Catching Tadpoles

"Spring has returned. The Earth is like a child that knows poems."
Rainer Maria Rilke quotes (1875-1926)

As I gaze out onto my office parking lot in Concord, Massachusetts, I see an amazing sight...a young boy and girl crouching low to the ground on the edge of the sidewalk that leads into my office building.

On closer observation, I see a net attached to a long pole in the young boy's outstretched hands. They are fishing for tadpoles in the flooded parking lot! With the historic level of flooding the Northeast has withstood over the past weeks, the ensuing hassles with closed roads, canceled train service between Boston and New York, rivers overflowing, dams breaking, pumping out of basements, loss of property and water damage to valuables; this sight in the parking lot...two small figures patiently fishing, eagerly anticipating their catch, made me stop and smile.

Time after time, I am reminded of the choices we make in viewing the world. Do we see a flooded parking lot with no where to park, or do we see an opportunity to fish for tadpoles in the sunshine? One situation, two very different experiences.

May you catch many tadpoles this month,
Pam

Love after Love

February is a month of the heart...both our physical heart evidenced by very important public health campaigns such as the Go Red for Women initiative by the American Heart Association; as well as the metaphorical heart...the heart of love and compassion. Often we think of love as simply the commercial accoutrements of Valentine's Day with roses and chocolates, but can we think of it as much more? How do we create a culture of compassion and empathy for ourselves and others? Now that the Hallmark day of love has passed, I thought I would share this poem by Derek Walcott that touches upon the very difficult task of compassion for self. I have included an audio clip of Jon Kabat-Zinn reading the poem....enjoy!

What does the poem mean to you? How have you included compassion for self into your day to day life? I would love to hear your thoughts and comments!

Love After Love

by Derek Walcott

The time will come
when, with elation,
you will greet yourself arriving
at your own door, in your own mirror,
and each will smile at the other's welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

Request for Research Help from Health Bloggers

Do you or does someone you know blog about their chronic illness? Lisa Gualtieri, PhD and I are interested in the motivation of why people choose to start and maintain a health blog for a research survey we are conducting. Can you help us out by answering the questions below or forwarding them on to health bloggers you may know? We appreciate any help you can provide us! Feel free to send emails directly to us at: pressler@stressresources.com or lisa@acm.org or post your answers in the comment section below.


We are researching why people choose to start and maintain a blog about a health condistion and would appreciate your answers to these questions:

When and why did you start your blog?

What do you see at the primary reason(s) you continue blogging?

How often do you typically post?

What types of feedback do you receive? How many comments do you typically get to each post?

Do you know how many unique visitors you have during a particular time period (say 2009)?

Do you do anything to promote your blog or attract new readers?

Do you use your real name in your blog?

Do you read other blogs by people with health issues and, if so, which and why?

Have you shown your blog to your doctor or other healthcare professional?

It's All About Connection

Each year The Kenneth Schwartz Center selects a Compassionate Caregiver who embodies the qualities of empathy, compassion, caring and presence in their work and life. This year's winner is Dr. Amy Ship, a primary care physician at Beth Israel Deaconess Medical Center in Boston. I was particularly moved by Dr. Ship's acceptance speech, where she explains that it is all about connection...connecting through presence, through compassion, through understanding as both the care-giver and care-receiver. “The longer I’ve practiced medicine, the more I’ve come to realize that we are all, as the years go on, ‘survivors,’” she said. “For some it is cancer, but for others it is diabetes, or seizures, or kidney failure, or all of the above. Others are survivors of loss – loss of a limb, loss of sight, loss of autonomy, loss of hope, loss of a loved one. And I have learned that many of us – like me – carry with us some secret sorrow – a loss or challenge that is not noticeable. Connecting with patients means looking for what is not immediately visible, listening for the hole in another’s heart.”

I encourage you to view Dr. Ship's speech by clicking here and see and hear what connection in healthcare is all about! Congratulations, Dr. Amy Ship, truly a compassionate caregiver.

Engage With Grace: The One Slide Project

I was honored to again be asked to participate in this year's Engage With Grace blog rally by my friend, Paul Levy, President and CEO of Beth Israel Deaconess Medicial Center in Boston. Thanksgiving is traditionally a time to gather with friends and family...and a perfect time to ask, listen, and learn about loved ones' hopes and desires if they could not speak for themselves. So between the football games, the turkey, and the pumpkin pie...take some time to begin a conversation by sharing Engage with Grace with the important people in your life.

Wishing you and your family a happy and healthy Thanksgiving,
Pam

"Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.
To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.

So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways. "



To learn more please go to http://www.blogger.com/www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.

Musical House Calls

The Longwood Symphony, an orchestra made up of physicians, medical researchers and health care providers, broke with their tradition of playing a large concert and instead took their music to their audience -- their patients. Dr. Lisa Wong, pediatrician and president of the Longwood Symphony Orchestra stated,“To launch this year, instead of having a concert in Jordan Hall, where we usually play for 800 to 1,000 audience members, we thought we’d bring it to the patients". This year the healer musicians were broken into several groups that spread out over Boston, visiting health centers, hospitals and elder care centers in an initiative called LSO on Call: Health and Harmony in the City. They reached a similar number of audience members yesterday, playing for a total of about 800 in nearly two dozen small concerts.

To read more about this great group of healing musicians, click here for the Boston Globe article.

My Summer Labyrinth Quest

I am fascinated with labyrinths and their use in meditation and health. On my summer travels I explored a number of labyrinths in the Midwest that I found on the worldwide labyrinth locator. Each of these five labyrinths are unique but are similar in their ability to allow the user to stop, take a breath, observe and proceed. Please share photos of your favorite labyrinths by emailing them to me and I will post them here. Enjoy!

Ellsworth Labyrinth Garden, Ellsworth Michigan
11 circuit, Medieval/Santa Rosa labyrinth. Constructed in 2004 by members of the community of Ellsworth. It is located on the banks of Lake Ellsworth and surrounded by perennial gardens. mosaic stepping stones line the outer edges of the labyrinth made by community members representing their hopes and wishes. (http://mi.imagemakers.com/labyrinth.html)

Sacred Sparks, East Jordan Michigan

Linda and Jerry Aydlott have lovingly constructed this classical labyrinth on the land behind their gallery and store in Northern Michigan. Labyrinth, goddess garden and rustic fairy walk at the back of their property are all open to visitors to explore. The labyrinth is a 7-circuit design, 50 feet in diameter and was constructed from field stones in 1998. (http://sacredsparks.com/)

Raven Hill Discovery Center, East Jordan Michigan

Constructed from field stones, this rustic classical labyrinth graces the front entrance to Raven Hill Discovery Center. It was constructed in 2004 and is 35 feet in diameter(http://ravenhilldiscoverycenter.org/)

Nelson's Herbs, Edwardsburg Michigan

Imagine a labyrinth constructed of over 560 lavender plants...that is what I experienced at Nelson's Herbs. A fragrant meditative walk. Originally built in 2004, it is 60 feet in diameter in the medieval/Santa Rosa style. (nelsonsherbs@aol.com)

Saint Mary's College, Notre Dame Indiana

Located near the entrance to Saint Mary's College, this is a 7-circuit classical design constructed with black river rocks with circular pavers to line the path. Twin finger labyrinths are near the entrance allowing you to "walk the labyrinth" with your hands. (http://saintmarys.edu/)

Finding Meaning in the Face of Mortality

I recently read an interesting article in the Wall Street Journal by Melissa Beck: A New View, After Diagnosis, highlighting a program on "meaning-making" at Memorial Sloan-Kettering for advanced stage cancer patients. The program is based on the seminal work of Viktor Frankl, Man's Search for Meaning, in which he suggests that people can endure any suffering if they know their life has meaning. Dr. William Breithart, who developed the program known as meaning-centered psychotherapy, explains that through the program participants are guided to "reconnect with many sources of meaning in life -- love, work, history, family relationships, and teaches them that when cancer produces an obstacle in one, they can find in one, they can find meaning in another". Results of a pilot study comparing "meaning-making" groups compared to traditional cancer support groups were encouraging in respect to decreased anxiety and increased spiritual well-being.

You don't need to have cancer to benefit from the exercise of reflecting on what is most meaningful in your life. We are generally too mindless and busy to notice! But it is never too late to stop, take a breath, and reflect on what we love.

Empathy vs Emotional Reasoning

Is there a difference between empathy and emotional reasoning? Michael LaFerney, PhD, PMHCNS-BC, believes that healthcare professionals often confuse the two, and this can often hinder or derail patient-provider communication. In the current edition of Advance for Nurses, Dr. LaFerney defines empathy "as the ability to understand another person's circumstances, point of view, thoughts and feelings." He goes on to explain that, "Empathy involves communication. Trying to understand what another person is experiencing without communication leads to interpretation without meaning. It becomes a mechanism of internal thought processes rather than an understanding of another's point of view or feelings." Dr. LaFerney describes emotional reasoning as "mind reading" on the part of the healthcare professional; unconsciously inferring one's own feelings, anxiety, or needs to the patient. Emotional reasoning is a lot faster for harried physicians and nurses than empathetic communication, because it does not require slowing down and taking time to truly listen to the patient. But as Dr. LaFerney points out it often leads to misdiagnosis and disconnection from the patient's needs, fears, or desires. The bottom line is MORE COMMUNICATION LEADS TO QUALITY HEALTHCARE.

What are your thoughts on empathy vs. emotional reasoning?

Medicine in the Age of Twitter

Dr. Pauline Chen poses an interesting question in her NY Times article, Medicine in the Age of Twitter: Does online social media help or hinder patient-provider communication? If you haven't heard about Twitter, it is a new social media platform that allows users to communicate via short, 140 characters or less, "tweets" to other users. I am intrigued about the possibilities of connection, but am wary of the lack of human touch. What do you think?

Letting the Patient Call the Shots

Today's New York Times has an interesting article written by Dr. Pauline Chen exploring what we, in the healthcare system, really mean by "patient centered care". Does the definition of patient centered care shift if we are in the role of patient or healthcare professional? In the article, Letting the Patient Call the Shots, Dr. Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Massachusetts, suggests that, “ We would all be far better off if we professionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.” Radical changes in our healthcare system will need to occur to allow this to happen, are we ready for such changes? What do you think?

Perfectly Happy?

Cognitive scientists who have conducted research on happiness have found that we are not very good at predicting what will make us happy. Ironically, chronic pain, constant noise can decrease our happiness dramatically and winning the lottery or achieving a life long wish often do not substantially increase our overall happiness. A recent Boston Globe article, Perfectly Happy, explores "happiness research" and its role in guiding priorities for social and health policy.

What do you think?

Quality of Life

Thank you to those of you who alerted me to a wonderful documentary series which aired on WBUR in Boston last week. It is beautifully written and produced, an informative view of the dilemma over end of life care in this country. The title of the documentary is Quality of Death, End of Life Care in America: Inside-Out. As I listened to the documentary I felt a more appropriate title might be Quality of Life instead of Quality of Death because even as patients, families and healthcare providers prepare for death, life continues. Perhaps our emphasis on what we DON'T want done at the end of life overshadows what we DO want done? I read an interesting article recently that proposed changing the terminology of D.N.R. (Do Not Resuscitate) to A.N.D. (Allow Natural Death). Is there is a difference in your mind between these two statements, or do you feel it is only semantics? This is difficult topic to wrestle with but one that is growing in prominence in the health care world as we confront a rapidly aging population as well as staggering healthcare costs.

Healing Music in the Neonatal Intensive Care Unit

Sometimes healing comes through low-tech interventions in high-tech medical environments. That thought resonated with me when I came across an article in the McAllen Chronicle, describing the work of Dr. Anatoliy Ilizarov, the medical director of the Neonatal Intensive Care Unit (NICU) at Mission Regional Medical Center in Mission, Texas. As you can imagine, stress is rampant in a NICU, for staff, families and the tiny, fragile patients. Dr. Ilizarov, a trained classical pianist, began streaming music into the NICU to help reduce stress, and discovered that the premature infants began to gain weight faster, and began to feed earlier. Staff and families felt more relaxed as well. Dr. Ilizarov theorizes that the beat of the music, between 60-80 beats per minute, mimics the mother's heartbeat while the infant is in the womb. I was struck by the simple beauty of this intervention, a doctor who is a pianist using his gifts of art and science to heal gently. Good work, Dr. Ilizarov!

Stress So Bad It Hurts

An article caught my eye in today's Wall Street Journal..."Stress So Bad It Hurts -- Really" by Melinda Beck. The article presents a patient's perspective on being told that chronic physical pain is caused by stress and it is "all in your head". Without further explanation, the patient feels indignant and angry that the health care provider does not believe their pain is "real". The medical community is slowly becoming more comfortable with the notion that psychological stress can exacerbate and even produce physical pain in individuals. Yet, we currently do not have a health care system that is set up to be multidisciplinary in response to chronic pain. There are initiatives going on around the country that begin to address multidisciplinary ways of dealing with complex pain issues. I am currently involved in graduate work at Tufts University School of Medicine's Pain Research, Education and Policy Program, the only one of its kind in the United States. As an initiative to share information and dialogue about pain management, we have started a blog (http://www.go.tufts.edu/pain) on the complex subject of pain research, education and policy and would welcome your voice. I hope that as President Obama considers health care reform, we as health care providers and consumers take on a vocal role of advocating for a multidisciplinary approach to true "health" care and not procedure oriented "illness" care. Only when we begin to acknowledge the innate connection between the body, mind and spirit will we truly begin to understand the complexities of the human body.

I would love to hear your thoughts!

Wellness Care Moves onto the Radar

The Institute of Medicine has taken a step in the right direction by beginning to advocate for putting integrative medicine on Congress's radar this year. With a new focus on health care dollars and economic use of limited funds, it only makes sense to begin to look outside standard disease based care and at more integrative models of good health care. "Health is more than the absence of disease", said Dr. Ralph Snyderman who is heading up a three day meeting of the Institute of Medicine on the topic of wellness and integrative care.

Kudos to the Institute of Medicine for beginning to view the many aspects of quality, health care as more than just a disease based model. Read the Boston Globe article "Doctors Move Wellness Care onto the Radar" on this topic.

I would love to hear your ideas about how we can create a new model for quality health care in our country.

Become a CMO...Chief Motivating Officer

Motivate Like a CEO...I love the title of the book that came across my desk recently, written by my colleague Suzanne Bates, but I was a bit skeptical as how this book would be relevant to folks outside of the corner office. However, as soon as I began to read Motivate Like a CEO, I realized that Suzanne's message is universal to anyone who needs to communicate and motivate a team to be more effective, productive, and creative. Communicating a strong sense of purpose, connection and shared goals creates an environment for inviting change and growth; qualities necessary in education, health care, business, politics, and life. For those in health care, think of how helpful it would be to be a more effective motivator and communicator with patients and families; helping to change behavior and lifestyle. For those in education, imagine the positive impact of inspiring students to work toward common goals. The opportunities to use these strategies are numerous and extend much farther than the traditional corner office. Motivate Like a CEO is clearly written and filled with strategies for becoming a CMO...Chief Motivating Officer. A must read for any leader or potential leader!

On Monday, January 26, Suzanne Bates and a number of experts and authors in the fields of business, communication, consulting, stress management, health care, and education will come together to offer special bonus gifts to those of you who purchase Motivate Like a CEO on that day. Stress Resources is pleased to be the stress management firm selected to offer a valuable bonus to book purchasers. What a great way to add an invaluable book, Motivate Like a CEO, to your business library, and also take advantage of a myriad of complimentary bonus gifts from noted experts. To find out more about this one day offer, click here: http://www.bates-communications.com/motivate-bonusoffer.php

Let's Get to Work

Today I joined with millions of others from around the block and around the world to witness an amazing moment of hope; of picking ourselves back up, dusting ourselves off, and beginning again the remaking of America. President Obama has set before us this challenge...will we accept it? I know I am up for the opportunity to help redefine our collective vision. Will you join me in making a difference? My good friend and colleague Dr. Harvey Zarren, president of the Integrative Medicine Alliance beautifully articulated what so many of us felt today. With Harvey's permission, I share with you his words:

"Know that now a torch has been passed, turning away from fear and into
hope, turning away from coercion and into invitation, turning away from
insulation and into brotherhood, and turning away from the oppression of
privilege and into the responsibility and possibility of
humankind.

The question is raised and the challenge has been
offered: can we, each of us, starting within ourselves and then in all our
relationships and all our positions, can we carry that vision forward with
courage and curiosity, persistence and humility, love and the conviction of all
possibilities?

Let's continue working at the new vision with all
the capabilities and all the energy that we possess and of which we can
conceive."

Thank you, President Obama, thank you, Harvey...now, let's get to work!

New Year...New Possibilities

"Now let us welcome the New Year,
Full of things that have never been."
Rainer Maria Rilke

Welcome to the new year, a year of new possibilities. Thank you to Pat T., who reminded me of the above quotation as the old year passed and the new year was born. As we in the north bundle ourselves under many outer layers, perhaps this can also be a time of examining the inner layers of our lives and exploring this new place of opportunity, of freshness, that exists in 2009. Inertia is easy, unfolding into new ways of being is challenging...I wish you a new year of challenging exploration!

E Pluribus Unum

As is our annual tradition in our Concord, Massachusetts neighborhood...we gathered together, assembled and lit 1200 candles to glow into the winter night. As each family lit the candles in front of their house, the individual small flickering flames joined together in the cold winter darkness as one cohesive glow illuminating the neighborhood. This tradition seemed especially appropriate and poignant this year, as we, together, face challenges and new beginnings in our country and world...e pluribus unum...out of many, one.