Attending

I just finished reading Attending by Ronald Epstein. In this book Dr. Epstein talks a lot about having presence as a physician. Presence here being more than physical, but emotional, intellectual, and “spiritual” as well.

As I’ve mention in a previous post, I received this book from a mentor and friend of mine who I met through Doctors Without Walls. When I started volunteering with the organization, I really knew nothing about street medicine or people experiencing homelessness. As the story goes, after a few weeks I fell in love with the organization and the people I met through it, patients and volunteers a like. For a long time I wondered what it was about those first few clinic days that made such an impression on me and inspired me further to go into medicine. I feel like I always had an idea and this experience is something I have written and talked about numerous times in applications and interviews, but it was always kind of vague. I would talk about how I was inspired by the team of volunteers and was motivated by compassion towards the patients, but this book has given me new language to talk talk about this experience more specifically.

What impressed me most all those years ago was the presence of the volunteers. Working in street medicine, not only benefits from, but in fact requires you to see a patient as a whole person. If you plan to have any level of success in treating someone on the streets, you have to know their whole story; where their from, where they sleep, what they do during the day, who they hangout with, what they know, what they don’t know, how they get around, where they get money, what resources they utilize (or don’t utilize), etc.

One could argue these are all things that should be a requirement for working with any patient, but I think when working in clinics or in specific environments, a lot of these factors can be taken for granted or are deemed socially inappropriate to talk about. And why I think it was hard for me to articulate all of this before is because when my senior volunteers were present with patients, it felt so seamless and natural that it didn’t feel like anything special was happening, which is ultimately what made those interactions so special, it was just a conversation.

This is the exactly presence that I think Dr. Epstein is talking about and that which he proposes we bring into all settings as healthcare providers, as physicians (who are stereotypically lacking in this area, at least in recent history), and just as people.

I feel extremely fortunate to have had such amazing examples of this presence prior to starting medical school, one of whom passed away this past week. So this goes out to you Fr. Jon, a beacon of compassion and a truly unforgettable presence.

Healthy Anxiety

Anxiety is one of those emotions whose connotation is almost exclusively negative. Anxiety is something we try to avoid, and to have anxiety may give off an impression of weakness or mental instability. On two separate occasions today I was presented with the idea of healthy anxiety; once in the meditation app I’ve been using and once in one of my psychiatry lectures. In lecture, healthy anxiety was defined as a normal human emotion which provides important information to make decisions and energy that empowers us to act.

Anxiety contributes to my motivation to get work done. It contributes to me satisfying basic necessities like hunger and thirst. Without any anxiety there would be no drive to do anything. Of course in some cases emotions can be “pathological” if you are experiencing too much or too little to the point where it impairs your “normal” functions (which is why we are learning about it), at which point of course it is worth seeking help.

From a meditation perspective, the goal I think is to be able recognize “negative” emotions like anxiety without judgment, or even with a sense of appreciation. Having some anxiety is not necessarily something to be stressed about, but something to be acknowledged.

This block in neuroscience has been a good reminder that the full range of human emotion serves a purpose, even those which are typically seen as negative (otherwise we probably wouldn’t experience it). This has been an important realization for me, especially recently as I’ve been feeling a little more anxious than normal for different reasons, and being prompted to take note of that anxiety and just let it be in my meditation sessions has been helpful.

The Fastest Way to Board a Plane

There are studies and simulations out there that show that the traditional method by which we usually board a plane, back to front, is not the fastest way. A while ago Mythbusters saw that back-to-front board was even slower than purely random boarding. In their experiment outside-in boarding was even faster, and unassigned seating was the fastest. Of course Mythbusters doesn’t operate under any standards of statistical analysis or verification of results, but intuitively these results make sense. The faster methods allow for parallel boarding; multiple people can be stowing their bags and getting settled simultaneously, whereas back-to-front causes a build up of people waiting for their turn to have access to the overhead bins.

Another more recent study (Popular Mechanics article on the paper) used 4D models and simulations to study other factors involved in plane boarding. Here they found that having “slow-boarders” go first is overall faster than allowing the “fast-boarders” to go first.

All these faster methods seem pretty straightforward and could be easily implemented in an ideal world. What they don’t take into account are individuals’ realities. If you have families travelling together, separating the children from the parents for the sake of a few minutes quicker board time doesn’t make all that much sense. Classifying passengers as slow and fast also seems like it can be potentially insensitive or just come with its own social issues. AND all of this assumes that airlines want more efficient boarding in the first place. Sure they may have costs associated with flight delays and such, but they also sell priority boarding at a premium.

So were the outcomes of these studies every really going to change how airlines operate? Probably not. Does that mean those studies were useless? I don’t think so. But I do think it is good to recognize that just because something is ideal on paper doesn’t mean it could ever work in the real world, and the limiting factor will almost always be the human factor.

Where Are My Feet?

I’m currently reading a book that a received from a mentor and friend of mine just before leaving for medical school; Attending, by Ronald Epstein. This book is all about mindfulness and the practice of medicine. Throughout the book, Epstein talks about different mindsets, attitudes, and practices that he has adopted or that he has seen that can benefit both patients and physicians, many of which involve taking moments to pause for introspection.

One such practice he mentions is in moments of anxiety or frustration, to stop and ask yourself, Where are my feet? And in doing so bringing awareness to your physical connection to the earth (or lack thereof), your surroundings, and the sensations and position of your body. It’s such a simple question that is very simple to answer, and both the question and the answer themselves seem mundane. But the mundanity is the beauty of it. When my mind begins to wander or to spiral, asking myself to bring my attention to my body helps me refocus and reorient my mind.

What I also appreciate about this practice is the metaphorical nature of it. Where are my feet? doesn’t only have to apply to my physical state, it also makes me think about where I am mentally and emotionally. Am I feeling grounded? What is keeping me grounded? Where are my thoughts? How can I get back on my feet?

Mindfulness

Meditation is one of the practices that is most associated with being mindful. I find it kind of funny that the goal of meditation is to clear your mind, to be mind-empty. Dumb jokes aside, I think the idea behind mediation, at least from my understand is something that I need to continue to work towards. I need to work on evaluating my thoughts and feelings without judgement. I need to work on improving my focus, but at the same time not get caught up in random thoughts sometimes. Recently I’ve been just letting my mind get away from me every now and then, but I am glad I have people in my life who help keep me grounded.

Outlets

Recently, I’ve been feeling like I’ve just got a bunch of emotions bottled up inside, but I don’t really have any outlets right now to let them out fully and comfortably. I mean I have this blog, but I can’t exactly be completely candid here. I have friends and family, but some of it isn’t stuff I wanna talk about with them. Given those, conditions I realize that it makes this post just seem like a cry for help or just kinda futile, but it helps a little.

Maybe I’ll take up boxing.

Killers

There’s nothing like a good burn. I was reading the YouTube comments on one of Conan O’Brien’s videos and there was a comment by a fake Jordan Schlansky (for the uninitiated) that said, “Rejection is such a small adjustment for Conan.” Even though its a fake comment and also obviously a joke, you gotta admit this is a pretty good insult. I love insults that feel so carefully worded or carefully crafted. There’s something about the irony of using mature language to make an immature comment that makes it all the more funny.

Optimized

Optimization… it has such a positive connotation; it’s something we believe we should all strive for. When things are optimized everything is running smoothly and efficiently. Productivity is maximized, and so are the profits.

But optimization itself is a process and so it too can also be “optimized”. A lot of times when we think about optimization it involves ideal conditions and an ideal world. The reality is that the world we live in does not operate under ideal conditions.

I was listening to some public health experts talking about the ongoing vaccination rollout against COVID-19. Logic and perhaps morality suggests that there are certain populations (i.e. healthcare workers and the elderly) that should be getting the vaccine first in order to minimize deaths. One of the experts made a point that I thought was important, and that I hadn’t really considered up until then: the logistics required for getting these populations vaccinated comes at the cost of the rate of vaccination, which results in slower roll-out and ultimately to potentially more deaths and further spread of the virus.

It can be easy to get caught up in optimization, especially since it seems like a universally good thing, but just like with any optimization problem, maximums (or minimums) can be achieved in more than one way in more than one place, you just have to find the way that fits within the parameters of the situation.

Novel

There are times when I end up deciding not to publish a post or write a post because I feel like (or know) that I have written about a specific idea before. I don’t want to be too repetitive and everything I write is supposed to be novel compared to what I’ve written before. Now you may be thinking, Well Niko, I’ve read a decent number of your posts and you seem to touch on a lot of similar themes pretty consistently, and that is true, it doesn’t always stop me especially if I feel like I have something new to add or if I just forgot that I already wrote about it. But I think it’s interesting that this is a source of resistance for me. Each time I sit down to write, whether I like it or not, I am going to be in a different headspace, a different person from who I was the day before (even if only marginally).