Wellness Committee

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

Love and Loss – Coping with Our Emotions in the Era of Covid-19

Posted on Aug 5, 2020 in Wellness Committee | 0 comments

Love and Loss – Coping with Our Emotions in the Era of Covid

For those of us who work on the nursing units at ABSMC, the death of Janine Paiste-Ponder was a body blow.  An amazing nurse, teammate, human being gone suddenly, and she died in our ED. Wow, still shocks me as I see it in print now.  

“Feelings” are feelings because they are an embodied phenomenon.  Emotions are not just in our heads they are in our hearts and bodies.  The loss of Janine has felt like a body blow because I felt so many powerful emotions – some at the same time, sometimes different ones in waves.

Covid continues to turn the world upside down.  Previously, death for me has meant grief. With Janine’s tragic death from Covid, I imagine that many of you felt many more emotions: shock, anger, fear, love and awe in addition to grief. Understanding this might help us cope with our emotions.  In doing so, move forward and heal ourselves with the help of those in our community.  Perhaps, we will be stronger as a result.

Why all these emotions? I am not typically a fan of war analogies, but emotionally this might be the best one we have for facing Covid. We didn’t just loose a friend or co-worker.  We lost someone who was living by her values, putting her life on the line to protect others and our way of life. 

The emotions we are feeling? We are angry at the appalling response of the federal government.  Angry that those who think Covid is just a Democratic Party conspiracy.  Angry at those in this country who are not masking and then want us to put our lives on the line to care for them when they get sick!

We are feeling fear. Her death has moved the virus’s virulence from the abstract to the real. Everyone is more afraid for themselves, for their teammates and families.  Coming to work now is harder as a result.   The virus doesn’t feel “out in the community” now with our PPE to keep it at bay; it has penetrated us.  I know my risk remains small with proper PPE, yet even with my scientific self in the driver’s seat, I admit to quick moments of near panic as I doff and don.

We are feeling compassion.  Our hearts went out to our nursing colleagues who showed up to work last Friday, learned of Janine’s death and then set about doing their job: comforting, medicating, feeding and bathing those under our care. And of feeling of compassion flow each time we step on a nursing unit.  This type of expansive concern is the gift that loss brings and offers us a way forward.  We have lost a sister in the struggle and have a stronger sense of commitment for those still taking on the risk to serve.

It can be overwhelming; we are being buffeted between fear, grief, frustration, anger and compassion – anxious and ruminating all the while.

What I have learned about the “Science of Happiness” is that many of our ideas about a happy life are misguided.  A meaningful life is not one where we avoid negative emotions, but one where we learn to properly take them in as part of an emotionally rich life.  Few things make you feel more alive than profound grief – not a joyful sensation but one is certainly not numb!  We need to take in the negative emotions; we need to sit with them, at first without searching for someone to blame or for solutions, and then we come together to make meaning that takes us forward.

At Summit, now our job is to feel all these emotions.  Sit with them individually as we treasure our loved ones at home. And we need to experience them collectively at work with one-on-one conversations and larger memorializing events. This is how we build stronger relationships, how we create a more connected community and a shared sense of purpose. Then we can work together with open hearts to better face the continued challenge of this virus.  Those of us who knew Janine understand this is how she would have wanted us to move forward.

Leif Hass, MD
Summit Wellness Committee – Chair

How Can We Live and Practice and this New (Awful) Normal? With Attention to Connection!

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

Well, I think we have all had that huge sigh of relief that Summit didn’t turn into Brooklyn’s Elmhurst Hospital west, but now here we are with this new awful normal: masks, gloves, social distancing, fewer patients and still plenty of COVID -induced anxiety to go around.

We may not be acutely afraid that we are going to die, but prolonged low (medium?) level stress is toxic.  What is not immediately apparent is that we are not just stressed, but we are losing much of what fuel so and builds resilience at work.  We can’t touch or even get near our great teammates.  We can’t see each other’s face.  Much of what keeps us going happens at an unconscious level: we see a smile we smile, we reach out and grab a patient’s hand and we feel our compassion flow. There is a virtuous cycle, a positive feedback loop where our sensations and proc-social emotions activate and amplify themselves.  The masks, the gloves, the distance, the anxiety all interfere with these and leave our work feeling just not the same.

To prevent the worry about infection, the financial stress, the frustration about political leadership from taking us on a downward spiral, we need to jumpstart positive spirals.  Since much of the external stimuli is missing we need to consciously think about using what we do have – and maybe even in a little exaggerated way.  We need to use:

  • Touch (with gloves, as we can) to convey connection
  • Body language that adds emphasis to our message and our
    emotions that may go above and beyond what we are used to
  • Tone of voice that enhances our words
  • Talk that emphasizes the big stuff, such as love, fear, connection and community when we talk to each other and our patients.


A poorly appreciated silver lining of disasters is that is frees us from our private never-ending stressors and give us a common goal that is only met through acting together.  We have a great culture here at Summit.  If we pay attention to what connects us to our patients and each other, we can come out of this craziness with a stronger more resilient medical center.

Lief Hass, MD – Wellness Committee Chair

Well-Being Checklist

Posted on Apr 2, 2020 in Uncategorized, Wellness Committee | 0 comments

We are all struggling to deal with this unprecedented outbreak.  I wanted to share with you a Well-Being Checklist  I created with the guidance of colleagues at Berkeley’s Greater Good Science Center and a longer reflection on how we might deal with this stressful time.

1. When in doubt take few deep breaths and slow down
2. Appreciate our teamwork
3. Find beauty in those we care for
4. Let your compassion flow 
5. Look for the gifts that life offers
6. Take stock of the people in your life and check in on them often
7. Hug those you can
8. Get outside and smell the roses
9. Move your body and get some sleep

Stress, Anxiety and Well-Being in the Time of Covid-19

1. Let’s keep the existential threat in perspective.  Let’s go to the big question that crosses all of our minds.  Am I going to die? We are use to the idea of pathogens surrounding us, but this threat is on a different level and rising death tolls and worried families makes it feels a lot worse.  Doctors describe feeling “radioactive” and are making up their wills. It is important to look at the data and not the news stories of deaths without a denominator or circumstances of the infections (no PPE) . First of all, we are now taking universal precautions – all masks all the time now. If we take a high number of 10% healthcare worker infection rate ( it was much lower in Hong Kong without universal precautions) and a high death rate from infection of 5%, the chances of dying from COVID-19 is 1/200.  If the numbers are 5% infection rate and 2% mortality, the chances of dying from it is 1/1000.  If I got on the bus to Cache Creek knowing my chances of winning was 199/200, I would feel pretty good about it.  Something to keep in mind when your brain, like my mine, starts spinning out of control in moments of worry. 

1. Anxious, Stressed? Of course, we have good reason to be! Anxiety can have this negative connotation of repetitive thought patterns and wasted energy, but when we have to process an unprecedented event and ever-changing data, anxiety is an appropriate response.  There is a lot we need to learn and there is new information daily!  It takes time absorb it and then process it.  However, we can slip from productive processing to unproductive ruminating pretty easily. Self awareness can help us see the addictive nature of the computer and social media. When this happens, it is time to change the channel and utilize our social support systems to move our thoughts away from the news.  We also need think about mindfulness and other self-care tools.

3. The answer?  It starts with the breath.  The best way to quiet our minds through the breath. A single deep breath will decrease sympathetic tone.  And if you take a few, focusing on the breathing as you do so, you can begin to calm the mind as well as the body.  This is basis for most mindfulness practices.  Research has shown that those who do even brief but regular breathing meditation get back to a calmer nervous system faster after a stressor than those who don’t.  Part of this is just learning to pay attention to our bodies and thus notice and let go of the tensions that build up.  

It is inevitable while working these days to have a mind racing with ruminations about lack of PPE and insufficient testing and worries about what is next.  For me sometimes this happens to the point that I am not paying as much attention to what is actually happening right now, right in front of me.  And that is how errors with doffing and donning happen.  Even just a single deep breath helps! Practice makes it better; I have found that my 5 minutes of meditation most days – a  practice of being in the present moment – allows me, at least for a moment, to stop the fretting and see more clearly what I need to do right now. With a sense of calm, I then carry on. 

4. “Never waste a good crisis!” I am not sure who said this first, but crises can lead to change.  For many of us, well-being practices have gone from feeling like a luxury we don’t have time for to anecessity.  So take this opportunity to start a practice which will benefit you a lifetime.

For those interested in a breathing or meditation practice.The headspace meditation app https://www.headspace.com/ is free to physicians for the rest of the year.  I like  https://insighttimer.com/ and it is always free.

There are other easier well-being practices like gratitude, connecting with friends and looking for the wonder and beauty in our lives. There are many easy tools to develop these types of practices at the Greater Good Science In Action site https://ggia.berkeley.edu/.  

5. Gratitude in the time of COVID.

People who study gratitude talk about the idea of hedonic adaptation – you get use to stuff going well so you take it for granted.  Well, nothing like a pandemic to make you realize how good things have been. Now I am saying thank you to those who grow the food, make the toilet paper, pick up the trash and make it so the internet and lights go on every time I push the button.  I am sure we all are taking stock of the important relationships in our lives and in so doing, feeling gratitude for them as they grow.  And at work, we all appreciate the support we give one another and the incredible leadership we have.  So be sure to deliberately count your blessings everyday!  We do “three good things” at the dinner table to share good things that have happened.

6. “A Paradise Built in Hell”. 

In her fantastic book, San Francisco based writer Rebecca Solnit describes how disasters often allow people to be their best selves: to act with generosity, and selflessness, to make community, to find courage, and to act with purpose that can elude them in the day to day when we are lost in the routine and more focused on ourselves. If we take a break from the grim statistics on Twitter, we can find much of this inspiring behavior on social media:

Here is a card passed out to  help neighbors in need

Here, People singing with their neighbors in Spain:

Some of the love is directed toward healthcare providers like the people of Madrid cheering for healthcare workers:

The tension at work can make it hard to see, but we can see the heroic work of everyone at the med center – from the nurses who continue to provide the gentle loving touches our patients need, to EVS who is diligently killing the bad guys, to the leadership teams that has expanded the med center’s capacity and changed workflows practically overnight! 

7. The Science of Happiness: Concern for others ->Meaning ->  Purpose-> Service-> Happiness.  We all need time on the beach with a margarita (or a corona?!) in our hand, but the research compiled by my colleagues at the Greater Good at Berkeley come up with a  surprising at is in line with religious traditions: concern for others is the key to a meaningful life and a sense of overall happiness with one’s life.  The research suggests that finding meaning and acting with purpose are the keys to happiness. We intuitively know it having chosen this work, but we often fail to appreciate it. Now is time to take this in: We are dedicated to serving the most vulnerable members of our community.  We save lives everyday. 

Despite our concerns, we understand we are privileged to be part of the solution to this crisis. Taking care of our community is what we do.    We open our hearts to strangers and treat them like family. We live with purpose.  Keeping that in mind may be the best thing we can do for ourselves in the time of COVID. Now is a time to feel pride in our work and to live life with a real sense of meaning.  

If we take care of each other and learn to take better care of ourselves, we can will find deep satisfaction in our work and our lives even as we confront this pandemic. 

Happiness = love+ fun+meaning and purpose!

8.  Famous last words: Fear of things getting out of control has rightfully driving much of the anxiety.  Thankfully, the infection curve remains relatively flat and we have only a week until of social distancing should kick in. We appear to be ahead of the curve in terms of preparation in the East Bay.  We have learned from the mistakes of others and  we have had valuable time to prepare.  Everyone from the state, local government, big Sutter and especially our local leadership has done an amazing job. We need more PPE, clarification of new work-flows, more capacity, more vents, a palliative/ fever unit and guidelines for palliating those at extreme risk –  all of which are happening now.  With these steps in place, our great team of hospitalists will be safe along with the rest of the med center staff.  Importantly, our community will get the care it deserves, too. Of course, we are not there yet, but I think we can have a certain degree of confidence that we will be pretty well prepared when things inevitably heat up.  

Thanks for being great teammates and all you do for our community!
Leif Hass, MD