Thursday advice for Friday Night Fun

Karly Kaplan, plastic surgery, found some Friday Night Fun last week and offers some great suggestions for how you might do the same. She wrote, “Just wanted to write in to say I have used the Beyond KP resilience course a lot during this COVID time!! Here is a picture of me in the office with my resistance bands. After a day of video visits where I’m barely even getting up to walk around it feels good to get the blood flowing a few times. I’ve also been keeping up with using gold stars In a calendar to reward myself for doing my zoom workouts at home. And I use headspace to help get to bed after spending a few hours on Twitter in a depressing news spiral. For dinner, we ordered takeout from The Waterboy in Midtown. They offer a nice 3 course meal hot and ready to eat and you are assigned a 10 minute pickup window so the food is prepared at the perfect time for you. Pay is contactless- credit card taken over phone so you don’t have to sign anything. The meal was DELICIOUS, perfectly prepared and beautiful. Click here for the menu. When I got home my husband had cleaned the house. I put on a dress and we used cloth napkins while the kids watched a movie upstairs. It really helped my sanity. Highly recommended 10/10.”

Lockdown reflections from Maui

Kimmie Ouchi is a family physician in Maui, Chief of the Kaiser Permanente Lahaina Clinic, and Co-Chair of the Hawaii PMG Health and Wellness Committee. She was born and raised in Maui and came to the Mainland to play Division 1 tennis for Santa Clara University. This was followed by medical school at the University of Hawaii. We first met when she was a resident at UC Davis. She was a pleasure to work with and radiated an inner light that brought joy to all those around her. I see her about once a year at wellness conferences and we stay in touch by email and text messaging. Yesterday she sent me this beautiful poem and pictures of her enjoying a patch of sunflowers in Central Maui with her daughter, Nanea. She reminds us that “the sunflowers are still blooming” and adds, “it’s always important to take time to stop and smell the flowers.” 

People are like stained-glass windows

We all like happiness. But happiness is conditional, relies on external factors mostly out of our control, and takes a beating during dark days such as these. So let’s make it our Plan B. Let our Plan A be the cultivation and generous sharing of a joy that resides deep within our souls, a joy that brings light to even the darkest recesses of the human experience. Elizabeth Kubler-Ross references this inner light in a quote brought to my attention by Johnny Greenfield, orthopedics.

If you want to fight a virus wash your hands

Monday is a good day to remind ourselves to wash our hands to help limit the spread of germs. That message comes across loud and clear in this entertaining music video from Algernon, the husband of Nicky Hjort, Women’s Health. Nicky herself is also quite creative, as you can see on her Amazon book sale site and her recently launched LIT Sisterhood blog.

The best of times, the worst of times

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair …, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way …” - A Tale of Two Cities, Para. 1, Line, 1

In his 1859 novel, A Tale of Two Cities, Charles Dickens tells a story of love, hope, despair and grief in London and Paris during the French Revolution. Lucie Manette represents the light of the world, and Madame Defarge is the darkness. The concept of human beings living with multiple simultaneous polarized beliefs and behaviors is playing out again during our current pandemic. Worldwide, we are seeing selfish behavior seeded by ignorance and fear, and bold acts of benevolence and inclusion fueled by facts and love. The latter is where we aspire to be as a civilized society, one where we treat one another as we want to be treated ourselves. Before and during COVID-19, Kaiser Permanente has been a shining light in the darkness. Our mission to improve the health and wellness of our patients and the communities we serve, combined with our integrated, prepaid, evidence-based group practice, perfectly position us to lead our communities through this pandemic. We stand on the shoulders of visionary giants such as Henry Kaiser, Sidney Garfield, Cecil Cutting, Morris Collen, Bruce Sams, and Robbie Pearl who introduced industry leading new models of care. And when this pandemic hit, our Permanente leaders immediately stepped up with facts not fear and implemented a plan to flatten the curve. This has been followed by rallying resources to support the professional, social, and emotional needs of our workforce and adapting our daily operations to meet the needs of our patients and secure our financial footing. #permanentemedicine #bestoftimes

Be flexible and get along with other people

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” – Charles Darwin

Cynthia Dirkx, radiology, shared this Darwin quote with me and told me that it helped her to successfully navigate her department’s transition to teleradiology and other technology-based tools years ago. The quote echoes the advice given at my son’s college graduation ceremony in 2012. The speaker was Jorge Garcia, who earned his degree in communication studies from UCLA in 1995. Wikipedia describes Garcia as “An American actor and comedian best known for his portrayal of Hugo "Hurley" Reyes in the television series Lost from 2004 to 2010. Garcia also studied acting at the Beverly Hills Playhouse acting school and spent six years working at Borders Books and Music while auditioning. He was in a few commercials during that time. He later said that his first taste of street recognition came from starring in a Jack in the Box commercial which was aired frequently on local television. He began landing roles in television and film, but his career really took off when he played the role of Hugo Reyes (Hurley) in the television series Lost. Garcia was the first actor to be cast on Lost after the producers saw him on Larry David’s Curb Your Enthusiasm the night before casting began, and created the character of Hugo Reyes specifically for him.” Now back to the memorable graduation advice. Based on his personal path to success, Garcia encouraged the new graduates to “Be flexible, and learn how to get along with other people.” Flexible because rigid doesn’t work in a constantly changing world. Flexible because it lets you bounce back from disappointment and liberates you to discover new and often better ways to get things done. If you need a Claymation role model for this, think Gumby. What does it look like to get along with other people? Think of the team players and servant leaders you know. These are the people we all like to be around. They think more about others than themselves. They listen deeply. And during pandemic times, they are the people who keep us inspired and make good things happen amid chaos and uncertainty. #gumby #hurley 

Pandemic freebies and discounts

This pandemic can be likened to a prolonged case of food poisoning caused by the sweet and sour dish from hell, with a huge emphasis on the sour and hell. Think sudden onset vomiting, bloody diarrhea, severe abdominal cramping, and spiking fevers with chills. Plus anosmia and some fatalities. But for the sake of our sanity, let’s take step back and focus on the sweet for just a moment. Every Monday through May 12th, Krispy Kreme is offering us a free dozen of their original glazed donuts. McDonalds is providing a free meal to health care workers and first responders through May 5th. Jennifer Lin, head and neck surgery, notified me that The North Face is offering a 50% discount to health care workers. The verification process takes a couple of minutes and gives you a promo code for a one time purchase to be redeemed before December 31st. Note: those who routinely purchase items at full retail should know that anything you buy at half-price looks and feels twice as good. And Crocs is donating a pair of its funky shoes to people on the front lines (though there is a daily limit to what they give). Those of you behind the TPMG firewall can click here for additional information about discounts and freebies for your emotional wellness, lodging, telecom, elder care, and transportation.

Fish out of water

“Adaptability is about the powerful difference between adapting to cope and adapting to win.” -Max McKeown

Some of us may be worried about the numerous change initiatives that are helping us match our work force and how we provide care to the rapidly evolving needs of our patients. Examples include redeployment assignments, transitioning to more video care, and the strategic use of vacation time. Such pivot shifts are unsettling because they take us out of our comfort zones. Sabine Hill, AFM physician and wellness leader, GSAA, sent this uplifting message to her colleagues after her recent HBS redeployment training: “A big warm thank you to my HBS colleagues who helped me retrain my brain and fill it with HBS skills, especially Viet Tran, who was the kindest, most patient teacher I have ever encountered in my career. I have felt a tremendous welcome by the HBS department, so don’t be surprised if you see me hanging out more with you. I had the great fortune to train with many of the specialists this week, an extra bonus as these are colleagues I rarely get to connect with personally. I felt so privileged to learn neuro from Jina, Aparna and Stephanie; bump elbows with Amee, Kunal and Christian from GI; met new cardiologist Stephanie and reconnected with her colleagues Laura and David; ran into my AFM San Lorenzo colleagues who greeted me each morning waving the temperature probe at me; connected with Arora on a shared patient; and had a coffee chat with Yelena and Neelam from nephrology. After the first two days of initial HBS anxiety wound down, it was a true JAMM moment for me today.” #emergebetter #adapt2win

The antidote to boredom

“When you pay attention to boredom, it gets incredibly interesting.” - Jon Kabat-Zinn

From Ethan Cutts, Pediatrics and Med-Legal Chief, a reminder that the boredom associated with shelter-in-place is largely a state of mind, and often times the catalyst of creativity. Case in point: these hilarious YouTube videos of marooned BBC sports announcer Andrew Cotter (who normally covers major international events such as Wimbledon, The Open, and The Masters) delivering play by play calls of . . . his dogs Mabel and Olive eating their food and competing over a chew toy. As reported in The Guardian: in the first contest held on March 28th, Olive, the older black lab, “focused, relentless, tasting absolutely nothing,” beats out the rising star, Mabel. Then last week, Mabel, with a steady intensity of focus “built on patience and sheer belief,” snatched the chew toy title away from Olive just as time ran out, winning the title of “very good dog.” The chew toy video garnered over three million view in less than five hours – which I find very interesting.

Silver lining wisdom from Lou Klieger

In response to a recent Daily Dose message about three equations for a happy life, Lou Klieger, ophthalmology, sent me the following: “Stuck at home I’ve spent some time taking free online classes including one on the science of well-being taught by Professor Laurie Santos at Yale. Lots of review of stuff I’ve learned from our programs, but one interesting thought that came to mind was this: one of the strategies which she notes can be used to thwart hedonic adaptation and reset your reference point is to interrupt your consumption, making you appreciate what has become routine and thus lost its luster and impact on happiness. It made me think that this whole current experience is one giant interruption of consumption. So it stands to reason that while it’s a very difficult time for everyone right now, just think about how much collective improvement in a sense of well-being we’ll probably see on the other side when we get to re-experience all of the things that we were failing to appreciate in the moment, such as a nice dinner out, a beer at the bar, and a group class at the gym. I know personally the next time I can go eat sushi in a restaurant I’m going to be pretty happy.”

Clockwise from top left: Ronald Tamaru, Matthew Carnahan, Scott McFarland, and Lou Klieger enjoying Serotonin Surge charity golf; Professor Laurie Santos; eating out at Chez Panisse; beer served by a bartender in a bar (imagine that!); group exercise classes; and going out for sushi.

The Prayer

I love watching ABC’s American Idol. The personal stories and performances by the aspiring musicians make me cry. Contestants Makayla Phillips & Cyniah Elise recently teamed up to perform this stirring rendition of “The Prayer” written by David Foster, Carole Bayer Sager, Alberto Testa, and Tony Renis. The song was commissioned as a solo for the 1998 movie Quest for Camelot and won a Golden Globe Award for Best Original Song and an Academy Award nomination for Best Original Song. Soon thereafter Celine Dion and Andrea Bocelli recorded this classic duet version. The melody is beautiful, the harmonies mesmerizing, and the lyrics a perfect fit for the challenges of our day

Weekend travel idea

Ingrid Lim, ER physician, CME chief, and wellness leader, San Francisco, sends a weekly wellness newsletter to her colleagues. This is an excerpt from her 4/8/20 edition that is perfect for today: “I want to emphasize that as a frontline physician in the ER, I fully recognize the seriousness of what we're facing and the importance of preparation. I regularly grapple with fear and anxiety about my own safety and my family's, as many of my colleagues have. But we can't just be in a state of perpetual threat. It's not sustainable. It's exhausting. Writing these newsletters has brought me much joy and meaning because throughout the week, I continuously look for positive things to share with you each Wednesday! I want to thank you all for indulging me in my own therapy and for sharing your tips, your experience, your stories, and your feedback. Looking at the map for some weekend travel ideas? The walk-in closet might be the most exciting - I spend a lot of time in mine, hiding from my three kids!”

Liquid gold

Cal alums will especially love this story from UC Berkeley News featuring the good works of graduate student Abrar Abidi and research assistant Yvonne Hao. Together they figured out how to make liquid hand sanitizer for themselves and friends - and then quickly scaled up the project to get this product out to high-risk groups such as those people living on the streets and in shelters and prisons. Their initiative combined with faculty support, donations, and the repurposing of existing lab space has the campus on track to produce 200-300 gallons of hand sanitizer per week. Abidi describes the work as "satisfying, exhausting, and fulfilling.” I would add to that “lifesaving.” #GoBears #Blue&Gold (normally followed by #BeatStanford, but not during a pandemic).

Three equations for a happy life

“We need to learn how to want what we have, NOT to have what we want in order to get steady and stable Happiness” - The 14th Dalai Lama

Thanks to Alan Anzai, AFM and Sacramento’s elected director, for sharing this article from The Atlantic titled “The Three Equations for a Happy Life, Even During a Pandemic” by Arthur C. Brooks. It’s worth the entire read but I’ll summarize it here for you: #1: Subjective well-being = genes + circumstances + habits. We are born with a set point for our subjective sense of well-being and it accounts for about half of our happiness. According to Brooks, circumstances account for anywhere from 10 percent (a figure I’ve seen a lot) to 40 percent (sounds high). This leaves habits, which can be cultivated. #2: Habits = faith + family + friends + work. Any faith or secular life philosophy. Family and friends are where we build deep, long-lasting relationships that bring us joy and meaning. What kind of work? Work that gives us a sense that we are earning our success and helping others. #3: Satisfaction = what we have / what we want. A life focused on accumulating the most toys is a futile “hedonic treadmill.” Better to get simple and decrease the denominator, during a pandemic, and always.

Jan Buchczik

The new face of patient gratitude

From Jennifer Keller, pediatric surgery: “Just passing along a moment of gratitude. This is a gift from a patient’s family following their son’s surgery. I tried to refuse multiple times yesterday but they were not having it. So today, when I discharged them from the hospital this was waiting for me. Not sure there’s a more generous way to say thank you right now than to give someone Clorox wipes and hand sanitizer.” Note: For dramatic effect, I took the liberty of embellishing the photo Dr. Keller sent me with a crown, angel wings, and an Olympic medal podium theme. This in no way implies that cute puppies and chocolate chip cookies are no longer welcome, but it does demonstrate how times have changed.

From "Woe is me" to "WOW is me!"

"Gratitude is an opener of locked up blessings." - Marianne Williamson

When I was about ten years old, my father, a minister who frequently called on sick people in the hospital, advised me that I should be grateful every morning I could wake up and pee. You can imagine how this comment made little sense to me as a fifth grader. It wasn't until ten years later while studying anatomy and physiology that I began to understand what my father meant - namely that we should never take for granted the miraculous ways that the human body works because soon enough our highly evolved functions of swallowing, pooping, peeing, speaking, and thinking will begin to falter, sometimes in the split second it takes to have a car accident, heart attack, or stroke. What are the measurable benefits of replacing our typical morning growls with gratitude? Bob Emmons, a UC Davis professor of psychiatry and expert on gratitude, performed groundbreaking research on gratitude thinking in patients afflicted with neuromuscular diseases. He instructed a subset of these patients to engage in daily gratitude journaling. Specifically, he asked them to start out each day by writing down three new things they were grateful for. He found that the patients who did gratitude journaling twenty-one days in a row or more had better health outcomes and mood scores than those patients in the control group. The positive effect of starting out each day with an attitude of "Wow is me!" as opposed to "Woe is me" was so impressive that Bob was awarded a $5.6 million grant from the Templeton Foundation to further investigate the science of gratitude. To bring this gratitude message home with a bang, I invite you to enjoy this gratitude video by Louie Schwartzberg and Brother David Steindl-Rast.

"You are not alone"

Straight from the KP.org website, this story about one of our ICU nurses enveloping our sickest patients in her loving concern: Mohini Chand, RN, an intensive care unit nurse on the front lines of the coronavirus pandemic, has been fighting the outbreak since its arrival in late January at the Kaiser Permanente San Jose Medical Center. Santa Clara County is one of the hardest hit areas in the San Francisco Bay Area. Although Chand understands it’s a stressful time, she wants people to know it’s going to be OK and not to feel scared. “Patients without underlying conditions are getting better,” said Chand, who has personally treated several COVID-19 patients. “Some are going to be released from the hospital. I’m hopeful. This is a glass-half-full situation.” Working in the ICU, Chand treats people who are in critical condition and whose fears are heightened. In addition to excellent medical care, she provides emotional support and eases their worries. “I whisper in my patients’ ears, ‘I got you. I’m here for you. You are not alone,”’ she said. “Every day I encourage them and say, ‘Things are looking better, and slowly and steadily we will win this race.”’

Easter Sunday at St. Bart's, 2007

13 years ago, when dinosaurs roamed the earth, my wife and I introduced our two teenage kids to New York City during Spring Break. It was really cold that week. How cold? So cold that it snowed while we watched the Orioles play the Yankees. Highlights included Broadway shows (The Lion King and Hair Spray); a Knicks-Pistons game at Madison Square Garden; hot pastrami on rye at Roxy Deli on Times Square; attending the David Letterman Show; sweeping city views from the “Top of the Rock”; and late night jazz with Bill Frisell at the Village Vanguard. On Easter Sunday, we tried to attend services at St. Patrick’s Cathedral on 5th and East 51st but there was no room at the inn. So we walked a mile or so and stumbled upon St. Bartholomew’s, aka St. Bart’s, on Park Avenue. We were seated in a balcony pew where we warmed up and heard a rousing message delivered by Reverend William McD. Tully. I grew up the son of an American Baptist minister, so I had heard plenty of Easter Sunday sermons. But this one in particular was quite moving in its simplicity and I remember it to this day. He said, “The message of Easter is this: LOVE wins; we all matter; God and I care about you.” On this COVID-19 Easter Sunday, our world is gripped by fear and the disenfranchised are bearing the brunt of illness and death. Now is the time for people of all faiths and beliefs to come together and CHOOSE LOVE OVER FEAR and extend that love to others who need our help.

  

Be more like Chuck Norris

We need to show up with our best game to defeat COVID-19. At times like this, we need to draw courage and inspiration from a true American hero, someone who never puckers, flinches, or backs down to a bully. That person is Chuck Norris.

How badass is Chuck Norris?
25. Chuck Norris is currently suing NBC, claiming "Law and Order" are trademarked names.
24. Chuck Norris can divide by zero.
23. Chuck Norris doesn't climb trees. He just pulls them down and walks on top of them.
22. Chuck Norris can kill two stones with one bird.
21. Outer space exists because it's afraid to be on the same planet with Chuck Norris.
20. Chuck Norris ordered a Big Mac at Burger King and got one.
19. Newton's Third Law is wrong: Although it states that for each action, there is an equal and opposite reaction, there is no force equal in reaction to a Chuck Norris roundhouse kick.
18. Chuck Norris counted to infinity—three times.
17. Chuck Norris can slam a revolving door.
16. What came first, the chicken or the egg? Chuck Norris came first.
15. When Chuck Norris falls in water, Chuck Norris doesn't get wet. Water gets Chuck Norris.
14. Chuck Norris is suing MySpace for taking the name of what he calls everything around you.
13. There is no theory of evolution. Just a list of creatures Chuck Norris has allowed to live.
12. Chuck Norris doesn't actually write books. The words assemble themselves out of fear.
11. Chuck Norris is so fast, he can run around the world and punch himself in the back of the head.
10. Chuck Norris sleeps with a night light. Not because Chuck Norris is afraid of the dark, but the dark is afraid of Chuck Norris.
9. Chuck Norris once visited the Virgin Islands. They are now The Islands.
8. Chuck Norris doesn't read books. He stares them down until he gets the information he wants.
7. If you have five dollars and Chuck Norris has five dollars, Chuck Norris has more money than you.
6. If you Google search "Chuck Norris getting his ass kicked" you will generate zero results. It just doesn't happen.
5. Chuck Norris doesn't wear a watch. He simply decides what time it is.
4. You know how they say if you die in your dream then you will die in real life? In reality, if you dream of death then Chuck Norris will find you and kill you.
3. For some, the left testicle is larger than the right one. For Chuck Norris, each testicle is larger than the other one.
2. When Chuck Norris does a push up, he isn't lifting himself up, he's pushing the Earth down.
1. When the Boogeyman goes to sleep every night, he checks his closet for Chuck Norris.

#chucknorris #permanentemedicine

Diary of a quarantined father-in-law

From the father-in-law of Andrew Walter, urogynecology
My Self-Isolation Quarantine Diary
Day 1 – I Can Do This!! Got enough food and wine to last a month!
Day 2 – Opening my 8th bottle of wine. I fear wine supplies might not last!
Day 3 – Strawberries: Some have 210 seeds, some have 235 seeds. Who knew??
Day 4 – 8:00pm. Removed my Day Pajamas and put on my Night Pajamas.
Day 5 – Today, I tried to make Hand Sanitizer. It came out as Jell-O Shots!!
Day 6 – I get to take the Garbage out. I’m So excited, I can’t decide what to wear.
Day 7 – Laughing way too much at my own jokes!!
Day 8 – Went to a new restaurant called “The Kitchen”. You have to gather all the ingredients and make your own meal. I have No clue how this place is still in business.
Day 9 – I put liquor bottles in every room. Tonight, I’m getting all dressed up and going Bar hopping.
Day 10 – Struck up a conversation with a Spider today. Seems nice. He’s a Web Designer.
Day 11 – Isolation is hard. I swear my fridge just said, “What the hell do you want now?”
Day 12 – I realized why dogs get so excited about something moving outside, going for walks or car rides. I think I just barked at a squirrel.
Day 13 – If you keep a glass of wine in each hand, you can’t accidentally touch your face.
Day 14 – Watched the birds fight over a worm. The Cardinals lead the Blue Jays 3–1. Stay safe everyone!!

Feed the right inner wolf

An elderly grandfather is telling his grandson a story. “A fight is going on inside me,” he said. ”It is a terrible fight between two wolves. One is evil — he is anger, envy, greed, arrogance, resentment, lies, and ego.” He continued, “The other is good — he is joy, peace, love, hope, serenity, humility, kindness, empathy, generosity, truth, compassion, and faith. The wolves are fighting to the death. Wide-eyed, the boy asks his grandfather which wolf will win. The grandfather simply replied, “The one you feed.”

It’s important for us to keep up with the facts associated with the COVID-19 pandemic so that we can position ourselves to provide the best care for our patients while keeping ourselves and our families safe. At the same time, we must balance this sobering news with a steady diet of stories that are uplifting. One source of such stories is KarunaVirus.org. From the website: “Times are tough. Many are struggling. Everything feels uncertain, and with that, fear is in the air. Increased stress weakens our immunity, which can leave us even more worried. To step out of this vicious loop, enter KarunaVirus. Sounds like Corona, but it's even more contagious. :) It's the Sanskrit word for compassion. Good news, uplifting stories, goose-bump-raising videos, inspiring ideas. Scientists call it cognitive reframing, but we just call it love. A new story. The intent behind KarunaVirus.org is to amplify the voice of our collective compassion -- by featuring news of everyday people choosing love over fear. We feel that the acts of courageous kindness we're seeing all over the world will far outlive the virus, and if enough of us keep it front and center of our consciousness, it could well bring new possibilities for our future.” Enjoy, and thanks to Aman Sethi, Urology, DSA, and Regional Director of Wellness Operations, for bringing this good news story to my attention.

Recent Karunavirus.org stories (clockwise from top right): Vanderbilt nurses praying for patients on a rooftop helicopter pad; deputy sheriffs grocery shopping for the elderly; children using their “tooth fairy” money to buy toilet paper for struggling pensioners; and a doctor taking to the streets to meet people where they are in their time of need.

Sun's out, guns out

We all know about the numerous benefits of regular exercise which include optimizing objective measures of current health and pushing our mortality further into the future. However, what’s left to do in a physical distancing world beyond virtual yoga in your living room? LOTS of things! Now that the rain has let up, put on your sneakers and GO OUTSIDE for some fresh air. Literally stop to smell the roses; look up and marvel at the trees in bloom, bright blue sky, and fluffy white clouds; and take a picture of a squirrel eating its lunch. Dust off your bike, put on a helmet, and go for a ride. Rediscover your yard and do some pruning and planting. And if you are feeling really bold, lather on some posing oil, don a snug tank top, and show off your guns.

Getting good sleep in an age of anxiety

Having trouble sleeping? When your head hits the pillow, is it hard to turn your brain off? From David Sobel, former Regional Director of Health Education for TPMG, this video featuring Dr. Judson Brewer talking about getting good sleep in an age of anxiety. With all of the unsettling stimuli related to COVID-19, we need things that quiet our nervous systems, not jack them up. Here are some things to try today. 

Practice good sleep hygiene. Get in some exercise during the day. No large meals, caffeine, or alcohol before bed. No laptops, iPads, or smartphones in bed unless they are used to bathe you in soothing sounds or messages (see below). 

Don’t check the news before going to bed. That would be like watching Alfred Hitchcock’s The Birds before vacationing in Bodega Bay. 

Practice doing a body scan in bed. Click here for a guided body scan from Dr. Brewer. Many patients like this better than medication. It’s free and has no side effects. Bring your awareness to the toes in your left foot. Are they warm or cold, moist or dry? Then invite your awareness to the bottom of your left foot (and so on). Do it for ten minutes or longer if necessary. It works well because you aren’t trying to force your mind not to think, or your body to calm down, which you can’t do anyway. Instead, this naturally draws your attention away from your worry thinking and grounds you in your body.

The Phoenix Phenomenon

You may recall from your high school or college literature classes that in Greek folklore the phoenix is a long-lived bird that obtains new life by arising from the ashes of its predecessor. This 2017 post from the University of Wisconsin titled, “The Surprising Benefit of Going Through Difficult Times” reminds us that after an initial period of grieving, we need to move on to a process of personal discovery called “post-traumatic growth,” aka The Phoenix Phenomenon. Some questions to ask yourself during this process that will take you from a place of fear to one of growth are: What do I want to be about in the face of this difficulty?; What would the person I want to be do right now?; What is the gift from this experience?

Sunday salmagundi

It’s Sunday, and I like alliteration, so I’m dishing up a Sunday salmagundi of wellness messages. Clockwise from top left: a poem about our healing powers from Folsom family physician Deepika Goshike; a thank you letter to doctors and nurses from a 7 year old girl whose parent works with Andre Algazi, husband of Hillary Campbell, North Valley Chief of UME/GME; and finally, this video featuring shelter in place treadmill juggling by Justin Ha, son of North Valley APIC Angelica Ha.

UK family's lockdown adaptation of "One Day More"

From Stacey Bowman, pediatrics, Lincoln, this UK family’s stirring and hilarious adaptation of “One Day More” from Les Misérables. The performance is an example of how the human spirit can bear the brunt of the coronavirus and bounce back with songs of joy and laughter. From The Advocate online: "One day more, another day another destiny, shopping for online delivery. I tried again only to find, there's nothing till September time," the family sings in acknowledgment of the stay-at-home and social distancing orders that have swept the world. The clever lyrics address the day-to-day changes required where the world is now: bathroom sharing, homeschooling, difficulties Skyping with Grandma, and waiting for a vaccine. The singers are members of the Marsh family from Faversham, Kent in England. Father Ben Marsh, a history lecturer, said they were "overwhelmed" by the reaction to the video, which has received millions of views on social media and has been aired on mainstream outlets like Good Morning America. “It has been a bit of a strange day. We obviously hit a nerve.”

Thank U Front Line

Thanks to Laura Tinti, North Valley Assistant Medical Group Administrator, for sharing Thank U Front Line, Chris Mann’s adaptation of Alanis Morissette's Thank U. As you can see in his lyrics, we are part of a “front line” that includes many dedicated people from all walks of life. Today I am especially grateful for the custodians, garbage collectors, and sewage workers who keep our workplaces tidy and make our wastes magically disappear; the farmers, ranchers, field workers, manufacturers, truck drivers, and grocery clerks who produce food and make it easy for us to buy locally; and my wife Lesli who makes our house a home and did the lion’s share of raising our children.
How bout taking a moment to thank the front line?
How bout thinking about others who can’t stay home?
How bout fighting to get these workers protection?
How bout standing up for ones we love?
Thank you doctors, thank you nurses, thanks for working the front line
Thank you scientists, thank you pharmacists, thanks for working overtime
How bout reigning it in for the bigger picture?
How bout putting another before yourself?
How bout appreciating what we took for granted? (Everything)
How bout slow clapping those who are soldiering on
Thank you Amazon, thank you grocery clerks, thank you all night truckdrivers
Thank you janitors, thanks mail carriers, thank you selfless volunteers
The moment we can all buckle down, the sooner the moment this all will be over
There’s so many ways to help out
Let us start by giving thanks. Thanks.
To everyone who’s sick we’re sending you love
To everyone who’s struggling I feel you
How bout governing without all of the politics?
How bout working to gather for the greater good?
Thank you garbage men, firewomen, teachers holding class online
Thank you companies, changing strategies, to make more medical supplies
Factory workers, first responders, civil service employees
Thank you farmers, thank you journalists, thank you military
Bless the unemployed, the house workers, and the work-at-home parents
Thank you! Thank you!!!
To everyone doing your part . . . Thank U

Surf's Up

“You can’t stop the waves, but you can learn to surf.” - Jon Kabat-Zinn

The COVID-19 surge is still in our future, and to date, no one has asked one of our dermatologists to put in an arterial line or adjust ventilator settings, so why do we have a bad feeling in the pit of our stomachs? In this Harvard Business Review article brought to my attention by Marjorie Villa from our Sacramento medical center, David Kessler names the discomfort we are feeling. It’s called grief. We are grieving the loss of normalcy, the fear of economic toll, the loss of connection, and finally a loss of safety on both the microscopic germ level and macroscopic societal level. Kessler reviews the five stages of grief. I’ve modified the italicized comments for a health care audience:
There’s denial, which we say a lot of early on: What happened in Wuhan, Italy, and New York won’t happen here.
There’s anger: You’re making me cancel surgeries and clinic, provide remote care, and/or work outside of my specialty.
There’s bargaining: Okay, if I just gut this out for 4-8 weeks, everything will be better, right?
There’s sadness: I don’t know when this will end.

And finally there’s acceptance. This is happening; I have to figure out how to proceed. Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can work outside my normal hours and scope of practice. I can do less than perfect and still be a valued contributor to a noble cause. My body sinks like a rock, wet suits make me look fat (even in black; how could that be?) . . . but I can learn to surf. I will learn to surf.

Some Good News

Thanks to Nichole Tyson, pediatric/adolescent ob/gyn, for alerting me to Some Good News, a 15” YouTube video starring John Krasinski (The Office) as a news anchor who features real-life feel good stories from around the world. From www.boston.com: “Without question, we are all going through an incredibly trying time,” Krasinski said. “But through all the anxiety, all the confusion, all the isolation and all the ‘Tiger King,’ (the newest Netflix binge watch), somehow the human spirit found a way to break through and blow us all away.” Krasinski shared uplifting videos including people applauding health care workers, a man who mowed his neighbor’s lawn, and a man who left bottles of hand sanitizer and rolls of toilet paper out on his porch for delivery truck workers to take. He also interviewed a 15-year old girl named Coco, whose town lined a street to cheer for her as she arrived home following her final chemotherapy treatment. He closed the show with this: “No matter how tough life can get, there’s always good in the world.” Maybe more episodes to come, but even if not, this one packs a punch.