Decompress

It’s a day of remembrance, and also looking forward. I’m finishing up the podcast—at least for now—and thinking about what is needed now. If you’ve been listening, you have built a new habit about detaching from the day, and worked with intentionally shifting your attention, regulating your emotions, and working with your body. And now, i’m feeling, there is more to do that is a bit different. In the meantime, if you have 3 min to fill out a survey, it would help me discern where this work could be of service next.

Inspired by Peter Senge today—in this moment, what’s our intention? We all have a usual answer, but today could listen beneath our usual chatter? And: i’d love to hear what you have taken away from this podcast here—10 randomly selected respondents will be offered a private chat with me about their own sustainability!

As clinicians, we’ve generally thrown ourselves into the next phase of life without much forethought—for physicians like me, for example, the transition from student to resident wasn’t something that occasioned a lot of reflection. But this pandemic is different, and we need to make space for it.

We’ve entered a new phase of the pandemic. And you’re still surfing the changes. What makes that possible? Plus: fill out a feedback survey and get a chance for a phone call focused on your resilience!

Many of us have been inundated with patients, and I’ve heard more than one clinician confess to feeling guilty because they can’t remember them all distinctly. Perhaps there is another way for us to process all this. Today, a poem by Billy Collins—enjoy.

Whether we’re in a place where the ICUs are full, or a place where the pandemic hasn’t really hit, the uncertainty can be exhausting. So what do we turn to when our usual sources—the news, our friends, our livelihoods—only seem to raise questions?

If you’ve ever felt that you ‘can’t unsee’ something, this one is for you. How do we recover when we feel pushed off-center? The research tells us that the answer is not in suppressing our thoughts—it’s something quite different.

We end up carrying so many things during the day. So when it’s time to power down, is there a way to put everything away for the evening? It’s a mental habit you can build.

With the news of furloughs for some staff, it seems that we’re entering a new phase. The stresses are changing. Which makes it even more critical for us to be working from a robust psychological stability. Today, then, is about coherence, and how to find it.

Some days, especially when the work is intense, it is hard to separate from the day. You walk out of the hospital with unfinished business still swirling around in your head. Could we find the mental fluidity to shift into a different mode for evening? Could we feel that fluidity in the body?

The first sign of civilization was, to Margaret Mead, visible in a healed human thigh bone. She was pointing us towards an important part of the purpose we enact in caring—something that we are rediscovering along with clinicians around the globe.

Even with the resources out there, some days it feels like the pandemic is presenting us with just too much. We’re in some kind of huge phase shift. But even though the new normal is still unclear, we can find our way back to a grounded place.

The moment when we realize that we can’t turn away happens so quickly we often don’t think about it. But when we have those shifts it is worth understanding what enables us to stay present. What is it that we can cultivate within? Today—reflecting on what we need to stay in this work.

There’s a lot of attention give to the experience of seeing someone else’s pain. But what follows—the moment that makes all the difference—is when we move from being confronted with pain to acting. Today, we deconstruct how that can happen.

A paramedic was talking today about the emotional toll of his work. What he witnessed left him with a deep sadness, and one that is compounded with new experiences. But if we take the long view, an evolutionary view, sadness is adaptive. It’s a way our brains and bodies cope with stress. And that contact with stress is something we can shape.

We know that a new normal is coming, but what it will be like is still blurry. These in-between times are what Raymond Williams called moments when a new structure of feeling is emerging—we can’t articulate it fully yet, but we can sense a bit of the new normal from reading between the lines. How we do this isn’t about thinking harder—it’s about getting in touch with what is just beyond our conscious awareness.

It’s so easy to feel overextended in the midst of this pandemic, and to feel that everything you’re feeling are signs of weakness. But it is possible to return to a place of strength—it’s within you.

We all have cases that stick with us—ones that occupy more of our bandwidth than they deserve. What do we do with them? Today, we’re dealing with emotional fallout, and moral residue. Because it turns out there is a way.

Today, we’re shaking up the language of powering down. We spend so much time in a particular relation to language—at work it’s the language of technicality and expertise. Yet another way language can work is in a completely different mode—to capture the allusive, metaphorical, ineffable aspects of life that don’t submit easily to metrics and outcomes. The powering down today is about shifting your attention—and brain activity—using language from the poet Jorie Graham.

When you are starting to feel tired, it’s easy to let the emotional intensity of the hospital become your everyday fuel. Yet if that becomes the norm, when you walk out to go home, what you might first notice is absence: no overhead pages, no backchannel murmurs, no monitors, no whoosh of PPE in the hallway. But there is another way. Could leaving be a signal to your body and brain that a new phase of the day is starting?

After an intense day, it’s common to leave feeling depleted and contracted. But at that point, putting more and more effort to make yourself ‘relax’, can exacerbate that sense of contraction and easily turns into more problem solving. Instead, consider that powering down has a physical correlate: expansion. Research suggests that a different way to change the patterns of our brain activity from the task-oriented, me-focused work of the day to renewal is to contrast contraction to expansion. Which you can do in about 11 minutes.

As the number of health care workers who have become infected grows, we pause for a tribute. Can we recognize their contributions in a way that strengthens all of us?

The media, while sympathetic to health care workers, has also been generating ominous predictions—the coming psychological trauma, for example. But while psychological sequelae are real, there is also another interesting phenomenon: post-traumatic growth. About half of the people who live through a traumatic event actually come through it feeling stronger and wiser. Could we prime ourselves for wisdom?

We keep hearing that we’re at war: the surge is coming, crisis standards, peak engagement. Certainly those war metaphors grabbed everyone’s attention. But now, as we settle into something that is actually much different, it is worth stepping back to examine these metaphors, because they carry a lot of baggage. There’s a down side to being perpetually at war. And you don’t have to live like that.

Yesterday, NPR ran a story about front-line clinicians that described how a nurse would spend his hour commute home ‘haunted’ by all the stuff that he hadn’t been able to do. It’s totally understandable—we just shouldn’t valorize it as a coping strategy. Rehashing the day, in the form of rumination, can (unintentionally) create habitual patterns that make it more likely you’ll be wound up all evening and into the night. But there is a way to disrupt the rehash—and it’s about learning to reallocate your attention.

Right now, the media is full of stories about loss, we’re confronted with it at work, and then even when we get home we face the loss of small everyday pleasures. This is often called ‘grief work’, a term I’ve never really embraced. Not because dealing with losses isn’t work—it is indeed—but because the focus of work should not be about rehearsing the loss—the work should be about reconstituting what that person, or routine, or ritual brought forth in you. What can you call forth, as you power down for the evening?

“By the end of my shift,” this doctor writes, “every patient begins to blend into a single patient…..I can’t even keep track of them anymore.” What do you when you can’t deliver the care that you’ve dedicated your life to giving? The impulse to self-judge is pretty strong in many of us. That does not mean, however, that it constructive coping. There is an alternative, and your sustainability depends on it.

What do you do with moral outrage? It turns out that the way we approach and hold our moral outrage can drain us, or motivate us. The pitfall, that drains us, is getting stuck in our heads. When what the research shows now is that moral outrage has a lot in common with other experiences of disgust — and disgust starts in the body. Today’s practice takes you from anger, to outrage — and then to action. So it doesn’t gnaw away at the time you need for renewal.

My tendency after getting home from a long day is to plunge into the news—even though it just adds to the fear & uncertainty I’ve been dealing with all day. We all have a limit to this, and when we reach it, we hit a wall. But fear & depletion are not forgone conclusions. Today, we work on replenishing courage—and it doesn’t mean you have to pretend your fear doesn’t exist.

Somehow I picked up from my mentors that to acknowledge gratitude was prideful, or maybe dangerous. I was wrong, and new research backs that up. To push those thanks aside is to miss one of most meaningful satisfactions of a life in service to the well-being of our fellow humans. Today, take a moment to feel the gratitude. You’ve earned it.

We are witnessing, and treating, and healing in ways that we didn’t even know we could do. The value of that—especially in the health care system of this moment—is incalculable. But we’ve all been working harder than ever. Chronic stress, over time, changes your brain. So what could you do to sustain and renew yourself tonight? Today you practice giving yourself permission.

How do we clinicians—even as we negotiate the dangers we face ourselves—do justice to those who work alongside us who are returning home to many fewer resources? It is a troubling issue, that one cannot easily put to rest at the end of a busy day. Yet—it is possible to power down for the evening without just ignoring the issue. The practice is called ‘giving and receiving’, and by doing it you can begin to find a path for yourself.

Reporters seem quite interested in the moments when a clinician’s sense of invulnerability is ‘shattered’. The New York Times Daily podcast made much of this today. But I see the whole issue quite differently. You don’t have to protect your so-called ‘invulnerability’—it’s not a shield. And vulnerability is not a black-and-white, yes-or-no matter. The truth of it runs much deeper. You can get a taste of what i mean in today’s podcast. You might even feel stronger, shield aside.

A friend said yesterday, “It’s like the rug has been pulled out from under us.” Reality check: it’s never been clearer that we are not in control. Turning on your empathy feels kind of risky because it so rapidly leads to helplessness. We can end the day feeling depleted and discouraged. And our brains go into cognitive overdrive. Today, three ways to reaffirm and remind yourself of what your heart still knows, so that you can end your day in a way that jump-starts your renewal.

When the day was just too much, what's the best way to power down? It turns out that trying to process everything might not be the best...

When you can’t look someone in the eye—directly—your encounter isn’t quite the same. I’m not questioning the value of video or PPE right now. But it’s like being covered in bubble wrap when we’re trying to connect. We miss out on what neuroscientists call the ‘retinal eye lock’—what babies experience with their mothers as their very first relational experience—and consequently our brains miss out on a gratifying neurochemical shower of connection, comfort, and safety. Recognizing that, however, we can spend a few minutes on our way home reconnecting with ourselves as a prelude to catching up on what we missed at work. A respite from the bubble wrap.

We’re all getting super-efficient—with PPE, surge planning, pharmacy shortages—as a survival strategy. It’s a way of getting the work done while limiting our droplet exposure. But if we don’t shift out of our efficiency mode of being once we leave work, it’s all too easy to buzz through the good stuff at home. And then the renewal that comes with that good stuff doesn’t happen. Today, we discover what slowing down makes possible: savoring. It turns out that our ability to self-regulate the meaningful experiences in our lives is something we can cultivate. Savoring is a way of taking back control that is linked to well-being. While you walk home, hit pause on the automatic-future-projection machine that is your brain. In just a few minutes, you can retrain it to savor.

By the end of the day, the feeling that you are surrounded by contagious vectors can leave your flight and flight systems stuck in overdrive. But there is an antidote: a practice that has persisted across millenia to be validated by science—the latest systematic review includes 20 studies involving over 1300 participants. See if you can use it to power down so that by the time you walk through your front door, you’ll be able to find a measure of the safety that all of us right now crave. In under 10 minutes.

You've been running flat out all day. How do you power down? Today, we try out a visualization that addresses the feeling of being weighed down by all the serious stuff you saw today.

To my fellow clinicians everywhere: we’re in a marathon, not a sprint. So what you do to sustain yourself is more important than ever. This podcast is meant to give you a few moments of space to focus on how you detach from work at the end of your day, give yourself something that replenishes the fuel you need for your own mind and heart, and prepares you for deep rest. Listen on your way home from work—it’s designed to take advantage of the minutes when you’re walking or commuting home. So that by the time you walk through the doorway to your own home, you’ll have shaken off at least some of the residue of the day, and you’ll be ready to power down.