Prescriptions and Psychedelics

1392 Relax and Succeed - We never know how much control we have

It is easy for people to be medicalized by definitions, and then pharmaceuticalized through treatments. For better and for worse, those definitions and choices can go on to shape how caregivers and health systems will interact with people for the rest of their lives.

There are undoubtedly cases where these interventions are wise and worthwhile. But unless cases and the effects are extreme, we are often better to start off with the internal interventions that are naturally built into our biological, chemical and physical systems.

We all have our own chemical factory in our minds, and science is also learning that our microbiome may play a major role, which can mean that even the chemistry of our diets can play a big part in how we feel emotionally.

Where possible, when tackling emotional issues, we are often best to start with diet, exercise and thought-based interventions before proceeding onto more externalized responses through drugs.

However, if those other routes do not allow people to maximize their potential, then no one should feel badly about taking whatever course of action leads them to their best health outcomes.

I have worked with people who took more control over their thinking and eventually went off their medications by choice and were fine. At the same time, no one is ‘failing’ if  a drug intervention is the only thing that gets them the relief and healthy life they seek.

Many of those interventions involve things like SSRI-classed prescription drugs, but brain science and behaviour labs are increasingly investigating newer, more experienced-based therapies based on formerly illegal drugs. Especially in extreme cases, many people are finding these methods can lead to life-changing epiphanies.

If you would like to know more, below are several links to a series of programs on new approaches to therapy that are gaining increasingly wider acceptance. What works for one person may not work for another, but if we’re looking at all potential directions to approach our health from, these may prove helpful where all else has failed.

CBC – Ideas – High Culture Part 1

CBC – Ideas – High Culture Part 2

CBC – Ideas – High Culture Part 3

ABC – Health Report – Anxiety, depression and the new science of psychedelics – Part 1

ABC – Health Report – Anxiety, depression and the new science of psychedelics – Part 2

CBC Radio Series – On Drugs

 

peace. s

The Interval

1391 Relax and Succeed - From the moment we are born
Life is precious. Spend it living deeply.

When any human being talks about ‘living their life’ we are talking about the interval between life and death; the short burst of time our soul spends being human. During that period our naturally expansive and connected souls narrow themselves down into a limited identity (our ego).

We create that limiting ego by using our thoughts to tell ourselves stories about how reality ‘really’ works and who we are within it. We then act like those thoughts are a shared reality when that’s impossible. Everyone sees things a little differently, that’s what it is to be an individual.

We all essentially ‘are’ the sum of the decisions made by the internal logic of the people we subconsciously became by telling ourselves stories innocently built around random experiences. But what else could we do?

Like waves go up and down, the human soul oscillates. Before life and after death, the soul is wide and connected. In living life we are shaped by limits. And where there are limits there is an interval, and within that interval are challenges, and where there are challenges there is life.

Being is important, but living is too. Even our struggles are a part of our story. This is why it is better to flow than to fight.

peace. s

Sick Kids and Relationships

1390 Relax and Succeed - Even during our most stressful times

Only those going through it can truly appreciate the massive impact that an unhealthy child will have on a parent. They are a living expression of the fact that every life is precious.

Despite every life’s remarkable value, we can innocently come see our lives as a blind routines, where the loved ones we encounter each day are taken for granted. They lose their value only because we’ve lost consciousness of the fact that no life is guaranteed.

That lack of awareness applies to ourselves as well, so it serves us well to remember that –sick child or not– the parents lives are also precious. We are all someone’s child, and we are all worthy of the care we require when we’re under extreme strain.

There is no question that the child comes first. But the sheer enormity of the feelings associated with the child’s experience makes having a ‘sick kid’ a taxing time for any parent. That’s exactly why it is important for the parents to not be entirely absent from their own consideration.

None of us can drive the people we love to where they want to go if we don’t ensure we have the fuel to get there.

It depends on the dynamics of the family, the individuals, the ages, the reason the child is in the hospital –each family reacts differently. Under whichever conditions, and for no intentional reasons, some marriages grow closer and some become strained.

Even in many strained relationships, the marriages are fine, but very stressed people can have trouble recognizing that without a very particular kind of help. And people often know they need that help, but they’ll also often have narratives that appear to prevent them from following their own beckoning wisdom.

In these narratives, the parents of ‘sick kids’ tell themselves stories about being a bad parent, being selfish, about how they should ‘buck-up,’ or about how weak they are to feel genuinely weak. But those narratives are all just words.

If parents recognize the ephemeral nature of thought, their choice of action can contradict the stories they concoct in their heads. We are all always free to ignore all of that rationalization and we can trade that for trusting ourselves to know whether or not we need care. If we do, there is no shame in calling to get it.

Having an actual ‘sick kid’ is simply an awful experience. But going through that experience with a better understanding of ourselves can profoundly impact how we engage with life and with others –including our sick kids.

The unfortunate challenges in life can also be experiences that help us discover closer, deeper versions of our connections to others. Turning a negative into a positive; that’s how powerful love is.

peace. s

Managing Extreme Pain

1382 Relax and Succeed - Eyepain 1

I arrived in the Emergency Department with a complex problem. Through no fault of my amazing doctors, I had a rare and excruciating outcome that was largely created by the sheer fluke of how my body is built, and how it subsequently reacted to my surgery. It was like being in ‘pain school’ and I paid close attention to its lessons.

Rather than shrink away from the experience in an effort to wish it away, I tried to make the experience useful by going ‘into the pain.’ For the purposes of this post, I investigated it closely. What was it to be in such pain, and what hidden opportunities did it present to me?

This operation often includes putting a silicon band around the eyeball to change its shape, and thanks to my unusually small eyeballs, the combination of that and the extensive surgery is what lead to my rare outcome. I was told that my pressure situation was possibly the worst case that most if not all of the doctors recalled seeing.

The pressure was the issue, so I will begin by attempting to describe the pain I was in. Normally eye pressure would be between about 10 to 20 mm HG. Doctors become concerned if this pressure rises to anything higher than 24 mm HG. My pressure started off at 62-64 mg HG, then slowly fell over a week and a half to 58, 54, and 37 –which will lead to glaucoma and blindness if not relieved.

Fortunately, the skill of my doctors allowed them to take action that did lower that pressure and save my vision. They lasered some pressure-relieving holes into part of the eye, and the pressure dropped to 34, and by my next visit I was at a safe 24, and soon after saw my pressure lower to a relieving 9 mm HG. Whew.

In terms of my internal experience, keep in mind, this pressure is inside your head. My nose, cheek, and brow were badly bruised, and it placed a great deal of pressure on my eye cavity as well as on my sinuses, which in turn badly irritated the Eustachian tube linking our sinuses to our ears.

In addition, I had a bubble of nitrous oxide gas placed inside the eyeball, which meant I had to constantly look down, which placed a strain on my shoulders and back. Sleeping facing downward was also an issue with badly plugged sinuses. I really didn’t sleep at all for at least a week.

By looking downward, the bubble of gas rises to the back of the eye, which then holds the wound in place while it heals. Looking any other direction made the bubble move, which was also very painful.

It’s fair to say that my extreme case lead to extreme discomfort. People are fortunate that most cases are nothing like mine. Many people have in-office procedures that have them seeing fine in ten minutes, with no pain at all! Do you see why I encouraged you to see your optometrist regularly?

In trying to define the pain associated with that pressure, I came up with the following description, which I’m frankly quite proud of. For turning a feeling into words, I doubt I could have done better than this:

Start off with someone pounding a rough spike or chisel into your ear until it bursts your eardrum and pierces your brain. Then imagine a major league baseball player swinging a bat as hard as they can at your eye socket, where the impact very badly bruises your nose, brow, and cheek bone.

Following that, imagine that this impact drives the eye straight to the back of your head where it hits the skull hard and bruises itself on all sides. Then the bad stuff starts.

Next was the sensation that someone had stuck a long, candle-shaped cone of sharp, burred metal into the black iris at the centre of your eye. That was in turn pushed so hard into my head and eye that the ‘metal cone’ sensation felt as though it had pinned the front of the eye to the back of my skull. Finally, imagine that someone takes a wire brush and rubs the rest of the eyeball roughly.

I’ll say it again: do you see now why I urged in the previous post that you go straight in as soon as you get symptoms? As previously noted, the surgery for just minor damage is itself quite minor and not overly painful. Wait, and you could end up like I did (even though I did go in as soon as I saw symptoms).

1382 Relax and Succeed - Eyepain

One of the doctors described my experience as ‘giving birth through my eye, with no pain medication, for nine straight days.’ Oh yeah, and in order to monitor pressure, you’re also limited to plain old acetaminophen (Tylenol). On scale of 1-10 I’d put this pain at about a 40.

So how did I ‘manage’ this pain? Largely it was practised acceptance. For the first week, I accepted that my identity simply was pain. I had no arms, no legs, no stomach, no feelings like hunger or happiness or exhaustion –just excruciating pain. It keeps a person quite busy, so that may have strangely been the easiest part.

Eventually the pressure dropped to the point where it was still ever-present and super painful, but I also started to have other sensations enter, like hunger, awareness of my sore back, and the desire to have my sinuses clear. That actually felt relieving after how I’d felt.

Everything is relative. I accepted these tiny gains with substantial gratitude, and I reminded myself that my father and uncles were in WWII, and that many people before me had suffered even worse.

Eventually I could slowly start to eat again, I could tolerate normal voices and light, and around this time my gratitude had a surge as I was able to better-appreciate the efforts of my brother and several key friends who not only cared for, cooked for, and visited me, but some also took up caring for my parents as I normally have that responsibility. The people I work with were also very kind with their patient reactions.

There were times when I lamented the pain and pined for relief, but I did manage to spend 95% of my time grateful that I didn’t lose my sight, that my care was so excellent, and I was extremely grateful to all those who expressed their compassion through action, either for me or for my parents.

For my part, much like our fovea controls the focus of our vision, my mental focus was largely controlled, whether I was focused on the inevitable pain, or my deep gratitude for all of the people who were helping me and for my positive outcome. I had done as well as I could and felt good about it.

As I felt better each day my gratitude surged even further. If we can imagine our attention as a hose, and our thoughts as the water that perpetually flows from it, my salvation was that –rather than watering thorns– I kept my focus on the ‘flowers’ that were my various caregivers and compassionate friends. I could never put my thanks into mere words, I’ll just say that I love every single one of them.

There is no getting around the fact that parts of life will be painful, even extremely so. And we can be forgiven for sometimes giving into this as we move through these experiences. There were times where my pain lead me to be impatient and unkind but, overall, I felt like I had been in some kind of pain Olympics, and I ended it happy with my performance.

1382 Relax and Succeed - Enjoy the little things

I couldn’t call the experience a ‘win,’ but I remain very aware that it was also not a loss –I can still see to write this, even if I needed help with the proof-reading for a while. My outcome looks quite quite, although the eye was too filled with blood for the doctors to see if the operation did all it needed to, so we’re still not entirely sure if another operation will be required.

What I can tell you this: I know my immediate future is unlikely to be worse than what I’ve already experienced, and that makes that future feel extremely positive to me.

So what should you the reader take from this? Certainly not that we can avoid pain because we want to. In 20,000-25,000 days of life it’s a simple fact that some serious pain will be in there. But we can remember that it is what provides the contrast that makes normal life feel like a blessing. Right now most of you are reading this largely pain free in relative terms. Be grateful.

Normal is normal; it’s like a fish trying to find water. But once our ‘water’ has been boiled or poisoned, we gain a deep and meaningful appreciation for what not long ago had been the most basic qualities of life.

By having those advantages taken away, we do become more aware of the grace that is created as a part of our everyday existence. And even just by hearing about others situations, if we’re wise, we can look about our own lives with a new vision and a sense of grace.

Imagine never seeing your loved ones again. Imagine never seeing a flower again. Imagine never seeing the sun filter through the trees, or the smile of a child you love. Every day most of us are given these gifts along with life and it is my hope that by reading this, you can spend some time more appreciative for something it’s easy to take for granted: our vision.

Finally, please know that if you ever find yourself in what feels like unbearable pain, be it physically or emotionally, remember that no sensation in life lasts forever. Sometimes the best we can do is endure. But even that allows us to traverse time and to cover ‘distance.’

As a Buddhist monk once said to me, ‘the secret of life is that everything changes.’ If life is good, be grateful. It will change. But if life is bad, be patient. For it will change too. Our job is to merely be grateful no matter where our journey is taking us.

peace. s

PS Special thanks to Doctors Baker and Sia, as well as the entire remarkable staff at the Alberta Retina Consultants. In addition to them, I would also like to thank the support and surgical staff at the Royal Alexandra Hospital, as well as the family and friends that supported me throughout this process, including Don, Anita, Henry, James, Nick, Mike, Kirsten, Christina, Brian, Jarrid, Christian, Sausan, Sue, and for the compassion shown by Tracy, Elizabeth, Beth, Rob, Dwayne and Charlotte.

Foreboding Symptoms

1380 Relax and Succeed - Nothing in life is to be feared

Every adult knows that any life can be loosely divided up into experiences that are ‘good,’ or ‘positive,’ and those that are ‘bad,’ or ‘negative.’ Joy is pretty easy –we can all do that. But our suffering is where we generally require either guidance, or lengthy, meaningful and dedicated meditation.

Whether it is spiritual, psychological, or a mix of the two, any guidance we receive will only come from people who have done their own very practical psychological or spiritual ‘work.’ If there was a way to ‘learn’ our way around suffering, everyone who took psychology classes or who attended places of worship would have miraculous, pain-free lives –and yet we know this does not happen.

In the end, it is only experience that truly teaches us. This is why one of my favourite testimonials for my work comes from a very talented and successful cinematographer who wrote, in part, “The training gets you in the Moment. It’s experiential. Unlike reading about living in the present, this actually lets you do it. It’s the difference between reading about swimming and taking swimming lessons.”

That last sentence is smarter than anything I could have written about what I do. It’s a brilliant metaphor and it is the reason I will undertake this series of posts about how I psychologically managed what would commonly be seen as a very bad situation.

Using my recent eye operation as the example, it would be easy to describe my complex situation and intense pain as being a ‘bad’ experience. But can it really be called ‘bad’ if I live in a place with first class care, and that I was able to help some young medical residents learn to be better doctors, or if I can use the experience to help others through this writing or through my work helping others?

My own story began with good news –I was at a dinner with beloved friends. Due to my heavy workload and the care I provide for my aging parents, this was an extremely rare night out. I remain grateful that such a happy and warm event was my springboard into the most serious medical issue I have ever faced since the childhood accident that ultimately lead me to write so passionately about life in this blog.

Being seated where I was, it was late in the dinner before I noticed the blacked-out semi-circle of darkness that had taken the lower left portion of the vision in my right eye. Thanks to a story told by a friend, I was lead to torque my vision hard enough to the right that it lead me to realize that the spot was there, and something likely worthy of quick medical attention.

Being a scientific sort of person with a penchant for experimenting, rather than immediately follow a course of fearful thinking, I chose instead to focus on testing the eye for both pain and capability.

I diligently used those tests to gather information I felt would be useful to any diagnosing doctor. This included the shape and density of the darkness, as well as its specific location, and whether or not it moved as my eye moved. I was also grateful that it did not hurt. I also thought about the preceding days in case I could find an injury or impact that might explain it (a minor impact from playing hockey was my best candidate).

Thanks to a lifetime of learning about all manner of weird things, I rightly guessed that what I was experiencing was likely a detached retina. My first question was to ask myself how useful or helpful any fear might be.

This represents the moment in which we can all choose to use our thoughts as tools, rather than having them blindly, habitually and emotionally control us. It was like the situation had shown me fear on a menu. My job was to decide whether or not I wanted to request more of those thoughts to actually ‘consume’ with my consciousness.

Since I could find no rational reason that fear could serve a purpose beyond motivating me to get care, I chose not to pursue that line of thinking. The fear had already done its job so I gratefully accepted it as a signal, and after that I largely dismissed it from my consciousness.

Because I have grown up in Canada where hockey is a common sport, I knew that detached retinas were something experienced by athletes who experience impacts to the head. With no recollection of ever hearing about a player’s career ending because of one, my working assumption was that there was likely a fix that would allow some form of ‘normal’ life. That helped to keep me calm.

Following my personal and quite logical test of my vision, my internal thought process would have sounded much like this:

Clearly there is a black spot in the right eye that likely has physical causes. It is fortunate that something that serious is only in one eye. I’ve collected as much useful data for a diagnosing doctor that I can think of. This does not appear to impede my ability to drive, so I should probably leave the dinner as soon as possible and do some immediate reading of some scientific papers and relevant medical websites.

I bid my fond farewells, headed home, and immediately began doing some preliminary research on good old Wikipedia, where I ensured I understood any important relevant terminology. I then visited sites for HarvardThe Mayo Clinic, Johns Hopkins, (among others), as well as reading some relevant scientific papers. This further reinforced my belief that I was experiencing a retinal detachment, which every bit of reading suggested required immediate care.

Since I wasn’t sure if driving was wise in case the condition was neurological and not something actually relating to my physical eye, I chose to have a short sleep and then called a good friend in the morning and he kindly offered to drive me into Emergency.

Once there, I found a very busy waiting room and yet I was rushed in ahead of almost everyone. Since triage is about sorting the most serious cases first, I knew that this indicated that my situation was time sensitive. I was grateful for the quick response.

1380 Relax and Succeed - Acceptance doesn't mean resignation

Since further fear served no useful purpose to me, I quieted my mind and surrendered to the process and did my best to focus on, and be cheerful about, anything I could. This left me free to actually help some other waiting room patients cope better with their own fears.

In the end a broken piece of diagnosis equipment meant that they could not get a pressure reading on my eye, but the emergency ophthalmologist arranged for me to get the very first appointment at the hospital’s eye care centre the next morning. That had me feeling lucky.

Following my diagnosis, the doctor asked if a resident could also put me through a quite uncomfortable diagnosis process because it would be good for the young doctor to see what a rare case looked like. Despite the real discomfort, I focused on the fact that I was in a rare position to assist in that doctor’s education. I was grateful to be able to help.

The attending surgical resident then arranged for an appointment as soon as possible at the Alberta Retinal Consultants offices. A visiting Australian doctor explained that the centre is a world-renowned, state-of-the-art facility that was the very reason he had travelled so far for his education. That had me feeling lucky to live where I do.

I will leave what followed for a following post about my potentially frightening diagnosis. But to conclude this portion of the experience I would like to note that, so far, I was simply aware that my situation was very serious, but otherwise I had felt fortunate to get such quick and quality care all the way through the process.

I had reacted quickly, had been given emergency priority, and I had a good friend who had offered to take me to what was the first appointment of the day at a world class facility. If a person isn’t choosing to follow a course of fearful thoughts, that really is a lot of good news.

It might seem strange to some of you that I felt fortunate at this stage. But, if we’re living in the moment, and we’re accepting about life and have no expectations that anyone would live their entire life without any serious medical issue, then the rest really was very positive news. That was the gratitude I focused on rather than investing my energy in worry.

My conscious choice to pursue that course of thinking is what allowed me to get a good night’s sleep before I went in to face what would be a somewhat daunting diagnosis.

No life is lived without some pain and suffering so I do not live with the expectation that I will be able to avoid experiences like this one. But I reminded myself that I come from a family where many had served in WWII and, no matter what my future held, I was still likely better off than many of my own relatives. That had me feeling fortunate again.

If maintaining this state of mind seems impossible to you, remember that I too learned to do this. Yes, I had the advantage of starting my lessons after my accident at only five years old, but whether we start high school at 10 years old or 40 years old, it’s still just high school. Everyone reading this can come to know what I know through practice.

By reading your way through my experience, it is my hope that you will glean something about the active process that allows me to see life in an overwhelmingly positive light.

You may need to find your own way through your own experiences but, in the end, the tool we use –our minds– and the way we use it, are universal principles shared by us all. That being the case, I sincerely hope you find comfort in the knowledge that you too are capable of this sort of beneficial perspective. Any thoughts you have to the contrary are merely limiting, self-imposed beliefs.

In the following post, as things grew more serious, I will attempt to convey my internal process so that you can even better understand how we can all use our minds and our thoughts to generate positive responses to every kind of life experience.

If any reader goes back to just focus on the italicized sections of what I wrote above, everyone will easily see that I was not lying to myself by being positive. I was merely focusing on the most positive, realistic thoughts I could. We can all do this, but first we must believe in our ability to do so. My hope is that this post will help you in that regard.

Until the next installment, value your vision. It’s not guaranteed to last our lifetime, so don’t forget to meaningful behold the faces and places that you love the most.

peace. s

How to Avoid Going Blind

1378 Relax and Succeed - How to Avoid Going Blind

Please accept my apologies for being unable to notify you about my medical emergency and its impact on my posting. As the word ’emergency’ indicates, I got very little warning. As things were bad, they moved very quickly and I’m still under daily care.

Thanks to a dear friend, I am able to dictate this post to ensure you get it. My reason for posting while still undergoing care is because it’s not impossible that learning this could save you or a loved one your sight. I’m no ophthalmologist, so I can’t tell you all the ways you could go blind. But I can tell you about one.

Let me begin by saying that there is an extremely tiny chance that your situation would be anywhere near as serious as mine. Good doctors and modern medicine mean this isn’t something you have to be afraid of, just aware of. My case is rare, difficult, and extremely painful. Most people, if they react quickly, rather than facing blindness, have quick and relatively pain-free recoveries.

What I’m describing is a retinal detachment.

You can think of your retina as the pages of an open book, shaped into a curve and lining the inside surface of your eyeball. It serves many functions, and includes layers where your cones and rods are located (it’s all very fascinating).

Even in a normal case of a detached retina, it is important that you do not delay in going to an emergency ophthalmologist as soon as you notice your symptoms. Do not wait. Go now.

Potential symptoms include: sparkles in your vision; black flecks in your vision that block out the background completely (not to be mistaken for the floaters that all of us normally have); flashes of light in one or both eyes; blurred vision; gradually reduced peripheral (side) vision; a curtain or veil-like shadow over your visual field; a heavy feeling in your eye; straight lines that start to look curved; or, as I had, a disc or section of your vision completely blocked out. Pure black.

In a normal detached retina, a tiny hole will occur on the top page of the retina that receives light. The fluid of the eye will then get through this hole and create a blister. At this stage, this is where you are likely to experience your first symptoms. If you react quickly and head to emergency, ask to see an ophthalmologist. Trust me, they will get you in as quickly as they can.

If you’ve caught it quickly, the ophthalmologist will arrange for a painless laser operation to weld the hole closed. You may have blurry vision for a few months, but then you’ll be fine. Yay, modern medicine!

But if you wait, the fluid in the blister will slosh from side to side and turn that tiny hole into a tear—and you will also place several pages of your retina at risk. Obviously, spot welding a little hole in a single layer is much easier than welding an entire jagged canyon through many, or all, the layers.

1378 Relax and Succeed - Eyeball diagram

These are the things you need to know to protect yourself and your family. This can happen to anyone at any age, although people playing sports or who experience impacts to the head are at even greater risk. Let me reiterate: if you act quickly, this is not something to be afraid of. If anything, you’ll feel like you’re in an episode of Star Trek. But delay, and you risk your sight.

The one thing you don’t want to be in a doctor’s office is ‘interesting’. This means you’ll be beneficial to teaching residents about rare cases. But rarely are those rare cases easy. I have some great stories to share with you about my fantastic doctors, as well as fear, pain, and mood management, as soon as I’m well enough to get back to writing—which I hope is very soon.

In the meantime, if any of you have been thinking about booking time—particularly telephone time—now would be a great time to schedule it, as it will be somewhat problematic for me to meet people in person for a while.

I’m sorry I can’t tell you exactly when I’ll be restarting, but I can assure you that time away from you has even further invigorated my spirit about my work. Despite the fact that I was worse off than many of the other patients that I met, their choices led them to have much more challenging interior experiences than mine.

Thank you for your patience, understanding, and dedication to my work. I very much look forward to reconnecting with you all very soon.

peace. s

Bad Medicine: The Two Types of Doctors

1372 Relax and Succeed - Every type of doctor

Dear Doctor,

It is my hope that you will receive this with an appreciation for my intent. In no way am I interested in attacking you. To the contrary, I would like to offer my assistance. I have no doubt that you are a good person at heart. I do however feel that you (and many other doctors), would benefit by asking yourself how your patients would define a ‘good’ doctor vs ‘bad’ one.

In caring for my parents, and in tending to my own health for more years than you have been alive, I have witnessed the approaches of a very large number of doctors. In addition, people talk in labs and waiting rooms, and the general consensus about doctors is extremely clear.

Over the last several years there has been a notable shift (as one group retires and another comes on), and there is an increasing number of these weaker doctors. I suspect this is entirely innocent and unconscious, and it may in fact be that modern training leads with better science, but it may have done so at the price of developing a healers approach.

As patients in your waiting rooms and hospitals, we know your receptionists and the nurses you work with are generally the ones who are often left managing the confused, worried or angry patients you leave in your wake. I don’t not see this as an issue with you, which is why I plan to post this publicly, so that all doctors who have this common lack of awareness can also learn from our unfortunate experience.

My hope is that by offering you a compassionate explanation, maybe all of you can be better at what you do as a result. I prefer that, because it seems more likely to generate a win-win scenario for doctor and patient alike. On a broad basis, this increased awareness could have a considerable impact on the quality and cost of care in medical institutions everywhere.

I will begin by stating that I fully support the scientific method and have enjoyed studying all of science’s major disciplines. Many of the tools and methods that have doubled life spans over the last 100 years came from the evidence-based medicine for which I am grateful. It is an extremely solid basis for us to lean on both as a doctor and as a patient.

As important as that scientific knowledge is, it’s still only half the job. Because it’s not a bio-bag of chemistry sitting on the exam table, that’s a human being who is thinking about how good you are at your job the entire time you are with them, and long afterwards as well.

My general suggestion is that many of you would benefit from at least attempting to be aware that you are not singular. You are quietly being compared to every other doctor we have ever seen. In fact, if you are open to improving, the patients themselves can become fantastic resources in what is hopefully a lifelong education in what it is to be a good doctor.

Today, the weaker doctors act as though people like Dr. Patch Adams aren’t real people, and that medicine didn’t change as a result of him, and people like him, offering a bold example of what it is to be a better and more complete kind of doctor. The film, The Doctor (based on Dr. Edward Rosenbaum’s 1988 book, ‘A Taste Of My Own Medicine’) also expresses this same point, though in a much different way.

Many doctors are just people who want high grades or a good salary or status, and the world would be better off if they went into business rather than medicine. Others are equally problematic, but they are simply lacking in awareness, rather than being in the wrong profession.

Those good-doctors-in-potential are more like Patch Adam’s roommate in that film, played by Philip Seymour Hoffman. He is extremely earnest in his desire to be the best doctor he can be, but I would hope that this missive might motivate you to do as his character did, and at least experiment with being this other kind of doctor. I feel confident in saying that it’s very likely to make practicing medicine much more rewarding for you as well as us.

Our problem came from not seeing my father when we came to you. You saw a chart, an old man, a concern about breathing, and a question as to whether his troubles breathing were due to pneumonia, or something relating to his heart. At his age, these things are profoundly meaningful and quite foreboding to those who love him.

In every case, the best doctors will stay aware of that reality, and they will respond to it by offering suitable comfort. This better connects the patient to the doctor and that increases the odds of open, honest communication, which can be incredibly useful to you.

1372 Relax and Succeed - The very best kinds of doctor

In most cases you enter the exam room and often keep your hand on the door handle, as though you’re just ducking in for a second but have to go. You speak extremely quickly, which is complicated by your thick accent. Our family is well-travelled and has always been fascinated by other places and cultures, so we’re fine with a foreign doctor and an accent. But whether it’s done with a thick accent or in perfect English, slowing down to ensure you are understood would profoundly help communication. You never even seem to note whether or not your words have sunk in.

This isn’t an issue with an accent; even if you were speaking English clearly, you go so fast, and seem so generally in a rush, that we honestly almost feel bad interrupting you for clarity about our concern. It does not help you as a doctor when we have a concern, but feel your scheduling needs are taking precedence over our health concerns.

In the case of my father, your response was to let go of the door handle, grab your stethoscope, and listen quickly to his lungs. The entire exam took under a three minutes and you didn’t ask a single question about changes in his diet, behaviour, or about any other useful information. And I wish that was more uncommon but in fact you are in a unfortunate majority today.

If a doctor’s going to use the Socratic Method to come to some sort of well-founded diagnosis, you need data. The better the data the better the analysis. Even from a science perspective bad communication is a loss of valuable data.

As an illustration of how it can be, and of who you’re being compared to and why patients universally prefer the other approach, I will use an example from my own life and my now-retired, but excellent and very popular doctor. I had been seeing him since I was 20.

Every visit started in his office, in comfortable chairs, in a non-medical environment. This helped patients relax. He would review my file carefully, and then he would always begin by asking about my life. How was I eating? How was work? Was I stressed about money or living in excess or using any substances? Data, data, data.

After that 5-10 minute conversation –wherein he relaxed patients so they would talk about scary or potentially embarrassing things– we would shift to the exam room where he would do his examination, ask more questions, and then tell you to come to his office once you were dressed. Once back in there, he was often in a book or on his computer, reading up on the latest relevant studies, or even boning up on some basic science.

The humility of slowing down and checking himself was worth a lot. He accepted that all humans are fallible, and that scientific knowledge doubles every seven months, and his humility bred a strong confidence in us as patients. Also, that kind of constant double checking was why he was concerned about, for instance, opioids, a decade before others even started talking about them. That is being an excellent doctor.

You may be wondering how all of this materially helps medicine, so allow me to provide an example.

I once went in with a very painful, bloated stomach that had become chronic over time. He greeted me warmly, then lead me into his office. He listened carefully, then took me into the exam room to check me over.

When I joined him he was reading, then he turned to me and sat quietly in his chair and stared at me, thoughtfully, with his fingers templed in front of his mouth and his brow furrowed in thought. He searched through mind’s data-banks of the previous conversations we had on previous visits, and here is what he said:

“You’re still dating the Italian girl?”

“Yup. She’s awesome.”

“Wasn’t her mother moving to Canada this summer?”

“Yeah, she got here a few months ago. She’s settling in pretty good.”

“Is she planning on working?”

“Yes, but she’s waiting for paperwork.”

“So, she’s home all day?”

“Pretty much, yeah.”

“So, is she doing any of the cooking?”

“Yeah it’s been great. She’s really good and she does almost every meal.”

“Your last name is Scottish. And your Mom is from Saskatchewan, isn’t she?”

“Yes and yes.”

“Grew up eating a lot of potatoes did you?”

“Tons. Love them.”

“Me too,” (involving himself helps maintain the connection between us). ”But now it’s mostly pasta?”

“Almost exclusively.”

“Since your symptoms line up with the diet change that’s our most likely candidate. Otherwise you’re extremely healthy. For a few people the issue can be gluten, so we can check for Celiac disease but, it runs in families, so if no one else has it that’s much lower odds.

“But when I just checked while you were getting dressed, a lot of gluten misdiagnoses are turning out to be allergies to other things in some kinds of wheat, like fructan. And I just checked, and they often use durum wheat for pasta. So let’s (note, he describes it as something ‘we’ are doing), try cutting out the pasta for two weeks. If nothing happens, we can do more testing, but if the stomach goes back to normal, then we’re probably dealing with an allergy. You can try introducing the pasta one meal a week until your body tells you to stop. The angry mother-in-law I can’t help you with.”

“You want me to go home and tell an Italian woman her cooking makes me sick?”

“This way I get paid for an extra visit after she tries to do you in with a poison meatball.”

Bingo. That worked. I was fine and could eat pasta once or twice a week and I survived the ‘mother-in-law,’ (although that was a close one). Even if it turned out I had Celiac Disease, or any other permanent root cause, he had explained how to avoid it as an issue because there is no effective cure for either Celiac disease or a fructan allergy.

He essentially told me to listen carefully to what my body told me. That’s brilliant advice that I have used since that day. It amazes me how much people will eat things that hurt them and then blame the food rather than change their habit, as he prompted me to do by helping me to appreciate my own role in the maintenance of my own health.

Note, in that example, our trip to the exam room was just to check to see if I had any symptoms I couldn’t sense, but other than that there were no tests required, no expense to the system, none of the common suggestions about drugs or antacids. Just wisdom gleaned from data and a request to follow-up if the food experiment didn’t work.

It saved me time, the system money, and it made me recommend him to all of my closest friends, who were all excellent patients who managed their health responsibly. Plus the doctor and I got to like each other –I considered him a valued friend within a few years. It’s fantastically better than the drive-thru effect that currently exists in yours –and it seems now most– doctor’s offices. You lose as much through that as we do.

1372 Relax and Succeed - There is a reason it is called health care

Doctor, I can appreciate that everything in life is now very expensive and that running an office, and having such an excellent receptionist and all of your other administrative responsibilities, all add up to a lot of responsibility. I do respect that. Just as I want you to see my dad not as symptoms and a question, but as a human with needs, I have done the same in thinking about you.

Please know I am not questioning either your good heart, your education, or the challenges of practicing medicine today. Most patients will come in prepared to respect you, but we will lose that respect if we feel it is not being genuinely reciprocated.

Fortunately, despite the challenges that all doctors face, the fact remains that many doctors do find a way to be this other kind of doctor, so clearly that is possible while maintaining some level of financial viability. I doubt any patient, nurse or medical receptionist has found that the difference between these doctors is about money.

Good medicine is about attention. It’s about, are we distracted or focused? It’s about actual compassion brought on by real consideration of the complete human before us. You’re the leader in the exam room. The patient is often scared, confused, embarrassed or in pain. They’re often in their worst state of mind, so it’s a lot easier for the patient to open up and be honest with you if you’re the one that initiates the building of that rapport, through your demeanor.

To be honest with you doctor, I’m not sure I’ve made anything clear with this. I can see kindness in your eyes despite the rush, so I do hope this slows you down. In my experience, we all get better at any job through realizations of deeper layers of the job we hadn’t previously considered.

I know I have been made better by wise criticism in my own work, so I do hope this has that effect for you as well. The criticisms can sting at the time, but I’ve always liked those moments in the end because they always leave me feeling bigger and more capable, and my aim in taking the time to write this is entirely to be beneficial to you.

My father has always been like a wise Buddha, teaching smart lessons about a good life. And even with dementia, he often has a notably positive impact on all of us around him. He brings out the best in us, and when we lose patience it’s like he’s the monk putting us through our spiritual training.

It’s through his innocence that he does this. Because he is guileless he assumes all others are too. He takes people as they are. That’s why, despite your harried care, he thinks you’re fine the way you are. But it is my hope that with the guidance of your experiences with him, that you too might consider him a temporary guide. Because in the best of worlds, I’d like to think this unfortunate experience will lead you to more fully appreciate your patients as people, not as only the issues they present.

If you’ve managed to keep reading until here, thank you. I do appreciate your consideration and wish you the very best in both your personal and professional life. I do hope hope this communication can help you gain more joy from your work days, because I can only assume it would be a much nicer day spending time with human beings than with just their diseases, injuries and illnesses.

Finally, please don’t forget to thank and value your nurses and receptionists. There are many times when it is they who protect you from angry or painful reactions I’m sure you would rather not experience. I am confident they are often keenly aware of many ways that the doctors they work with could be better.

Thank you.

peace. s

Unhealthy Habits

1370 Relax and Succeed - We either make ourselves miserable or we make ourselves strong

All day long a billion details offer themselves up for our focus. And yet many of us walk around largely oblivious to our surroundings. Very few people will even notice the eye colour of the people they’re speaking to. Many people need photos to know the eye colour of their friends.

But if billions of these potential stimuli are offered to us, what makes us choose which ones to bring into focus?

Wiring. Our brain is flexible and it builds itself to efficiently do the things we often do. If someone hand-writes every day, the writing gets better and better unless some illness or injury is involved. The same goes for adding numbers. We might feel slow on week one, but by week four our brain has built a bunch of shortcuts.

When those shortcuts are super-efficient and are often used), they are often referred to as habits, and they will even often initiate themselves at specific times of day. These can be external reality things, like the way a photographer will often look at the world in ways that are different from non-photographers, or how someone might keep an ear out for the baby.

Or, we can also have internal, thought-based habits — like someone who worries, or a kid in church who sits there the entire time with their mind filled with thoughts about how much they wish they weren’t in church. We feel the urges to do those things, or think those things, due to the force of habit, just like water flows along low ground.

The popular shortcuts that we find destructive –or even meaningfully counterproductive– are not seen as habits, they are viewed as either obsessions or addictions. But to our brain those are largely the same things. They are things we feel compelled to repeat.

Why we want to repeat them is simply because nature naturally seeks efficiency, so the courses of thought most often used are the ‘low ground’ for our energy. If we’re tired and don’t have a strong flow of reality coming in, our brains will do what’s easiest –our habits– the things we practice and that our brains wire us to do very well.

If we’re struggling with alcohol, or games on our phones, porn, or anything else, plugging that brain superhighway is not how our brains work. We don’t shut down pathways in the brain, we redirect them.

1370 Relax and Succeed - Life does not get better by chance

It was by repeating actions that we built our brains in the troublesome way they may be. But it’s simply by repeating different actions that we can divert our thinking and steal all the traffic from our troublesome road. We can divert the energy to take another path through life that we find more productive.

But this requires us to stay conscious of what we’re really doing with our brains.

If we look at what drugs and alcohol, video games of whatever sort, as well as gambling, food, or sex, all have in common, it is that they either require our attention or they numb us. By doing either, the brain creates a way not to do the painful thinking it might otherwise do. This is a healthy awareness but an unhealthy response.

The healthy part is that, in a low energy state, our desire is to reduce the number of stimuli. These include the considerations and deliberations that can obsess our internal ego-talk. But if we’re doing it by distracting or numbing ourselves then we’ve just replaced a negative with another negative masquerading as a positive. We can do better.

The pressure –or urge– we feel to participate in an addiction will be like that kid in church. But just because we feel that urge to think a course of thoughts does not mean we need to actually think them, or turn them into action. If we think anything at all we are better to meditate on reality.

We can recognize that –in the technical brain sense– our urges makes sense. But we also know brains can re-write themselves. These two facts mean that we can take an addiction impulse, and then use it as a signal to divert our attention to a replacement activity that is something truly valuable to us. (It’s always much easier when we trade a leaning-post for a passion.)

If we’re lazy with our brains they will create more work in our lives. But if we do our best to stay as conscious of ourselves as possible, we can recognize those tugs and urges for what they really are: thought-thin prompts to start a justification narrative.

They are only thoughts. All we have to do is watch ourselves, because if we succumb to a habitual justification we often end up in self-hating loops of thought. But if we divert to something better (a book, a call to a friend, a class), we will soon find that we will feel quite positively about having converted an addiction into a healthy and rewarding habit.

peace. s

Devices of Judgment

1359 Relax and Succeed - Thoughts are a good servant but a bad master

Our world was shaped by thoughts. Those thoughts get codified into social codes or guides or laws or through things like school grades, or peer pressure built around the concepts of popularity or acceptability.

Some of these devices are tangible things like step counters or gym weights or weigh scales. The pressure we feel in life is us trying to fit our natural shape into the predetermined forms these tools or ideas create.

The outcomes are somewhat predictable. Every code gets applied to every person equally, even though some people may never be athletic no matter how hard they try, and others may struggle academically in ways that do not reduce their value as a human being at all. But all of us will be judged by many people –most notable ourselves– for not being many things, as though we were supposed to have been them all.

The only way to escape is to be so far removed from those ‘tests’ that we get a free sympathy pass from society because we have one huge natural judgement running against us, like childhood cancer or deformities or severe mental challenges.

Some are seen to be so obviously struggling with what is obviously a heavier load that it’s a more definitive signal that knocks us out of our personal thinking. That jolt to our awareness ignites our compassion by so strongly exposing our good fortune.

That is a beautiful thing to do for others, and that is why people in those situations should be seen more like spiritual teachers in society. They elicit an essentially universal reaction that does expose our natural tendency as humans, which is decency, while also making us grateful, which is spiritually healthy. They’re monks in wheelchairs and in canes.

Where we can benefit from increased awareness is to realize that while some people have their suffering jammed into a generally narrower set of experiences, (like those of a severe autistic, or someone who is born without any limbs), others are also suffering badly, but with more general things like their weight, or their income, or the acceptability of their personality.

Because those feel like the problems of more common, so-called ‘normal’ people, we often don’t realize that those issues and people would also benefit from our awareness and decency. Smaller issues –even presumed– can pile up to the point where they can cripple our lives.

1359 Relax and Succeed - This scale does not

If we count steps or weigh ourselves for our health, it’s not to hit some numerical target. The point is to feel good and have a doctor feel that the weight –whatever it is– is in a range that respects our unique bodies. A healthy heart should be about getting more time with loved ones, not meeting the doctor’s target. We must love ourselves, not try to be someone for others.

Too many times something like a calorie app or a weigh scale are not simply weighing things in the physical world. Instead, they are drawing some abstract chalk outline onto the world and then asking us to fill it. It’s crazy. We weren’t supposed to become what an app said because the person who wrote it never met us. Nor the person who built the weight scale, and just because a hairstyle is popular does not mean it looks or feels good on us.

We suffer when others have generalized the individual us. And when we do that to ourselves as well, all we’re doing is using an abstract cultural whip to beat ourselves. It’s the opposite of spiritual awareness.

Can we really imagine someone going to the Buddha, or Moses or Jesus or Mohammad and having them tell the person their soul will find nirvana when they lose some weight? Or get a better haircut? Or a job that’s more respectable? Would Jesus tell us that we can give up now, because we were born gay, or in the wrong country, so nothing we could ever do could make us worthwhile?

It’s hard to imagine the Buddha saying, “Sara, you will find enlightenment but you must get your Thursday Tinder date to like you or your life will be an unhappy disappointment.”

Deep down you already know this is true. The people that love us don’t need us to be any particular way. Not a shape, or age, and they love the person that lived our experiences, even if they don’t always like some aspects of the personality that grew out of those experiences. They love the soul at our center –the being living all of that life. We should all love that person too.

What others think are merely individual experiences they are having inside their own heads. Those judgments don’t impact us at all if we don’t start thinking them in our heads.

If we saw a loved one beating themselves up terribly over their weight it would be heartbreaking because we would all know they are so much more than that dumb number. And that impulse is beautiful and natural. But enlightenment really comes when we learn to direct that compassion toward ourselves. Because only then will we free ourselves from the suffering we generate when we use our devices of judgment.

peace. s

Resting the Soul

1313 Relax and Succeed - Resting the Soul

We can be kind to ourselves with our thoughts, but we can also be kinder to ourselves with our lives.

Whether it’s what we eat, how and when and with whom we eat it, or if it’s walks outside or time with a book, we must ensure that we are not expecting our minds to compensate for a life that is drastically out of a balance in terms of expenditures of energy versus opportunities for rejuvenation.

If we are under stress, then it will feel like it and we must simply accept that there are times in life where rest and good nutrition is not really possible. We can generally endure far more than we suspect but, despite that, we must ensure we make room to rest or else everything will become stressful.

Rest is not a selfish luxury of ego, that is sloth. Rest is what a healthy mind needs to sustain their hold on equanimity. Sloth is when we deny the world the benefits of our inherent value.

What makes this challenging is that no one desires the hardships of life so it makes sense we will often feel resistance to needing to react. At the same time if we don’t react we naturally feel uncomfortable because our nature moves us to contribute meaningfully to our society because that is actually a selfish, self-preserving approach. We are better together. Knowing that, we need to nurture our value to the larger world.

1313 Relax and Succeed - True silence is the rest of the mind

In the end, all we need to contribute is some wisdom and some enthusiasm. The former comes through experience, but the latter is more a matter of us getting out of the way of our nature. In many cases, we really do find the tougher jobs more rewarding. But in order to take them, we must feel we have the energy to succeed.

Do not feel guilty about needing real rest. Deep down, we all know when we really need it versus when we’re simply seeking to avoid a responsibility we feel inside. By spending more time with the difference between the feelings we can learn to tell one from the other more quickly, which allows us to accomplish more, while also ensuring that we’re rested enough to do so.

Let us all balance our weeks as much as we can. With the right attitude, we can make a huge impact on how our days feel. Enjoy.

peace, s