The White Walls and Beeping Machines of the ICU Couldn’t Mask the Heartache

As an oncologist, I am no stranger to difficult situations, but the case of Mr. Smith was particularly heart-wrenching. Mr. Smith had been diagnosed with metastatic lung cancer and was being treated in the intensive care unit of the hospital. The sterile white walls and beeping machines were a stark contrast to the normally tough and stoic Mr. Smith I knew from our clinic visits. He was the kind of guy who seemed to take everything in stride, just like a character out of a Clint Eastwood movie.

But as I walked into his room that day, I was met with a scene I had never witnessed before. Mr. Smith was in tears, telling me about how he had missed his daughter’s award ceremony at school and how the thought of dying had finally hit him. His usually cheerful disposition was replaced with a deep sadness, and my heart went out to him.

“I can’t believe I missed it,” he said, shaking his head. “I always thought I’d be there for my girls, no matter what.”

I took a moment to sit down with Mr. Smith and listen to his concerns. I encouraged him to talk about his feelings and gave him the space to express his emotions. “It’s okay to feel sad, Mr. Smith,” I said. “It’s a tough situation, and it’s natural to feel like this.”

“I just can’t stop thinking about all the things I’m going to miss,” he said, tears welling up in his eyes. “I don’t want to leave my girls behind.”

“I understand,” I said. “It’s important to make decisions that are best for you and your family. And remember, you’re not alone. We’re here to support you every step of the way.”

As the conversation came to a close, I could see a visible change in Mr. Smith’s demeanor. The weight of his worries seemed to lift from his shoulders, and he sat up a little straighter in his hospital bed. The sadness in his eyes was still present, but there was a glimmer of hope and resolve there as well. He seemed more at peace, as if he had found some clarity in his difficult situation.

I left the room feeling grateful for the opportunity to be there for my patient and to make a difference in his life. The hospital can be a cold and intimidating place, but in that moment, I felt a sense of connection and purpose. I knew that I had done my best to support Mr. Smith through a difficult time, and that was all I could ask for. As I walked down the sterile hallway, I took a deep breath and reminded myself that this was why I became a doctor.


Feeling Tired All the Time? It Could Be Anemia. Here’s What You Need to Know.

As a hematologist, I often see patients who are struggling with anemia. In my experience, many people are not aware of the causes and symptoms of this condition, and they may not know how to properly manage it. That’s why I find it important to educate my patients about anemia and how to cope with it.

Anemia is a condition in which a person has a lower than normal number of red blood cells measured in hemoglobin, a protein that carries oxygen in the blood. This can lead to a lack of oxygen in the body’s tissues, causing symptoms such as fatigue, pale skin, shortness of breath, and a rapid heartbeat.

One of the most common causes of anemia is a deficiency in iron, a mineral that is essential for the production of hemoglobin. When a person doesn’t get enough iron from their diet or their body is unable to absorb iron properly, they may develop iron-deficiency anemia. This type of anemia can be treated by increasing iron intake through diet or supplements, or by receiving iron injections.

Another type of anemia, called megaloblastic anemia, is caused by a deficiency in vitamin B12 or folic acid. These vitamins are important for the production of red blood cells, and a deficiency can lead to the production of larger, abnormal cells that do not function properly. Megaloblastic anemia can be treated with vitamin B12 or folic acid supplements, or by receiving these vitamins through injections.

In some cases, anemia may be caused by chronic diseases such as kidney disease, cancer, or HIV/AIDS. These conditions can interfere with the body’s ability to produce red blood cells, leading to anemia. Treatment for anemia caused by chronic diseases may involve treating the underlying condition, as well as medications to stimulate the production of red blood cells.

It’s important for people with anemia to manage their condition properly to avoid complications. This may involve making dietary changes to increase iron and vitamin intake, taking supplements as prescribed, and regularly monitoring blood cell counts. It’s also important to avoid medications that can interfere with the production of red blood cells, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin.

Living with anemia can be challenging, but with proper management and treatment, people with this condition can lead full and active lives. If you think you may have anemia or if you have been diagnosed with this condition, it’s important to talk to your doctor and follow their recommendations for treatment. By working together, we can help you manage your anemia and improve your quality of life.

From Injured and Bedridden to Stronger Than Ever: My Journey with Bodyweight Training

“The only way to change your life is to change your mindset. If you want to be successful, you can’t let your mind hold you back. You have to be willing to push through the pain and the fear and the doubts and the excuses. You have to embrace the suck and keep going. You have to take control of your thoughts and your actions and refuse to be a victim. You have to be a fighter, not a quitter.”

David Goggins

As a former gym rat, I never thought I would find myself bedridden and unable to exercise. But that’s exactly what happened after I ruptured my Achilles tendon. For weeks, I was unable to do any form of physical activity and I quickly began to lose my strength and fitness.

At first, I struggled with the victim mentality. I asked myself “why me?” and blamed everything else for my situation, including my injury, my work, and even my family. I felt helpless and frustrated, and I didn’t know how to move forward. Instead of trying to find solutions, I just sat around feeling sorry for myself and doing nothing.

To make matters worse, I started drinking alcohol to cope with my frustration and boredom. I spent hours watching TV and mindlessly scrolling through social media. As a result, I gained weight and became increasingly grumpy and irritable. I was unhappy and unfulfilled, and I didn’t know how to change my situation.

But instead of succumbing to this mindset and continuing on this downward spiral, I decided to take control of my situation. I knew that I needed to make a change.

One of the challenges I faced was that my ruptured Achilles tendon made it impossible for me to leave the house to go to the gym. But instead of letting this obstacle hold me back, I decided to explore other options for staying active at home. That’s when I discovered bodyweight training.

I began my calisthenics and bodyweight training routine with just 10 push-ups each day, and gradually increased the number of reps as I grew stronger. Over time, I was able to build up to a daily routine of at least 100 push-ups and 60 pull-ups.

But it wasn’t always easy to stick to this routine. I had to overcome numerous challenges and obstacles along the way. For one, I have a family and a full-time job, so finding the time to workout can be difficult. But I made it a priority, and I never missed a day, even on weekends. I would work out at 6am every morning, before the rest of the household woke up. If my kids woke up early, I would incorporate them into my workout, playing with them and getting them involved in my exercises. If I needed to take calls for work, I would do it while working out, multitasking to make the most of my time.

By prioritizing my health and fitness, I was able to reap numerous benefits. Not only did I regain my physical strength, but I also improved my mental clarity, focus, and discipline.

First and foremost, having a regular exercise routine helped me to overcome the victim mentality and take control of my life. By focusing on what I could do, rather than what I couldn’t, I was able to shift my mindset from one of helplessness to one of determination and resilience. This shift in mindset had a positive impact on other areas of my life, and I found myself becoming more disciplined and focused in general.

Another benefit of regular exercise was the positive impact it had on my overall health. By getting my heart rate up and increasing blood flow, I was able to reduce my risk of heart disease and other chronic illnesses. I also found that I had more energy throughout the day and was able to sleep better at night.

But perhaps the biggest benefit of regular exercise was the way it made me feel. I am more confident and self-assured, and I have a newfound appreciation for my body and its abilities. I feel strong, powerful, and capable of tackling any challenge that comes my way.

In short, regular exercise has been a game-changer for me. If you are struggling with the victim mentality, I highly recommend giving bodyweight training a try. By just starting and taking small steps, you can overcome this mindset and begin to take control of your life. The benefits will spill over into other areas of your life, and you will be amazed by the positive impact it can have on your overall happiness and health.

From Oncologist in Training to Oncologist in Practice: How Focusing on What I Can Control Helped Me Find a Career

“You have power over your mind – not outside events. Realize this, and you will find strength.”

-Marcus Aurelius

Towards the end of my fellowship in hematology and medical oncology, I was anxious about not being able to find a job. I had applied to two places, but had not been offered a position at either of them. The burden of medical school debt, combined with the responsibility of providing for my family, including two small toddlers, weighed heavily on my mind. I found myself worrying constantly about the unknown and what the future might hold.

At first, I tried to control the situation by applying to every job I could find and even considering relocating to another state. But as the weeks went by and I still didn’t have any offers, I began to feel increasingly helpless and frustrated. I was consumed by thoughts of failure and the fear that I would never be able to provide for my family.

Eventually, I realized that I was letting my fear and anxiety control me. I decided to let go of the things I couldn’t control, such as the outcome of my job search, and focus on the things I could control, like my mindset and my determination to keep going. I started to see the job search as a challenge to be overcome, rather than a source of stress and anxiety.

I began to focus on my mindset, reminding myself that I was a skilled and knowledgeable oncologist with a lot to offer. I also started applying to more places and networking with other professionals in my field. As I continued to take action and stay determined, I gradually began to feel more in control of my situation.

One day, I received an offer for a job at a private practice group. It wasn’t my dream job, but it turned out to be the best career decision I ever made. I accepted the offer and began my new job with a sense of accomplishment and gratitude.

Looking back, I realized that I had let go of the things I couldn’t control and focused on the things I could. By accepting my situation and taking action, I was able to overcome my anxiety and find a job that provided for my family and allowed me to continue pursuing my passion for oncology.

Here are the crucial points to remember and apply in order to achieve your goals and live your best life:

  1. Take control of your life by identifying the things you can and can’t control, and focusing your energy and efforts on the things you can control.
  2. Make self-care a priority in your life, and take time to focus on your own well-being. This can help to support your personal growth and development.
  3. Practice gratitude on a daily basis, and focus on the good in your life. This can help to shift your perspective and keep you moving forward with positivity and purpose.

Consistency is Key: The Last Shot In Wins the Point

In high school, I was a competitive tennis player, and I was determined to be the best. I would spend hours on the court every day, hitting balls and practicing my shots. But despite my hard work, I often struggled with injuries and burnout. I would go through periods of time where I was unable to play at all because of these issues.

One day, my coach suggested that I try a different approach. Instead of always trying to hit the ball as hard as I could, he suggested that I focus on consistency. “Mike,” he said, “it’s more important to consistently hit the ball in the right spot on a regular basis than it is to always try to hit winners. The last person to get the ball in wins the point.”

At first, I was skeptical. I didn’t think that this approach would be as effective as my previous training methods. But over time, I started to see the benefits. I was able to maintain my skills without getting injured or burned out. And I even won more matches. I realized that consistency was the key to my success, and that always trying to hit winners was actually holding me back.

So in the end, I learned that consistency is better than perfection. I was able to achieve my goals and improve my performance by focusing on consistency and playing smart, rather than always trying to hit the ball as hard as I could. It wasn’t always easy, and there were times when I still wanted to go for the big shots. But I learned that staying consistent was the key to success, and it helped me become a better player.

I learned that being consistent allowed me to consistently outperform my opponents and achieve my goals. I learned that being consistent allowed me to build my skills and confidence, and that it was the key to achieving success on and off the court.

The Surprising Secret to Making Meditation More Enjoyable: Smiling!

Meditation can be a powerful tool for reducing stress and improving mental and emotional well-being, but it can be difficult to stick with the practice. When I first started meditating, I would sit with a serious and focused expression on my face, trying to force myself to concentrate and clear my mind. But despite my best efforts, I often found myself getting frustrated and overwhelmed by my racing thoughts. I was about to give up on meditation altogether, when I stumbled upon the idea of smiling during the practice.

It was a simple but transformative realization. By smiling, I was able to relax my body and mind, and to approach meditation with a more positive and playful attitude. And as a result, I found myself looking forward to my daily meditation sessions, and feeling more relaxed and content throughout the day. In this article, I will share the benefits of smiling while meditating, and why it can make all the difference in your practice.

Research has shown that smiling can have positive effects on mental health. For example, a study published in the journal Psychological Science found that smiling can help to reduce stress and improve mood. The study found that when participants were asked to hold a pen in their teeth (which activates the muscles used for smiling), they experienced a reduction in heart rate and blood pressure, and reported feeling happier and more relaxed.

Another study published in the journal Social Cognitive and Affective Neuroscience found that smiling can help to activate the brain’s reward system and reduce feelings of anxiety and fear. The study found that when participants were shown images of people smiling, their brains showed increased activity in the amygdala (the part of the brain involved in emotional processing) and the ventral striatum (the part of the brain involved in reward and pleasure).

Additionally, research has shown that smiling can have positive effects on social interactions and relationships. A study published in the journal Emotion found that people who smiled more during a conversation were perceived as more likable, and that smiling can help to create a sense of connection and trust with others.

While there is no specific research on the benefits of smiling during meditation, it is likely that smiling can enhance the benefits of the practice in several ways. For example, smiling can help to reduce tension and stress, which can make it easier to enter a relaxed and focused state of mind during meditation. Smiling can also improve your mood and overall sense of well-being, which can make the practice more enjoyable and satisfying. Additionally, smiling can help to cultivate a sense of compassion and connection, which can be beneficial during group meditation.

In my own personal practice, I have found that smiling during meditation brings a sense of lightness and joy to the practice. It can help to shift your mindset from one of effort and struggle to one of ease and enjoyment. And as a result, I find that I am able to meditate more consistently and with greater benefit.

If you’re new to meditation or are having difficulty sticking with the practice, I encourage you to try smiling during your sessions. You may be surprised by how much it can improve your experience, and how it can make meditation a more enjoyable and beneficial part of your daily routine.

The Map of Reality is Not Reality: Guidelines and Melanoma

How often do you use GPS to get somewhere? I use it all the time. Whether it be going to the hospital, dropping off my son at daycare, and even going back home, I have GPS on. Using GPS is useful. If there is traffic on the route, GPS will reroute me to a better route. If I am lost, I can easily get home with a few touches on my phone.

Relying on a map can lead to a variety of problems. The map can be wrong, missing information, or can be interpreted incorrectly. Maps should be treated as a guide, not the rule.

Map is not the territory

In 1931, mathematician Alfred Korzybski popularized the idea that the map is not the territory. Basically, the description of something is not something itself. Abstraction is not reality.

Alfred Korzybski poses three downfalls to using maps.

  1. Maps can be incorrect without our realization.
  2. Maps are a reduction of reality by necessity, and this reduction can lose viable information.
  3. Maps require interpretation, which in turn can generate errors through misinterpretation.

A map is a representation of a territory. We use maps all the time. Whether it be physical maps or Google maps, maps are useful in getting from point A to point B. However, maps are not perfect representations of reality. Maps should be served as a guide, but if something in reality does not appear on the map, we should trust reality. With this mental model in mind, I successfully treated and continue to treat one of my longest living patients with active cancer.

Beyond the guidelines: Treating melanoma in a Jehovah’s Witness

An elderly male with past medical history of advanced melanoma presented as a follow-up in my clinic. He is a known patient of mine who was initially found to have melanoma of his right axilla (armpit) several years ago. At the time he had no sites of metastatic disease. The standard treatment for him would have been surgery followed by immunotherapy. However, his melanoma was almost 10cm in size which would have been a big surgery. Further, he was a Jehovah’s Witness. Jehovah’s Witnesses believe that Christians should not receive blood transfusions, even from themselves.

Since the surgery would have been extensive requiring blood transfusions, I presented the case to our multidisciplinary tumor board. We reviewed the guidelines and decided to treat with radiation first followed by immunotherapy. With radiation, he would not require blood transfusions. Immunotherapy was successfully given to patients with melanoma after surgery, but there is a paucity of data on radiation only. There are no guidelines to support this approach, however based on clinical experience and reasoning, this approach was the best option.

At the follow-up, he is doing well. He has been on immunotherapy ever since his radiation treatment with no sites of recurrence. In fact, the melanoma has been stable and decreasing in size. His quality of life returned back to baseline and is enjoying life.

Guidelines are like maps. Every patient is different so there is no one size fits all type of treatments. Religion is not a factor mentioned in the guidelines for treating melanoma, however it is a huge factor for patients in real life. If the guidelines contained nuances for every religion and personal belief out there, the guidelines would be too large for any clinical benefit.

Better decision making requires a firm grasp on reality

By remembering that the map is not the territory, we can make better decisions. Maps don’t strictly apply to geographic areas but to guidelines for life as well. By staying footed in reality, we will make better decisions. If reality and the map contain a discordance, follow reality. Remember who created the map as their perspective may not necessarily coincide with ours. And there is plenty in reality not seen in the map.

If I strictly followed guidelines for my patient, I would have likely recommended no treatment. He would have passed a long time ago. Instead, by following reality, he is alive today.

I read 60+ books in a year, you can too!

Warren Buffet, the greatest investor of modern times, was once asked how to read more. He held up a stack of papers and said, “Read 500 pages like this every week. That’s how knowledge builds up, like compound interest.”

Everyone knows that we should read more. The question is how?

In 2020, I read over 60 books. I did this while working as a medical doctor during the ongoing COVID-19 pandemic and raising two little boys. So when people tell me they don’t have time read, I interpret it as they don’t choose to read. Super productive people like Elon Musk have only 24 hours a day, and so do you. Need some help? Here are some tips that helped me read more.

Develop a love for reading

In order to read more, you need to actually like reading. So to develop a love for reading or for anything else, just do it. Start with the small stuff. It can be even the “junk” that people tell you to avoid reading. Angel investor Naval Ravikant says “There’s no such thing as junk. Just read it all. Eventually, you’ll guide yourself to the things that you should and want to be reading.” For me, when I don’t feel like reading heavy nonfiction, I turn to fantasy. Currently, I’m working through Brandon Sanderson’s epic fantasy series Stormlight Archive. Call me a nerd, but like the Immortal Words that the Knights Radiant lived by, I live by too: “Life before death. Strength before weakness. Journey before destination.”

Quit more books

In elementary school, we were taught to finish what we read. There were deadlines to finish books. In the real world, no one is keeping tab. As long as you get one new idea from a book you’re reading, I think that’s enough. Even if the idea is that the book isn’t any good, then it should be even more reason to put the book down and move to something else. James Joyce, author of Ulysses, put it best, ““Life is too short to read a bad book.”

Read several books at the same time

To read more, you need to read more books. Don’t be afraid of reading multiple books at once. Read one book at a time, but feel free to switch to different books when you get bored. Bill Gates, Microsoft founder and avid reader, carries with him a bag of several books he’s currently reading at any given time. Reading more books at the same time brings multiple benefits: you’ll finish more books and never get bored.

Allocate time for reading

Time is the most valuable and precious resource we own. In order to read more, you need to allocate more time to it. Don’t have time? Make a routine. One method is to schedule time for reading. Try scheduling at least one hour of your time to read. Write it down in your calendar. If one hour is too long, try at least 15 minutes.

“When you don’t have much time, a routine helps you make the little time you have count. When you have all the time in the world, a routine helps you make sure you don’t waste it.”

Austin Kleon, author of Steal like an Artist

Make reading a habit

James Clear, author for Atomic Habits, describes creating a habit into four steps:

“How to Create a Good Habit

The 1st law (Cue): Make it obvious.

The 2nd law (Craving): Make it attractive.

The 3rd law (Response): Make it easy.

The 4th law (Reward): Make it satisfying.”

To make reading obvious, reduce the friction to reading books. I know having a tidy place is the priority for some people. It is for me. I was brought up and taught to always put things back to where they belong. My fiancé on the other hand leaves things out everywhere. At first it drove me nuts, but then I realized by leaving my books out everywhere, I was more likely to pick it up and read it if I saw it. So some mess is ok, as long as it’s conscious mess. Besides, life is supposed to be a little messy, so I’ve learned to live with the mess.

To make reading attractive, Clear recommends temptation bundling. Take a daily habit and pair a habit (reading) you want to do with it. For example, when I wake up I reach for my phone to turn off the alarm. With my phone on, I open the Kindle app and just start reading whatever I was reading last night for a few minutes.

To make reading easier, Clear describes the “2 minute rule.” Start with a smaller, mini task that takes less than two minutes to complete. This can be picking up the book and opening it and reading at least one page. Even if it’s one page, that will be better than none. If it’s a book you like, it will be more than one page.

For your reward, you can keep a book list and cross things out as you read them. For me, I kept a numbered list of books I finished on my Notes app on my iPhone. Seeing the numbers increase gave me enough dopamine rush to keep going.

Bonus: Speed reading

There’s a lot of debate on whether speed reading works. Personally, I think some techniques make more sense than others. Here are two techniques that I use and seem to work for me.


How many times have you reached the end of the paragraph and wondered what you just read? Hopefully, it’s not this post! That is called regression, and one method to prevent that from happening is called tracing.

Tracing is simply taking a pointer like your finger or pen to run across the text. The point of tracing is not to go as fast as you can. Tracing prevents regression. For me, tracing keeps me focused on the page at hand instead of drifting to the next page or elsewhere. For paper books, I use a pen and glide the pen over the words as I go along. For the kindle, I hover my finger above the text. Tim Ferris, author of Four Hour Workweek, does a great job of explaining this method here.

Minimize subvocalization

Remember when you were little and had to read in front of the class out loud? I do and still hate it. Unfortunately that’s how we all learned how to read. Subvocalization is your inner voice speaking the words you read in your head. Many studies have shown that eliminating subvocalization won’t increase your reading speed, but minimizing it may.

The average reading speed is about 150-250 words per minute (wpm). And the average talking speed is exactly the same. Minimizing subvocalization can increase your reading speed to 450-700 wpm!

So how do we minimize subvocalization? Try being a visual reader. When we read, we extract ideas from the words written down. Sounds abstract, but a concrete example would be to think of a “STOP” sign. When you are driving and see the “STOP” sign, do you you say the word “stop” in your head? If you’re like most people, you understand the combination of those letters means stop. So, you stop your car (hopefully) when you see the “STOP” sign. This is similar to being a visual reader. When you look at the words, try to take in the meaning of what’s written instead of saying it to yourself in your head. This skill will take practice, but I guarantee it will be a useful tool for you and your reading endeavors.

Now read more

To read more you need to develop a love for reading, quit books quicker, read several books at once, schedule time for reading, and make reading a habit. Speed reading is up for debate, but tracing and minimizing subvocalization will help you read faster and more efficiently. Remember, reading is for fun and learning. So, now go have fun and learn something!

Have any other tips on reading? Let me know what you think!

Fastest Way to Get Out of a Funk: Negative Visualization

What’s the worst thing that can happen?

Some days are harder than others. For me, it would be rainy days. The rain made me feel trapped inside the house. I didn’t like feeling wet so I’d avoid going outside. Being stuck inside made me think of all the things I was missing in life: the super successful job, the huge house, the Tesla. It became a vicious cycle of victim mentality and self-criticism. Being so negative reminded me of something I read on Stoicism and the practice of negative visualization.

What is negative visualization?

Negative visualization is a practice where you think about what your life would be like without your loved ones or possessions. Sounds simple at first, but the exercise is quite profound.

By practicing negative visualization, we enjoy every moment as if it were our last. The Stoics recommended that we imagine losing our most valuable people and possessions. We must imagine our loved ones dying, our house burning down, or losing our job. By doing this, we learn to appreciate our loved ones, house, and job more than we normally would.

The final step that many Stoics believed would be imaging our own death. By contemplating our own death, we discover what really matters.

Don’t believe me? Amazon CEO Jeff Bezos had a similar practice called “regret minimization framework.” Bezos imagined himself at 80 and whether or not he regretted trying this decision. Also, former Apple founder Steve Jobs once said, “Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.”

Practicing negative visualization is essentially thinking with the end in mind. By thinking of the end, we are able steer our lives towards the end result we want.

How to do negative visualization?

Practicing negative visualization is really quite easy. The main method is to ask what if. “What if my loved ones died suddenly? What if my car was stolen? What if I lost my job?”

Negative visualization does not have to be just the big things. We can find value in the small things as well. Tired of your iPhone because it’s not the newest one out there. Try imagining what if you didn’t have a phone at all. Now you can value your current phone and all the wonders that it can do like call, text, surf the web, and watch anime.

3 lessons I learned from practicing negative visualization

If every time is the last time, then make every time the best time.

Practice every goodbye as the last goodbye. When I say goodbye to Kari (my fiancé) before work, I imagine that might be the last time I see her. By thinking that in my head, I am refocused on the moment. Thinking that this may be the last goodbye, I hold on to her a little bit longer and stare into her eyes with more precision. What normally would be a pat on the back and peck, becomes an intense embrace and kiss.

When I am alone with my sons, instead of waiting for time to pass by, I imagine that this might be the last time I played with them. All of a sudden, dancing with them becomes more fun than annoying. Letting them ride me like a horse doesn’t cause as much back pain. I get to enjoy their presence instead of being annoyed by it.

Keep in mind, the Stoics focused more on actions rather than words. I do not tell Kari or my sons that I’m thinking of their death, I only think and act with it in my mind. Otherwise, I don’t think they would take me thinking of their death the right way.

By contemplating that everything is only temporary, we are forced to realize that this might be the last time. So if it is the last time, might as well make it the best time.

To be happy is to desire what we already have.

By imagining the loss of everything we own, everything we own becomes much more valuable in our eyes. The other day, I dreaded waking up early to walk our rescue dog, Coral. It was freezing and the sun was not out yet. I just wanted to spend a few more minutes in bed. While in bed, I imagined what if Coral died later today and this might be the last time I walk her. Like with Kari and my sons, walking Coral became a blessing rather than a chore.

I thought the same thing to when I was stuck in California traffic the other day. All around me I saw Teslas, BMW’s, Lambo’s zoom past me as I was driving my mom’s Toyota Camry. I sure longed for the nicer car, but then I reminded myself, what if I couldn’t drive anymore? What if I had to take the public transportation to get where I was going? Not to hate on public transportation, but it’s essentially nonexistent where I live. Driving became fun and I was glad I could.

Negative visualization is not resignation.

Although we are pretending that we might be living our last day, this isn’t meant to change what we do. The point, the Stoics believed, was to change how we thought about what we do. Instead of giving up on everything or making dumb decisions a la “YOLO” (You Only Live Once), we should still continue our daily lives and remember to appreciate today. So don’t go spend your life savings because you might die tomorrow. Instead, continue to save for your goals and appreciate that you are able to do such things because you might die tomorrow.


Life can feel hard. Life can feel mundane. Life can feel unfulfilling. By practicing negative visualization, we can learn to appreciate the now and make the best of today. So practice saying your goodbyes as if it were your last goodbye, make every time the best time, and feel blessed with what you have. For me, what if it was that last time it rained? Wouldn’t I miss it? I sure would, so I put on my rain coat and took the boys outside.

Want to learn more about negative visualization? Check out this awesome book, A Guide to the Good Life, by William B. Irvine.

What if this was the last time you read this blog? What would you comment?

Mind Games

Over this past year, I had a lot of time for introspection. My third year of fellowship was split into 70% research time and 30% clinic time. The pandemic compounded the social distancing by turning all of my research meetings into virtual Zoom meetings. Basically, I spent nearly all my time at home. Since I was left to myself a lot, I did a lot of thinking.

Life is a single player game. People’s greatest problem in the modern era is that they cannot sit in a room by themselves for 30 minutes. I learned that the hard way.

Sitting by myself is hard because I always had the need to do something or be somewhere. Several years of medical training always kept me busy with exams and papers and the like. With what seemed like more time on my hands, I found time to sit and think. I soon realized that my mind literally acted like a monkey. The monkey was running around throwing poop everywhere and making a mess.

People can speak up to 4000 words to themselves every minute. These are the words of the monkey mind. Sometimes the words are positive (I can do this), sometimes are negative (Ugh, I can’t do this), or just nonsense (Baby Shark doo doo doo doo doo). The quality of the words matter. I needed better quality. I stepped up and talked to myself.

The most important conversations are the ones you have with yourself.

Win the game with two steps.

Pay attention.

In order to change is to be aware of a need to change. By not being aware of your mind, you can easily succumb to the powerful emotions and be enslaved by them. If you can observe your thoughts without forcing change, you often times can find both pain and happiness at the same time.

Pay attention to things that you can control. The things you control are internal, like your thoughts. Things you cannot control are external like health, wealth, and pleasure. Epictetus, a Stoic philosopher, describes this as your sphere of control. “Externals are not in my power; will is in my power.” Your will is your thoughts, and your thoughts you can control. Being aware of your thoughts is the key to freedom from the monkey mind.

Talk to yourself as a friend would.

Good friends are compassionate friends. Since the most important conversations are the ones you have with yourself, might as well make yourself your best friend. Self-compassion works. Research has shown that self-compassion increases happiness, positive outlook, and motivation and decreases anxiety, depression, and negative introspection.

Showing compassion is listening. How do you like it when you are venting to a friend and all they do is interrupt you with what you should do and how to fix the problem? I sure hate that. Especially, when I need to vent. So you must do the same with yourself. Pay attention and listen to what’s going on. Give yourself space with no judgement. Allow the situation to boil over.

Everything needs nourishment to survive. You need to eat, right? So, does negative thinking. Let the negativity run its course. As long as you don’t feed the thoughts, they will die of starvation. Just like after letting friends dump their suffering, just let yourself dump your suffering. You can speak to yourself nicely and gently. Motivational lies won’t work here. What works is validation. Validate yourself. Tell yourself “Yeah that sucks!” or “Wow, I see where you’re coming from.” You just need to know that someone is listening. That someone is you.

Life is a mind game

“Every day is like a blank page: When you’re finished filling it, you can save it, you can crumple it up, or you can slide it into the recycling bin and let it be. Only time will tell you what it was worth.”

Austin Kleon, Keep Going

Life is a mind game. The only player that matters is yourself. To win, you need to do two steps. First, pay attention. Pay attention to your thoughts, feelings, and actions. Second, practice self-compassion. Be honest with yourself. Talk as your best friend would. Best friends are there for listening.

Negative thoughts will always happen. You can’t or shouldn’t avoid that. Instead, you must accept that they do happen and realize you have the tools to help yourself when they do happen.

I needed to hear that.

What does your monkey mind say about that? Mine is still singing “Baby Shark doo doo doo doo doo.”