Working Your Inner Burn

C H A P T E R O N E

In this chapter, we are going to tackle the most challenging work of this entire program. I put it at the very n beginning because this really is the shit they didn’t teach us in medical education. We were sent out into the r world of healthcare well prepared in diagnosis and management, but absolutely naive on how to deal with u ourselves and our own thoughts, feelings and emotions. The notion that stoicism, cynicism and suppression of

B personal beliefs is the way we all must practice has become status quo. I mean, we all can think of examples of attendings or preceptors that were prime examples. But guess what, we're freaking human! And we better start r acting human because by acting like a bunch of superhero, god complex, perfectionist, stone cold loners with no e life or support system is getting us nowhere. n

n Suicide rates are climbing. Colleagues are leaving medicine in droves. Patient loads are getting larger and more I

complicated by the minute. People, we have to take care of ourselves before we try to heal and help others.

e Because remember, the most important pulse in the room is your own. h

t This workbook is designed to help you get back in touch with your pulse, your life, your purpose.

h If at any point doing these exercises you feel overwhelmed, frightened or anxious, STOP and BREATHE! Then, hop over to the Doctor Me First Facebook page and tell me about it. This inner self stuff is hard and can bring up TONS g of emotions. But that's ok, because now you are dealing with this and you have a community that is here for you! u o Also remember, no right answers OK?!? Don't listen to your mind screaming at you to write down "what makes the r most sense" or "what's the most logical" or "what my colleagues, parents, family, friends, etc would want to hear." h This is about you. Just write the answers that come to you first. Use this as word vomit. And later, if you don't want t

anyone to see this, then shred it or have a ceremonial bonfire and cook some s'mores. But start with just writing it

g down because it's amazing what comes out of your fingertips when you no longer pass judgement on yourself or are scrutinize every answer. n i k r o W

-11- Ready to dive into yourself? Well, it's word vomit time. This is about you. Just write your answers. You can re-read f l them later and finesse or add details. e s

y 1) Give me some words you use to describe yourself. h T w o n K 2) What are your strengths (personally and professionally)? [Need help: think "what would my BFF say were my strengths?" Still having trouble? Then ask them!]

3) What do you consider to be your most significant accomplishments (personally and/or professionally)?

-12- 4) What is the hardest thing you have ever had to overcome? 2 # f l e s y

h 5) What gets you really energized?

T w o n K 6) What is your “secret” passion? The one thing that is almost too exciting to think about?!?

7) What is so significant in your life that if you lost it, you would devastated?

-13- 8) What activities leave you feeling empowered, energized, excited, etc? What about them makes them special? 3 # f l e s y 9) What is something that you MUST accomplish in this lifetime? h T w o n

K 10) What's your big dream that is so crazy you don't talk about it because it's so far out there?

11) What is the thing that is so painful that you don't let anyone know about?

Now, read back over these 2 pages. You, my friend, are pretty amazing!

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Whether or not you are in touch with them, your values drive your actions every day. These important and s enduring internal beliefs help you measure what's good or desirable and what's not. They serve as broad e guidelines in all situations, and exert major influence on your behavior, perception and decisions. u l When your life and work are aligned with your core values, you will feel at most ease and “on your A game.” a When actions or situations conflict with your core values, you will feel unsteady, uncomfortable and V troubled. When my life/actions are out of line with my values, I describe it as "a rough edge." As if I was

rubbing my hand along an unsanded piece of wood, it's uncomfortable and I want to smooth it out. e

r Hopefully after you identify some of your key core values, you can start to sense when things are not aligned as well. o

C Once you have a list of core values, they can be especially helpful as you are examining your life, thoughts, and actions. You should be able to recognize the pattern of you: how you live, why you act/react to situations, what you say and what you think.

Look back at the previous page "Know Thyself." What words did you use for question #1? This is a good start to a list of core values. On the following page, rewrite those words.

If you need more help discovering words, go to my site at http://www.truthrxs.com/downloadables-1 for a full list of personal core values pdf.

-15- My Core Values: 2 # s e u l a V e r o C After you get some words down, do a second read-through and circle the words that really resonate with you.

Now for the third read-through, take each circled core value and spend some time summarizing what it means to you personally and why it matters. [You’re actually making a personal definition for each your core value. (ie core value: "fierce" to me means passionately and whole-heartedly pursuing what I love and care about and I will fight you to the death for it!]

-16- Want to talk through core values with me? Let's set up a call! So many times we go through our days, doing what we are supposed to do because, well, we're suppose to do it. y When was the last time you stopped and asked yourself, "Why am I doing this?" Not in a snarky, pissed off

h teenager kind of way, but in an exploratory sense. When was the last time you curiously asked yourself, "Why did I really become a doctor?" W This is a no judgement zone so write below your VERY TRUTHFUL answer: "Why did I really become a doctor? r u o Y h t i w

Now answer, "Why do I continue?" g n i t c e n n o c e R

-18- After understanding your why, I want you to think about who you are. y t i

t Do you say: "I AM A DOCTOR" or "I WORK AS A DOCTOR" n The 2 small words I AM mean so much more than the surface appearance. Most people when using the words I AM e are telling you their self identity by stating "this is WHO I am at my core." This can be a very positive and extremely d

I powerful tool. I'm not saying that it is wrong to identity yourself as a physician. However, I now realize that when I

r made my entire identity about being a physician and attempted to be perfect, do everything and be the superhero u that I thought being a physician was, it landed me in a world of hurt. I put myself and let others put me in the box

o of doctor. I felt locked in, trapped and a fraud because I could not live up to those expectation/false beliefs that I y had constructed around my entire sense of self. I felt like I really didn't know who I was for a while. g So that's why I want you to take some time and explore your ENTIRE identity. What makes you, you! n i y

f 1) Filling in the blank using descriptive words not just direct nouns (ie I am honest, caring, empathetic, a truthseeker, i

t nurturer vs I am a physician, mother, wife.) n

e I AM:______d I

Pretty significant list, right! Re-read your list, is it the identity you desire? Explain why or why not in the space below:

-19- The way you identify yourself also translates into how you talk to yourself and how you talk about yourself. Imagine d you were a cute little puppy who was constantly cuddled, praised and rewarded vs a cute little puppy who was a mistreated, kicked and badmouthed. When those two little puppies peed on the floor, the conversation would go e one of two ways: "Puppy! I love you, but you can't pee on my floor!" vs "Puppy, bad dog, bad bad dog! Bad dog for

H peeing on the floor!" r

u We do the exact same thing with our inner self talk. For instance, when you make a mistake, do you say, "I'm so

o stupid!" (this is equivalent to Bad Dog) or "That was a stupid thing to do." (I love you, but that was bad behavior, puppy). Y

n It's really important to start to notice how you speak to yourself because calling yourself stupid and saying you did a i

stupid thing are 2 very different stances. e c i Write examples from your own life and your inner self talk: o V e h T

How would you grade your self-talk?

-20- You need to clean up your self talk. Start talking to yourself like you would talk your beloved pet, child or significant e other. One way to do this is to repeat a positive phrase, verse, saying, song, etc. Anything that refocuses your mind. g Just because you have thoughts doesn't mean every thought that passes through your mind is true. n e

l An Example of my favorite mantra/self-talk is "I love you. You are a badass mother. Sometimes you make mistakes, l but that's ok. I still think you are amazing. Nice butt. I love you!" a h Another example: "I am significant to this world no matter if I work another day in my life. I am a good physician

C because of my compassionate heart and caring spirit and not because of my assigned scores or benchmarks. I am

enough, not alone, and worthy of love." w o Write some self-talk mantras: N

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Once you have your core values, your identity, and your why described clearly, it's time to do some spring cleaning r on your mind clutter. Remember any neuroanatomy? I seem to remember that the brain stem essentially keeps

e me alive through involuntary processes. The good old limbic system (mesocortex is made up of the amygdala, the t hippocampus, hmm a lot more but...aaghhh so much I've forgotten!) The nightmares are coming back Really, all I t remember from the limbic system is the "Fs" (fight, flight, feeding, fornicating, freeze and fear). Cerebral cortex, u

l neocortex/the mammalian advantage of brains, is centers of information and senses. C

Neurospecialists are still teasing out where emotions, addiction, mood, and many other mental and emotional l processes reside in our brains. But the fact of the matter is you have internal thoughts, bad habits or recurring a behaviors that are limiting your success and keeping you from reaching your goals. Through nature we have t patterns and with nurture we have reinforcement of unconscious thoughts and beliefs that we were taught or n learned from observation as children. Today, we are going to analyze and tease out the thoughts that are not e serving you well. M

I want you to use the following questions to identify any negative mind clutter comes up for you: e 1) If I don't watch out, someone will ______h t

2) Everyone expects me to ______r a 3) Everyone keeps telling me to ______e l 4) I cannot be happy until ______C

5) I don't have enough ______

6) If I only had ______

7) I know what everyone is thinking about me: ______

8) If I'm too happy, this will happen: ______

-22- Another way to look for your negative thought patterns, bad habits or recurring behaviors is to answer these 2 questions: # r 1) What kind of problems and/or crises do you keep attracting or that keep finding you no matter what you try to e

t change? t u l C l a t 2) How do you typically handle a tough time? n e M e

h 3) What are you currently tolerating in your life? t r a e l C 4) What statements do you keep saying in your struggles? (ie: I can stop worrying about money when...or I'll know I've really made it when...)

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The statements/thoughts/ideas that you have had completing the last few pages may feel like whining, but I s want you to stick with me. When you identify these thoughts, you will start to uncover belief patterns you didn't f even know resided in you! e i l Now, write a list of all your "can'ts, shouldn'ts, I suck at's, I want but can't have's, etc" Just write, word vomit, no e editing, or no overthinking. GO! B e s l a F g n i t n o r f n o C

Whew! Got that done. At this time, I want you read over the above statements, how did they make you feel. Are they the real-honest-to-God Truth?

-24- Now's time for some confrontation! Let's look at your statements from the last 3 pages. These actually are your

2 false beliefs. Feel them. Appreciate them for what they are and that they have gotten you this far. Then tell them ADIOS and replace them with new, powerful statements because these statements are no longer serving your #

purpose. Write in your top false beliefs on the left. Then make a new one by writing a statement that is the s opposite to your false belief and feels good when you think it and speak it f e i l FALSE BELIEF NEW POWERFUL BELIEF e "I don't believe there is a job out there "I am capable, in control of my life and I

B that is for me." choose to find a job that is life bringing rather

than life sucking." e s l a F g n i t n o r f n o Great news, these new, awesome beliefs are now affirmations that I want you to use! Write them on sticky notes,

C put them on your screen saver or put them in your status updates on social media. Freaking SURROUND yourself with this new glory because cleaning out the old beliefs and infusing new thoughts WILL take you places. Experiment and see what happens because, hey, the worst that happens is that it makes your day better!

-25- If you don't have anxiety or deal with anxious thoughts, congratulations...you are super human and can skip this y part of the workbook. Ok, now for the rest of us. Anxiety can be both an instant paralytic and slow poisonous drip. t As physicians, we deal on a daily basis with decisions and states of anxiety that would cause most people to lie on e i the ground in the fetal position calling for their mamas. x

n Yet, somehow, we swallow it down, take another hit of coffee and go. But at some point, we all have to deal with our anxiety. How you cope can range from therapy or a breathing exercise to throwing back a few drinks or A

indulging in other substances or self-harming behaviors. Some coping mechanisms are healthier than others, of course, but let me share ways that I do some "self-coping." h t i

w 1) Question the Question This is an exercise you use when you have the "what if's" running through your mind. Instead of jumping on the g crazy train and going down the anxiety tracks of "What if that guy I discharged doesn't take his medication? Oh God

n what if he doesn't follow up with the specialist I recommended? Hell, what if he dies in his recliner and no one finds i

l him for weeks?" a I challenge you to STOP, BREATHE and question the question. e

D What if the guy you discharged doesn't take his medication, doesn't follow up and dies?---> Do you go home with him and control his actions and life?

Of course not! BAM, instant anxiety train derailing.

What's one of your "what ifs" you deal with on a regular basis? How can you question the question?

-26- 2) Replacing feeling for facts

2 We all have feelings or situations that place a black cloud around us. We start to say things like, "I feel like a failure"

# or "I just feel unprepared." Instead of staying in this state, I want you to complete the following statement:

y SOMETIMES I FEEL______t HOWEVER THIS IS JUST NOT TRUE BECAUSE: (now I want you to list all the logical and real reasons) e i x 1) n 2) A

3) h t i 4) w

5) g n i l (ie: I feel unqualified, however, I know this is not true because (1) I've successfully completed training in this (2) I've a done X number of these with good success (3) I continue to learn and study X so I stay updated in this topic (4) (I'm e board certified in medicine for Christ's sake!) D [Side note: you can also use this to confront false beliefs]

-27- In Zen tradition, the word "hell" in Japanese can be translated to "no space." "Heaven" can be translated as s "spaciousness." I take this as if you open yourself up to experience all emotions then you will be living in a more n heavenly place. Too many times we want to assign "good" or "bad" to our thoughts, feelings and emotions. Instead,

o let's acknowledge what we feel and experience because without the full spectrum of emotions, are we really a full i person? Some emotions are much easier to embrace: Joy, Gratitude, Love, Beauty, Wisdom, Compassion, etc. t However, other emotions like Sadness, Anger, Selfishness, Disguise, Fear are integral to the full human experience. o You should show as much attention to each emotion as if they were your children. Would you only turn your attention to your "good" child and ignore the "bad" one? No, of course not. So treat your emotions like your kids, get m to know each one of them. They may surprise you E

r In this exercise, I challenge you to name your emotions and recognizing how you feel when experiencing them. You can try using the Mindful CT scan exercise along with this one u o

Y Right now, I feel ______(emotion). When I experience ______(emotion) r

o I feel ______in my mind/body. f e Repeat this often and I bet you will have a new appreciation for acknowledging your emotions rather than c suppressing them. Because suppression generally leads to inappropriate compensation, irrational release or a unexpected redirection. p S n e (Side Note: For more on this type of emotion work, check out "The Art of Fear: Why Conquering Fear Won't Work p And What To Do Instead" by Kristen Ulmer for which I got a good bit of material for this exercise.) O

-28- Chapter 1 complete! That was my version of lightning rounds for self-improvement. Give yourself a pat on the

1 back or a margarita. That was some amazing work! r

e As a wrap up, go back through and review your pages. t

p Do you feel your answers are an authentic representation of you? Why or why not? a h C

n What did you uncover about yourself? o p u p

a Anything you want to continue to process? r W

When you're ready, chapter 2 is waiting for you. Don't forget about the short video introductions that accompany this workbook. Also, I love check-ins in the Doctor Me First facebook page.

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