Recipes are Merely a Suggestion

I have been singing Kaiser’s praises as a HMO for the past nearly 2 years that I have been a member. It is delightful and refreshing how easy it is to get care there, in a variety of ways. I have had video visits, phone visits, email interactions and a flu shot in a walk-in clinic. The pharmacy was amazing; I’d request a refill on my app and my drugs would be in the mail to my house the next day, free shipping. This was also one of the first encounters with a provider in a long time (and few and far between throughout my life, truth be told) where I felt honestly cared for and listened to as a real, individual person. . Everything so organized and helpfully connected.  I was kind of reveling in feeling so good about my health care provider for once, that I was shocked when it all abruptly went to shit.

See I have a minor medical condition that wreaks havoc on my body and mind on a monthly basis. To add more fun to the situation, I am approaching menopause with all of the wacky symptoms that entails. I’ve been offered medications and treatments, even a hysterectomy to treat these things. Some of those things I have tried with variable success and some I have declined (cutting out my womb for anything less than raging cancer seems extreme to me, no thanks). I was thrilled to see that my beloved Kaiser offers yearly visits with a contracted naturopath. Hooray! How progressive! And much more in line with my own personal belief system about wellness. I immediately requested a referral from my primary care doctor and my request went to the review board for a blessing.

It was denied.

The reason? I am allowed care from the naturopath only after I have failed all traditional, “accepted” treatment. Since my employment has changed and this is America, my health insurance (and therefore, my healthcare providers) has also changed. Frequently. Don’t get me started on how messed up that whole scene is. However, as a result, records do not always follow in an orderly or timely fashion (I love our HC system), so the Kaiser reviewer was unable to see what I have already been through. For a hot minute I was all fired up and ready to collect all of my records to prove to them that I deserve these visits with a naturopath, I have earned them. But then it dawned on me how utterly fucked up and ass backwards this is. Why is this type of care reserved for “failed” cases? What if I want to reserve traditional care for the scenario where naturopathy has failed? Why am I not allowed to choose the primary modality that suits my needs and values? Kaiser: you have let me down; the honeymoon is over and now I can see you are just like all the rest.

Healthcare (HC) is the perfect profession for enabling perfectionists. Ask me, I know! Where else is perfectionism not just desirable, but actually deemed essential? That’s like crack for perfectionists. In this context, we are expected to be perfect not just for our own internal satisfaction, but for matters of life and death. HC is a comfortable spot for perfectionists because it fosters this illusion that perfection is a desirable and attainable goal. As perfectionists, we are comfortable with feeling like everything we do or say or produce is up for judgment. Fear of being or appearing imperfect is real and feels untenable, like we won’t survive if we aren’t perfect. HC just feeds our belief that perfection is not only possible, but necessary. Because the real-world stakes are too high if we mess up, or even just appear to mess up  – people may be hurt or die or sue us. We could lose everything – money, profession, reputation.

There’s the rub though – perfectionists may strive for perfection = an absence of errors, but we won’t make it. In HC or anywhere else. Why? We are human. Understandably, patients have bought into this illusion that perfection is possible in HC. Their expectation is that medicine can cure all and providers won’t make any mistakes. And they are not shy about taking legal action or threatening to, if things don’t turn out the way they think they should. No matter how unrealistic. This has led to a dilemma in HC where even if you don’t know something or you make a mistake, it may be tempting to keep quiet and at least continue to appear perfect in order to avoid retribution for being human. HC and patients demand the maintenance of this illusion. I guess a similar situation might be with airline pilots. I know intellectually that they are human and thus will make mistakes sometimes. But I don’t want to think about that possibility too much or have it happen when I am on their plane!

What makes it all the worse is that the culture of HC does not allow us to talk to each other about this. I suspect all HC providers feel the onus of perfection to some extent, but we cover it up with bravado. We talk “shop”, many of us enjoy the sound of our own voices and like nothing more than to ask questions that will stump the presenter and showcase our own superior intelligence on whatever matter is being discussed. But can we make ourselves vulnerable and talk to each other about our mistakes, the times we didn’t get it right or our fears about shouldering this ridiculous amount of responsibility everyday? I’ve been in 23 years and I have yet to have a real, open, honest, meaningful conversation with a colleague about this stuff. We just don’t go there. Is it the type of deal where we don’t want to speak about even the possibility of failure for fear it will be invited into our lives? All I know is it is pretty fucking lonely.

I picked the greyest area of HC in which to practice on purpose because I find rigid, garden variety black and white decision-making kinda boring. I like variety and challenge and using my brain, but even here in hospice I struggle with my own perfectionist tendencies. As a HC provider, I make oodles of decisions on a daily basis. Some big, some little, but all involve the care and well-being of humans. That’s some pretty heavy shit. I can’t afford to have bad days, I’ve got to be on at all times collecting, analyzing, synthesizing what information I have and putting together a plan to hopefully help and not hurt someone who is counting on me to care for them. There are days where I wear that responsibility lightly; I’m in the flow and enjoying my work as a combination of pleasant puzzle/problem solving, education and advocacy. And then there are the other days. The days when I am second guessing every decision I make, where I feel at a loss about what is the best thing to do, when I over research and overanalyze in an attempt to bring myself some measure of peace about what I’ve done or am about to do. That sucks. And then sometimes, I continue this pattern in my sleep and either dream about it or wake up at 3 am thinking about it, going over everything again, did I do the right thing? Is that patient going to be ok? Do I look like a complete idiotic buffoon to my peers? How would a lawyer demonstrate my culpability in this situation if things go wrong? It can be exhausting. And I’m not going to tie it all up with a neat bow and tell you that is it hard work but worth it because I get to help people. None of that martyr-y bullshit. I am altruistic at my core and I do enjoy helping people, but sometimes it does not feel worth it. At least not to me. Sometimes it feels like a much too heavy burden to have all of those people (including myself) counting on me and expecting me to be able to make 10,000 decisions without a single error. The recovering perfectionist in me is tired out and ready to hand it all over to somebody else.

I’m not sure why I’m feeling such angst this morning – a feeling of emotional and physical restlessness. Like I should and want to be doing something, but I’m not sure what. It is uncomfortable because I am an old hand at self-reflection and looking deep inside myself is typically a comfortable excursion. I know I’ve got that down to a science. I know where to look for answers in my psyche and history and deep corners of my mind and heart. I know myself. But this, this feeling is just puzzling.

Maybe I’m trying to find meaning where there isn’t any. Maybe this feeling is in response to a global pandemic and 10+ months of avoiding people and places like the plague, literally. Or maybe it is the anti-climax of the holiday season to cap off such a shitty year. Could it be that it is year-end reflection time and I’m unsatisfied with where I am in my progress toward living a full-time creative life? Do I need more exercise? Or is it just that this is a dreary, rainy, cold Sunday in December, my kids are complaining about being bored and I have to be on-call for a job that pays the bills but doesn’t light my fire?

And why do I always have to have a reason for feeling bad? Why do I need to justify my feelings to myself? Can’t I just accept that sometimes emotions blow through that are unpleasant but blessedly temporary? I tell other people that and give them permission to wallow and allow it to wash over and through them, but can’t seem to take my own advice. Why is my love, compassion and understanding greater for others than for myself?

Ooooh! That right there is a dark, unexplored corner of myself that needs some illumination. Not a bad endeavor for an angsty day…

‘The cup is already broken’. Ever hear that saying? In my mind, it is a mental nudge away from getting too attached to stuff, because at some point the stuff will break or otherwise be lost. There is an impermanence in the world that it is best to make peace with sooner than later.

This saying flashed in neon in my brain this morning when I dropped my brother’s coffee cup that he got on our trip to the Big Island when my teenager was just a baby boy. It is one of the few personal things of his I still have since he died unexpectedly in 2013. It has served as a cherished though melancholy reminder of him and our fantastic trips to Hawaii together and I had just broken the handle clean off. Damn.

I guess I could have just kept the cup on a shelf over the years, safe and protected from potential harm, but I didn’t. The risk of it breaking was acceptable to me and I kept using it and enjoying it in my daily life. Every time I made my tea in it or saw it sitting in the cupboard, it was an opportunity to remember Mike.

I thought I might freak out when it eventually broke, because I knew it couldn’t last forever. My brother didn’t. Nothing does. But I didn’t freak out and I didn’t whip out the super glue and desperately try to fix it either. I was surprisingly calm.  Briefly wistful maybe, but totally ok. Those memories are still there and those will never break. Even though the cup is no longer suitable for daily use, I’m still going to keep it because I like all of the things it symbolizes: Mike, Hawaii, impermanence, and treasuring memories over stuff. Like many things, it is still beautiful even broken.

What’s the difference between being in a funk which prevents creativity and experiencing the phenomenon of failing to engage with your medium that is sometimes called resistance, obstruction or perhaps disconnect, maybe simply failing to TCB (Take Care of Business, to quote the King)?

I think being in a funk, at least for me, is when I’m feeling kind of down and emotionally drained. The cause could be a whole variety of things (work or family stress, world events, raging hormones, too much peopling and going) but the thought of opening my computer to write at these times feels like a mountain too high to climb. Plus, my creative energy feels all stopped up and trying to “work through it” leads to lots of frustration, no flow and ultimately, more funk. Or maybe a deeper or longer funk. And then I start to feel bad about that! I’m not writing, my creative energy has left me for good, I have no talent or good ideas, I’m never going to make it as a writer…horrible thought spiral. Thankfully, these episodes do seem to pass with time, sort of like a storm blowing through.

The more difficult situation for me is when I have ideas and I want to write, but I just…don’t. Not for any good reason either. On most days I wake up at the crack of dawn before the rest of the family, so time and a quiet place to write really aren’t issues. I replaced my clunky old laptop with a sleek, beautiful machine with the apropos model name of “yoga” to keep me fit and flexible as a writer. I’ve got notebooks full of ideas ready to be fleshed out on paper. So why don’t I just sit down and do it? Inherent laziness? Fear of failure/success? Depression? A time-consuming habit/pseudoaddiction to pimple popping videos and endless hours of scrolling social media to see what the drones I went to high school with are doing?

Though the situations are different, the outcome (not writing) is the same. And I also think the cure is very likely the same. I suspect, even though I’d prefer to remain ignorant on this score, that at least part of the reason I am having both these frequent funks and periods of creative inertia is because I’m not taking care of myself as well as I could. As a living, breathing organism. I don’t mean this in a self-shaming, should-ing kind of way, but more in a practical, handle your shit kind of way. I think these uncomfortable situations may have increased in frequency lately because I need more real, nourishing food and fewer Cheez-its and martinis. More walks, more books and less phone, maybe a rest, maybe some journaling and yoga. Yep, that’s right, I’ve got my new age-y side (so sue me)! And though I’m far from perfect at recognizing and dealing with my funks and faults when they show up, I am more aware of them and moving in the right direction to be kind to myself when they do occur. I am nurturing self-compassion and committing to investing more in myself and my own well-being. Even if these measures don’t cure all of my writer’s woes, it is not a bad place to start. There’s no downside. Except to Cheez-it sales.