Taking One for the Team

Simone Biles knew that something was wrong. She had pulled herself out of the team gymnastics competition at the Tokyo 2020 Olympic Games after she developed a case of the twisties. This condition severely impairs a gymnast’s ability to know their position in the air and relative to the ground, something that could lead to serious injury if not addressed. She also decided not to compete in some of the individual events in the days afterward, citing mental health issues. Rather that find herself lost in the air, unable to add to her team’s scoring and possibly injuring herself, she decided to withdraw. “I knew they could do the job.” She wanted her teammates to medal, and she saw herself as a stumbling block. In an interview, she said, “We aren’t just athletes or entertainment. We are humans too. We have emotions that we don’t tell you about. I felt embarrassed at first. You have to put your mental health first. It doesn’t matter if you are on the biggest stage.”

There was mixed response to this turn of events from around the world. Some mental health advocates were very supportive of Ms. Biles. Some of her peers, such as Michael Phelps and Naomi Osaka, called her to offer their support, in that they had also struggled with mental health issues that affected their performance at times. They applauded her decision to put self care first and to keep herself safe. Others, not very sympathetic to her struggles at all, said that she should have “taken one for the team” and pushed on to compete in all the Olympic gymnastic events.

“Taking one for the team” means willingly undertaking an unpleasant task or making a personal sacrifice for the collective benefit of one’s friends or colleagues. It derives from baseball in the 1970s, when a player was asked to take a pitch on the body to get to first base for the benefit of the team.

The path that Simone Biles chose was self care.

In an October 22, 2020 Harvard Business Review article titled “Serious Leaders Need Self Care Too”, Palena Neale PhD addressed this very issue. She asked questions such as “Why are so many leaders so resistant to taking a bit of time for themselves?” She found that “it usually boils down to misperception around what good leadership is, what self care is, and how self care actually works.” One thing that is often lost is that “self care is an investment that can increase overall productivity and effectiveness as a leader.” Ms. Biles had faced similar circumstances before in her career, and I am quite sure that she expected her competitive days to go forward as well, so getting past a temporary block in her overall journey just made sense for her at that time.

Diet, exercise and sleep are three components of a healthy life that we already know about. Then why is it so hard for most of us to eat right, exercise daily and sleep enough hours? One of the answers that Dr. Neale found was “I don’t have time for that!” The feeling of constant stress to manage a busy life, perform, always be on, and to juggle too many tasks is “sadly all too common.” “Taking breaks can prevent decision fatigue, renew motivation, increase creativity and improve learning.” Could Simone Biles have accomplished all of her key priorities, including tying Shannon Miller with seven Olympic medals after coming back to win bronze on the balance beam this year, without paying attention to her health and sense of wellbeing?

Another response found by Dr. Neale was that “leaders need to be strong. If I’m a good leader, I shouldn’t need self care.” This is simply incorrect. Leaders are often taught to not show any vulnerability. They feel that they should have all the answers. I think that many medical students and newly minted doctors feel that they know everything that is to be known when they finish their training. It is only later, when one has practiced in the real world for a time, that one realizes that learning never ends, and that the correct answers are constantly changing. Leaders sometimes feel that if they do not meet these criteria that no one will follow them at all.

How do we follow the example of Simone Biles and make self care a priority in our lives? According to Dr. Neale, we should integrate self care into our daily routine. Make it your own. Make time in your agenda for self care. Experiment with different things to keep it fresh. Share with others when you have found something that works for you that you think might benefit others. After all, Simone talked with Michael, Naomi and even Oprah! Your team will see these activities and actions and resolve and will follow you. Everyone wins.

What lessons can we take from the experience of Simone Biles in the 2020 Tokyo Olympics?

First, if you see that taking one for the team will lead to injury to you or disaster for the team, then stop and reevaluate. Biles stated in an interview that “it didn’t go like I wanted it to go, but it will open doors for bigger connections”. Pause for self care when you need it. Almost everything can wait. Model your decision making and share with others what worked for you. Encourage others to follow your lead.

Come back stronger and achieve even more because instead of taking one for the team, you decided to take some much needed time for yourself.

Cast Off

It happened too many years ago to remember now, but I still do. It was a time when we who labored in mental health could be more real, could actually connect with our patients in meaningful ways and even let our hair down from time to time and have some fun. A group of staff members were playing a group of patients in a friendly softball game in Aiken, a few miles from the mental health center. I was old enough to know better but still young enough to think that the teen athlete still lived in me, and you know how that always turns out.

 

I was taking my turn at bat, connected with the ball and drilled what should have been a solid single to right field. I should have been more than satisfied with that, but of course I wasn’t. I rounded first, saw that the outfielder was fumbling with the transfer from glove to throwing hand, and made a split second decision to stretch a sure single into a maybe double. Getting to second was easy. I was still moderately fast in those days. The next decision I made was not a good one, however. Without a clear need to do so, I decided to slide into second in a blaze of dusty glory. Bad move.

 

I knew that I had really screwed up when my left leg made contact with the base, which felt at that moment like a concrete block. The snap was audible, the pain immediate and the shame followed close behind. When I tried to get up, I saw an acute angle between leg and foot that was not at all natural. Not good. A short ride and check in at the emergency room later, I was not at all comforted by the well meaning nurse who told me that “only really active people get injuries like these”. You know the drill. Ortho tech, clean it up, put it in a cast to the knee, get fitted for crutches, see ya in a few weeks.

 

The hardest part about being in a cast for those long weeks, besides not being able to take a real shower without wrapping my leg in plastic bags? I couldn’t walk with crutches and carry a coffee cup at the same time. This, my friends, is the definition of crisis. But, of course, like many weekend warriors, I made it through.

 

Fast forward to the doc’s office on the day that the cast was coming off. I had lost about half the muscle mass in my leg, and I was more than a little worried about taking away the plaster exoskeleton that had held me up for those weeks. Would I fall down? Rebreak the leg? Be able to do the things that I could before the injury? Getting the cast off felt so good in one way, with cool air on skin and mobility that I had missed terribly. But the worry about reinjury or weakness or worse still gave me fits for a few days, until I knew things would be okay again.

 

Now, forward to March 13, 2021. The CDC decides that after more than a year, those who are fully vaccinated against COVID-19 can shed their masks indoors and out, around people who are also fully vaccinated and those who are not. This seems to come so suddenly that it catches us off guard.  After being so careful for so long to avoid exposure, protect ourselves against infection and illness, we are now told that all is clear and safe! To me, it almost instantly brought back memories of taking my cast off, something that I was more than happy to shed, but with the anxiety of what my health would be like after it was gone.

 

Protections, even if restrictive and painful in the short term, often make us feel safer in the long run. Removal of these restrictions is exhilarating but can be frightening at the same time.

 

When I was recovering from my broken leg, just as we are now seeing the beginning of the end of the COVID-19 pandemic in the United States, letting protections fall away was the only sure way to test ourselves and our safety going forward.

 

The second half of that lesson is also clear: testing ourselves is the only way to grow.

Lend Me Your Ears

Okay, so I made it clear in my last post that I do not like really big, long term change. That’s just me. That being said, I have been in a maelstrom of rapid, relentless, major, workflow altering change, much as many of you have, over the last two weeks now. Sort of like that frog in the pot of water that is unaware that the temperature is rising until he starts to boil, we have been the recipients of a slowly gathering storm, pushing a tidal wave of change on us from way out at sea, knowing that it is coming but not having a clue exactly when it will hit, how much damage it will do, or whether we will survive it.

On top of that, we are now seeing reports of people actually dying from this COVID-19 infection and disease, not just getting sickened or inconvenienced by it. A young lady. A middle aged media executive, a child, an infant, a renowned neurosurgeon, a country music artist. In other words, people like us or people that we love and care about. Ouch. Much too close to home. Anxiety, More stress. Worry. Paranoia. Enforced isolation which leads to functional isolation which leads to real isolation even at home. Not good for the psyche. Not good at all.

I can handle this, I tell my bad self. I will not get sick. This could never happen to me. I’m too young to die. I’m in my prime. My brain, smart as it is in the area of fact assessment and reality testing, is also super duper good at deception. The person it is the best at deceiving is me. I do not feel sick, therefore I cannot get sick. I am able to handle this stress, and even more stress, without feeling it physically. I will not notice a thing, not one little thing that will give me a clue that maybe my physical or emotional systems are overloaded. Right.

A couple of weeks ago, my left ear started to feel a bit stuffy. Annoying, but not terribly debilitating. I chalked it up to the myriad allergens in the air in the southern United States at this time of the year. I had felt this before, sometimes saw it turn into a mild cold, and had developed a way to cruise through it. Daytime and nighttime cold medicine at the very start of this syndrome, plus nasal spray to keep me breathing enough to work and be productive, all for about a week or so, had always worked before. Dutifully, at that first little feeling of stuffiness and discomfort, I embarked on my standard regimen. I thought little more about it.

A week later, things were worse. The ear was more stopped up, I could not hear well on the left side, and there was an uncomfortable feeling of having one side of my head in a barrel. I knew best, I told me, and I continued to doggedly prosecute my tried and true regimen. More liquicaps, more spray, more time. Nothing doing, my ear said, we will not budge. The left side of my head, down onto my neck, around to my cheekbone, got numb. When I would talk to colleagues, albeit from six feet away, I felt that I was shouting. Conversations at the island in the morning with my wife were unsatisfyingly one sided unless I turned my head towards her and practiced a mixture of something like torticollis and lip reading. “This is one bad allergy season!” I pontificated. All the while, this was really starting to drive me nuts, with the changes at work, schedules upended, my wife getting back on planes to fly germs, I mean passengers, around the country.

Then I remembered an episode a few years ago when a similar thing happened, but a time that I felt that I lost ALL the hearing in the same ear. Total hearing loss. Nothing. Scary. I ended up going to an urgent care center that time, and as you may have guessed by now, I had a monster, hard, obstructive impaction of cerumen, that’s ear wax to you and me, in that ear canal, completely and utterly obliterating any path for air or sound to travel one way or the other down my ear canal. A little soaking and a splashing shower of irritation, I mean irrigation into a small metal pan, and I could hear! I had never felt that happy in my entire life.

Fast forward to this week. No hearing, numbness in my face, unsteady on my feet, oh my God do have a tumor somewhere kind of angst running amok among the COVID-19 particles , I finally remembered that episode. I go to Walgreens, buy some ear wax nuking stuff (No, they still don’t have hand sanitizer), and get to work. I won’t bore you with the tedious details, but after three nights of this intervention, one evening in the midst of a showering royal flush, out came an ugly piece of wax that had bugged me for days. I could hear! I was no longer numb! It was a miracle!

Funny thing, though, the right ear, the one that had felt pretty normal through all this, felt a little stuffy itself once the left one was crystal, drive a gondola down the ear canal clear. Oh, no, migratory aural tumor, I thought to myself, and had to smile. Really? Really? More wax nuking drops, two more days, then blessed relief. I am virtually normal now, if I ever was.

So, I quipped to my wife at breakfast the next morning, sitting at the island, and NOT turning my head as I could already hear her replies, I wonder if increased stress and anxiety can cause one to create more ear wax? Ever at the ready to end wanton ignorance in our little world, she snatched up her iPhone and searched for an answer.

I’ll be damned.

Turns out, increased stress and fear can cause the body to produce more cerumen.

WHAT?

PRODUCE MORE CERUMEN!

SEASON WITH CUMIN? WHAT?

NO! EAR WAX. EAR WAX!

Oh……

We are all overloaded right now. We are frogs in a pot. The temperature is rising, and we are in jeopardy of boiling if we are not careful. We think that we have seen it all, done it all, figured it all out because we are smart, successful, resourceful people. We have all the answers. We are large and in charge.

Wrong.

This is bigger than us. Tiny viral particles, too small for us to see, have brought our world to its knees. Our economies are reeling. Our social institutions are paralyzed. Some of us are sickened. Some of us are dying. Our bodies know this, the ancient parts of our bodies and those cells and systems that really HAVE seen it all and survived, they know this, even if our younger, smarter, more resourceful brains cannot accept it.

Listen to your body. It will tell you when you are maxing out your biological credit line. It will tell you when to slow down, when to meditate, when to eat, when to rest. If you do not heed it, it will find a way to get your attention.

Thanks for lending me an ear while I waxed eloquent.

Yes, I really went there. Be well.

F5s

F5
Incredible tornado.
261-318 mph.
Strong frame houses lifted off foundations and carried considerable distances to disintegrate; automobile sized missiles fly through the air in excess of 100 meters; trees debarked; steel reinforced concrete structures badly damaged.

tornadoproject.com

 

We had a strong storm front come through the southeastern United States last week. Of course, this was not the first time this happened, and it will certainly not be the last. It was fascinating to watch it march inexorably across the country, showing up on my weather app as a ragged green diagonal slash from Gulf to heartland to northeast, moving slowly and relentlessly across the landscape. In the center of the ragged slash was a well defined hard bright yellow-orange-red line of destruction. Pretty on the screen, destructive on the ground. Destroyer of worlds.

Texts began to trickle in from my daughter, who lives in Spartanburg, of an apparent tornado that touched down not five miles from her house and destroyed a shopping center. A coworker who sees patients at the mental health center by telehealth connection also reported frightening noises that drove her to her basement to hunker down until all warnings were lifted later in the day. Both reported the loud, surreal wail of tornado warning sirens, something that I have never heard in real life, but that I am sure must be quite distressing in the midst of gray skies, howling winds,  pouring rain and lightning flashes. Not an F-5, but terrifying nonetheless.

When I hear about such stressful situations and see evidence of the destruction they bring,  I think of my friends, family, acquaintances and patients have who struggled with cancer, financial stress, persecution for various reasons, and other stresses that lead to anxiety, fear and emotional upheaval. My aunt who succumbed to ovarian cancer when I was a boy. My mother, who is a breast cancer survivor. My friend, who tragically committed suicide. My patients, who tell me stories of unbelievable trauma, neglect, abuse and hopelessness. Like an F-5 monster tornado, these life circumstances can drop on any of us unexpectedly from the sky. Pretty colored X-rays and scans reveal the destructive power of the cancer underneath. Sirens go off. The mind screams take cover, take cover! The body sometimes is only grazed, shrapnel cutting but not killing. Other times, the impact is devastating. Nothing looks as it did before the storm. The landscape is flattened and only rubble is left. We return to a place, time or set of circumstances that we expect to be familiar, only to realize that all of our old landmarks are gone, destroyed. We do not know whether to drop to our knees and cry, run headlong into the pile of rubble, or turn and walk away.

Is there anything good about F-5s, cancer, abuse, trauma, and destruction?  What an odd question, I hear you asking me.

These scourges, while leaving city blocks, body parts, and psyches in absolute ruin, are often coldly surgical in their devastation. That is, a few hundred yards away, or a few inches outside the margins, or in some other part of the emotional us, the sun is shining, the tissue is healthy, the coping is reasonably good and life goes on. Friends rush to help. Prayers go up. Communities, wonderful , supportive, dynamic communities form. Support is not only offered but insisted upon. Rebuilding begins immediately in the aftermath of the siren’s wail, the surgeon’s knife, and the abuser’s fist.

When the horror and the shock and the denial and the anger and the tears and all of it subsides, victims become empowered survivors.

Strong!

The chorus goes up.

We will rebuild.

Life will go on.

We’re still here.

A Routine Should Be Just That

So, I was on vacation last month.

A seven thousand mile trip in my little red car, zooming from Chicago to Fargo to Billings to Seattle to Salt Lake.

I had a blast. Maybe you’ve read about it.

It was funny to me how many of my friends and readers and acquaintances, how many of you, worried about me. Not about my safety or my driving or my being run down by one of those triple rig FedEx trucks in North Dakota (I must admit, I did have a few moments of fear and trepidation around those monsters). You worried that I was not slowing down enough. That I was not sleeping in. That I was (gasp!) going to the gym and (oh, my GOD!) exercising every day. On vacation! Away from home, where the air is sweet and the food has no calories and dessert comes automatically with every meal.

When I would post that I was walking or biking at the Hampton Inn in Portland, someone would tell me to take it easy, relax, skip a day, take a nap.

Funny, that, because if you know me well, as many of you do, you know that I do NOT do well with down time. I do NOT relax if I am lying on a bed or in a chair trying to make my eyelids close for a late afternoon nap before dinner. I do NOT feel good if I skip the morning workout and sleep an extra hour, then eat two plates of free breakfast that includes pancakes, sausage, and plenty of syrup.

Oh, I’ve tried. I have. I have tried to lie down in the evening and watch television. I have tried to not set an alarm on vacation and just sleep until the sun smacks me on the eyelids and says, “Get up, rise and shine, buddy!” Every once in a while I’m successful.

But you know what, dear readers of mine? As we get older, we get set in our ways, for better or worse. Now, we can argue until the cows come home what is better for you, healthier for you, what makes you happier, calmer, lowers your blood pressure, etc. I’m not writing this to do that.

I’m writing to tell you that I firmly believe that we all have set-points, mid-points that we naturally settle into. Places and states (not literal states, no, though Washington state was killer…) where we feel our best, have the most energy, eat the healthiest for our own metabolism and where we are the most creative, productive and happy. I believe this. I think you should give it some thought.

No matter how hard I try, I keep coming back to what my body is trying to tell me is a good place, a happy place, a contented place where it wants to do what I tell it to do with minimal muss and fuss. Now, for many of you this will sound absolutely crazy, and thats okay.

It’s my set-point, not yours. Get your own!

I do best if I get up at five AM. At that time of the day, which I love, I can make coffee, eat some breakfast, read the paper, process my email, and acknowledge comments here on the blog and elsewhere. I do not need to worry about the day, because I’ve already thought it through. I can take my time, not feel rushed, get ready, and get out the door by seven or so most days depending on where I need to be.

I do not exercise in the morning, with one exception. In the winter months when basketball season is upon us, like now, I like to go watch the Aiken Pacers, who play a mile or two down the road from me in the evenings. This cuts into gym time, so I must work an hour walk into my morning routine. No problem. It just needs to get done, people. Make it happen!

I count on working until the day is done. Some clinic days, that means five PM and finished. Days that I tack a telepsych shift on after clinic, the day is done at midnight or one AM. I feel much more content if I do NOT worry about the crazy hours I work. For now, I choose to work these hours. That will change one day, no doubt. For now, I work until the work is done.

Exercise usually comes in the evening, an hour and a half or so at the gym. If I don’t have time to exercise today because I’m working sixteen hours, that’s okay. If I’m not working the whole day and I have time to exercise, there is no excuse to deprive my fifty-seven year old body of what it needs to stay active and healthy-movement. This is not a chore after you get used to it. You miss it if you miss it.

I try to eat “real” food, when my lifestyle is much more conducive to eating junk or whatever I can grab on the way from one place to another. My body has repeatedly told me, very clearly, that it does NOT like and does NOT feel good if it is topped off with sweets or excess carbs or junk food. The insulin rush and crash after candy bars and Pop Tarts is not for this boy. That said, I LOVE sweets and had rather eat that kind of stuff more than almost anything on earth. I just know that if I want to feel strong and healthy and alert and awake, I’d better not overdo it. It’s just not worth the blahs and the bloats and the mental dulling that comes with that short-lived binge of sweetness.

I use a Jawbone Up24 (Yes, I have pre-ordered the Jawbone Up3, to be shipped December 1st and it looks awesome) to help me track activity and sleep primarily. I have learned about my own non-patterns (again, I work crazy hours, have an insane schedule and most people think I am slightly off for doing so). The software for this device has told me in no uncertain terms a couple of times that it cannot figure me out! There are not enough patterns for it to process and give me meaningful feedback about. Wow.

That being said, sleep is not normal for me, but I’ve learned that this is okay too. I can try to get seven to nine hours of sleep per night as suggested by those who know, but I will just be constantly frustrated because I NEVER sleep more than six and half hours on a normal night. I have found, again, that I feel much better if I get up at the same time every day (which I CAN control most every day) and get to bed just as soon as I am finished work (which I usually CANNOT control at all most days) I do okay. I get enough sleep. I could be getting more, but in my life right now, that is not going to be the routine pattern for me. No worries. I run with it.

Some of you need eight or ten or twelve hours of sleep a night. That’s great and I’m glad you can do that. I can’t.

Any time that I have more than just a day or two off work, I plan to DO something. Go somewhere, see something new, hike, fish, travel, take pictures, visit, see a show, eat in a new restaurant. This is routine for me right now. (See down time above). I love football and basketball games. I like to see my family. I have dreams to make a few more big trips.

The take home?

Routine should be just that, whatever that means for you.

Figure out what keeps your body feeling physically good, energized and ready for action.

Eat healthy as much as you practically can.

Exercise.

Sleep as much or as little as you need to perform at your peak level.

Seek out stimulation that makes you learn and grow.

Be responsible for your own happiness.

In the end, you’re the only one that has that duty in the present.

Don’t let your future self down.

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