A New Notebook and Sharpened Pencils

 "Tell me, what is it you plan to do with your one wild and precious life?" ~Mary Oliver

For me, September signals new notebooks, sharpened pencils and anticipation of a new adventure. It doesn't matter how many decades removed we are from our back-to-school days somehow the idea of new beginnings continues to resonate.  It is a season of reflection and introspection, as is the custom during the Jewish holidays of Rosh Hashanah and Yom Kippur, but also one of unlimited possibilities and opportunities  Mindfulness can help us to pause, notice and choose opportunities that were previously hidden. Perhaps by making a few tentative marks in that new, clean notebook we will forge a new direction or circle back to a passion that we have consistently ignored due to the busyness of our everyday. 
This is a month of new beginnings; metaphorically a month of clean notebooks and sharpened pencils. I invite you to pause and consider, in the words of the poet, Mary Oliver, "Tell me, what is it you plan to do with your one wild and precious life?"

Wishing you a month of new notebooks and many sharpened pencils,

Summer Mindfulness Challenge Results

Last month I challenged readers to "locate a food item you have never eaten before, photograph it, then explore it mindfully with all five senses (sight, sound, smell, touch, taste), write a few lines about what you discovered, and email me the photo/description". Four adventurous souls accepted the challenge and this is what they discovered.....

Dragon Fruit (both N.B. and K.W. tried dragon fruit)

"It’s shaped like an extra large egg – perhaps the size of an ostrich egg, and cuts easily in half with a knife.  It’s very much like a  kiwi in terms of texture and taste.  Like the kiwi it shares the black crunchy bits inside and tastes better cold (in my opinion), although not quite as flavorful.  The skin is tougher than the kiwi and once cut into slices you can easily peel it back and eat like an orange. Overall, very enjoyable and refreshing." ~ N.B.

Cricket Chips

Cricket Chips (Chirps) "Chirps Chips are the most delicious taco chips that I have ever eaten! They have a wonderful wholesome flavor. I was unable to finish my bag of Chirps because a friend disappeared with them."   ~ W.S.

(I also tried Chirps, and they ARE really good! ~ P.R.)

"A cross between a plum and an apricot. They are sometimes called Dinosaur Eggs. It was really good. Did you know there are actually four types of pluots?" ~ G.K.

Thanks for your mindful experiments during July, KW, NB, WS, and GK. All were so great that each of you will receive a complimentary copy of my CD Opening the Door to Meditation.

Unpacking Privacy






Pamela Ressler @pamressler

Privacy is an ambiguous, powerful concept that, while meant to protect individuals, often shuts down useful conversations and innovations. As we continue to unpack our #MedX topic, Privacy: Preventing Harm or Innovation, by flipping the panel and actively engaging conversations I am struck by the notion that perhaps the word privacy does not fully address what we are examining in the context of social media and online communities.  The Merriam Webster dictionary defines privacy as "the state of being alone: the state of being away from other people: the state of being away from public attention." If we are engaging in online communities can or should we expect privacy?

Jodi (@jsperber) pondered in her initial #MedX panel post, What's Your Relationship with Privacy...Um it's Complicated, that when we use the term privacy in this context, are really responding to a lack of control of the dissemination of the information we are sharing? Perhaps this is rooted in the difference between privacy and confidentiality. Confidentiality refers to the ethical grounding of the patient-provider relationship. Information shared is not divulged without the express understanding of both parties. Are we uncomfortable with the perceived violation of this ethical concept  when we openly share health experiences in the public forum of social media? Do the benefits of connection outweigh the risks of information sharing? Is our digital footprint truly controllable?

In 2011, when my  Tufts University School of Medicine colleagues and I surveyed patient bloggers in Communicating the Experience of Chronic Pain and Illness through Blogging, we found the majority of bloggers chose to publish their blogs on public, openly searchable platforms (such as Blogger, Wordpress). These blogs were frequently shared and read by friends and family, and potentially a broader audience of unknown readers. The issue of privacy/confidentiality did not seem to be as prominent as it is today. Did the controlled ability of blogging; being able to edit, revise and then share  lend a level of perceived privacy even though the information shared resided in a public space? Was there an unstated expectation of confidentiality between blogger and her/his audience? Has the increased prevalence of social media and online sharing changed our perception of the concepts of privacy or confidentiality?  It is interesting to consider whether participation in online communities and the rapid, real time conversations in spaces such as Twitter or Facebook feels more vulnerable and public than the more controlled method of blogging.  Do online communities and real time digital interaction with others support the benefit of group empathy but at the same time expose participants to increased fear and vulnerability?  

As the ability to connect through social media evolves,  in health information sharing and creating more personalized medical systems,  let us begin to unpack privacy by examining and investigating broadly this elusive, ambiguous, powerful concept.

Do we have you hooked on this topic yet? We are thrilled to throw open our sandbox to those who want to think, discuss and create with us. This is the essence of a flipped panel. The conversation continues and evolves  through each interaction… please join us, Colleen Young (@colleen_young), Susannah Fox (@SusannahFox), Wendy Sue Swanson (@SeattleMamaDoc), Jodi Sperber (@jsperber) and me, Pam Ressler (@pamressler). We will be using the hashtag #MedX.

Farm Share Bingo

If you want to increase your mindfulness, join a CSA. A highlight of my summer is the weekly mystery bounty from our farm share or CSA (community supported agriculture).

We have participated in the First Root Farm CSA for several years and I always enjoy arriving for pickup on Tuesdays to discover what my share of the week's harvest will be. I think of this weekly adventure as farm share bingo...a root vegetable or two unused from the previous week pairs perfectly with something from this week's share, along with pantry items at home...and BINGO!

Beets, carrots, baby lettuces and spicy greens from our farm share came together with a couple of apples and a can of pineapple from the pantry into Glowing Salad this week (from my collection of favorite recipes from Debra's Natural Gourmet)...it's as pretty as it is delicious! BINGO!

My 6 Word Summary of the Mad Men Finale

OK, I'll admit it I was a Mad Men groupie, tuning in each Sunday night to have a glimpse into the dysfunctional fictional lives of the gang at Sterling Cooper advertising agency. I think the show exposed the underbelly of the not so nice features of being human, and along the way also shed light on the innate qualities of resilience. A sense of resilience wasn't predicated on noble qualities of compassion or empathy, but on self-preservation and survival.  Whatever you thought of the moral ambiguity the characters exuded and the choices they each made during the seven seasons of Mad Men, in the end the commonality for all was meeting adversity with a sense of resilience, having taken control of their experience but not the outcome of their choices.

My six word summary?.... Resilience wins even in flawed humans

Still on the Journey to Ithaca

It is commencement season, a time of new beginnings and setting forth on new adventures. This week is also Nurses Week, a week set aside each year to honor nurses. I have been reflecting on my nearly four decades in the nursing profession...what I imagined as a young nurse setting sail into the world of healthcare and where I have found myself so many years later.

Several of my nursing colleagues and I have been thinking about our stories or narratives as nurses -- where have we been, where are we going, what has shaped us and what gives our work meaning? #WhyINurse

So, in the spirit of this reflection and with immense gratitude to those who have allowed me to learn from their lives and teaching, I share the commencement address I gave several years ago as I completed my graduate work at the Tufts University School of Medicine. Several years later, I am happy to say that I am still discovering my way to Ithaca. My wish for each of you is for your journey to be long and circuitous as well.  ~Pam

Commencement Address
Tufts University School of Medicine: Pain Research, Education and Policy Program

To the faculty, administration, fellow graduates, and especially to my wonderful family; I am both incredibly honored and extremely humbled to stand before you today. 

It has been 32 years since I last wore a cap and gown and I am reminded today of that spring day so long ago in Ann Arbor, Michigan.   In 1979, the adventure on which I was embarking appeared so clear and direct, much like Homer’s Odysseus as he set off from Troy enroute to Ithaca.  But as with Odysseus, we often find our journeys far more complicated than we ever anticipated…meeting not only with trade winds and gentle seas but also with violent storms and towering waves that can batter us and throw us off course.  And so it is for the patients we meet each day in healthcare.  They, too, are voyagers on their own Homeric journeys, each filled with unique, authentic stories waiting to be told. It is up to us, in healthcare, to elicit, acknowledge, and honor these stories, to bear witness to their individual journeys and to help them navigate through difficult passages.   
When we first enter the world of healthcare our mission seems clear and direct – we want to quickly fix what we see as broken, to cure what we see as diseased.   While this is a noble mindset, we often miss the opportunity to heal when we blindly set out in this direction.  What I have learned is that often we cannot cure, no matter how desperately we try, but the potential for healing is always possible.  This statement may seem  incongruous to what we see as the measurement of medical success.  But, as we look broadly at what healing really is… isn’t it all about reducing pain and suffering…about living and dying with dignity, grace, and a sense of purpose?  We meet our patients at many points on their journeys and I see our work as assisting them in gathering the necessary tools of healing to find safe passage on their voyages. 

During the course of my studies here at Tufts I have discovered many tools of healing.  The Pain Research Education and Policy program was not on my navigational charts when I set off in 1979, but I am so grateful that I found my way here.  Through my work with inspirational faculty mentors, especially Dr. Bradshaw, Dr. Glickman-Simon and Dr. Carr, as well as Dr. Gualtieri in the Health Communications program, I have explored pain not only as a physical manifestation of injury or disease, but also as a complex pattern of psychosocial and cultural components that contribute to a sense of suffering.  Addressing the suffering has a direct impact on reducing the sensation of pain.  The Pain Research, Education and Policy Program has allowed me to explore the intersection of modern medicine, technology, ancient healing practices of the body and mind and spirit, and the innate human desire to survive adversity.  It has given me a voice in advocacy and scholarship by helping me to articulate the meaning of pain and suffering for individuals and society.  For this I will always be grateful.   

Some of you may be familiar with the poem, Ithaca, by Constantine Covafy.  It is a poem that has kept me company on my journey and I would like to offer it to you as a metaphor for this commencement, as each of us sets forth on new journeys and adventures:  

When you set out on your journey to Ithaca,
pray that the road is long,
full of adventure, full of knowledge.
The Lestrygonians and the Cyclops,
the angry Poseidon -- do not fear them:
You will never find such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your spirit and your body.
The Lestrygonians and the Cyclops,
the fierce Poseidon you will never encounter,
if you do not carry them within your soul,
if your soul does not set them up before you.

Pray that the road is long.
That the summer mornings are many, when,
with such pleasure, with such joy
you will enter ports seen for the first time;
stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and coral, amber, and ebony,
and sensual perfumes of all kinds,
as many sensual perfumes as you can;
visit many Egyptian cities,
to learn and learn from scholars.
 Always keep Ithaca on your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for many years;
and to anchor at the island when you are old,
rich with all you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would have never set out on the road.
She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.

And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing.
Thank you and Bon Voyage.

The Language of Cancer

Have you considered the language of cancer? Battle metaphors abound..."the war on cancer", "survivor", "hero", "winning the battle", "conquering", "fought the heroic fight", "lost the battle" etc. Why do we use these metaphors with cancer but not with other diseases? For instance do we use the same language to describe someone living with or who has died from such chronic and life-limiting illnesses as chronic obstructive pulmonary disease, heart disease, diabetes? Why the difference? Language is important and the effect on ourselves and others as we identify with certain metaphors is interesting to consider. An interesting discussion of this topic in a blog post from the Dana Farber Cancer Institute in Boston

The Power of the Narrative....It's Here!!! The Healthcare Narrative Playbook

I often hear..."so what do you "do" in your work?" Perhaps the best way to describe what I "do" is that I help individuals and organizations recognize and enhance what is going right when often a lot is also going wrong. In other words, I help to cultivate resilience. What I have learned, and continue to learn each day, is that to build resilience we need to tell, share, listen and understand our narratives -- identifying the hero's journey which we all travel. In the healthcare world, the fullness of our human experience is often cloaked in a diagnosis, rendering us a series of test results, medications and prognostications. The "person" is often lost while the patient's diagnosis is tended to. We enter the healthcare world with a story but we leave with a diagnosis...how can we continue to support and hear our stories and narratives along side the diagnosis?

So it is was with great pleasure that I accepted an invitation from the Robert Wood Johnson Foundation to be one of 30 thought-leaders from the United States and the United Kingdom in the field of health care narrative to gather together in Providence RI at the Business Innovation Factory to collaborate and create the first Healthcare Narrative Playbook. I am very proud of the depth and breadth of this interactive playbook as both a resource and guide, whether we are a caregiver, patient, clinician, clergy, friend or family member, tell, share, listen and understand our experience of health, illness and healing. Here is a 4 minute video explaining the concept: Healthcare Narrative Playbook Video

What can you do with the playbook? First, take some time to peruse through the various sections. Many of us have added our personal stories to the pages. Try some of the suggestions. Sample some of the resources listed. And most of all please share widely with your friends, caregivers, and community. Finally, I would welcome your comments and thoughts about the Healthcare Narrative Playbook -- what did you find helpful and what could be improved, as this is meant to be a living, breathing document...ultimately empowering and building resilience and changing our culture of health.

The Art of Mindfulness

The art of mindfulness -- noticing beauty made exquisite by its impermanence.  A special rite of spring in Boston is the return of the hanging nasturtiums to the courtyard of the Isabella Stuart Gardner Museum. The nasturtiums are displayed just 10-14 days each year at the beginning of April. I visited the nasturtiums today and was awed by their vivid, simple majesty. Rapunsel-like plants letting down their tresses. Grateful for the moment of beauty and the promise of spring.

Find a Bit of Beauty...Countdown to Spring #8

My found bit of beauty today came in the form of a little shell that usually sits silently and unexamined on my office bookshelf. Today, I took time to really notice its amazing qualities of symmetry, translucence, bumpiness, and complex coloration of this remarkable gift of nature. My little shell friend also reminded me that it is time to re-read Gift From the Sea. What bit of beauty did you find today?