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.
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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. What? 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?
What? 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. The Process 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. Be well. |
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