Tuesday, December 31, 2013

S.M.A.R.T. Resolutions

Like many people I usually make New Year's Resolutions. There are always plenty of things in my life I feel I could improve on and the start of a New Year feels like a clean slate, a chance to start over and do better. Sadly I'm also like most people in breaking my New Year's Resolutions fairly quickly. I might start off well for a week or two but it only takes one bought of illness or one stressful week at work to knock me off course again. Still, I'm an optimist. I'm also fully in agreement with the statement "If you always do what you always did you'll always get what you always got." So this year I'm trying to go about New Year's Resolutions in a different way.

I've been going through leadership training at work, both formally and through reading on my own. I never intended to be in a leadership role and never saw myself as a leader, but here I am now and I'd like to do a good job, so I'm trying to educate myself. One of the things I've learned is about setting objectives and goals for employees. The acronym for these goals is "SMART" which stands for Specific, Measurable, Achievable, Relevant and Timely (or time-limited). I'm still working out how exactly to apply these to the jobs we do at work, but it occurred to me that these principles make good sense for New Year's Resolution's too.

Specific goals are just what they sound like. Instead of vague wishes like "I'll lose weight" or "I'll exercise more" or "I'll be a writer" they give details. "I will walk 3 miles a day" is a specific goal. "I will take one writing class" is a specific goal. A specific goal spells out exactly what it is you are going to do.

Measurable is also an easy term to understand. You can measure how far you walk each day, how much time you spend on something, or whether or not you did something. So "floss daily" is a measurable goal. Measurable also implies that you will, in fact, measure and keep track of what you are doing in order to review your progress and stay motivated. There are plenty of ways to measure; you can use a notebook, your phone, or even a sticker chart like I make for our preschooler.

Achievable is an area where I often have problems in making resolutions. I've set quite a few ambitious goals like "walk 5 miles daily" which just doesn't make sense right now given my daily schedule and my current fitness level. Even "walk 2 miles daily" or "30 minutes of yoga daily" might not make sense because it doesn't allow any flexibility or leeway for life's vagaries and disruptions. I've also gone into the New Year with a list of resolutions that was 8 or 10 items long in the past, which is too many items to realistically accomplish while balancing work and family. I need to focus on what is most important to me right now, among the many, many wonderful things I could be doing to improve on a personal level. So achievable goals for me might be "walk 2 miles four times a week and do 30 minutes of yoga twice a week." An achievable writing goal might be "write 1000 words five times a week" as opposed to "write a novel this year."

Relevant in organizational terms means that the goal or objective should contribute to the organization's overall mission. In personal terms, I think meaningful might be a better term. Why is this goal important to me? What is my motivation? If I look at goals I have achieved in the past, for example learning to knit socks, I can see that this goal is personally meaningful because knitting gives me a deep sense of satisfaction, because sock knitting is a little tricky and makes me feel clever, and because the techniques in sock knitting transfer into toy knitting which is even more fun. My fitness goals above of walking and yoga would be personally meaningful because I would like to be stronger so I can carry my daughter for longer at a time (35 pounds of preschooler is no joke!) and have more stamina and energy at the end of each day. My writing goal is meaningful because writing helps me think, helps me problem solve, keeps my creativity alive, and also because someday when I retire from medicine I'd like to make writing my second career.

Time limited is a factor I've never considered before in New Year's Resolutions. It always seemed obvious to me that a resolution would have to be for the whole year. However, an entire year is a pretty long time to for me to promise to sustain a habit. I know that I got through difficult classes and difficult medical rotations and difficult assignments by reminding myself "only X more weeks." Even now, when I'm having a hard time at work I cheer myself up by remembering "only X more days until a weekend" or "only X more workdays until vacation." So perhaps I hold on to motivation best over a period of days to weeks. So instead of a New Year's Resolution, perhaps it makes more sense to make a New Month's resolution. A month is about 4.5 weeks, which is enough time to see if a habit is truly going to be achievable and meaningful for me. I will plan to re-evaluate my resolutions on 1 February and decide if they should continue, be modified, or be dropped all together in favor of new resolutions.

So, my month's resolutions for January 2014 will be to:
walk 2 miles 4 times a week
do yoga for 20 minutes 3 times a week
to write 1000 words five times a week

These are specific, measurable, achievable, personally relevant and time limited goals. I'll track my progress using an app on my phone and on 1 February I'll take a look at how I'm doing and decide what I want to do for the next month.

Friday, December 27, 2013

Christmas 2013

I celebrated Christmas this week with a fever and a cough and laryngitis. It had been the toughest week before Christmas I can remember, including the one when I was deployed. Work was very hard; long hours and a lot of pain and suffering that I just don't always have the skill to heal. Plus at home our furnace broke, my husband and daughter were both sick, and then my beloved cat who had been with me since college died. I think all that stress just knocked my immune system down. I became progressively more ill throughout the day on Christmas Eve and I'm wheezing and coughing still as I write.

I'm glad for Christmas though. I'm glad for time with my family and time to rest. I'm glad for my daughter's questions about why we have Christmas and who is Jesus and who is Santa and also for her joy in opening presents and playing with new toys. I'm glad for special cookies and my mom's holiday soup, which is what we call the creamy chicken potato soup that she always makes on Christmas Eve. Mostly though I'm glad for the promise of Christmas, the promise that light comes after dark, the promise of hope and renewal inherent in a story of Emmanuel, which means G-D with us, present in our lives.

One of the commonly sung and read prayers this time of year is the Magnificat (Luke Ch 1 Vs 46-55) spoken by Mary to her cousin Elizabeth.

“My soul magnifies the Lord,
and my spirit rejoices in God my Savior,
for he has looked with favor on the lowliness of his servant.
Surely, from now on all generations will call me blessed;
For the Mighty One has done great things for me,
And holy is his name.
His mercy is for those who fear him
From generation to generation.
He has shown strength with his arm;
He has scattered the proud in the thoughts of their hearts.
He has brought down the powerful from their thrones,
And lifted up the lowly;
He has filled the hungry with good things,
And sent the rich away empty.
He has helped his servant Israel,
In remembrance of his mercy,
According to the promise he made to our ancestors,
to Abraham and to his descendants forever.

Mary spoke these words in a time of fear and anxiety in her life; newly pregnant, unwed, uncertain what would happen to her in a time and culture that condemned unwed pregnant women to death. She spoke as a poor woman and a member of a conquered and occupied nation. Her words ring with hope for the oppressed, that justice will triumph and G-D’s arm will lift them up while casting down the oppressors. Her words don’t speak of armed rebellion or violence by humans. Instead they bathe in the promise of G-D’s action to save his people.

Cultures around this world celebrate this time of year, this turning time when darkness and cold are at their deepest in the Northern hemisphere. We light candles and fires, we feast on good things, we rejoice in the green that does not die. We celebrate in peaceful defiance of the night, the dark and the chill. We gather as communities to remind ourselves that light will come once more. Our specific stories change but our themes are the same; hope, love, peace, joy.

The Christmas story is about the power of light over dark. It’s the story of G-D, the creator, the all-powerful, entering this crazy beautiful broken mixed up world as the son of a unwed mother from the ghetto. G-D identifies with the oppressed, living and dying in a way that rejected violence, power, wealth and dominion. And in doing so he planted a new seed in our hearts, a new idea that love and peace and joy are powerful, that all people are valuable, that in G-D all are equal, men and women, parent and child, slave and free. That seed is slow growing and that plant has not come to full fruition yet. The Magnificat promises us that it will.

Thursday, December 19, 2013

The Pain of Suicide - A Professional's Perspective

I hate suicide. It is my number one professional enemy and I just hate it. I write this instead of the Christmas oriented post I've been turning over in my mind because yesterday we had a young woman die of apparent suicide. None of us had met her before. I don't know if she was sad, or depressed, or receiving help. All I know is that her family found her and brought her to our hospital but it was too late for us to save her and she died. Along with many other people, I was trying to help them yesterday because we didn't have a chance to help her. And then I was trying to help all the helpers, because this hurts us too. 

There really is not anything you can say to a family except "I am so sorry. I am here if you need to talk." So that's what I said. That's what we all said. They were so shocked, so horrified, so devastated that I don't know how to convey it. They were beyond tears and screaming, just blank and numb and you could see something inside them had been completely crushed. And I thought - how could you have done this? What happened that you didn't know how much your family loved you, wanted you? How could you not realized what a terrible thing you are doing to them? Why didn't you ask for help?

And I am so sad, so angry and yesterday all I could do was come home and cry and hug my own precious daughter and pray. Some of the other staff I talked to did the same thing. Just cry and go home and love your own family and pray. Pray for me, and my family, and for everyone I work with, and for her family, and for her. Pray for G-D's healing presence with us all in this terrible, terrible event.

I have worked with so many people who have survived a loved one's suicide. It is so hard, so confusing. Along with the dreadful loneliness and sadness, the sheer weight of missing this other person, is this poisonous blend of anger and guilt and shame. How could he abandon me? Why couldn't I save her? If only I had done this differently. Why did she do this? It's not their fault, and I tell them that. People make choices and sometimes they make really bad choices. You can't save them from their own choices. I tell them. I tell myself. It helps, but not enough.

I often hear people who are suicidal say "my family would be better off without me" and I tell them no. No, they wouldn't be. I have walked with too many families after someone has committed suicide and I know that they are not better off. And they don't "get over it," not really, not even with help. They learn to go on, but it's a permanent ache, an unfillable emptiness, a wound that scars but still hurts when it is touched. 

I don't know all the people who read this blog. I don't know what pain you may be holding or what terrible situation you may be facing. But I tell you that your life is precious. You, yourself, simply for who you are, are precious and unique and irreplaceable. It doesn't matter what you have or haven't done, you are worthy and valuable, just because you are. Even if you can't see it right now, your life matters. Please find the courage to reach out, to get help, to keep going. 

Some places to start are http://www.afsp.org which is the website for the American Foundation for Suicide Prevention and 1-800-27-TALK which is a national crisis hotline. You can also get help in an emergency room, by calling 911, or through any medical provider. If you are a friend or family member or even a casual acquaintance of someone who you are concerned about you can help just by asking. Asking "are you thinking of suicide?" doesn't make people suicidal, it frees them to talk about the problem and ask for help. If someone seems down, or their behavior has changed, or they are giving things away or talking about harming themselves or saying they would be better off dead then please take them seriously and ask the questions. Then help them reach out and get that emergency help, and stay with them until help arrives.

There is hope - pain can be treated, life can improve, new joy can be found. If you are so desperate that you want to die then it's time to be desperate enough to make huge changes. Find another way, please. Please, please don't kill yourself.

Friday, December 13, 2013

Christmas Giving

My interfaith family celebrates both Hanukah and Christmas. I love lighting Hanukah candles but most of all I love Christmas. I love cookies and egg nog and pie and extra treats. I love walking into work and seeing evergreens and ribbons and ornaments where there are usually blank walls. I love special peppermint drinks at the coffee stand and Christmas cards in the mail. I love getting out my Christmas ornaments, many of which I've had since I was a child and most of which have some small story attached to them. I love all the memories that come with Christmas. I wouldn't quite say that I love addressing Christmas cards but I do love thinking about my friends and family as each name comes up. I love the cookie decorating party that my husband and I host for our friends' children the way my mother hosted for my sister and I and our friends when we were small. I love opening presents on Christmas morning, with my family.  I just really, really love Christmas.

I particularly love thinking about Advent. I love lighting the candles in the wreath each week and meditating on the qualities of hope, peace, joy and love that the candles represent. I love putting stickers on my daughter's advent calendar and talking about the time going by.  I love the solemn joy of Christmas Eve, as we sing the beautiful old songs and light candles and remember that we are so loved. I love to remember that G-D loves us all so much that he came here to live with us, as one of us, so that he could show us that love in a way we could understand. My family was never that much into Santa Claus. Instead we talked about giving gifts as an act of love, the way G-D sent his son to us.

So when I say I don't love the holiday shopping season, please understand that I'm not a scrooge. I just think that it's out of control. The constant pressure to buy, buy, buy is annoying. The crowds in the mall are stressful and agitating and at times scary. Very little of the commercial message feels in tune with the spirit of celebrating love. One of my the Christmas decorations I love best at my mom's house is a kneeling Santa; Santa kneeling by the manger of Christ. The toys and commercialization of the holiday subordinate to the celebration of G-D with us. That's how I would like things to be for me and my family.

I'm also very aware that most of the people I know don't really need or even want anything. And even though I love opening presents, neither do I. I am incredibly blessed to have enough in my life. Most of my friends would say the same. We just don't really need more. And even though holiday giving isn't so much about what people need, when we all have so much already a giving things just isn't very meaningful.

So this year I am doing something a little different. I am still buying gifts for a few people, although I am choosing smaller and less expensive gifts. But for most of the people I usually exchange gifts with I am donating money to Heifer International in their honor. Heifer International (http://www.heifer.org) is an organization that provides live animals and training on animal husbandry to people around the world living in poverty. The families who receive animals pass on the gift by donating the first living offspring of their animals to another family in need. The animals range from honeybees to cows and for the bigger animals you can purchase a share to donate. The gift of an animal that provides milk or eggs can make the difference between enough food and not enough food. The families can also sell wool, baby animals after the first ones they donate, eggs, extra milk and by doing so acquire enough money that children can get health care and go to school. Families are helped to help themselves, which I think is wonderful.

I had a really good time choosing the Heifer International Gifts. I chose a training package on animal health for a friend who has a health care background. I chose a knitter's basket for my mother-in-law who taught me to knit. I chose rabbits for a friend who adores animals and baby chicks for some friends who just had a baby. For some friends and family I couldn't figure out an appropriate symbolic animal but it was still fun to think of a family somewhere owning a llama in honor of some newly married friends or a goat in honor of my father. I hope that my friends will get a kick out of this and maybe even consider doing the same for me.

I think this is a good way to honor the spirit of the holidays; the giving of gifts as an act of love. I think this is a good way to connect and create meaning; by thinking about people I love and in their honor trying to make the world a better place.

Monday, December 9, 2013

Stopping Child Abuse

I was at a playground a few miles from home with my daughter last weekend when I saw something that troubled me. A young father was screaming at his two sobbing small children. They looked like they were about four and two years old, and I couldn't understand what they were saying through their sobs so I'm not really sure what the problem was. I could understand him well enough though. "Stop crying!  Stop whining! What did I expect? I can't believe I was stupid enough to bring you here! For the third time, no! We're leaving!" And he crammed both children, who were now shrieking and wailing at the top of their lungs, into their double stroller and stormed off. The entire scene played out over about two minutes. There was no hitting, no violence, but it was terribly uncomfortable.

I desperately wanted to speak with him. I wanted to step in, distract the children, help him calm down and regain his balance. I would have if he had hit them, but for yelling I didn't feel like I could. But oh, how I wanted to help. I've certainly been there with my own daughter; making an effort to do something nice for her and being met with whining and fussing. I've had that feeling of not being able to take one more second of high pitched preschool shrieks. I've yelled at her just as unproductively at times. Which is why I didn't speak. I'm not sure in those moments of high emotion that I could have tolerated a stranger stepping in, no matter how diplomatically, with the clear intent of calming me down. I'm not in a good place when I've hit that edge and it didn't look like he was either. But I wish I had now. Maybe just a "Hi! Wow, it's cold out here!" could have sent things off in a different direction.

I've been thinking about parents and children a great deal lately. Much of the work I do as a psychiatrist is with adults who were abused in various ways as children. Recently I've been working with one particular patient whose past is dreadful, so dreadful that I haven't been as able to put my work down when I leave as I usually am. I find myself troubled, thinking about this patient, thinking about the events in her past. Feeling angry and sad, and helpless to do enough to help her now, and wishing that someone had stepped in for her in the past. Her resilience is astonishing but so is the damage that has been done.

I looked up child abuse prevention on the internet the other day. The work I do is after the fact, repairing the damage. If child abuse could be prevented I would lose about 75% of my patients. If that could happen I would throw a huge party and cheerfully redesign my life to find another line of work. So I looked into what I could do to make it happen. It was fascinating that the information from US Health and Human Services on child abuse prevention was mostly about communities. The steps they suggested ranged from getting to know your neighbors to participating in the parent organization in your child's school to helping organize community resources for childcare.

I get that. If I had known that father, if we had been friends, I could have stepped in. I know that when I'm feeling distressed my friends can still talk to me, can remind me to calm down. I could have talked to him, talked to his kids, helped get things back on an even keel. I also feel calmer and happier in general when I'm with friends. Perhaps having a friend there would have helped him stay cool in the first place. I don't think that young man was abusing his children, but I also know that most parents don't ever intend to abuse their children. Having a strong community, people who know you and love you and are willing to speak up when you are losing it, can make all the difference.

I don't know if I'll ever see that father again. I think that chance is lost. But there is a playground in my neighborhood, and there are families around us. I think I will start talking to neighbors a little more, talking to people on the playground even when I feel shy or uncertain. I can't change the past for my patient. I can't stop all child abuse everywhere. But I can take some small steps to create a stronger community where I live. I can ask other people to do the same; to keep their eyes and hearts open, to be involved even when it feels awkward. I have faith that small changes add up to big changes eventually. Seems like it's time to get started.

Sunday, December 1, 2013

Preschool Packing

My daughter is wailing this morning about not having her purple shoes. We are hundreds of miles from home today preparing to board a cruise ship later this afternoon and the purple shoes are sitting on the floor of our living room.

There is an art to packing for a three-year-old, a balance of parental authority and preschooler choice. It involves observation of your child to see which items are current favorites and might be missed as well as resignation to the fact that you will make some mistakes. My husband and I frequently travel with our daughter and have since she was very young and we still get that delicate balance wrong at times, as we did this morning. In many ways packing for an infant is easier. You need more items, including some large ones like a stroller and a portable crib, but the infant herself is not likely to gainsay your choices. The preschooler, on the other hand, is perfectly likely to pitch a fit over her outgrown purple sandals that have lately become her absolute favorites.

We typically start with clothing when we are packing. Clothing comes primarily under the heading of parental authority, since a three-year-old doesn't know what the weather is going to be like or what we may be doing. Since having a child we have found it best to plan to do laundry sometime during the trip, because packing enough clothing for a person who will likely require at least two outfits a day becomes unwieldy when the trip is over three days long. We do the primary selection of pajamas, underwear, socks, and daytime clothes, although we usually try to pick the items that have been recent favorites. This means sorting through laundry to find  the ones she is picking out of her closet for herself. Then we add shoes, jackets, and bathing suits at our discretion.

Toys are more a matter of her choice. We limit as to volume by giving her a preschool sized roller bag to fill. We also keep an eye on what she chooses so that we know she has a few of her favorite comfort items and a few staples such as crayons and legos. We would prefer to veto noisy toys for our own sanity but if she picks something obnoxious we make sure it's only accessible in our hotel room so at least the rest of the traveling world isn't perturbed. We used to choose books together but now we have many favorites on our Kindle. That cuts down both the weight and the challenge of making choices.

My husband and I don't typically consult our daughter in the matter of snacks, although that would be a good opportunity for her to exercise choice. However, our daughter is one of those children who likes the same foods over and over again and so we don't bother asking. We know she's going to tell us graham crackers, applesauce, and goldfish so that's what we pack. We are also in charge of special items, such as sippy cups, a sleeping tent and a few blankets, her epi-pen and her personal hygeine items. Mostly the entire process works well, although her items typically make up more than half of the luggage we are bringing on any given trip. And we do have the occasional minor tempests over items that didn't make the cut.

That's ok. We try to use these moments as lessons in tolerating not having your own way and being flexible in finding other solutions. She can wear the pink sandals today and with a little distraction and a little comforting she'll be content. As she gets older we can expand the amount of choice she has, training her in both making decisions and accepting the consequences of those choices.