Over the rainbow

“Someday I wish upon a star, wake up where the clouds are far behind me, where trouble melts like lemon drops, high above the chimney top, that's where you'll find me.” - Harold Arlen & Yip Arburg

I’ve longed believed that 90% of health is mental health, so I’m really glad that that this week’s North Valley leadership communications focused on our emotional wellbeing. I hope that you will take advantage of at least one of the many resources we have made available to help you get more settled. We’re embarking on a three day Memorial Holiday weekend. In addition to creating space for us to honor and mourn members of the military who have died while serving our country, this weekend gives us the opportunity to slow down and reconnect with our thoughts and emotions. I encourage you make a solid connection with your sense of optimism and hope for a better tomorrow. To get you started, please enjoy this Davis High School Madrigals performance of “Over the Rainbow” sent to me by Kathy Eastham, Pediatrics.

Lessons from a fighter pilot

I know a young man who is a US Navy fighter pilot. He’s an elite aviator who engages in high stakes work, under imperfect conditions, at great risk to his personal safety. Sound familiar? I asked him to share some cockpit wisdom that might be helpful for us as we engage our enemy, the COVID-19 pandemic. These are his cockpit pearls (followed by my comments in italics):

“No fast hands in the cockpit.” A misconception in the public is that the best fighter pilots must be those with lighting fast reflexes. However, in reality, our training emphasizes just the opposite. During an inflight emergency, when the Master Caution light is flashing in your face, the urge to impulsively flip a switch or activate a back-up system can be overwhelming. It is during these moments that we fall back on our training, find the checklist that is the best fit for the scenario, and execute with deliberate focus. When things get ugly, take a deep breath, and fall back on your training. Stick to the fundamentals. The 4-P’s mantra comes to mind: “Keep them puffing, pumping, perfusing, and peeing.”

“Bounce Back.” Fighter pilots make mistakes all the time. Whether in dynamic training exercises or in actual combat, there is no shortage of threats that hinder perfect execution. The best among us are those who are able to acknowledge the mistake, mentally compartmentalize the error for the debrief, and continue the mission with a focus on all the other opportunities left to succeed on that sortie. Rapid sequential tasking interrupted by generous self-affirmation is what our patients need from us.

“Show of Force.” Unfortunately, in combat, the enemy gets a vote. This reality can produce moments of intense frustration when the circumstances of the engagement feel dictated by the adversary. In a tactical jet circling overhead as a chaotic ambush below unfolds, our most requested response is a “Show of Force.” This maneuver calls for an extremely low, fast, and loud pass over the engagement and is intended to display to the enemy what a poor decision they just made. Although the desired response is a retreating enemy, often the feedback we receive is that of the uplifting effect the maneuver had on our friendly forces during their time of need. There is no greater show of force than our dedicated teams of health care professionals bringing their best to the fore as we fight the battle of our lives.

The one thing

The topic of yesterday evening’s weekly North Valley Town Hall meeting was Workforce Wellness. The faculty included leaders from psychiatry, human resources, physician wellbeing, and the employee assistance program. It was my pleasure to represent physician health and wellness. During Q&A, a listener asked me to identify the one wellness practice that I have observed to be effective during the entirety of my thirty-one year career with TPMG. My immediate answer was CONNECTION. Why connection? John Travis, the founder of the modern wellness movement, said that “the currency of wellness is connection.” I like to say that “connection is the coin of the realm in the kingdom of wellness.” Connection to what? The answer to that lies in the writings of Dr. Richard Swenson in his book, Restoring Margin to Overloaded Lives.

Connection to other people = your social life. During my first year of work with TPMG in 1989, I was doing weekend rounds on an elderly gentleman on the hospice service. After I completed my bedside evaluation, he asked permission to give me some advice. Of course I said yes. I was a 29 year old newly minted family physician who didn’t know much about anything. He leaned in and said, “Young man, I just want to let you know that at the end of your life, all you really have are the relationships you developed with other people.” His words immediately struck me as pure gold. He died a few days later, but his wisdom lives on, today in this email.

Connection to yourself, your purpose for living, and the story you tell yourself about you = your emotional life. This emotional life is in many ways the most complicated one. I encourage you to consider meeting with a counselor to make sure you get it right.

Connection to God or a mighty transcendent being or idea = your spiritual life. For many people, this is the one abiding life, the one that unifies all elements of life.

To appreciate the importance of connection to wellness, consider the consequences of life without connection: isolation, loneliness, simmering in destructive stories about the self and others, wandering with no purpose or direction, the futile pursuit of happiness based on things and circumstances. You get the picture.

In summary, there is consolation in community, and desolation in isolation. The choice is yours. Make a good choice. If you need help doing this, please reach out to a wise person that you trust. It might be a licensed counselor, a religious leader, or your favorite relative. It might also be a patient who has been through a lot, and in doing so, has learned something important that he/she is eager to share, much like the hospice patient who intentionally connected with me in the sunset of his life.

The making of a miracle

“The only place where success comes before work is the dictionary.” - Vidal Sassoon

We all love miracles. The curing of leukemia, the birth of a healthy baby after prolonged infertility, the ending of a pandemic. In sports, one of my favorite miracles was “The Catch,” Dwight Clark’s leaping touchdown reception of a Joe Montana pass in the 1981 season’s National Football Conference championship game between the perennial powerhouse Dallas Cowboys and the upstart San Francisco 49ers. Trailing 27-21 with 58 seconds left in the game, the 49ers faced a third down and three on the Cowboy’s six yard line. Joe Montana took the snap from center and rolled to his right looking for his primary receiver, Freddie Solomon. Solomon slipped while running his route, forcing Montana to scramble to elude the rush of three oncoming Cowboys, including 6’8” Ed “Too Tall” Jones. A split second before being forced out of bounds, Montana lofted a pass to the deep right corner of the endzone, where Clark leaped above defender Emerson Walls to catch the ball with his fingertips and send the 49ers to the Super Bowl, where they would win their first of five Super Bowls over a thirteen year period. What many people forget about “The Catch” is that it was preceded by a dramatic thirteen play drive that began for the 49ers on their own 11 yard line with 4:54 left in the game. “The Drive” included four Montana pass completions, four runs totaling thirty yards by Lenvil Elliot, and an end-around run by Solomon good for fourteen yards. Just as we remember “The Catch” as being the play that defined the end of the Cowboy’s reign and beginning of the 49ers dynasty, I suspect that historians will attribute the end of this pandemic to a vaccine or drug. However, when we eventually get to the other end of this virus infested tunnel, we should record for posterity that we would not have survived this disease without the people who sheltered in place, the engineers who kept the lights on and sewage flowing, the essential workers who kept us fed, and the many members of the healthcare team who left their homes and families to tend to the sick. They, we, are the unsung Lenvil Elliots and Freddie Solomons, without whom there would be no civilization left for a vaccine or drug to save.

Take yourself to a happy place

Feeling cooped up by the shelter in place restrictions and the cancellation of your vacations? Me too. But rather than be a helpless victim of a tiny coronavirus, I choose to leverage my mindfulness and guided imagery training to regularly take myself to happy places throughout the world, not in the typical bodily sense, but in my mind. It works like this. I put on my Rainbow brand sandals that are a constant companion wherever I go. My dear friend and wellness colleague, Richele Thornburg, Executive VP, People and Leadership Strategy, The Permanente Federation, reminds me that the correct name for this luxurious footwear is “slippas.” Of course, my slippas call for me to accessorize with a comfortable well-worn t-shirt, shorts, and a wide brimmed hat for UV protection, or a farmers cap if I am feeling young, hip, and unafraid of skin cancer. I then set out on a walk in my neighborhood (pictured below, bottom row, center). But instead of mindfully appreciating my immediate surroundings, I take myself to one of my happiest places in the world. That place would be Hawaii, a cluster of tropical islands where I am filled with peace and joy with no effort. In an instant, my stress and worries melt away and I am connected to the tastes and textures of savory Spam musubi and sweet shave ice, the 82 degree 55% humidity weather that forces me to slow down and mellow out, the sensation of weightlessness experienced while floating in warm ocean water surrounded by friendly tropical fish, and the hospitality of my island hosts who thrive on making me feel welcomed and cared for. Where is your happy place? Since you probably can’t drive or fly there at the present time, why not take a virtual visit in your mind? Slippas are optional, but highly recommended.

Pandemic PSAs from Jimmy Fallon and Friends

Nothing stirs, inspires and calms the soul like music. And some of the best music during pandemic times is found in collaborative virtual remixes of classics whose messages describe our current angst and admonitions. Melissa Arca, Pediatrics, shares this Jimmy Fallon, Brendon Urie, and The Roots remix of “Under Pressure,” a recognition of the intense stress we are feeling from all angles. And from Stacey Bowman, Pediatrics, a Jimmy Fallon, Sting, and The Roots remix of “Don’t Stand So Close to Me,” a rousing reminder that a fundamental element of surge containment is physical distancing.

Training our brains to be Velcro for the good

"It's time to rewrite the maxim that practice makes perfect. The truth is, practice makes myelin, and myelin makes perfect.” - Daniel Coyle

Have you ever found yourself feeling stuck in your quest to become more emotionally resilient because of a tendency to focus on the negative? Where does that come from and how can you retrain your brain to focus more on the positive? The answer is summarized well in this Inc. article by Susan Steinbrecher that features the work of Rick Hanson from UC Berkeley’s Greater Good Science Center. “The brain is hardwired to focus on the negative. It is a phenomenon that social scientists have labeled as the ‘negativity bias.’ It refers to the innate ability to absorb and anchor negative events and thoughts, and to bypass or give less attention to the positive ones. Simply put, the brain is built with a greater sensitivity to focus on bad news. As Hanson puts it, our brain is ‘like Velcro for the bad experiences, and Teflon for the good ones.’ The negativity bias is the result of the way in which our ancestors' nervous systems evolved, millions of years ago. While they hunted for food and avoided predators their brains were constantly on defense mode -- planning for the worst case scenario, in order to survive.” I’ve heard this tendency for our primitive survival-mode brain to be Velcro for the bad described as “frog brain.” The good news is that we can rewire our brains to be stickier for good news. The path to this enlightened brain starts with mindfully looking for positive situations in our lives: one more day of good health, clean water, electricity at the flip of a switch, a refrigerator, food in that refrigerator, a thank you from a patient, a colleague who replies to your Cortext question, a nurse who dresses your patient’s wound, a custodial worker who keeps your office tidy . . . the list goes on and on. It’s equally important to let the good feelings associated with these positive situations sink in. According to Hanson, this drives the process of installation into your nervous system, essentially rewiring your brain = neuroplasticity. Like the formation of any other adaptive habit, looking for the good requires intention and practice. But oh, the places you’ll go in your life with a brain wired to be Velcro for the good!