as part of this challenging process of becoming. Learning something new every day is becoming, studying for a summative is becoming, gaining more clinical insight during your 3rd year clerkships (at 5 AM) is becoming. Becoming is okay, we need becoming, but we also really need being. I spent most of my early life becoming, and only becoming, because I was good at it. If you are receiving this message now you are also very likely to be quite adept at becoming. But it wasn't until I took time away from this becoming, to rest and discover how to truly be, that I could ever make peace with the becoming process. What does being look like? For me it's engaging in creative exploration through writing, recording podcasts for my webpage, spending time in nature, meditating, practicing yoga, reading non-medical literature, growing my Christian spiritual faith and sharing a hot beverage with a close friend. There are tons of ways to be, but often, these ways of being can fall away to make room for becoming and only becoming.  I know this may sound strange or impossible given the fact that I haven't met any of you in person, but I genuinely care about all of you. I want you to happy, healthy and free from suffering. I want you to succeed and be surrounded by joy. I know medical school is challenging, but I also know it can be incredibly rewarding.
You may get to a point during your training where you feel hurt, depressed, depleted, tired, burned out, exhausted, disillusioned, physically sick, or broken. It's okay 4.5 years ago I was depressed, hurt, sick, depleted, simply done. It took a long time for me to finally ask for help, but I did. I simply asked for help. I finally accepted it was okay to be vulnerable, to say I didn’t have the answers. There are so many people in this community here to support you. Deeply and truly support you. By this point, you have probably received a message from two of my close friends and current students Anja Miller and Corinne Roberts regarding the interdisciplinary group Compassionate Awareness and Living Mindfully (CALM): an inter-professional group dedicated to supporting your well being though the practices of mindfulness, self care and the cultivation of resilience. Back in 2013, upon my return to medical school, I was fortunate to start this group with the help of a few amazing colleagues and friends. I had never "gone to school," for mindfulness, self care or inter professional communication. I had no formal training. i had no idea what to really do. But I started the group because I perceived a deep need in our community to remain healthy and build resilience through mindfulness practice and simply being. I didn't care if only one person started meditating with me or if no-one came to any of our events. I just wanted people to know we cared about their well-being. I understand meditation or mindfulness practice would not and may not be your thing, it's okay, we are all okay. Over the past 4.5 years I've seen tremendous strides made in the UVa School of Medicine to prioritize your well-being, to promote and provide you with opportunities to renew and simply be. I helped to grow partnerships with the School of Nursing to hold retreats, FREE retreats, and days of self care to promote your flourishing. Once again, it’s amazing to see all that can happen in 4.5 years. When I first came to school I hadn’t even heard about yoga, meditation, reflection, or mindfulness. If you had asked my first year self if sitting still for 5 minutes to pay attention to my breathing or pausing outside of a patient's room to set an intention for the encounter would make any difference I would have likely laughed you off the face of the Earth. And when I first started practicing at the urging of a colleague and dear friend, I didn't fully believe in it. I wasn't really convinced. But I just started practicing. Just practice, even if you don't believe. I cannot guarantee you will find the practices of mindfulness and meditation to be helpful. Nothing is right for everyone, and everything is certainly not right for everyone, but SOMETHING is right for everyone, and you should seek to be exposed to a buffet of SOMETHINGS as part of your medical training, all for you to consider, practice and incorporate into your life. To say I am excited for you would be a tremendous understatement. But THIS is only the beginning, and YOU ALL are the lights to help change the lives of your patients, and to hold spaces for each other to learn and be nourished, to become and to be. As you will soon discover, a collective stress bucket will develop in your medical school class, a figurative and sometimes literal bucket of worry. I urge you to the best of your ability to TRY and not add to the collective stress bucket, recognizing the sometimes, most likely completely unintentionally, that you will add to someone else’s burden and this stress bucket. We simply must be aware and take ownership of the energy we carry, the words we use and the spaces we hold. Make a joke about how much work you have left to do, how stressed out you are, or how poorly you will do on a test because you haven’t studied enough, it’s okay, it’s probably funny, but take ownership of it, be willing to accept the consequences of sharing those kinds of words, carrying that type of energy, holding that type of space. While I may have formally graduated and "left" the medical school, my heart and soul remain in these walls and with this community. You are all amazing people with so much passion, intelligence and drive to change the world and I want to do all that I can to promote your flourishing. If you have made it this far in this message, I commend and appreciate you. I am still quite local and active in the Charlottesville community, returning on weekends when I am not busy with residency obligations in Front Royal. I am more than happy to meet, talk and simply listen to whatever it is you want to share or discover. You can respond to this email or simply bug Jill Clarke. She knows how to find me. But in all seriousness I am more than happy to meet and share a conversation over a cup of tea/coffee. I’ve been there. I get it. I needed help, lots of help and I am willing and open to talk with you if at some point you need help. No judgment. Complete acceptance. You guys have an amazing journey ahead of you and some remarkable people with which to share it. Don't be in a rush. Remember that if you are alive, you are breathing and if you are breathing, you can stop to take a pause. Congratulations and welcome again. I am so glad you have made this choice to pursue medicine. And I look forward to seeing you flourish in the years and experiences to come. All the best Rob Abbott
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It takes 4 minutes and 30 seconds. Unless I trip and fumble for my badge. Then it take 4 minutes and 32 seconds. 4 minutes and 30 seconds. People run miles faster than this. But my intention is not to run or to even walk. My intention is to be, breath and simply be, It starts with a phone call. Can you see another for me? Room 19, 72 year old female, looks like a COPD exacerbation, maybe a new pneumonia. Call me when your done. “Okay, sounds good, will do.” For the next 84 seconds I prepare for the pause. I scour the electronic medical record for vitals, white count, current meds, what did the ED doc do anyway? I even get a a glance at the CXR, seems like another overread. And then its over. 84 seconds is all its takes for me to realize the real answers I need aren’t in the chart. They will never be in the chart. Unless I decide to put them there. And then it begins. The 4 minutes and 30 seconds began to tick. I grab my white coat, pocket my phone, double check for my keys, and scoop up my stethoscope. I start to walk. I notice the heaviness now of my burdened white coat, stained with the tears and spit up of infants. Badges of honor I like to think. Telling the stories of past hugs and cuddles gone awry. I shrug my shoulders mid stride, and complete the roll of my scapula back to where they should have been all along. There’s no time for tight trapezii during the pause. I start to notice the ground beneath my feet, my minimalist shoes gripping my toes like a 2 year old hugging his ice cream cone. The ground never felt so alive. I’m nearly 2 minutes in now, 3 staircases down and I’m on to flat ground. I begin to smell the Subway stench, the half baked bread, and half eaten sandwiches beckoning to the adventurous souls willing to wander from the comfort of the cafeteria.  3 minutes now and I’m in the lobby. There’s a four maybe five year old kid running towards the gift shop. He just saw the giant panda. And it’s about time someone fed him some bamboo. I start to smile as I round the corner, the chapel calling to my heart, reminding me it’s time to center. There’s only one minute left. And I’m still half full. One deep breath in, And a heavy sigh out, I feel the weight begin to lessen As the space becomes a void And the void becomes an awareness. That the emptying has now begun. My heart erupts to open As my mind chooses to close Thoughts start to flee for safety In the bowels of my unconscious. There’s no room for petty attachment In the world of empty freedom. 4 minutes. I feel it churning, burning, yearning to remain unseen Judgement and hurt never dress for the party, you see. They found out long ago That the best way to remain unseen is to wear no clothes. The only problem? Judgement and hurt forgot one thing: One very important thing. Naked can see naked There's no place to run and hide 4 minutes and 30 seconds And I’m naked at your beside. My body become a vessel To receive your heart and fears It’s what the moment calls for A pause to find my ears. I have confession to make as we start the New Year. Well to be honest, I have several confessions to make, but the one I want to share with you now is that despite my breadth of current training as a family medicine physician, and desire to care for people at all stages of life, I feel God is strongly pulling me more and more towards the world of pediatrics. Yep, kids, kids and more kids. You’ve probably heard me say on the podcast before that while I do not have kids of my own, YET, I am drawn time and time again to the world of our youth and seek more than ever to nourish strong family dynamics and supportive relationships so that kids can flourish. I have been fortunate to have found a couple incredible mentors when it comes exploring integrative and osteopathic principles within the scope of pediatric care: Greg Gelburd DO and Jef Groesbek DO. While by no means do I feel capable yet of fluently performing manual manipulations on my patients, the foundations of osteopathic medicine are rooted far beyond simply addressing skeletal alignment. Osteopathic medicine is foundationally whole person, whole mind, whole body care and is precisely the approach I seek when looking to identify root cause disturbances for my patient’s suffering. In an effort to bring about more awareness to both osteopathic principles and a special population of courageous children: those with cerebral palsy, I wanted to share some insights and ideas that have been growing in me since my first experience in 2013 volunteering and participating in workshops with Ruth Goldeen, OT, an occupational therapist at the University of Virginia specializing in yoga and play for children with special needs (cognitive, emotional and physical).  Osteopathic Therapy for Cerebral Palsy
Osteopathic medicine is a field that not everyone understands but that provides an alternative or a supplement to traditional medicine. For children with cerebral palsy, there can be great benefits of working with these medical practitioners who focus on the musculoskeletal system, the part of the body that can commonly cause these children pain and mobility challenges. Ongoing research is proving that osteopathic therapy may be able to treat individuals with cerebral palsy to relieve pain, reduce spasticity in muscles, and improve mobility. What is Osteopathy and Osteopathic Manipulation? Osteopathy is practiced by a trained and licensed osteopathic doctor. These doctors have undergone all the same training as medical doctors (there is an incredible one in my current residency class; thanks David Clark DO!), but also have special training in approaching patients in a preventative and holistic way, using a gentle manipulation practice to the musculoskeletal system, called osteopathic manipulation therapy. The idea behind this is that all the systems of the body and brain are connected and cannot be treated in isolation. By gently stretching, pulling, massaging and manipulating the muscles and joints, an osteopathic doctor can promote wellness and healing as well as bring relief to specific symptoms. This kind of work is most often used for musculoskeletal issues, like back pain or injuries. Cerebral Palsy and the Musculoskeletal System With this in mind, osteopathic therapies seem like the perfect match for someone with cerebral palsy. Cerebral palsy is a condition that is caused by brain damage but manifests in both neurologic and musculoskeletal symptoms. There are different types of CP and each individual has unique symptoms of varying degrees, but most children with this condition struggle with pain, mobility, muscle strength and tone, and muscle control. Treatments usually focus on using surgery, medications, and physical therapy to manage symptoms. But are there other options? Can Children with Cerebral Palsy Benefit from Osteopathic Medicine? Many parents turn to osteopathic doctors for an alternative or complementary treatment to help their children. Osteopathic doctors may use manipulation therapy throughout the body, on problem joints, on specific muscles, or on the neck and head. Research into how effective these manipulations are for children with cerebral palsy is limited, but there is some emerging evidence showing that it is likely very helpful. In one study involving 55 children, those who received osteopathic manipulation therapy had better outcomes compared to a control group. They saw improved mobility and a greater ability to control their muscles. Another study proved that osteopathic manipulation could actually help improve constipation in children with cerebral palsy, a secondary symptom many struggle with and one that is well appreciated by clinicians like myself well versed in functional medicine and improving digestive health. While there aren’t many other studies currently evaluating this therapeutic technique for treating cerebral palsy, there is plenty of anecdotal evidence from individuals who have benefitted and plans for ongoing osteopathic and cerebral palsy research. I am and will always be a proponent of evidenced informed and individualized care using the lowest risk/highest reward therapies available. Most importantly, these therapies must be alignment with the values of the patient and family, and osteopathic care certainly seems like a reasonable low risk therapy that could benefit many children with CP. It is important to note that parents of children with cerebral palsy find and work with licensed and trained osteopathic doctors with experience working with similar patients. While I am neither a DO or have significant experience caring for patients with CP, I have strongly believed it is my duty to seek out workshops and experiences beyond the scope of my current training such as those provided to me by Ruth Goldeen and the osteopathic curriculum in my residency program, to acquire knowledge so I can better treat and ultimately inform a child’s family and supportive medical team of any practices that may be helpful to their child. In the end, we, as medical professionals should be able to work together to give a child the best possible outcomes. We, together, best. As I confessed in the beginning and I confessed within the paragraphs above, kids are my passion and I don’t yet have fluency in osteopathic manipulation, but I am learning every day thanks to my mentors in medical school and current residency training. It is as I see it, precisely what the world and God is calling me to do. Resolutions Seemingly ubiquitous at the start of every year, it can be a little frightening and overwhelming when the thought of making changes starts to flood our minds. The boundaries between what we think we need, what others want for us and what seems acceptable to society can all begin to blend together resulting in a distorted sense of “What do I actually care about again?” or even “What is actually and was originally me?” Bringing in a helpful visual we can see a spectrum of “thought content” with one end being direct, purposeful, self-reflection constructed from our “internal” dialogue, core values and foundational beliefs, and the other end being the perceptions and thoughts of the external world, the thoughts of others seeking to enter our sphere of awareness. Blurring in the middle are the shared values, conversations and relationships that interact with our relational mosaics, the mosaics of our “assembled” selves constructed from the pieces, the stories, the hearts of all things with which we relate. Positive or negative, this “relational zone” can be the grounds for nourishing connection, as well as the battlefield for misconception and misunderstanding. Assimilating negative values, thoughts, and behaviors from others such that the negative thoughts begin to move from their place on the spectrum in the discerning “relational zone” to that of your internal dialogue, your personal values, and your unique story can lead to suffering, doubt and significant distress.  Subtle and without a clear beginning, this pattern of negative assimilation can be approached gently by cultivating an engaged awareness practice of our thoughts, their origins, and how they entered the story we are currently telling ourselves.
In no fewer words this practice, this way of being is Yoga The Heart and Science of Yoga So as we sit, ready and engaged to move forward with a new intention, we must first pause to reflect on the true origins of this desire to progress. Are our intentions driven from the language of an internal or external source, or are we dancing somewhere in the “relational zone?” Now poised and aware we can now curiously ask, “What really is our greater intention?, what do we, if at all, want to change?, and how exactly did this thought even come into being? You may be surprised by the anwer. Wishing you all a joyful beginning to the new year! |
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