Wellness Committee

Summit Physician Wellbeing

Posted on Jun 1, 2021 in Wellness Committee | 0 comments

Cultivating Emotional Balance

  • An Important Strategy for  Coping with Stress and Finding Joy in our Work!

Our work is full of time pressure, life and death situations as well as amazing opportunities to see the depth of the human condition.  We are not taught any strategies the help us cope.  I have stumbled upon a great one.  Dan Siegel, a  Harvard psychologist,  developed this idea he calls  “Name it to Tame it”.

Simply naming an emotion is a great way to get control over it.  Functional MRI show that when we name an emotion the activity of the brain moves for the arousal areas of the limbic system where we really feel the heat of the emotion to the prefrontal cortex where appraisal happens and with this, calming neurotransmitters are released to sooth.   Simply naming the emotion helps put out the fire and gives us some control.  Moving our thoughts away from the source of the emotion to the emotion itself can help stop ruminative thoughts that can be fuel for the flames.

The first crucial step is paying attention to our emotions which, at least for me, I was not in the habit of doing.  Emotions are an embodied phenomenon.  We feel them.  Paying attention to our body is a good way to help us recognize what we are feeling.

Interestingly, when we are feeling positive emotions, naming them helps us appreciated them more; the good get amplified!

Give this a try.  It doesn’t take any extra time and with some practice I am sure you will notice the benefits!

The link below is to a longer essay I wrote on this for the society of hospital medicine.  In it, I describe how I used this technique on a tough day on our Covid unit last winter.

https://www.the-hospitalist.org/hospitalist/article/240455/coronavirus-updates/cultivating-emotional-awareness

And look for more Celebrating our Physicians post in June!

Leif Hass, MD
Summit Wellness Chair

Patient Experience

Posted on Jun 1, 2021 in Wellness Committee | 0 comments

At ABSMC We Live a Life of Purpose!

Posted on Apr 6, 2021 in Wellness Committee | 0 comments

Walking toward our Covid unit at 7:30 on a Saturday morning, I passed a very ill patient being urgently transported on a gurney.  With an RT bagging and couple of all PPE’d-up nurses   pushing, this frantic caravan moved the patient towards the ICU.  When I arrived at the nursing stations a moment later, the team there had just figured out the staffing for the day. “Linda and Marina, thanks so much for staying over and working a double” called out Tola the charge, “And Claire, thanks for staying over to help with that Rapid Response call.” Even the nurses who just arrived already look tired with their glasses steamed up and their shoulders hanging low.

They turned and got to work as I stood still taking it in. These exhausted nurses were getting at it because there was work to be done.

“I wish you all could see it with my eyes.” I said, “You are all amazing and you might not even realize it.  Well, I have to tell you.  Our community thanks you.  The medical Staff thanks you.  Your nursing colleagues thank you.”

“As thanks, let me offer you this.  Something so obvious we tend to forget it around here.  You live a life of purpose! You believe in taking care of the elderly, the sick, the disenfranchised.  You believe that people take care of people, because that is what human beings do, because that is how we build a just and beautiful society. You sweat and hustle and breathe all day through N-95s because that is what a nurse has to do to serve in the pandemic. Looks like we need better staffing and you could all probably use a cup of coffee, but I offer you this because you should have great pride in what you do!  Tell your friends and family that you live a life of purpose.”

A little embarrassed by my preachiness, I then shut up. But I felt compelled to tell them. It is true and it is something we all need to hold in mind as we grind through this awful pandemic. I tried to slink away but the team was energized now. “You are right; we don’t think about it and people don’t often remind us of it either. Thank you so much!”  Phones came out and we did socially distanced selfies.

I had been feeling crispy myself the week before when I got a text from my friend Ray. Ray is a wonderful human being and a person whose life is inseparable from his faith.   Every couple of weeks, I get a text from him.  On that morning the text said, “Have a great day on purpose!”  I had heard that playful pun-like phrase before, but going to work, to work caring for some of the sickest and most vulnerable people in the east bay, it didn’t feel trite that morning; it felt profound.   My purpose was my path to make a potentially tough day a work into a “great day”.

That night, I started doing a little reading about purpose and got even more fired up!  Dacher Keltner who co-teaches UC Berkeley’s class on happiness says, “a sense of purpose is possibly the best predicter of a life well lived.”  Developing a sense of purpose is one of the keys to happiness.  Nothing predicts performance and satisfaction at work as much as having a sense of purpose.  An entire industry has developed to help people find a sense of purpose at work. Why had I lost sight of this sense of purpose in my work?

Turns out that perhaps I had started to fall into common trap. I started to equate wellbeing with thoughts about one’s self. While working on ourselves is necessary, it could be a life time before I get myself “dialed” just right. It seems those community focused, hardworking ideals that got me into medicine in the first place, ideals that seem naïve at times now, are fact right.  Our years of study and training to earn the right to care for the most vulnerable in our community is something to be very proud of and should be a driver of our wellbeing.

Purpose is energizing and motivating.  Purpose won’t empty your inbox or get the OR to run on time, but it can put gas in our tanks, and we all need that from time to time.

Perhaps the purpose in our work is so omnipresent we lose touch of it.  Perhaps it is the relentless emotional content of the work or the irritating administrative tasks that blind us to it as well. Perhaps there is an important sense of humility, too.

Yet we can hold these notions in our minds and hearts at the same time: Ours is a life of service and purpose.  We accept the responsibility with humility and a tender heart. As an institution we should have a sense of full-chested pride.  And with each other, we should remind each other of our purpose.  When we have those late-night phone calls, those tough conversations with patients and those grueling days we need that pride in our purpose to turn our sacrifices into a great day.  Thank you for living a life of purpose and all you do to serve our community!

Leif R. Hass, MD
Summit Wellness Chair

Two ends of the Covid Cove

Posted on Feb 1, 2021 in Wellness Committee | 0 comments

Two ends of the Covid Cove

Ms. A was an 85-year-old woman who always clutched her rosary and had a traditional Central American shawl on her bed.  My Spanish is not great, but I understood her prayer when I entered the room.  She had come in the night before with cough, fever and shortness of breath.  She had tested positive about 7 days before – so had all the people in her multigenerational home.  Her o2 sat was 95% on 5l nasal canula, so over the phone, I felt comfortable reassuring both her and family that she would likely do well.  All the time Ms. A said she just wanted to go home.

Down the hall was Mr. D; he was an 81-year-old former Vietnamese “boat person” refugee.  He had experienced cognitive decline and weakness for a couple of years and went into a snf 6 months before the “lockdown.”  He had come in 3 days prior to my coming on service.  While he didn’t talk even with an interpreter, he ate well and had looked comfortable for days on 45% O2.

Each day the hard-working nursing staff on the unit, donned their sweaty blue plastic robes, face shields and N-95s and worked to feed, bathe and provide medicines.   And of course, we all relied upon the RTs who essentially managed the all-important oxygen for us.

Ms A’s o2 needs crept up each day as did her anxiety and the plaintive tenor of her prayers and enquiries about going home.  I got a priest to visit, not for last rites but just for some support.  I backtracked on prognosis with the family. 

4 days into her stay she needed 95% O2 and with that her pO2 was only 70.  I told her family it seemed the virus would likely claim her life shortly.  I said we could see how she did on 60% – that’s the max she could get at home with hospice.  If she did ok with that, she could get home which was clearly her wish.  I called them after 2 hours on 60% to tell them she was up eating and despite a low sat and slight increased resp rate, she looked ok.  “Can you guarantee that she would not make it if she stayed in the hospital? “

“I am sorry, but this is such a new disease, I can’t say that for certain.” I replied.   Feeling bad about it, the opted to have her stay in the hospital.

Down the hall Mr. D had stopped eating.  First it was dinner and now it had been a day and a half without food; also, his sats dropped as did his bp.  A nurse exited his room; despite the mask and steamed up glasses, I could read her body language.  “That poor man is dying.’ She said.  I told her I agreed and called the family with the news and to offer them a chance to visit and to talk about home hospice. 

“He has not seen any of us in 10 months. We would love to visit and talk about bringing him home on hospice.”  The next morning 4 of his 9 kids showed up with a quart of jook, an Asian rice porridge, for him and pastries for the staff.

They left the room smiling an hour later. “He ate all the jook and he smiled!  Yes, let’s work on home with hospice.”  That night he bp was better and we were able to move him to 8 liters oximizer and the staff agreed he looked much better.

The next day Ms. A was less responsive with sats in the 80’s, but still had this great sense of warmth and dignity about her.  Family was able to visit and when I walked in the room, Spanish catholic hymns were playing on a phone, her two children each had hand and, on an iPod, there was a chorus of tears.  20 family members were all crying on a Zoom call.  Together this made the most beautiful soundtrack to an end of life I have ever heard. I tried hard not to join the chorus as we talked about turning off the oxygen to help limit her suffering.

With the help of Sara, the RT and Kamal, the nurse, we added a bolus of morphine to her drip and removed the oxygen.  She looked so much more beautiful and peaceful without it.  Briefly, she closed her eyes then opened them, her breathing calmer.  And with the hymns and the chorus of her crying family, she lived another 20 minutes in the loving presence of her big family.

Meanwhile, down the hall, Mr. D’s family arrived in great spirits armed with more food for patient and staff.  He was to go home later that day with hospice.  When they saw him up in the chair without the oxygen, they said, “It is a miracle Dr Hass!  He is going home on hospice but having beat Covid!  We can’t thank you enough!” 

“Don’t thank me!  He was cured by love and jook!  What a lesson for us all.  Sometimes there is no better medicine than food from home and love!”  All bursting with joy, we shared some “elbow love” and took some pictures before he was wheeled home.

Back at the nurse’s station, there were tears. Sometimes life is so full of emotion that it is hard to give it a name – joy? grief?  Our bodies almost pulsing, our minds searching for words, it is as if an ancient process is marking a time and place in our souls.  “This is what it is to be a human being living with love and creating meaning” the experience seems to be telling us.

All I can say is “Well everybody, thank you all for your efforts. And isn’t this amazing work!”

Leif Hass, MD
Summit Wellness Chair

Cultivating a Sense of Gratitude – Learning to better appreciates of gifts of a healthcare provider

Posted on Dec 2, 2020 in Announcements, Wellness Committee | 0 comments

2020 has been an incredibly tough year: COVID-19 rages across the country completely altering the way we work and live and putting our lives in danger, then there has been all the political and social unrest.  Yet as we approach the time of year when we traditionally seek a sense of gratitude, there is still much to be thankful for.  Those of us with ABSMC have been able to get paid, get out of the house and, I hope, have health in our families.

While our work is meaningful, finding the moment to moment, patient to patient sense of gratitude is not always so easy.  When I talk about healthcare and gratitude, I often hear, “Yeah, I wish my patients were more grateful for all I do.”  While I understand this sentiment, it misses something fundamental in the provider patient relationship. To develop a deep sense of gratitude as a provider, it helps to understand the cycle of gratitude.

Robert Emmons, a leading researcher of gratitude, defines gratitude as a recognition of the gifts that others give us, a recognition of the source of those gifts, and an appreciation of those gifts.  The good feelings that follows lead grateful people to “pay it forward”.  So, gratitude is not a simple emotion but a virtuous cycle that perpetuates giving and goodwill. If we consciously think about this cycle as we move through our day, we can foster a sense of gratitude that can transform our experience of work.

The tricky and counterintuitive part of the cycle for providers is recognizing the gifts.  Who is doing the giving? And what exactly are the gifts? Aren’t we the ones prescribing meds, offering advice and performing procedures?  We are the ones doing things in the encounters so it is easy to see why we can fail to see that the real story in healthcare is the patient’s life and thus we miss the gift that is the beauty of the lives before us.  Witnessing firsthand the struggles with serious illness is as rich and as humanizing an experience as life offers; being able to heal in this setting transforms this rich experience into a profound privilege and a gift.  These gifts can be missed if we don’t take the time to recognize them.

To best appreciate the gifts, we need to receive them properly and that means calming the stress-driven sympathetic nervous system and activating the connecting parasympathetic nervous system. We can do this with just a deep breath or two.  When calm, the Vagus nerve can be activated by receiving the gift and we get the visceral, embodied, good “feeling” that serves to physiologically reinforce the behavior. We experience this as warmth and expansiveness that facilitates our desire to reach out and give ourselves in turn.

We all know the beauty of this cycle of gratitude – leaving a patient’s room with an up-lifting sensation, feeling eager to open our heart to help our next patient. The goodwill and joyful feelings are especially useful when we have those challenging encounters that can pull us down the path of anger and frustration. This is why gratitude might be our most powerful antidote against burnout. With gas in our tank and a desire to pay it forward, we can better handle tough patches we inevitably face. Not only that, but by fostering the ability to see the beauty in our patient’s struggles, we can more easily detach from the interpersonal challenges that arise in some clinical encounters.

Gratitude is at the heart of all of the world’s great religions; I think we have all heard that “gratitude is good for us.”  In fact, there is a rich field of research with hundreds of studies that demonstrates this intuitive fact to be scientifically valid.  We can all call upon a sense of gratitude when we think about our personal lives and feel the sense of connection and humility it inspires.  If we learn to see each patient encounter as a profound privilege and a gift, our work can be transformed into a spiritual practice abounding with gratitude and purpose.

2020 has taught us much: the need for community, the importance of working together as a society and it has reaffirmed the importance of our work.  If we take the lessons from 2020 and use this Thanksgiving time to learn how to foster a sense of gratitude at work, we will indeed have much to be thankful for. Our lives and those of people we care for will be richer for it.

Lief Hass, MD
Wellness Chair – Summit Campus

To Our Patient Experience and Our Experience

Posted on Oct 1, 2020 in Wellness Committee | 0 comments

To Our Patient Experience and Our Experience  

You may have seen the signs and the posters in the doctor’s cafeteria that went up a few weeks ago. There are couple.  One is a in the form of a “thank you letter from a patient”, another that says, “Relationships are Central.”  While the idea for these posters was generated by the Patient Experience Team, the Wellbeing Team fully embraces the effort.

We are living in a world with so much uncertainty.  I had been busy, perhaps thoughtlessly so, living my life these past years under the assumption that things were going to keep moving along as they had been, but it is hard to make any safe assumptions about the future these days.  It is not clear how and when the corona virus pandemic will resolve; the divisiveness and inequality in the country is disturbing; meanwhile, the health of the planet appears to be deteriorating faster than we thought possible.

The one thing that is certain is the present moment and the one thing we control is our actions in that moment. It is easy to lose sight of this with so much to preoccupy our minds. Here is how we do it.  We need to slow down, keep present and see how the person in front of us is feeling. Then we thoughtfully engage.  This goes for conversation with colleagues, staff and importantly our patients. As we acknowledge the struggles of our patients, our compassion naturally flows and in a virtuous cycle, we are energized and eager to continue to serve. This is how we strengthen friendships, build institutional culture and give our patients the best kind of care. Care that not only mends the body, but touches the soul.

As we need food, water and shelter, relationships are essential to human beings.  Heartfelt genuine connection is our fuel and our path forward in these uncertain times. “Relationships are Central;” let’s stay present to make the most of this one thing we can control.

Lief Hass, MD
Summit – Wellness Chair