6

The Courage to Care for True Self

Self-care is never a selfish act—it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self, and give it the care it requires, we do so not only for ourselves but for the many lives we touch.

—Parker J. Palmer

In 2008, Dr. Mukta Panda was chair of the department of medicine at a nine-hundred-bed university hospital. She had just received an award for her dedication to teaching new doctors and her talent for creating innovative and effective residency programs.¹ But Mukta wasn’t happy.

“I was questioning my purpose, value, and worth. Two days earlier, I received news about a personal loss of twenty-five years. I was not sure of where I belonged.”

She was struggling personally and professionally. The politics and expectations of the department chair role no longer seemed aligned with Mukta’s values and gifts. When she had first taken on the role eight years earlier, it was with the goals of growing the faculty team, both in size and in their sense of collaboration, and nurturing young doctors. Over time, the role had come to demand more focus on fiscal issues, less on relationship. “And that’s not who I am,” she said.

Mukta explained: “The health care system today is very challenging. From every side there is change. As an educator and physician, I’m asked not just to take care of patients but to guide the future doctors. This challenge requires not just technical skills but my full human capacity, to connect that role with my soul.”

Burnout can happen to anyone at any time. Conditions are ripe in professions where you face intense competition, long hours, expectations of stoicism, and stigma around asking for help with emotional stress. And that can lead to depression, addictions, physical symptoms of stress, loss of meaning and purpose, and even suicidal thoughts.²

Even as she was working hard to help young physicians avoid burnout, Mukta had to tend to her own well-being. One of her first decisions was to accept an invitation to attend a Courage & Renewal retreat offered to the physician award winners.

Looking forward to the weekend retreat on her calendar gave her hope. Then the retreat itself was a pivotal moment. She saw how reflective practices with the support of community could draw forth one’s insights. She stayed up late into the night asking herself new kinds of questions: Where do I belong now? Who am I?

“Before the retreat, I did not have language or skills and did not know the art of how to have that conversation with myself. I tried but couldn’t get past the superficiality of what I was facing. It gave me a really different way to get past the layers of shame, blame, anger, and feeling totally unvalued.”

“It was surprising and energizing to remind myself of what I had written about in my medical school application, the reasons I wanted to be in a health profession, to be a doctor. I reconnected with who I am.”

Mukta realized that how we perceive ourselves and take care of ourselves is related to so many factors: How do we face challenges at work every day? How do others perceive whether we’re knowledgeable or not? How do we cope with negative or positive stimuli? She began thinking more about the link between self-awareness and resilience.

“The key is realizing you have to take care of yourself and know who you are. You must have an authentic voice to be able to take care of others—including colleague care, too.”

She also realized that the isolation of being department chair, especially given the changing focus on fiscal issues, was depleting her joy in medicine. Eventually she chose to step down and become assistant dean of medical education instead, where she could use her gifts to nurture the well-being of new physicians. She had fresh ideas about how to do so.

Mukta began holding weekly reflective sessions with two colleagues and soon also a resident who they knew was struggling. “I used the third things and reflection process with them. It was truly a circle of trust with the touchstones and confidentiality around it,” she said. It wasn’t long before they decided to offer the same sessions to their resident physicians. Medical students and residents enter their training with intense altruism and a commitment to care for their patients. But during training, they rarely have an opportunity to reflect on their emotional experiences.

To address this lack, Mukta created a program called Relaxing, Rejuvenating, Rejoicing in Residency sessions (RRRnR). For an hour each Thursday, they gather, without an agenda, and sit in a circle. A few moments of silence allow them to become fully present and to leave the rest of their lives behind. Mukta tells them, “If you have things to do, write them on a paper and tear it up. Now be present here in this room for the next thirty minutes of your life.”

People can bring a book chapter, a video—anything they want to share. The session is a safe space for residents to talk about the emotional experience of being a doctor. “You can talk your heart out, about inherent fears and apprehensions,” as one resident described it. Another said, “Dr. Panda’s demeanor has such a sense of openness to it, you’re not afraid to share anything. We share our deepest fears and concerns, and surprisingly you find answers to questions you didn’t know existed.”

Now nurses, pharmacy students, and others from all different divisions within the hospital come to the sessions. People get to hear everybody’s frustrations and can relate to each other with more empathy. It has created a sense of community that leads to further collaborations and more camaraderie in their work together. People feel that they have a bond, a connection with each other, due to what has been shared in the RRRnR sessions.

In a research project Mukta conducted with a clinical psychologist, they studied the coping skills of residents who had gone through her RRRnR sessions over eighteen months. Residents who attended at least three sessions per quarter had positive coping skills and reported lower levels of stress.³

A Ripple Effect of Renewal

One of those residents who benefited from the RRRnR sessions—and Mukta’s firm but nurturing guidance—was Ramya Embar. She recalls being often on the verge of burnout during her residency and fellowship. “When I first came to the US, I was in tears because Dr. Panda set very high expectations for me, probably because I was so immature at the time. In residency I was crying about the long hours.” She remembers complaining to Mukta, “This work is not taking me anywhere. I don’t know why I’m doing this.” Mukta would ask Ramya questions to get her back on track, such as What is your purpose? Ramya would recall how when she was younger, she spent a few months working alongside her grandmother at Mother Theresa’s Mission of Charity in India. Seeing sick people through recovery or being with people who passed away made Ramya want to become a physician. Her parents encouraged her to pursue her dream.

“When you’re on the verge of burnout, you have all these thoughts,” said Ramya. “I wasn’t looking for answers but the right questions. I kept a diary.”

At one point when Ramya was feeling especially stressed, she started a daily practice of writing down one nice thing her mother had taught her. She would read through her notebook on hard days. “I’d look for meaning in all those things, as a reminder to keep going.”

Mukta also taught Ramya to recover from stress by building in a daily cycle of replenishing activities as simple as taking time to eat lunch or talking to a colleague or mentor. Another way to build resilience is by finding ways to successfully detach psychologically and physically from work for at least a short time. For instance, Ramya copes by doing things that have nothing to do with medicine: “I go to a spot by the river to my favorite tree. I just sit there and listen to music. And I teach Sanskrit classes on Monday evenings.”

Ramya benefited not only from restorative activities but also through mentoring relationships. She had the support of elder physicians who kindly received her 3 a.m. calls if she needed advice on a case. That helped her overcome feelings of isolation and offered her an ongoing dialogue to make meaning of her professional experiences in the context of her whole life. Mentoring also was a path to paying attention to her own emotions, becoming increasingly mindful.

“Dr. Panda taught me how to have a heart-to-heart talk with my patients,” Ramya said. “That phrase can be misleading. We use our minds to talk to one another about things that affect our hearts, our emotions, and feelings. She helped me uncover my feelings and helped me communicate with my patients.”

Being more present with her patients brings her joy. “I love laughing with them and building rapport. Patients often feel rushed. But many tell me, ‘Doctor, thank you so much for talking to me. None of my other doctors have time to explain things.’”

By slowing down and paying attention to her own interior condition, Ramya is able to recover and show up for her patients. She is taking care of her true self, and that translates into better care for others.

There is a pervasive form of modern violence to which the idealist fighting for peace by non-violent methods most easily succumbs: activism and overwork.

—Thomas Merton

Confessions of an Overactive Writer

Ramya’s resilience inspired me to dig deeper into the distinction between self-care and care of true self. The words of another leader I interviewed have stayed with me: “We can’t be creative if we’re exhausted.” As I got close to finishing this book, I was working extra-long days, nights, and weekends to keep my commitments to deadlines. I say that creativity is my caffeine, but I was waking up in the middle of too many nights with ideas I had to write down. My body was reacting with adrenaline surges and crashes. I tried acupuncture, deep breathing, quitting coffee, thyroid tests. I even went for an EKG to rule out heart trouble. Thankfully, all tests showed that I was healthy and strong, in technical terms. A couple weeks later, I submitted the first draft just past noon and breathed a huge sigh! Everyone said, go take a nap! It was too noisy and broad daylight to sleep. Instead, I decided to go for a walk and take my Canon camera along. It had been almost nine months since I’d allowed myself to go play photographer, or play much at all. As I stepped outside, I noticed the weight of my camera in my left hand. I felt the weight of the zoom lens. And I felt a weight lifted as I recognized, Oh, there I am. That was the moment I could feel in my body what we mean by true self. A little while later, I sat in the sun and spoke by phone to my son, grown up and living on the opposite coast, starting a new soul-fitting job. Laughing with him, more true self showed up. I am also a mom.

Self-care may seem at first glance to mean care of our physical bodies. It’s important to replenish our energy with restorative activities that serve us deep down. It’s important to make time for the things—and the people—we love most, so that we can replenish the wellsprings of our passion for living. And that is care of true self. Our well-being depends on tending our wholeness—and not waiting until the end of big projects to do so. Carving out moments to connect with true self doesn’t have to eat up time. That connection can feed us instead.

Thomas Merton writes, “To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything is to succumb to violence. The frenzy of the activist neutralizes his work for peace. It destroys the fruitfulness of her own work, because it kills the root of inner wisdom which makes work fruitful.”⁴

What’s most vital is to care for true self, the integrity of who we are at our core. We care for true self when we listen to our emotions, our fears, those things we rarely speak out loud. By asking the right questions of ourselves about the underlying reasons for our soul-deep exhaustion, we can replenish our hearts for the ever-present challenges of being human. That is how we build our resilience. Listening inwardly for those clues is an ongoing practice, not a one-time event. Self-awareness can grow when we make time for reflection. And it helps to have access to the nonjudgmental support of other people.

I must wrap my life around this question: “How do I stay close to the passions and commitments that took me into this work— challenging myself, my colleagues, and my institution to keep faith with this profession’s deepest values?”

—Parker J. Palmer

A Creative Response to Suffering

Vera is a longtime, valued top-level manager at a community foundation, where she is committed to excellence in her work with clients and coworkers. When her chronic autoimmune illness began to flare up periodically, she found she had to take a day here and there to stay home and take care of her symptoms. She often didn’t mention her condition to anyone, which left her feeling alone as well as ill. When she finally had the courage to bring it up with her managers, they were receptive and helpful in ensuring that their short-term disability policy was updated to accommodate people with episodic “flare-up” health conditions.

However, even with the support of her employer and its “intermittent leave policy,” Vera found that her health condition was still difficult to manage, especially during busy and stressful times. She wondered if taking an extended leave from work would help her body heal and enable her to better manage her condition. She also had a growing desire to spend more time with her mother, who was retired, and wanted to travel with her children.

“When my father died a few years ago, my mother said to me and my siblings, ‘I don’t want you to wait to visit me when I’m sick in a hospital or at my tombstone. I want to spend time with you while I’m alive.” Vera began to think about taking an “adult gap year” or sabbatical to include traveling with her mother to Antarctica—the last continent that her mother had yet to visit. She thought of going with her mother to visit the remaining twenty US states left on her bucket list. To have the luxury of time (and money) to travel with her mother and give herself a much-needed break from the daily stresses of work seemed like a worthy yet unattainable goal.

Knowing that time for rest and renewal would be good for Vera, in 2013 Vera’s supervisor recommended that she participate in a Courage to Lead retreat series. Over eighteen months, Vera gained skills in reflection and the support of a compassionate community of peer leaders. She finally felt safe enough to be completely vulnerable about her health needs and how torn she was about devotion to work and her physical limits. She shared her desires and plans for her sabbatical with her small leadership circle and closest colleagues, who listened and encouraged her to speak up for her needs. They encouraged her to take care of herself first in order to sustain her commitment to public and community service over time.

Because Vera gained clarity about her core values and her need for self-care, she managed her personal finances to allow for a yearlong sabbatical in 2017. Her participation in the retreat series and a series of peer coaching sessions helped Vera move forward. She created a succession and sabbatical plan to be an experience that would feed her soul and provide rejuvenation for the next phase of her career. Vera was been able to be transparent, focused, and trustworthy with her employer about her plan, and it all started with the courage to tend to her care of true self. She gave her employer a year’s notice before leaving and worked with her colleagues to ensure a smooth wind-down of several initiatives she had managed. Vera also helped recruit candidates to serve as her successor.

Vera was living into Parker Palmer’s proposal that leaders “must uncover, examine, and debunk the myth that organizations are external to and constrain us, as if they possessed powers that render us helpless—an assumption that is largely unconscious and wholly untrue.”⁵ Coming from a place of strength and courage, Vera not only practiced self-care but made sure that others would benefit from the systemic change that was needed to establish a policy for intermittent leave. And she worked creatively with her employer to take her gap year in a way that didn’t cause problems. But care of true self is more than taking time off. It’s living a life that’s aligned inside and out.

Care of true self, and sometimes systemic change, are possible when a leader speaks her truth and when another leader listens and responds, truly valuing the well-being of all employees. Vera was fortunate that she worked somewhere where the leadership was willing to be flexible and was open to creative win-win solutions.

The deeper our faith, the more doubt we must endure; the deeper our hope, the more prone we are to despair; the deeper our love, the more pain its loss will bring: these are a few of the paradoxes we must hold as human beings. If we refuse to hold them in hopes of living without doubt, despair, and pain, we also find ourselves living without faith, hope, and love.

—Parker J. Palmer

The Ongoing Need for Renewal

What does it feel like when you’re in need of self-care? What words do you use to describe your hard days? Discouraged, burned out, exhausted, demoralized. Those words don’t sound very whole; they sound fragmented and disjointed, just like you feel. It’s hard to bring your best self and whole heart to your work and the people you serve when you’re frazzled and fried. Renewal is important.

Resilience arises from the self-awareness, care of true self, and meaning-making that comes from reflection—especially reflection practiced within a community that can support you to take your next action with integrity. You discover not only stamina but a renewed sense of purpose for the long haul. Knowing what work is yours to do can give you joy and recharge your inner batteries. But batteries can recharge only so many times before they need to be replaced.

Care of true self is an ongoing task, a way of living. We often wait until something breaks rather than give ourselves a more preventive type of care. For you to live a conscious and most rewarding life, a practice of renewal must become habit. Having a community where you can be completely open and safe is a key way to continually fortify and renew yourself.

Where can you be yourself? Who are your people you can talk with honestly? Can you meet on a regular basis with the sole function of supporting one another’s lives? Find a place to be listened to deeply and asked good questions, whether in a therapist relationship or at church or in other ways. Look for places where it’s possible.

It’s helpful to understand your own story, what got you here, the scars you carry, and what sustains you. When you recognize true self with tenderness, you can attend to what is unresolved. When you know what you’re feeling and what is happening internally, you can learn from it, process it, and find your way through life with more courage.