mental health, Uncategorized

Finding Happiness

I really thought that by the time I hit my forties I had it all figured out. I was done with the bullshit, little things wouldn’t bother me anymore. I was ready to be the real me, take it or leave it. I had found my inner zen; I was more confident and more secure. Well, that was sort of …maybe true…or…maybe not.

When Covid hit my initial reaction was a bit of disbelief and then shock and finally grief. Mostly because of some big milestones that weren’t going to happen, at least not the way we imagined. And as time went on the reality sunk in. I was sad, lonely and isolated. A a physician I was scared by the unknown and the loss of so many lives. I tried hard to justify my feelings, to normalize them, to name them. And then one day, I just couldn’t do it anymore… I couldn’t positive my way out of it, I couldn’t see the bright side. This feeling of anxiety grew within me, fear and doubt took a bigger and bigger hold of my heart than I would ever normally allow.

I am familiar with depression, anxiety, and other mental health disorders as an observer, not as someone who suffered from it. But I was in the throws of it and needed to get out. But I didn’t know how. My thoughts went from numbing the feelings by numbing my brain (watching mindless TV mostly), talking to friends and family (venting), considering a therapist (asked for recommendations but never saw one), or hiring a life coach (didn’t hire one, but a dear friend/coach offered me support). The best way I can describe how I got out of what I was feeling is being in a deep, dark hole full of loose dirt and climbing out, sometimes slipping, but not giving up, until I saw a flicker of light. And I kept climbing and climbing. (Some days I still am.)

What Covid made me realize is that the happiness and contentment that I knew needed to be found within me was something I had lost because I took it for granted. And when the world was open I didn’t miss it’s presence because I filled it’s place with So. Many. Other. Things!!! But the quarantine left a void and it got quickly filled with negativity, with people bringing me down, with fear, and with anxiety.


I really want to make clear that although I came out of it without a lot of outside help, I know that for many people diagnosed with a mental health disorder just telling them to “crawl out of the hole” and “be positive” is not necessarily the answer. There is true value in professional psychiatric and behavioral help and at times medication. I do not want to minimize that.

I’m sharing my story, to say that we all need reminders that true happiness lies within us. That we can’t let the business of our lives make us forget that. That although being quarantined is hard, I should be able to find contentment within me, not from positive attention from the outside world. I learned that I must find joy in the everyday mundane tasks. I discovered the true importance of gratitude and that we must look for things to be grateful for ALL THE TIME. I learned that my mind like my body cannot be ignored. I need to feed it with positivity ALL THE TIME. I learned that no matter my age, I will continue to treat my inner happiness as a fragile newborn that needs to be attended to and never ignored. I learned the value of true inner peace. A lesson I do not take lightly and hope to never have to relearn.

“Happiness is when what you think, what you say, and what you do are in harmony.”
Mahatma Gandhi

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Why We REALLY Need to Show Ourselves Grace

So I’m not gonna lie…Covid has not been the easiest for me.  And I know I’m not the only one.  But what I’ve had a hard time understanding is…why?

I love my husband,  I love my kids, I love spending time with all of them.  I have been transitioning to only work from home anyway.  I live in a place with great outdoor options (although trails and beaches were closed for a while!)  Yes, home schooling aka distance learning was not ideal but honestly my kids were pretty independent and didn’t rely on me (too much).

I was overwhelmed by the thought of “working” and growing my business and frustrated with myself that I couldn’t get more done with all this time.  I tried to give myself grace (because that’s what I told everyone else to do) but it was a half ass grace…like ” fine don’t do anything Elham, it’s fine, it’s stressful, just breathe, but you know deep down you’re just being lazy…get off your ass!!!”

And that was how I was showing up for myself…half grace, half drill sergeant! It wasn’t pretty.  Until one day it just hit me.  I have spent many of my recent adult years training myself to be productive and work in the pre-covid environment and then BAM everything changed…overnight!  I mean, seriously, I’ve worked for years on myself, on my schedule, on showing up for myself and others but not like this. Not with kids home needing at least some of my attention, not with a husband who’s dealing with Covid on the frontline, not while being home…ALL.  THE.  TIME!!  I, like most humans, need routine.  We thrive on it.  And at the moment we are all living in some version of chaos!

So, no, it wasn’t the lack of time, or the lack of motivation, or the lack of resources…in my case, it was the complete 180 change from life as I knew it and all the ways it affected the people around me.  And to be 100% honest, I’m not quite there with ALL the grace, but I’m learning to slowly forgive myself.  To talk back at that voice and say I’m not lazy and I’m doing my best.  To tell myself that most importantly we are safe, we are healthy, and that I need to breathe for reals.

These are my 3  daily covid non-negotiables, and if I accomplish them, I go to bed knowing I did the best I could;

  1. make one small step towards my goals
  2. daily exercise (preferably outside)
  3. remind myself of one blessing that happened that day because of covid

I do the last one with my kids nightly before bed.  We have to find one good thing because of, not in spite of, Covid.  How are you coping in the era of covid?  Are you able to give yourself grace?

I will hold myself to a standard of grace, not perfection.-Anonymous

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Telemedicine: The why, what and how

Many of you have been using Telemedicine services in the era of Covid pandemic.  Although it is a service that has been around for years it has certainly gotten a lot more publicity lately.  It is definitely a needed service in our current environment but there’s actually many reasons you may find yourself in need of telehealth services even before our era of social distancing.

I actually decided to transition to a virtual practice months ago; way before the threat of Covid was even known and with no idea that telemedicine would be so needed. For anyone unfamiliar, telemedicine or telehealth visits are video conference calls between a physician and a patient.  This should be done on a HIPPA compliant device although these rules have been waived by our government temporarily.  There are many platforms that your doctor can use to provide a safe, secure connection.  Once you are on a video chat your doctor can address any issues you have just as they would in a face to face visit.  The advantages are no drive time, no wait time, and it’s the comfort of your own home!  The disadvantages, especially for pediatrics, is the inability to diagnose certain ailments like an ear infection, strep throat or urinary tract infection with any certainty. (Although I do think technology and tools will decrease these barriers in the near future.)

This was my hesitation initially, how do I give the best care without actually touching the patient and seeing them face to face? So let me share with you my reasons for wanting a telehealth practice even pre-covid!  I get phone calls about once or twice a week from friends asking me for advice about their kids, mostly quick questions that I could help with and I was happy to do so, but that made me think.  What if you don’t have a friend that’s a pediatrician, where are those people getting their questions answered? I knew there was a need for a quick and easy way for parents to get their questions answered by a reliable source. I also truly love being able to guide and counsel parents.  I love talking to parents about the exciting milestones to come, how to discipline, how to pottty train, sleep train, etc. but in the modern era of medicine this was becoming increasingly more difficult.  The standard patient visit is 10 minutes and they are often double booked.  Once a patient is escorted into a room and the specific reason for the visit is addressed, there is no more time for counseling.  There is no more time for parents to share their fears and I could take the time to reassure them.  As a pediatrician and a mom this was extremely upsetting to me. With a telemedicine visit I could take as much time as needed to counsel parents and give advice, there was not a roomful of sick patients in the waiting room.  Lastly, shit happens!  Kids can get into all kinds of trouble and it’s usually after hours! If your child bumps his head, hurts a limb, has an earache or high fever after five…what are the options?  You may or may not be able to talk to a physician on call.  They may have a call service?  Not all bumps/bruises/falls need to be seen right away, not all ear aches need antibiotics but at the same time if you do need to be seen is it better to go to an Emergency Room or an Urgent Care?  This was another area that I felt my service could be very helpful.  If I could get a family through the night without having to go to the Emregency Room, that’s a visit well worth it in so many ways!

Now, if you do need a telehealth visit here are some key ways to prepare.

  1. Weigh your child.  A recent weight will be helpful if any medication is needed, including over the counter meds. If your child is an infant weigh your child and yourself together and subtract your weight.
  2. Check a temperature. This is vital information for your pediatrician as well as good for you to know.  I’d recommend having a thermometer on hand at home, especially now. If your child is over 6 months of age, a temporal thermometer should be acurate enough.  But for younger children (especially under 2 months) and to be really accurate you need a rectal thermometer.
  3. Check you child’s resting heart rate and respiratory rate. For the heart rate, you can find their pulse either on the inside of the wrist or the side of the neck, use your index and middle finger, not your thumb.  Count for 1 minute or less and extrapolate to number in a minute.  The respiratory rate is the number of breaths per minute,  this can be checked with by counting their chest movements in and out, for younger kids you could use their stomach.
  4. Your doctor will want to know if  your child been eating and drinking normally and how often have they have used the bathroom.  If they are not well you need to pay close attention to all three of these things.
  5. Make sure to let anyone new you see about any chronic medical conditions, along with hospitalizations, surgeries, and brief birth history.  Also have a list of medications your child takes either regularly or on a as needed basis and any allergies. Even if your child wheezed once in the past this could be pertinent information. In this case your provider will appreciate having more information rather than less!

 

There still may be some limitations to ultimately diagnosing and treating your little one on a telemedicine call and a face to afec visit may be required but there is certainly a role for telemedicine in our modern era of technology and certainly in the current era of Covid.

 

 

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Faces of Womanhood

We have a photo wall in my house of black and white pictures from different important stages of our lives.  I love the pictures, I love how the wall looks, and I stare at it often.  It’s on a wall between our 3 bedrooms and the laundry room, so let’s just say…I pass by it…a lot! Sometimes I take a moment to really look at it, not just fly by, and I usually just look at the kids but the other day I stared at my face in each picture.  No idea what prompted me to do that, I hate looking at myself in general let alone analyzing a photo of myself but each face told a story and this is how it went.

My Wedding Day:
I was ecstatic!!!!! It was hands down the best day of my life.  It started with the usual stresses, but the wedding was immensely fun!  The picture is of me with my husband during our first dance.  I’m beaming with a smile ear to ear…I’m truly happy.  We had no time to choreograph our dance, we were barely in the same city, let alone the same room before we got married.  But I didn’t care how lame we looked just holding each other and swaying like teenagers.  I was married to the love of my life and I was the happiest girl in the world!!!!  Plus I felt like a princess in that wedding gown!

The Birth of Thing 1:
It was exactly 7 days after he was born, his Bris (a religious circumcision ceremony).  Probably the most stressful event for a new mom.  In the picture, my husband and I were holding him and kissing the top of his head.  I look terrified! A complete look of self doubt and uncertainty. Am I holding him too tight, too loose, is he okay, will he be okay, what happens if he cries, what happens if he doesn’t cry, is he too hot, too cold?  I literally was worried about everything and felt responsible for every single emotion he may be having.  And I was certain I was going to mess it all up!

The Birth of Thing 2:
The pictures were taken 2 weeks after she was born, Thing 1 was 2.5 years old. My husband and I had a house, a mortgage and 2 kids and I felt like a real grown up.  We could actually afford a fancy studio photographer, and fancy birth announcements.  I now had 2 little people counting on me… and I was… exhausted.  In this particular picture of the 4 of us, I looked impatient.  I looked like I had a fake smile and I remember thinking, please everyone just look at the freakin camera…just one decent picture.  Hoping my naked baby does not poop on me. Hoping Thing 1 doesn’t tantrum and refuse to be in a picture, hoping we can get the perfect birth announcement…..Thinking:  Just keep it together people….!

So then I thought what would my current self tell my past self:
On My Wedding Day:
Remember this day and this feeling forever!  The love you have will literally carry you through some dark times.  You will be challenged, beyond the point you think you can endure and you will doubt yourself… a lot. Some days will feel like it’s too hard to keep going.  You will walk through fire, sometimes alone, sometimes with your husband by your side, sometimes him holding you and sometimes you holding him.  But you will come out the other side holding each other and completely in love! You are stronger than you think.

The Birth of Thing 1:
You have so many doubts, everything in you is unsure and worried. That’s okay, your son doesn’t see any of that.  He doesn’t care if you nurse him or give him the bottle. He knows you love him with all your heart and loves you right back.  You’re his rock, the one he comes to when things go wrong and you figure sh*t out and tell him it will be okay.  And he believes you ’cause you’re mom.  You got this, and…You are stronger than you think.

The Birth of Thing 2:
The next couple of years will be tough.  You will feel like you will never have your sh*t together… again…like ever! Your kids will get hurt and you will feel like the worst mom ever.  Sh*t gets real.  But things get better, they always get better.  You walk through fire again…and again…and again, but you get through it, stronger everytime.  You will meet many guardian angels throughout the way. In many different forms, just be open to it, to all of it. Life is messy and unpredictable and so hard for your controlling personality but you gotta let it go girl!  Just let it go and enjoy these fleeting moments.  They don’t last.  Be present and don’t worry about the perfect picture, the memory behind the picture is so much better….Oh…and you’re stronger then you think.

You are braver than you believe, stronger than you seem, and smarter than you think- Winnie the Pooh

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Dear Patients

Dear Patients,

We have failed you.  The medical system that you deserve no longer exists.  The time of personal relationships, long conversations with your doctor where they learn about your family and you know about theirs, those times don’t exist. Current visits are timed to the second.  If you or your doctor are 5-10 minutes late the whole schedule is thrown off. If your doctor has to deal with an unexpected emergency, you will likely be waiting for quite a while and your doctor will have no control.  If you book a visit for a cold there is no other topic that can be mentioned, not even if you have an acute concern.  For that you must schedule another visit because of the delicate and overbooked schedule.  Nothing could be squeezed in.

No, I cannot look into your other child’s ear, my schedule is booked and I can’t squeeze him in, I’m sorry.

But just a quick peak, you plead.  And here’s what runs through your doctors head:  what if the child has a another illness and I don’t fully evaluate them and miss something serious; what if I miss something and get sued, I’m not documenting this visit; what if they have an ear infection and I need to write for antibiotics…how will I find the time without delaying every other patient today?

This is the reality of medicine today.  I would love to spend 30 minutes with each patient and let them chat and answer every possible question they may have.  To reassure them about every vaccine, to tell them all the wonderful things they have to look forward to, and to assure them the guilt and doubt they feel is normal and they are actually doing a great job.

But the insurance companies only allow for 10 minutes at best, maybe 15 for a well child visit, and many visits are double booked. The result is doctors that are overworked and having a harder time caring.  Because if we cared the way we did when we started, if we cared the way we wanted to, if we cared too deeply, we would break so much faster than we already are.  We would not be able to withstand the onslaught from administrators, insurance companies,  and patients while maintaining an income to pay the overheard and our bills along with our student loans.

I too have experienced this as a patient.  I experienced it when my daughter’s pediatrician asked us to book a longer visit next time if I needed to discuss another issue with her.  I experienced it when my own doctor refused to see me when I was 10 minutes late because I drove to her prior office by mistake.  Even though she had canceled on me at the last minute the week before.  I was upset but I completely understood the delicate nature of the schedule.

Dear patients, we have failed you and the medical system has failed us.  We want to be there for you in every way but it has become physically and emotionally impossible.

The physician should not treat the disease but the patient who is suffering from it.-Maimonides