We get a break! By break I mean a week (5 whole days!) without classes. Exams are three weeks away, meaning that once we return from our class-free Thanksgiving we have one week of class and then finals. Inasmuch as there will be no class, there must be studying over break if any sort of sanity is to be maintained during the final two weeks of the term. Alas.
This week has been good, anxiety-provoking, relaxing, tiring all together and at once. We covered lung exams, both in theory and practice – anxiety provoking. I did some reading, had some spare time to see my partner – relaxing. We had an exam on Wednesday of this week – all the above. And, for the highlight, I joined a gym!
Never have I ever had a gym membership, the gym culture has always seemed a little to intense, a little to meat-headed for me. Not to mention music on loudspeakers and screens on the machines and TVs around are sensory overload for me. However, given the Portland cold and rain in addition to my recent lack of good running space (i.e. I am to tired to run but the time I get home) I have not been exercising. So I decided to check out a hospital associated gym – and LOVE it.
Let me explain a bit about this gym. Unlike the more popular chains, my gym is associated with a hospital, which means that there is a wide variety of people in a wide array of circumstance. Some are fit, focused, and well put together (medical students, hospital employees, etc). Others are not. Patients of the hospital are prescribed exercise routines, depending on where they are in their particular stage of illness or recovery. Trainers work with some others come in to do their prescribed time and exercises on their own. Regardless, there is an atmosphere of striving for health, whatever stage you may be in. There are also no cell phones allowed, and no music or common television. It is a haven.
There is some truth to valuing what you pay for. I pay a fair few bucks for the privilege of an unnecessary use of electricity via a treadmill, to be able to pick weights up and put them back down, and to do yoga with a teacher who actually knows what he or she is doing. Not to mention to use the sauna and/or hot tub and pool as the mood may strike. Money is going in, I for damn sure will be showing up to make use of the service.
Stress wreaks havoc on the human body. We are not made to be in constant, unending stress. Exams every week, practical labs sans shirts (not stressful for everyone, but certainly for me… and yes, we do have gowns), piles of studying for the ever impending avalanche of exams, work (albeit only a few hours per week), family, children, social lives – it is just too much. My own stress symptoms range from nausea, excessive appetite, no appetite, erratic bowel movements, gas, bloating, diarrhea, abdominal rash, muscle tension, inability to sleep, exhaustion… In short, I’m a mess. I’m tired, blotchy on my belly, may or may not be excessively gassy. This with weekly therapy and acupuncture. And so – to the gym! The beautiful thing about exercise is that it burns up the stress hormones, makes concrete use of overstimulated sympathetic nerves, helps the bowels move, enhances blood and lymph flow, which in term enhances detoxification and immune function. It is a win, win, win. And happily, just a few days in, I am winning!
I confess, this is not only due to the exercise (though the benefits here cannot be overstated). It is also due to the fact that the gym is a place where I do not have to talk to anyone, think about anything, or appear any particular way. I show up in the morning, messy and disheveled. I exercise, sweat, completely and utterly disconnected from every obligation and responsibility I have, present only to whatever questionable music choice I have made and the wonderful feeling of moving rather than being seated in class. GLORIOUS. The sauna has become my after-workout cone of silence. I sit in the heat and meditate and breathe in so much joy and thankfulness to just be.
Of course I shower and dress, leaving much more put together than when I rolled in. And I feel as put together as I look by the time I walk out the door. Certainly the upcoming week will bring a welcome respite from 8:00AM classes and unending lectures. My hope is that, moving forward, keeping moving will help me cope with the chaos of it all.
Riding in the back seat I flipped through an abandoned Reader’s Digest – the cover had a headline about a man that wanted me dead. At the time, a child, I wondered how someone I never knew had any awareness of my existence and why, if they didn’t know me, they would want me dead. The article must have been about Osama bin Laden, and I don’t remember any of the details, other than the intense fear and confusion I felt.
Much of my upbringing (and therapy) is focused around fear – intense anxiety around so many things. Fear of being home alone in the evening, having conversations with people (known and unknown), of failing out of school, of having people see the person I am, of letting go of the person I was, of growing, of making mistakes, of going crazy, of being out and about at night in the dark, of missing the bus, of fatal car accidents, of cancer…
It is no surprise or secret that the climate of fear is cultivated by the media in our country – it is how outlets keep people coming back, how they sell newspapers, how they get people to listen or watch. Many parents teach their children fear, over-cautious and over-concerned for safety and well being. We are a nation of adults who are consistently afraid and unable to differentiate the real threats from those imagined.
I also do not participate in a good deal of media, and was surprised when my mother told me what had happened in Paris. More than surprised, I was anxious and afraid. Will my holiday travel go alright? Will my family and friends be hurt, living so close to DC? If it can happen in Paris, it can happen anywhere… On my Facebook feed there were posts about #prayforParis to be sure, but there were also a great many about prayer for the world. Many to bring awareness to the bombings in Beirut just a few days prior, to the fact that Muslims in Paris were killed alongside white people (whose religion we neither know nor care to know, their skin color being their alibi).
In the midst of the gut-clenching fear and deep sadness for what appears to be an inescapable human condition of violence, the quiet thoughts that rises to the top are about those people who carried out the acts of violence. An unpopular stance I’m sure, what compassion might we find for those living the violence. Local gang violence comes to mind, perpetrated by individuals in deep poverty, who may or may not have ever known what it is to be accepted until joining up.
Fear is not meant to be a constant state of being – it is unhealthy and contributes to the wide array of stress-associated diseases and subclinical conditions: hypertension, hypercholesterolemia, diabetes, obesity, headaches, impotence, insomnia, generalized anxiety, depression, OCD, difficult menopause, cancer, etc. Conditions resulting from excess stress and poor diet and no exercise – the body, mind and spirit do not grow well in such soil.
Love bears out in the opposite way. When we love and are loved, we know we are well and safe. Fear does not exist in a state of love. The archetypal earthy mother’s love when we are newly of this world shows us we are provided for, cared for, that all is well in this world. Ideally, we are actually welcomed into our mother’s arms, our co-parent’s arms, and that love translates and transforms as we grow. Translates into an ability to love and care for ourselves, transforms into love we exude for other people, compassion for life such as it is.
Too often, people do not experience warm, nourishing love. Experience tells that there is not enough, will never be enough, that safety does not exist in this world. An exceptionally simplistic view perhaps, this is the root of violence. Not meeting of basic human needs, of teaching and learning scarcity ongoing threat. We are made to live, and threat to life naturally leads to lashing out in self-protection. This comes out as blatant violence – killing self and others, domestic violence – and in more subtle ways. Harsh words, bullying, excessive criticism (of self or others), overconsumption are all symptoms of fear.
It can be challenging to shift from a state of fear to love. Fear is, after all, easy – it is programmed into our DNA for self-preservation. Lions are scary – how about we don’t go near them and continue breathing. Love requires much of us – it demands care and awareness and responsibility and accountability for ourselves and those around us. Love asks us to show up in ways that are uncomfortable and vulnerable, to open ourselves down to the depths. It demands trust and faith at every level: in ourselves, in others, in the universe at large, in God.
Whoever you are, wherever you are, I invite you to cultivate love as best you are able. Curiosity is a good vehicle for this practice. Instead of harsh criticism or anger, ask questions and get really interested in what it is you are experiencing. The best place to start is within your body – ‘I wonder what this headache is about?’ ‘My gut just clenched really tightly a minute ago – I wonder what that’s about?’ With practice and in time, it is possible to harbor curiosity at every turn, to wonder at where someone’s actions come from (this does require inviting a bit of naiveté into your life).
Practically speaking, peace is cultivated on an individual scale, in daily and mundane choices. It lies in every moment of every day: waking, cooking, driving, childcare, self-care, errands, eating. Peace requires we face our discomfort, that we invite it in to sit with us. That instead of lashing out against others or ourselves, that we have compassion for whatever it is we are experiencing. There are many great resources for beginning this practice – one in particular is Thich Nhat Hanh’s book True Love. Practical and simple, it offers ways to practice love every day – in fact with every breath. Dancing with the Ten Thousand Things by Tom Balles is another life-changing favorite. Mystics have ever so much writing on love: Julian of Norwich and Rumi are two of my favorites. Victor Frankl’s Man’s Search for Meaning is similarly helpful in understanding the condition we humans are living. Sri Mati has wonderful meditation resources, and as of next month a podcast for living in ways that facilitate compassion and peace.
Whatever the global political climate, we determine our local climate, be it one of fear or love. What is happening in your home? To whom do you express love and compassion? Anger? Fear? How is it with your soul? If there is change to be made, and you are not sure how, you need only ask for help with an open heart – you will be supported. The pursuit of love is always supported by the universe – it is a universal force, after all.
~ In love ~
Two thirds of the term are finished, and I am struggling. Struggling keeping to the grueling schedule of study I need to keep in order to get so much information firmly embedded in my mind. Struggling to eat healthy foods, to keep my body running well and my mind focused. Struggling to find a balance, which, although I know is a falacy, is terribly important to me. Struggling with the deep Portland winter dark. And struggling to make decisions that are the best for me and my education and my future at large.
My most cherished possesion was broken this week: a shell given to me by my mother that belonged to her now deceased partner, Susan. It was a slow motion moment, hearing the shatter, turning to see pieces on the floor, and feeling the familiar dark grip of grief on my heart. Shock came and left quickly, replaced by incredible mourning. Through my mind ran, in amazingly quick succession, a lifetime of memories – of Susan, of her death, of trecking all of my things across the country, this one carefully wrapped up the whole time… I wept, muscles tense and full with grief. In a suprisingly short span of clock time, I relived my life’s most profound loss, surrendering completely to the depth of my emotion.
Breaking such a shell, you can see the beautiful pearlescent inner layer. Depending on the shell, the outside may or may not be so stunning – typically not. The outside reveals the beauty of spiral form, perhaps, or earth tones interestingly arranged in stripes. The inside, though, is amazingly beautiful, the moreso given its mystery.
That said, I’ve spent the week thinking about three things: things, my attachment to them, and the necessity of breaking open.
‘Stuff’ has not been a huge deal for me in a great while. An entitled millenial, I lust after things to be sure. Over time though, I have been wearied by too much stuff – not only while moving, but also in the day to day. The less stuff I have the less time it takes to care for my space. Having lived in a micro-apartment I have some practice living with minimal excess. Even now, living in a house, I crave divestment, to lessen the burden of things. Things require storage, cleaning, maintenance – I`d rather give it all away. My books I am highly attached to, along with a few select kitchen gadgets, and the clothes I regularly wear. I hadn`t considered myself particularly attached to anything until that shell broke. In that moment (and those following), any attachement I had to my other things disappeared – what do they matter? The most important is gone – take the books, my favorite pans, my juicer, my favorite socks and jacket… none of it matters.
From there I moved to thought about why that shell was so important – because Susan picked it, touched it, carefully selected it. Because my mother gave it to me to take across the country, away from her, a selfless gift on her part. Because it represented the time of my life when my family of origin was whole, when nothing bad could happen to me, when I was surrounded and steeped in love every minute of every day. Along with that shell shattered the last physical remnant I carried with me of the time before my loss of innocence, before my relationship with loss and grief began.
And so, now, living a different life entirely, integrating and broadening my family in new ways, I have put a good deal of thought of how to commemorate what has passed without the things. Susan being from New Orleans, I decided to take a friend to brunch at a cajun restaurant in town, in memory of Susan. I ordered Cafe du Monde coffee and chicory to have for my morning coffee, integrating memorial and memory into a cherished daily ritual. This is a new and ongoing question for me, how to nourish and honor the memory of time and people past.
Dismemberment, in some schools of spirituality and religious practice, is considered necessary. It is only when we are altogether broken down that we may be made new. The military uses this practice, initiating recruites into new ways of living, harsh and unknown, breaking them down completely in order to make them new. The universe (God) too breaks us open and apart with loss, chaos, unknowing. Changes burrow up and through the foundation we thought solid, destroying the base of the life we thought we made for ourselves. Turns out we humans have even less control than we thought we did. Marriages implode, careers fall apart, illness takes hold, and it is all we can do to draw one more breath. Existence is reduced to a moment to moment experience, becasue anything more is simply excrutiating.
Collective experience from those who successfully make it through these moments is that coming out on the other side we somehow find ourselves in a place of beauty we were sure could not possibly exist. The dark night of the soul somehow, and mysteriously leads to a new dawn. Breath is renewed. We were reduced to ash and in mystery made new. It is a mystery to me how this happens, why it must happen… and my sense is that it must. My intuition is that this breaking apart, including the incredible difficulty and pain and discomfort, is critical. I don’t know why, and perhaps never will. Tremendously I wish there were another way around transformation than complete annihliation of the familiar and comfortable.
On starting school I was sure that my period of profound unknowing was finished, at least for a year or two – it turns out I am being broken down and rebuilt day to day. So to my struggles – practices – I add surrender. And compassion, care. Leaning into discomfort as best I can.
In one day I had the most stressful event I’ve had this far in med school (registration with 100 other over-achieving type-A personalities), and the most awe-inspiring.
We are doing our first swath of heart physiology and learning the associated physical exams: chest exams and blood pressure. In labs, we partnered up, got gowns on and listened to the hearts in the room.
Truly, how many people listen to your heart over the course of your lifetime? Your mother, perhaps your father. If you are a woman, your children know your heartbeat, having developed under its cadence. Maybe your spouse lays his or her head on your chest, or your children, a sibling. Only those closest to you hear the beat that moves your blood and enlivens your organs.
Surprisingly, many doctors don’t listen to the heart, unless they are cardiologists. It has been years since I’ve been to a doctor myself – I think the last visit was in 2013, to the gynecologist, who, specializing in other anatomy, did not listen to my heart. The last time a doctor listened to my heart that I remember was when I was a child, likely younger than 10.
As naturopath and a primary care physicians, we are taught this dying physical exam. Listening deeply to the rhythm of another human being is amazing. Through the stethoscope can be heard the steady opening and closing of a healthy heart, the ongoing movement of a seemingly tireless muscle. The sounds from each set of valves may be heard, sometimes affected by the breath. Subtle sounds that take time and attention to decipher. Having only listened to a grand total of 4 hearts I have much to learn. What an exciting endeavor, to learn to listen and decipher the beating heart.
Monday two weeks ago, at the beginning of week 6, I took a spectacular fall, substantially injuring my left foot- I’m not sure I didn’t break it. Not wanting to take the time to have an x-ray or see a doctor, needing to get to school via the bus, to which I walk, and being an enterprising herbalist and first year student, I took matters into my own hands. The wonders of homeopathic arnica had been touted to us just a few weeks before, and having some on hand for an assignment, I decided to go full on, topically and internally at regular intervals, to see if it would help me so that I could at least walk to the bus stop without wanting to cry with each step.
Let it be known that I am a skeptic. If I have not seen something work that does not make logical sense, I withhold judgement until I’ve had some first hand experience. Homeopathy does not make good logical sense to me – even in lower dilutions, the amount of plant material is barely detectable. At high dilutions, there are no molecules of the original plant in the remedy. It seems like a bit of magic, and no small trick at that. And yet, so many use homeopathic remedies habitually to keep themselves well, with excellent results. Many naturopaths primarily use homeopathic remedies with their patients for a wide array of conditions and symptoms.
At any rate, as you might have guessed, it worked. Within 24 hours, the swelling in my foot went down, a nice bruise showed up, my range of motion increased dramatically, and I could walk, with minimal discomfort (!!).
Before my fall, I decided to try my hand at fermentation by way of sauerkraut. Ever a favorite, reading through the process of salting and pounding a cabbage I was skeptical. Yes, I know plants have a good deal of water, and I know the mechanism of salt bring the water out, helped along by breaking the cell walls with vigorous force. But the book said there would be enough water to cover the plant material. No… Surely not. I had a huge cabbage, slightly larger than a basketball. Maybe sometimes that works, if you have just the right cabbage, but no…
So I did it- I chopped, pounded, salted, chopped, salted, and pounded some more. And I’ll be damned if there was not enough water to cover the cabbage! This may sound terribly elementary and simplistic – really, I am in awe of the fact that it worked at all. It has been a beautiful reminder of the wonder that exists in the world, the everyday processes we take for granted, being as they are part of us. Osmotic shifts from electrolytes, innate healing capacity… The stuff of which we are made.
This past week I learned to take blood pressure and do a heart exam – and wouldn’t you know, the heart works. Again, this sounds dumb in writing – yes, of course the heart works, we would be dead if it didn’t. But think about it – there is a marvelous and complex interplay between electrical current, ion movement, and protein binding happening during every heartbeat (!!). For your entire life. It doesn’t stop, it keeps plugging along, beat after beat, compensating as best it can for any mishaps: contractility may be adjusted, stroke volume, pressure, coronary circulation… And sure enough, in the 5th intercostal space, I’ll be damned if there isn’t the apex of the heart, and the point of maximal impulse, the seat of the rhythm of the body, clear and palpable if you know where to look.
The majority of the time, if we can get out of the way, it all works! Mysteriously, amazingly, simply and effectively. Do you understand how simply amazing that is? That a remedy made of sugar and a molecule or two can help heal a nearly broken foot, that water can be removed from cabbage, and then made to ferment, generating, among other things, beneficial bacteria and B vitamins?! That your heart has contracted countless times from your conception to this moment, allowing for your vast life experience, no thanks to you? This is the part where, were I the jump up and down type, I would squeeze your shoulders and jump up and down – it all freaking works!!! It is just all so terribly exciting.
Certainly it is best to be prepared, to put in the time and energy to pull together information or resources for a particular endeavor. This might be camping, athletics, a party, a presentation, an exam, a meeting – anything that requires some forethought and planning. Certainly there is a great deal to learn at medical school: the obvious anatomy, physiology, physical exam, philosophies of healing and patient interaction. Something I hadn’t counted on having to learn is to fly by the seat of my pants, off book altogether while appearing as if I were perfectly prepared. It is a phenomenon I have noticed all around me, increasing with the progression of study.
Certainly, moving along and gathering knowledge as we go, there is more leeway for improvisation, simply due to a broad base of knowledge. In terms of patient care, new remedies or protocols may be tried with confidence, given a certain history and knowledge of both the patient and effective remedies. Scholastically there is no way to fit everything in – unless we adopted the life of a hermit, foresaking food and family, and even then it still would probably not all fit into the hours of the day. And so those things with which we are slightly more familiar get set aside, or an assignment is forgotten, and off we go, all improvisation, and let’s see what happens.
A good deal of emphasis is placed on appearing confident – we are graded on our confidence in both presentational classes and physical exam classes. How much do we look as if we know, regardless of what is actually consciously retained. The purpose of this I see as twofold. As physicians, we must instill confidence and trust in our patients – if we are shaky in the face of what may be a terrifying experience of illness, on what ground will a patient be able to stand? Secondly, subtle remedies require unwavering knowledge that yes, this will work. This is part of healing – having and holding unwavering faith and confidence in our abilities as healers and in the effectiveness of our remedies.
Confidence embodied comes only after a certain amount of experience, seeing what does and doesn’t work and fully integrating the knowledge. One of our professors commented we could borrow his confidence until we had enough experience to have our own, an offering I anticipate relying on as I move into the role of clinician. In the meantime, alongside confidence, we work to cultivate humility, knowing that people are vast and complex – unexpected effects come and go, people change where we thought them once firm.
Overarching the whole endeavor is faith in a system of healing that has endured despite the best efforts of technology and convention to eradicate it. Nature thrives in predictable rhythm- so too do we humans. Botanical compounds have reliably predictable effects on patterns of symptom. This, if nothing else, I know and trust. The rest will come in time – until then, I prepare as best I can, and when all else fails, improvise.
“Life is but a series of breaths” ~Yogi Ramacharaka
Essential and constant, breath is all at once a concrete and ethereal connection to the world around us. Oxygen comes into the lungs, along with whatever particles and gases happen to be in the air. Carbon dioxide leaves the lungs, waste of cellular processes that keep the body alive and moving. Movement of such small particles as electrons make use of the oxygen breathed in and circulated and give off the waste of carbon dioxide. Skeletal muscle opens and closes the lungs, nerve impulses determine the rate of breath for any given circumstance. Stress and threat yields an increased respiratory rate, relaxation lowers the same. We may leave the lungs and intercostal muscles to move as they will, never giving a thought to the breath. A great enhancement may be yielded, however, if a bit of attention is paid to this basic process.
Most subtly, breath connects us to the heavens – the word ‘inspiration’ is purposeful. The Holy Spirit in the Christian tradition moves with the wind, on the air. Mythical creation of human beings involves ‘breathing life’ into gross matter. It is the breath that carries with it the vital force, the deep mystery of what makes us uniquely alive. Breath bonds the critical essence of ourselves with that of the wide universe.
Moving into the finite physical realm, it is cellular processes that make up the energetic force and potential of the body – these processes require oxygen. On the most basic level, providing an adequate supply of fresh oxygen enhances and ensures good cellular metabolism. Similarly, exhaling adequately ensures timely removal of waste product.
On a gross level, movement of the lungs, expansion and contraction of the thoracic cavity, massages the visceral organs. In other words, movement of the lungs and the rise and fall of the diaphragm subtly massage digestive organs: stomach, liver, pancreas, small intestines, large intestine. The effect of deep breathing also extends to the nervous system. In the same way that the nervous system can determine the rate of respiration, conscious alteration of the rate of respiration can impact the activation of the nervous system. Taking a slow, deep breath enhances relaxation by enhancing parasympathetic pathways – those associated with ‘rest and digest.’
How, then, to make the most of the breath?
First is to pay attention – take a few minutes to ponder what it means to breathe, to appreciate and accept, with gratitude, the gift of breath in this human body. Your breath, continuous inspiration and exhalation, have carried you through all of the days of your life, whether you had awareness of it or not. At any moment, breathing may become challenging, maybe you have the experience of being challenged by the breath. Whatever your experience, bow in acknowledgement to the deep mystery of the link between invisible air and the obviously observable fact of the living body.
Then move your attention to posture. Compression of the thoracic cavity necessarily means the lungs cannot fully expand. Practice sitting up, keeping the shoulders up and back, standing erect and relaxed.
Finally, we come to the breath itself, in this moment – how are you breathing? There are those who hold their breath and don’t realize what they are doing. Is the breath shallow, rushed, relaxed? How does your body move when you breathe: belly, chest, shoulders? Do you breathe through an open mouth or through the nose? Can you breathe through the nose, or is there too much congestion or inflammation?
Breathing through the nose is how we are designed to take air in, and is the most effective way to breathe – the nose both warms and filters the air before it comes to the lungs. The nasal sinuses contain bony structures that swirl the air as it enters the respiratory tract. This means any particles coming in run into mucus of the nasal cavity and do not enter the lungs. If there is some impediment to breathing through your nose, it is imparative to sort that bit out, whether it is a matter of using a neti pot or reducing dairy or something else entirely.
From there it is a matter of practice. According to Yogi Ramacharaka and The Hindu-Yogi Science of Breath, there are three types of breath: superficial, deep, and complete. Superficial breathing fills only the topmost portion of the lungs. Deep breathing fills only the lower, belly portion of the lungs. The best is complete breathing, which fills (and subsequently empties) the lungs, bottom to top. This is done by sitting (or standing) erect and relaxed. Breathe into the belly, filling the lower portion of the lungs. In this part of the breath, the belly expands out. Next, breathe into the middle,portion of the lungs – the rib cage expands here over the belly. Finally, breathe into the topmost part of the lungs, raising the shoulders slightly. During this last bit, the bottom (belly) portion of the lungs should contract slightly, providing support and stability to the upper lung. Hold the breath for a few moments, giving time for full exchange of oxygen and waste. Then breathe out slowly.
Certainly this takes some practice to master – learning deep breath, particularly in our stress-ridden shallow culture can be a years long endeavor. Once you have mastered this method, however, the more you will enjoy the practice and the better you will feel. Increased overall relaxation and grounding are two aspects of breathing practice that are instantaneous – if immediate gratification is what you are looking for, this is the first and best thing you can do for your health. It costs nothing, and you have everything you need already at your disposal.
Yoga classes are an excellent resource for learning breathing, different types and benefits. Meditation instruction too provides valuable information regarding breathing and its importance – as long as there is breath there is life, and as long as there is life there is choice. As long as there is choice, there is capacity for health, wellness, peace and contentment. What better reminder than the breath, with us each minute of each day.
It is safe to say that the term has picked up and hit top intensity in the last week and a half. There is no way around the fact that there is simply too much information for one person to know, along with the fact that 26 credits is humanly impossible to keep up with all the time. On top of that there are facts of day to day life – food is necessary, clean clothes, and sleep. Add to that the fact that stress diminishes the immune system, and the mixing pot of germs found in schools. After getting sick for the second time in 6 weeks, and a daily progression of increasing crankiness, what I have taken on, whole heartedly, is an attempt to find some sort of balance, or if not balance, some way to keep myself well and healthy.
The self care regimen I have built over the weeks seems like it is simply too much – my time ‘should’ be spent studying. That regimen is psychotherapy once per week, acupuncture once per week (for the next 5 weeks anyway), a float once per month, daily journal writing, 8 hours of sleep nightly, a weekly trip to the farmer’s market, as near daily exercise as I can get, in addition to doing my very best to switch to a vegan, whole foods diet. Outside of sleep and diet, that is approximately 24.5 hours per month (out of approximately 720 total, 480 waking) not spent studying, but engaging directly with my own sense of wellbeing. I’m not sure I ever took bad care of myself, outside of an occasional donut binge, but this is another thing altogether. Until I did the math it seemed excessive – looking at the numbers now, it seems not unreasonable.
Our culture is contrary when it comes to things like self-care, taking time intentionally and deliberately to ensure one’s own well-being. As a woman especially, I have a sense that I ought to be spending my time helping keep the house clean and paying attention to my partner. Inasmuch as cleanliness and relationship are important, coming to terms with the fact that what I’m doing now with my life is not only the biggest and best challenge I’ve ever undertaken, but that it requires all of me most of the time, has been difficult. Expectations are being challenged both internally and externally, and I continue to wonder if I really need to do so much self-care. Instead of questioning the expectations from without, I question my own sense of what is good for me.
What I’m finding is that the work of self-care is too important to not do. It is an absolute and non-negotiable. The clincher in making this assertion lies in the work I want to do with patients. The work of being in medical school as a student naturopathic medicine is not only learning the didactic material of anatomy, organ system physiology, pathology, diagnosis, materia medica, etc., but also doing the healing work we hope or expect our patients will do. Much illness is caused not by pathogen or trauma, but simply by not taking even small steps towards self-care. Sleeping adequately, eating properly, tending emotional wellbeing. Truly, we each cannot show up for one another unless we have tended ourselves. And so self-care takes priority, as important as my studies if not slightly more so, because it lays a foundation for me to keep my mind in the game and stay healthy in each aspect of my being. It takes time and energy to be ill, more than those I’m putting into staying healthy.
Talking with other students, what I’m hearing is the same story – everyone is overwhelmed and can’t fit everything in, and is used to not only fitting everything in, but doing it damn near perfectly every time and being healthy while doing it. Now we are all together, getting sick repeatedly, failing an exam here or there, not able to remember the last time we got less than a B-, if that. It requires a new paradigm – good enough is, in fact, good enough. Depth of knowledge comes in time and with experience – we cannot know everything now, and this is okay.
In this pressure-cooker of an academic environment, the important things rise to the top, as they always do. In this case, those rituals of self-care have made themselves known to be critically important to keep me in a state of health in body and mind. This is my trade (or very soon will be), and how much more important for me to walk what I sincerely hope my one-day patients will have the courage to undertake, which is wellness, cultivated through intentional self-care.
Putting gas in a car is a ritual I have not participated in for nearly two and a half years. The last time I drove my 2006 Honda Accord was in June of 2013 – my mom sold it shortly thereafter, freeing up her driveway and saving on insurance. One of my goals on moving to Portland was to be in a place where I did not need to have a car to get around, the opposite of where I’m from in suburban Maryland. If you live in a place like New York City or Paris or London or Tokyo, or a small town where you can walk everywhere, it is far less significant to be without personal motorized transport. The fact that I, however, an upper middle class young woman from the DC/Baltimore metro area would be able to maneuver, day to day, sans auto, is mind boggling. Here’s what I’ve found:
- People are people and widely diverse. Sometimes they are wonderfully helpful, other times blatantly rude. Some are jolly and smiles all over, others curse under their breath ‘fucking cripple hurry up and get off the damn bus.’ Young and old, everyone in between – all sorts take public transit on any given day at any given time.
- Planning is everything. Particularly if the bus you need comes once every half hour, or maybe once an hour. There is nothing like realizing, five minutes too late, that you won’t make the bus or train you need to be on time. At the same time, I have become far more adept planning most all aspects of my life: meals, work, study, social engagements, etc. part of this has a great deal to do with the rigors of being in med school, but the trend began when I had to rely on public transit.
- Clear priorities are essential. I will find a way to get to those things I really want or need to go to. If it is happening on the east side, I must really want to be there if I show up. Before I commit to an event, I think twice – how long will it take to get there? What is the bus schedule at that time of day? If the thought of even getting there is exhausting, and the event is optional, I opt out.
- White Privilege is real. This shows up in two ways: who rides what lines, and overheard conversations. On a bus to the suburbs, primarily white riders, medical professionals or general professionals, commuting. Buses through town I’ve found to be more varied – the more run down the area, the more Black and Hispanic riders. Nothing brought my position of privilege into greater clarity than hearing a conversation among Black students, either late in middle school or early in high school, talking about their family members being shot, and which of their siblings or cousins were in which gangs. Neither I nor the majority of my friends (white) have ever even considered such variables – and without that concern were able to pour our energy into our education and whining about chores or whatever new gadget we wanted, and now have jobs or good career prospects from having completed at least one degree, if not several. Yes, privilege is real.
- People, when in a group, don’t listen and are afraid to (literally) step up. Most mornings, the aisle way fills up and for whatever reason, whoever is standing at the stairs to the higher level of the back of the bus will not move. Before or after the driver asks everyone to please move back… twice.
- Selfish is the norm. There are people who will storm on a train to make for the last seat, those who stand in the way of the backdoor of the bus (why?!), who get off the front of the bus instead of at the back door and who will absolutely not move to the window seat so someone can sit in the aisle. I’m still trying to figure out these behaviors, though I too will rush onto the streetcar if I see a single seat open…
- There is no better way to learn a city than by using public transit. Its places, its people, its quirks, its personality. Looking out the window riding the bus is a simple pleasure if you let it be – I have stolen beautiful views of Mt. Hood crossing the steel bridge, have seen stunning artwork, run down and graffitied neighborhoods, and discovered a number of fantastic restaurants and coffee shops from seeing lines out of the door repeatedly. Public transit is typically not the direct route, but it is often the most interesting.
- It is okay to say no and/or to disengage. Just because we happen to find ourselves on the same bus does not mean we have to speak (gender is a large part of this).
- Pacing. Akin to planning and seeing parts of a city you might otherwise not, I find my life tends to run at a slower pace on the bus. This is not the norm for everyone – I have a few friends who freelance and are running here and there quick as can be for one job or another. My own transit junket has forced me to slow down – I wait for connections, late buses, traffic and read, look at instagram, or simply sit. It is time I enjoy – in fact when I’m given a ride in a car with a friend I miss the time to myself.
- Timeliness. When I drive I am late – habitually and most always. The bus runs when it runs, however, and you never can tell if you miss your bus if you will be 5, 10, or 40 minutes late. I have been late once in the last six months – most always I am early. This too feeds into pacing – what a difference it makes to arrive 15 minutes early rather than walk in as something is starting or 15 minutes late. And never do I have to think about finding parking.
Here’s to public transit, for all its benefits and drawbacks. Wouldn’t have it any other way.