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.”

Writing, again

Stories are good when the characters face their fears

“I wanted it to be an easy story. But nobody really remembers easy stories. Characters have to face their greatest fears with courage. That’s what makes a story good.” [1]

What I was doing over the past 5 years

My last post was in 2016. Since then I finished my residency in internal medicine. In 2021, will be finishing my fellowship in hematology/oncology. I also got engaged. I had two boys. I moved 4 times in one year. To say I was busy was an understatement.

Over time, I forgot about writing.

And as time went on, I became more and more afraid of writing again. I wanted to write, but never made the time to. Time went on. I developed an uneasiness with writing. I couldn’t place my finger on what was causing it. 

After much contemplation, I realized it was my fear of failure.

Failure sucks, but it’s highly recommended.

“Many people dream of success. To me, success can be achieved only through repeated [[failure]] and introspection,” Honda said. “In fact, success represents 1 percent of your work, which results only from the 99 percent that is called failure.” [2]

People fail all the time. In fact, that’s how all progress is made. Science is just a result of countless failed experiments to prove a theory. What was I afraid about? 

I was afraid of people judging and criticizing this blog.

Make stuff for yourself

“Writing a story isn’t about making your peaceful fantasies come true. The whole point of the story is the character arc. You didn’t think joy could change a person, did you? Joy is what you feel when the conflict is over. But it’s conflict that changes a person.” [3]

Conflict turned out to be important. Conflict is what drives innovation. When there is a problem people find solutions. I was afraid that my writing would suck. But that’s just part of failing. To get to your best work you need to work through projects. Some might be great and most will fail.  So what was my next step? Getting started. Through writing and sharing my thoughts I can grow.

‘Dweck shows convincingly that the most reliable predictor for long-term success is having a “growth mindset.” To actively seek and welcome feedback, be it positive or negative, is one of the most important factors for success (and happiness) in the long run.’

‘Embracing a growth mindset means to get pleasure out of changing for the better (which is mostly inwardly rewarding) instead of getting pleasure in being praised (which is outwardly rewarding).’ [4]

I needed feedback. The best way to get feedback to ask someone to review your work. More reviews, the better. And what’s the best way of getting more reviewers? Sharing online.

My next question was what do I write about? What’s the hottest topic now? What’s trending? Should I write for others? Is that true to me?

In Steal Like an Artist, Austin Kleon beautifully captures this message

“The manifesto is this: Draw the art you want to see, start the business you want to run, play the music you want to hear, write the books you want to read, build the products you want to use—do the work you want to see done” [5]

I needed to make stuff for myself.

“Your life must be a progression towards ownership—first mentally of your independence, and then physically of your work, owning what you produce.” [6]

Why Write?

“IF THE POINT of life is the same as the point of a story, the point of life is character transformation.” [1]

After all that, why should I be writing anyways? Life has been great. I’m practicing medicine, raising a wonderful family, dating/romancing my beautiful fiancé. What else could I want?

Writing is knowledge

“Writing is not what follows research, learning or studying, it is the medium of all this work” [6] 

By writing we are able to communicate with the world and ourselves our thoughts and ideas. Sharing our ideas is important. Ideas need a space to mingle. Through writing we can give ideas a place to come together and that’s how creativity happens.

“the best-researched and most successful learning method is elaboration. Elaboration is nothing more than connecting information to other information in a meaningful way.” [4]

Writing ideas make ideas come to life 

“Writing those ideas down protects you against that idea getting lost. Once it’s on paper or your computer file, it’s there forever. Staring you back in the face whenever you look at it. Whether or not you act on it is still up to you, but at least you won’t forget it. Once you have it down on paper, you’re setting yourself up to make something valuable happen” [6].

Writing translates thoughts onto paper

Thoughts lead to feelings which lead to actions. Through writing again, I can write my thoughts down. The thoughts are frozen, and therefore are malleable. Changing my thoughts will give me more control of my feelings and my actions.

The only things you control are your mind, body, and time

Writing helps me to control my thoughts. Thoughts are like waves on the ocean. Writing is like surfing those waves. Writing lets us catch our thoughts, watch our thoughts, and swim in our thoughts.

“One way to envision how mindfulness works is to think of your mind as the surface of a lake or of the ocean. There are always waves on the water. Sometimes they are big, sometimes they are small, and sometimes they are almost imperceptible. The water’s waves are churned up by winds, which come and go and vary in direction and intensity, just as do the winds of stress and change in our lives, which stir up waves in our minds” [7].

‘The spirit of mindfulness practice was nicely captured in a poster of a seventy-ish yogi, Swami Satchitananda, in full white beard and flowing robes atop a surfboard riding the waves off a Hawaiian beach. The caption read: “You can’t stop the waves, but you can learn to surf”’ [7].

Write to reflect and forget

I write to reflect. On Rich Doc Poor Doc with Dr. Bonnie Koo [8], Dr. Koo discovered through journaling on how to be a watcher of her own thoughts. I write down new ideas as they occur to me throughout the day. At the end of the day, or even in the future, I review my ideas. This helps me iron out the good ones. I throw out the bad ones (or edit them).

I write to forget. In Greenlights, Matthew McConaughey wrote “I never wrote things down to remember; I always wrote things down so I could forget” [9]. I do the same. For one, I can write down any events I perceive negatively at the time. I forget about the event. I forget about my perception of the event. I am able to review the event later. Any negativity I still I have, I release the energy into words

Writing clears my short term memory cache. George A. Miller famously claimed that our short term memories can hold at most 7 items of memory, plus or minus 2 [10]. By writing down my thoughts, I can safely store the short term memories there, and make room for other short term memories and thus more memories. By creating more memories, life will be more memorable. A memorable life is a good life.

“A good movie has memorable scenes, and so does a good life” [1].

References:

  1. A Million Miles in a Thousand Years by Donald Miller
  2. Hustle Harder, Hustle Smarter by Curtis “50 Cent” Jackson
  3. A Million Miles in a Thousand Years by Donald Miller
  4. How to Take Smart Notes by Sönke Ahrens
  5. Steal Like an Artist by Austin Kleon
  6. The 50th Law by 50 Cent & Robert Greene
  7. Wherever You Go, There You Are by Jon Kabat-Zinn
  8. Rich Doc Poor Doc Podcast #17: Business Building with Dr. Bonnie Koo
  9. Greenlights by Matthew McConaughey
  10. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Miller, George A., 1994

Thanks for making it through! What will you write about? Share in the comments below!

A Swollen Arm, Radical Mastectomy, And Becoming A Doctor: How To Overcome Failure

Holly, a 68-year-old woman, came in with a red, hot, and swollen left arm. On presentation, her left arm was at least twice the size of her right arm. She’s a thin lady, so the contrast was remarkable. She told me that the arm blew up 2 days ago. Her left arm felt extremely hot. She chronically gets arm swelling because she had a mastectomy of her left breast about 5 years ago. This type of swelling is a common side effect of the surgery. Lymphatic ducts in the arm cannot drain the fluid correctly, thus congesting and blowing up the arm like a water balloon. Ever since the surgery, Holly tells me that her arm keeps on swelling up, but never this big. Normally she goes through her physical therapy very religiously; she never misses a session. She’s frustrated that her arm is infected, but she states she’s not going to let this stop her.

Screen Shot 2016-07-10 at 11.02.31 AM

Continue reading

Beach Ball Abdomens, The Ars Moriendi, And Why I Want To Be An Oncologist

Pam was a 62-year-old female with pancreatic cancer who first came in due to abdominal pain and distension. She said she was diagnosed with pancreatic cancer this past January and was going through chemotherapy. She was admitted to the hospital because her abdomen was the size of a beach ball. Several family members were with her at bedside. Although Pam looked weak, she was laughing and making jokes with her family. In fact, she jokingly remarked “Doctor, I look like I’m pregnant!”  I asked her if her husband knows. She asked me, “Know about what?” I pointed to her stomach and said, “the baby.” She broke a smile and the other family members in the room sheepishly chuckled. I told her we were going to run some tests and figure out what’s going on.

GOPR0732.JPG

Coconuts in Bien Hoa, Vietnam. Imagine a really big one of these in your belly. That’s probably how Pam felt. 5/12/16.

Continue reading

A Flood and Fiesta For The Common Good: How Family Might Save U.S. Healthcare And You

Over the past three weeks I have been traveling throughout Asia including Vietnam and Philippines. I don’t speak any of the languages, but it didn’t take much to see the culture of community and family.

On one particular day in Biên Hòa, a suburban area one hour away from Saigon, a storm flooded the street. As I stood at the doorstep of the place I was staying at, I watched cars and motorcycles trudging across the high water. I looked at the stores around my area and saw people helping each other put their belongings away, move their scooters inside, and even push cars through the torrent. There was hardly any hesitation in any of their actions – a firsthand example of working for the common good.

BienHoaFlood
Flood one hour away from Saigon, Vietnam. 5/12/16

Continue reading

Paralyzed Breathing and 2 Simple Steps To Be Happy Now

img_0280

Kari’s feet on a kayak in Halong Bay, Vietnam. Photo taken 5/16/16.

Several months ago, Gary came to my hospital complaining of weakness. Gary was 72 years old, so weakness was a pretty common complaint in his age population. While lying in bed, Gary told me that this morning he could not move his feet. Since then, the weakness has gotten progressively worse and traveled up both his legs. At presentation, Gary said that he could not even lift either of his arms or legs. I lifted up one of his legs, and let it go. The leg dropped like a dead weight. In addition, Gary said he recently got over a cold. Gary also told me he had a similar illness over ten years ago. He said at the time he was hospitalized for 3 weeks with over 10 days connected to a breathing machine. Essentially, what he had ten years ago was the same as what he had at presentation.

Gary had Guillain-Barré Syndrome.

Continue reading

How To Think Big: Taught By A Small Chinese Lady

Seize the Day.jpg

A couple of months ago, this short 70-year-old Chinese lady with a 6cm lump on the corner of her left jaw sat across from me and the attending. Sue was here for follow-up after completing her radiation treatment. Sue has a rare cancer of her salivary glands. The cancer invaded her jaw, so we couldn’t simply take out the cancer. Therefore, we had to treat her with radiation to decrease the size of the tumor so she can go to surgery.

Continue reading

Ventricular Tachycardia, Bomber Planes, And Checklists: How To Decrease Cognitive Load To Be More Productive

On my last day on the ICU rotation block, one of the patients went into an irregular heart rhythm called ventricular tachycardia. He was a 60-something year old guy with multiple medical problems and connected to a breathing machine. All of a sudden, he became unresponsive and hypotensive and had a heart rate of 150+ beats per minute. As we all rushed into the room, we systematically ran through the ACLS algorithm. We initially evaluated him, checked for pulses, started CPR, established the  airway, monitored blood pressure, identified the rhythm, and gave a dose of treatment. We repeated the process until the patient was stable. It was efficient, it was effective, and most importantly it was routine. It was a checklist that was used around the world and saved many lives.

IMG_0596

Continue reading

Goals Of Care, Family Meetings, And The 80/20 Rule

Surprisingly, in my past month in the intensive care unit (ICU), I spent more than half the time talking to family members about goals of care. In a previous post, my attending had a great quote about survival in the ICU. If one-third of your patients survive the ICU stay, you’re doing hall of fame work. So if only one-third of patients are surviving on a good day, then why am I spending most of my time speaking to families about goals of care? Shouldn’t I be spending more time treating the patients?

0001-227361283.png

 

“20% of our efforts leads to 80% of our results.”

 

Continue reading

Too Much Xanax, Depression, And What To Do About It

The other week, I had an 18-year-old guy who came in unresponsive after overdosing on Xanax and Tylenol. We stabilized the patient, and when he woke up, I asked him why he did it. He told me that he was just doing some dumb stuff with friends. However, when I asked the father later, he told me his son has been more depressed lately and attempted suicide just last month by cutting his wrists. They didn’t seek help at the time for a variety of personal reasons, and it’s fortunate that the patient’s suicide attempt failed the second time. Fortunately, I haven’t seen a lot cases like this at my hospital, but still, he was so young. The patient had so much to live for.

sunset2
Sunset in 2012 from my medical school campus, St. George’s University.

Continue reading