Dear Doctor,

I have been thinking of you lately, how hard, you work on the analytical, mechanical, decisive approach to medicine. How hard you work to get the diagnosis just right so you can prescribe the right cure. I remember how that felt, and I wanted to give you a little taste of how you change over the next 25 years.

To be clear, my ‘way’ of being with patients has evolved in the last 10 years. When I arrived on PEI in 2008 my process was very much the rushed American model of care delivered quickly. It was about establishing the diagnosis, arranging the treatment, and moving on. What I discovered was, that the people I was caring for wanted a relationship as much as they wanted health care, and maybe even a little more. They appreciated the quality of care I brought to my work, with just the right amount of OCD. However, what they valued more was my relationship with them, the care of them, and of their lives.

Arriving here, the pace of care was slower than the US, and for some time that maddened me. I would push against the system to move it more quickly. To get people in and out of the hospital more quickly. To get the diagnosis more quickly. However, I began to notice that all this did was create discomfort and grumpiness in my own head, doing little to change the course of the disease progression, and certainly not improving the lives of those who were manifesting the disease.

I learned to slow down, and as I did, I began to listen more. I found that I heard more of what was important to hear. My natural ‘tracking’ began to evolve. I found myself hearing the difficulties they had in making changes, the stresses they had trying to live up to the community standards, the internal struggles that would show up in the word choice during self-reflection. I found myself becoming more of a cheerleader for the possibilities, for the potential to change. However, the cheering did not accomplish much, and that is when I began to wonder into other options for helping people find a way to work with change in a sustainably. This was aided by the fact that I had been here 6 years, my panel was pretty stable, a few deaths, some births, but pretty much the same 2000 souls I had been caring for now for 6 years.

This is when I ran into hypnotic regression via Brian Weiss and Dolores Cannon. I started using this approach with some folks and had some success. I then found Hakomi, and eventually now EMDR, and have found even more success in helping people change the unconscious programming that runs their lives.

Throughout this, the tracking of the folks in a Hakomi sense, that close watching and listening, to what they were saying verbally and non-verbally, some gentle contact, some connection, allowed the opportunity to really be seen, really be heard, and in that brief moment, the possibility to consider change was opened up a crack. I began speaking to the part of the patient who was present in the room asking for change. It might be the adult who was in front of me, or the little kid inside them that had never been seen. In speaking to the one who was present but unheard, I began to see things really open, and I saw my medical perspective begin to recede just a bit from the forefront of my mind.

In thinking about your query around the effects of working with the dying, I have found that this has required my strongest work on myself. Initially it was the change of perspective from cure to comfort that I focused on. For me, it was like remembering which horse I was riding, the seasoned old mare or the green broke filly. They require different riders. It helped that in our small 18 bed hospital we decided to put in an artificial archway, decorate it, and designate the four beds beyond the archway as palliative, making sure that none only palliative patients step into that space. Being physically located in a specific hall, decorated to be different, helped me mentally shift gears when I went from my regular hospital patients to the palliative patients.

Once I had been able to successfully shift gears, remembering the purpose and point of my care (a soft landing as I put it to folks), then I began more of the work on my own soul. I had to come to terms with what it was like to swim in grief most days, to bring myself into the rooms where extended family surrounded their loved one. To speak words that they did not want to acknowledge, but represented the truth they all needed to hear. My meditation practice has paid off for this work. I began to take some time before walking down the hallway, to notice my breath, to speak in my heart a short prayer ‘may I bring the most good possible for all that are present here now’. I would step into the room, center myself and my breath before I began to speak or to listen. I started feeling for the energy of the room when I arrived, to notice how it felt to be there, to feel for the ripples of the relationships as I stepped into this stream. Could I feel the eddies of unspoken troubles, those that felt like we should keep fighting, those that felt we had done too much already, those that were simply heartbroken and could not fathom life without this soul in their world. What did the energy of the patient feel like, were they at a place of acceptance, were they worn out from the fight, ready for rest, were they afraid of this change and fighting to the very end. I would feel all of this internally before I would speak, it would inform the words that were chosen, the way they were spoken.

What I found from doing that work were all the internal snags that I could feel in my system that had nothing to do with the work, the words, or the room. These were my own internal battles, the unresolved beliefs, the un-soothed hurt, the feelings of unworthiness and unlovability that remained in my system, just below the surface, modulating and modifying my perspective. I began turning myself towards those ‘rough spots’ and diligently started sanding them smooth. In this way, I began using the difficulties of the work to help me seek and repair my own heart. To be able to do all of this, I had to allow my heart to once again become part of the work.

You see, my medical coming of age took place in Dallas Texas in 1990. At that time, crack and HIV had blown up in the city. Parkland Hospital was the epicenter of these twin disasters. At that time, UT Southwestern Medical School and Parkland Hospital did not have a palliative care team, hell I do not think they had even heard of the term. If they had, it was for Cancer patients only. For everyone else, it the full hard press of curative care to the bitter end. My time on the medicine floors was a time spent watching young men, my age, die grisly deaths. I listened to newborns wale and writhe withdrawing from crack. They were un-soothable, crying until they were physically exhausted collapsing into sleep. Listening to the older nurses who had worked the newborn nursery for years weep for these little ones. My heart hurt, I had no tools, few skills, and zero desire to work on it, so I put my heart away for safe keeping becoming the modern medical doctor, all science. It was a survival mechanism to make it through medicine. Watching families abandon young men because AIDS was God’s punishment for the sin of choosing to be gay. It was crushing, so my heart had to be safely placed in protective storage, or risk total destruction. I did not begin to pull it out of storage until I arrived on the island and was asked to feel again by the people of my practice. As I began to bring my heart back out of the shelter, I began to work on repairing the damage such a long period of solitary confinement had taken upon it. I began to think of medicine less analytically, and to think of my choices less decisively, thinking instead of the people in front of me, and what it was that they seemed to be asking for in this moment.

As I started that process, I noticed that the effect of being a machine began to diminish. I realized that I enjoyed sleep. I remembered the joy of reading for pleasure instead of knowledge. I started practicing art again, calligraphy, and writing letters to dear friends who had remained part of my life even when I had become a bit of a mechanized person. In this way, I began to nurture the part of me that had wanted to go into medicine in the first place, the part of me that wanted to help others, the part of me that truly loved the people who were sitting in the office. This process has allowed me to disassemble the side effects of medicine in my life and has allowed me to begin to repair some of the unintentional damage that has been done over the last 25 years.

I realize this is a lot to hear, and I know that so much of it seems so foreign to where you are in your life right now. Not to worry, it is a glimpse of a possible journey you could take, it is not the right choice or the only choice, but a choice. And, if you head this way, I will be here when you arrive, with a beer in my hand, a firm hug, and a deep love for who you are becoming.

Love Gil

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

‘Is there some secret you have learned that you wish you knew earlier?’

‘Medicine is a jealous lover…’

Hello,

Working hard is a tradition in medicine. The braggadocio around hours of call without sleep, number of patients seen in the ER shift, numbers on the hospital service all speak volumes to the cult of work that is medicine. By the time you enter medical school, you are already indoctrinated into the cult. You worked hard in high school to get the right university. Worked hard in university to get into the right medical school. Worked hard in medical school to get the right residency. Worked hard in residency to land the perfect job. There is a theme…. Work.

It is no surprise that doctors struggle taking time off, taking a break. It is not something we do, we always work hard. There is an unspoken pressure to always be on, be right, to know, and that takes lots of work. It is an unclimbable mountain of ‘always’ but we try none-the-less.

I remember during school, I would be sitting at supper with my wife and mid-sentence would simply fall asleep. I could fall asleep sitting, sometimes even standing. I fell asleep at a stop light, sitting on my motorcycle, and fell over. This ongoing devotion to work was simply part of the deal in school, you know what I mean, look at how hard folks work even with the ‘duty hours’ in place. It followed me to Utah when I was in the clinic at Dugway. There was a time where I was the only doctor for the post for over 6 months, thought nothing of it, being on call every day, seeing patients every day, never leaving the post. It was life, it was medicine, it was expected.

In residency, I would moonlight on the side, working hard until I had a bleeding ulcer. Standing in front of the GI doc who had just scoped me, hearing him dress me down for working too hard, I remember thinking, ‘I am going to have to smarten up’. I did for a while, then transitioned out of residency into academics and once again found a way to work all the time. I worked in medicine, in academics, in research, with a side of farm chores just to make it interesting.

“No matter where you go, there you are”- Confucius

We moved to Prince Edward Island to ‘get away’, to try once again, to find a balance in life. In just a few short years I once again built a mighty empire of work. But this time something was different. Nancy asked me how long I was going to do the same thing and expect a different outcome. That was a most valuable conversation that shifted my point of view, it moved my attention from the outside world to the inside world. I began to look at how I spent my time, and what it cost me. A book that really changed my point of view was ‘Overwhelmed: Work, love, and Play When No One has the Time’ by Brigid Schulte. As crazy as it sounds, the exercise where I looked at how I was spending my 168 hours each week really rocked my world. I had been living my life as if I had all the time in the world available to me, and the realization that I only had 168 hours each week that stopped me dead in my tracks. Tracking how I spent my time, seeing medicine consume more of my time than everything else, was eye opening. I was shocked, although no one else was. Medicine is a jealous lover, always asking for more, until you have lost track of your real relationships, until they have come to see their second-class status in your life. In the moment when you see how you have cheated on your life with medicine, you come to understand what has been lost and gained, and in that moment that you begin to break up with medicine.

Breaking up with medicine can be hard, especially if the relationship has come to define who you are. It is a disruption of a long-term relationship, hard and fraught with anger and worry. It is a dark night when you see what has been done, freely, by your own actions, to those who love you most. But it is this dark night that brings about the clarity of morning light. It is the realization of what has been given that cannot be returned, what has been lost that is beyond retrieval, that burns through your heart in these moments. It is the burning away of the selfish pride. It is a fire we need to feel in order to clear away the dead wood in our life, allowing new growth to arise. For my part, I let it burn me good, burn until I felt like I had nothing left to toss into the flames, allowing myself to be melted and pliable so I could begin to reshape into something new, building on the scaffolding of these hard lessons learned. So I say, work hard, commit yourself fully to the cause that is medicine, allow it to wear you down until you burn in the fire, for when the ashes are cool, what rises will be far more beautiful than what was burned my friend, and I will be standing near that fire ready to greet you with a knowing look and a big hug.

Sincerely Gil

This is a series of letters to a young doctor form so long ago, please follow along with me as we explore together this life in medicine and touch the history that has formed in the process. If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

‘What has been the hardest lesson you have had to learn?’

‘Saying No instead of Yes….’

Hello,

It has been surprising to me that the hardest lesson I learned from Medicine is how to say “No’. I suspected the lessons in school would be the hardest, maybe the ways to have delicate conversations, or to sit with the dying. However, nothing comes close to learning to say “No’.

What makes saying ‘No’ difficult is that ‘Yes’ arises so easily, so naturally. It happens all the time. You have been programed to say ‘Yes’ by your journey, by society. In fact, the very people you love so dearly have modelled the many ways in which you will spend the rest of your life saying ‘Yes’, when you might be better off saying ‘No’.

How I Learned to say Yes…

LaNere, my beloved grandmother, the one who always knew I was going to be a great doctor, could never say ‘No’. She came by this naturally, a product of the depression, when it was clear she was an extra mouth to feed. She heard ‘No’ most of her young life, and it was not until she met my grandfather, that she began to hear yes from others. She never said ‘No’ to me growing up, and it stuck.

Mother and father also modeled this behavior, helping all who asked, even when it meant taking time from the family. They were loved by the community for the many ways they said ‘Yes’, and in those ways, they trained me to say yes also. My time in Boy Scouts taught me to say ‘Yes’, to be courteous, kind, and friendly in the process of being helpful. All of these adults helped me learn to say ‘Yes’, I learned that this is what kind people did. By the time I was applying for medical school, I had undergone decades of programing to say yes to those around me. I had learned how good it felt to say ‘Yes’, feelings of fulfillment from being helpful. Little did I know it was hiding an unmet need.

It is common in medicine…

Gabor Maté has said that ‘medicine is the perfect drug for those that need to be helpful’, and there are no more perfect addicts for this drug, than young doctors. Recall how it felt to write that application essay on why you wanted to enter medicine. Remember the feeling you had in the interviews when you spoke with the students and residents, how much you longed to be like them, out there in the world, helping others, healing the sick. This was the chance to really be needed, to really be helpful, and you chased it down.

It should be no surprise that learning to say ‘No’ is going to suck. Believe me it will. It will not be easily at first, you will be forced into it by the unfortunate circumstances of saying ‘Yes’ too often. You will find yourself angry and irritable because you said ‘Yes’ too many times, it will leak out of you onto whomever is in front of you, much to your dismay and their regret. Anger will be the first clue card that maybe, just maybe you should ask some deeper questions about what is happening. You will not do this, you will push things down, drive on, just like you have been trained to do. It is what we do in medicine, and you will be no different, you give to others because that is what Doctors do.

You will wrestle with you anger, chasing it to blank walls of your mind trying to figure out why it is there. You will burn in frustration as your anger spills out onto your spouse, and the patients asking for your help. You will try to hide it from them, but they will feel the sting of your sharp tongue. Your pronouncements about their choices, their decisions, will make it clear exactly how you feel. Afterwards you will reassure yourself that you chose those words to encourage them to make ‘better choices’. No one will be encouraged, they will be scared, withdrawn, afraid. They will recognize it on some level internally, and it will get in the way, it will be a brick wall.

In the end, you will turn your attention inward, searching for the source of your discomfort. It is there that you will begin to see the truth of where it all comes from, to see the pain it has caused you, and others, throughout your life. You will see how your relentless ‘Yes’ hurt you and those you love. You will see how your ‘Yes’ has been a vain effort to fulfill needs that can only be filled from within, and that will be the hardest thing you learn from medicine.

It is ok. I see all that you become and can tell you that the lessons learned were valuable, integral to prepare you to turn inward and look at your heart. It is no different than preparing a field for hay. Steps must be taken to make it ready, and even then, the harvest will not come for several years. Do not try to avoid this lesson, dive in, get dirty, make your field ready, allow your heart to be broken, give more than you have until you are emptied again and again, and notice how you begin to question yourself, becoming curious about what it is that drives you along this path, and if you can, take a moment here and there to really enjoy the journey that you are on.

Be safe, and I will see you when you get here…

Sincerely Gil

This is a series of letters to a young doctor from so long ago, please follow along with me as we explore together this life in medicine and touch the history that has formed in the process. If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

“What do you wish you knew when you first started practice?”

“Everything”

Hello,

There are so many things that I wish I had known when I started in medicine, things that unfortunately are unknowable until you have spent some time in practice. There are some things that you cannot know until you have walked this path for a while. It is like a pair of shoes you plan to take hiking, you try them on, walk around the store, climb the fake rock to see how they fit going up and down, and make your best guess. The felt good while you walked all over the REI, looking at everything, but when you hit the trail you find they are not quite right. The break is a little too far forward on the foot and so after 20 KM the midfoot is sore, as are your toes. There are so many things like that in the world, they require first-hand experience to understand.

In 1990 I began my medical journey and have been on it without pause for the last 28 years, and in truth, I am not sure the pause will come until the breath fails me. I enjoy the work, and it gives something to me that I have not found anywhere else, a sense of purpose. What surprises me most are the unstated needs that were filled for so long that I was completely unaware of and how that purpose has changed over the years.

When I graduated from medical school 1995, I was given a wonderful quote from a friend’s mother. Her father had been a physician in New Orleans and she had this quote framed for me to display.

The Physician

When the final history of the world is written, the physician will stand alone in the variety of his economic usefulness, his field apart, yet touching at all times the toga of the citizen, the robe of the priest, the periwig of the advocate, the scarlet of the judge, the mask of the executioner — each shadowing his life with the mixt bitterness of reproach at the limitations of his ability in the midst of so great a field of labor and of so large possibilities of accomplishment, while always the whisper of the succored child, the prayers of the convalescent and the glory in sharing the salvation bring the ray of light which lends the soft harmony of gentleness which should be the signal standard of the true physician, as, at the end, he stands a sad and thoughtful actor in the Human Comedy.

-Isadore Dyer, MD New Orleans 1910

I remember reading this when I first opened it after graduation, and thinking to myself “Who is this kind of person? Who writes this kind of work, and what does this mean?” This has hung over every desk I have ever used for the last 23 years, I see it every day, and I think about it often. Dr. Dyer has been my unofficial teacher for this journey. I reference our conversation often when I find myself in a place where I wonder what I should do. I look to him when I think about how I might approach this problem, how to talk to this patient, to find the words that I need for a conversation. His words have prompted me to slow down, to take a little more time, to ask one more question. His words have pointed me in directions I would not have gone on my own quite so easily, or so quickly.

When I think about the young man who was starting, when he first landed in medical school in 1990, when he might have asked me this question, “what do you wish you knew?” It is like I am seeing him through the wrong end of a telescope. He seems so far away, and the pictures of him I have collected in an old box, look so young, so very, very young. When I look in the mirror I see him looking out at me through my eyes, but the face that surrounds has changed. It is less sure and more kind, it is less hurried and more thoughtful, it is confident in what it knows, and confident enough to own what it does not know. There’re so many things I would tell this young doctor, so many valuable things I would say to him…. Don’t be in a rush, it is a long road, there will be many steps, and you have a long time to get there. You do not know half of what you think you know, and you do not know a fraction of how much you truly do not understand. Your heart is going to be broken, again, again, and again. Your heart is going to be broken so completely that it will have to regrow in a new and bigger way. You are going to come close to dying because of your hubris, you are going to hurt people because of your ego, you were going to be the kind of doctor you promised never to be… and it is important that you do this, so that you can grow the kind of compassion that you truly want to have. This journey that you had committed yourself to is insane, and if you were smart, he would turn back now. But I know you won’t, you have a fire in your belly that can only be quenched by walking to the source. And so, I wish you the very best of luck on your journey and I will see you when you arrive.

And though I’ve been in practice for 23 years now, I have not found words that speak better the story of the physician than those that I was given on the day of my graduation, and I have found no words clearer in their direction to me of how I should conduct that life.

Sincerely Gil

This is the first in a series of letters to a young doctor form so long ago, please follow along with me as we explore together this life in medicine and touch the history that has formed in the process. If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

It comes down to the people. It is not about their work, but how they feel; feeling valued, feeling your work is valuable to those you serve, and feeling valuable doing the work. It is work as an extension of what you believe, what you love, and how you want the world to be reflected back to you.

For 22 years I have watched systems work to chart their way into the future. It is a difficult future; the Baby Boom generation is such that it is going to be a costly future as well. It is not a problem, problems can be solved. This is a predicament, it is inevitable, it must be managed. To manage a predicament people must bring their best, give it, and do that repeatedly.

Finding our ‘Why’ is how we do this

How do you get the very best from people? Simon Sinek outlines this in ‘Start with Why’. Find your ‘Why’, and work to connect that ‘Why’ with everything and everyone doing it. For Goodyear Tires, it is safety; Apple- personal empowerment; Coke- happiness. So, let’s take a thought experiment, let’s imagine the ‘Why’ for a health system.

Taking care of sick people

This misses the boat of prevention. It is focuses on acute care. Acute care and sickness are difficult and expensive. This system would invest in Emergency Response, lots of doctors, lots of support staff and lots of Hospitals. That is where the sick work occurs, in the trenches, in urgent moments. Get them well and get them home.

Preventing illness

Here we lose sight of the acute, leaving the sickest out of the mix. It has lots of disease prevention strategies, messaging about prevention, incentives motivating lifestyle change. Instead of the sick, it would focus on preventing illness in the first place. More nurses and educators, fewer physicians; more incentive and emphasis on taking care of yourself, and more cost if you did not. This system needs lead time to work, and time is short.

What is a ‘Why’ that encompasses all we have to do? Caring for the sick, preventing illness, and getting ready for the demographic push coming our way? What if the why is ‘Healing’, how would that system work?

Healing not curing

When I think about healing, it is not ‘curing’. Healing is working beyond the disease, problem, acute issue, and is more than prevention. I have worked to help people prevent illness, it is difficult, because change is hard. We have behaviors we do not understand driving our choices, driving us nuts, and making change difficult. I see this in my life, and the lives of people I care for. Watching them struggle to change on the outside without first changing on the inside. Healing is changing the inside first, and when you do, everything else begins to fall into place. Healing focuses on meeting people where they are right now and helping them change. It is working together, extending a hand and saying we can do this.

Health care systems be they corporate, not for profit, military, or governmental, share a singular design with a singular problem. They are focused top down. Whether the top is a General Officer, a CEO, Head Physician, or Minister of Health, they are focused this way, someone has ‘ultimate’ responsibility for outcomes of the system. Beyond responsibility, power and decisions flow top down, and this is where the healing needs to happen. It is those on the ground, delivering the care who need to feel engaged, valued, met, they need to feel like what they do matters. Decisions roll down from the mountain like commandments, landing in the messy mix of illness, people, fear and doubt, feeling like ‘just one more thing to do, one more box to check’. They feel disconnected from what is in front of you, they feel like the people in charge do not know you, get you, or care. This has to change in order to bring the best solutions to the predicaments coming our way, this has to change now before the crisis arrives.

Change begins at the top

So how do we do this? How do we change a Health System? It begins by caring, by leaders stepping outside their comfort zone, caring about the people doing the work as much as the work itself. Demonstrating this care with actions, actions that may not make headlines, may not make them grander/greater, but change the lives of those doing the work. Leaders who value the most important asset, the people providing the care. Making them the best people they can be, working to give them freedom to do their best work, encouraging them to take risks, try something new, to show up bringing their best. By encouraging others to bring their best to the table, we begin to heal the ones doing this work, and they pass that healing to the people they serve, and that is a ‘Why’ we can all be proud of.

So, what would this system look like? I have never seen one in action. I have caught glimpses here and there in small teams working together within the greater system. In those moments, it looks like one person deeply caring for the person in front of them. It is the doctor who cares about the nurse as well as the patients. It is the ward clerk remembering a birthday and getting something special sent up. It is the pharmacist realizing the patient cannot read, working to get picture labels, so medications get taken at the right time. It is feeling like the work you do is valuable and valued, willingly doing a little bit more without being asked, and feeling appreciated for all that you do. It is this kind of system that will find a way through the troubles ahead, and at the end of the day when you return home, you feel like you have given your all for something that is worth all that you can give.

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

‘One of the ways that Gil adds value and makes important contributions is…’ That is the assignment, to reflect upon when we are at our best. We were to solicit opinions from our colleagues, family and friends about moments when they had seen us at our best. Asking for positive feedback from people that know you well, why is that so difficult, why is it so frightening? Yet, here is was, that sense of trepidation as I pressed send, that sense of unease, of disquiet. It felt really wrong to ask for positive feedback from people, really wrong.

In medicine, you learn early on, that feedback is essential, and essentially negative. It is the key to improvement, and given the number of tests that you take to get through to the end of medical school, you become very familiar with feedback. Each test is a chance to see where you need to improve, and once you transition to the clinical training, you get feedback from pretty much every encounter. The intern tells you what you did not do, the residents tells you what you did not do, the attending quizzes you to the very edges of your knowledge base. It is relentless, these cycles of feedback, and pretty much all of it is on how to improve. You read, and read more, and still find your fund of knowledge short when rounds begin. In medicine, feedback is almost always about what you should improve, the shortcomings of your work, and where you should focus your attention. Positive feedback is pretty much a rarity, and so to step outside your comfort zone and ask for this is really stepping into the Twilight Zone.

The letters began to arrive, and as I read through them, themes began to emerge. A picture of a person began filing itself in, and slowly I began to see how other people viewed me. I began to see a person who was committed to mentoring at all levels, who embodied his values and leads by example, who builds teams and encourages each member to be their very best, who shares knowledge, who has a very deep compassion for the lives he touches. As I read through these responses, I thought to myself, ‘I would love to work for this fellow….’ And then it hit me, I did.

Mammals, and humans in particular, are wired to see danger in their environment, after all, the nervous horse running first and asking questions later is often the one to survive. Humans are wired to see the negative, to hold it close, and often to ruminate upon it. I have seen this in my own life, this negativity bias. Someone is giving me positive feedback, I sit waiting, patiently, for the ‘room for improvement’ message. Even in my Hakomi small group work, where I know that the people with who I am working love me deeply and support me in every way possible, I still find myself waiting for the ‘things I should change’. This is a crazy place to be, where all we see, all we notice is the negative evaluations, the negative self-talk, the negative.

So, the assignment was to seek out positive feedback from those that know me very well. To ask them to think of a time when I was at my best, describe it, and provide examples. Looking through these responses builds a collage of images for me to consider about who I am when I am at my best. It provides grounds for me to really consider what my best looks like, and where my strengths really reside. It is a difficult assignment, but one with tremendous value. It shows me where I already perform well, and it shows me where I can go from very good to great. It shows me where my greatest strengths lay in this moment, and also points to where I should lean in and look for support from others who possess skills and strengths that I do not. It points out to me how to build a team that will bring the best from each member, by asking them to do what I cannot, and by doing for them what they cannot. It is in this manner, in this way, that we create magic that makes the work seem almost effortless as we each do that thing that we do so very well.

And in this moment, I can see how I have worked to bring these innate talents and gifts forward. I can see how I have honed them to a sharper edge over the years, often on the grindstone of criticism. I can see how I have watched the way that medicine is taught, and I have chosen a different path forward for teaching. I can see how I have smoothed away the rough edges of who I am so that I can more readily give what I have to offer.

“When I am at my best, I am centered and grounded in my own sense of self.

From this place I have space to allow, to contain, and to expand.

From this place I can share without fear of losing, I can lead from any position, I can teach what is needed in this moment.

From this place, my values flow through my actions, I embody the changes I seek, I build teams to help bring this to fruition.

From this place, my actions help others step into their best, my focus helps others sharpen their work, my commitment helps others stay the course.

When I at my best, the needs of my ego step to the side so that the clarity of this moment and all that it needs is present.

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

They were kind and offered to put me up for the weekend. I did not know them, and they were trusting that this stranger in the house would be alright. That is the principle of Couchsurfing. People generously open their homes to strangers passing through to spend a night. I was coming back to Princeton for another Hakomi weekend, and the place I had stayed previously was not available. I put my name out with my plans for my weekend of education, and I got several offers from strangers to host my stay. Each one was kind, generous, and unique. However, one was on the bus route I used to get to the Yoga Center where the training was taking place, and I was intrigued. A family of four from the French Alps staying in Princeton for a couple of years, and their house was 50 meters from my bus stop. At the end of the weekend with them, my life had been forever changed.

I joined Couchsurfing in 2011 after hearing about it on a podcast, This Week In Tech. It had a similar ethos to other sharing applications, but something about it grabbed me. I am a naturally curious person, and I have traveled a lot in this world, and consistently I have been amazed at the kindness of strangers in all parts of the globe. This seemed like a way to bring more of that kindness into the world, and that seems like a very good thing.

My interaction and reliance on strangers goes back to my travel to Ghana. In 1988, I was headed to Ghana to work with Operations Crossroads Africa. I had graduated from Austin College, had been accepted to medical school, and had deferred that for a year or two as I wanted to get some graduate school experience. I heard about this group during my last year in school, applied, and was accepted to a team going to Ghana. We would be working with VOLU, one of the oldest volunteer work groups in Africa, working in two different villages, doing construction work. It would be the entire summer, and I was excited. However, I did not know a soul on the trip, and in those days prior to the internet, I communicated mostly via letter to the organizers and to the two leads for our group. I found myself, freshly graduated from College, boarding a plane in Dallas Texas for the east coast to meet someone I did not know, in an airport I did not know, to go to a country I did not know, to work for the summer. The number of things I did not know hit me as I boarded the plane for Baltimore, and I wondered exactly what I had gotten myself into. This trip opened my eyes about life, the world, and the kindness of strangers.

In 2003, I went back to Ghana to teach at a medical conference. I was arriving early, and the medical student I had been emailing kindly offered to pick me up at the airport. She had not met me, and in fact though that Gil was short for Gillian and expected me to be a woman. The porter she had asked to hold a sign for me in the luggage area was surprised when I walked up, and he smiled telling me I was not the sex he was expecting. Ama was a surprised as he, but quickly recovered, and made me a guest in her house with her parents, showing me once again the kindness of strangers in this world.

With these and many other moments of kindness in my memory, I signed up for Couchsurfing and offered our house to anyone who needed a place to stay. Given our location, the number of surfers that I expected was low, and it was not until 2017 that we had our first guests, and since then we have enjoyed hosting many travelers wondering through West Prince. It is a bit of a step back in time, before the arrival of modernity, when travelers would look for lodging wherever they could find it. It is the kind of travel that was common when the Camino de Santiago was being travelled by Christian Pilgrims in the Middle Ages. Along the way, there were places for the pilgrims to rest as they walked toward Santiago de Compostela, and in that time, travelers often would find themselves welcome in houses and pubs, sometimes for money, and other times for news and stories of the outside world.

Our guests bring with them a view of the world that I otherwise would not have. They bring news of what life is like for them, and they give me a glimpse into other ways life might be. From the young man hitchhiking and volunteering his way around the world, to others who are simply trying to see all of Canada prior to returning home. Each one has left an imprint upon my life, they have shown me something about myself that I did not previously know. They have shown me a point of view that I would not have had, they have demonstrated another way to live this life, and have given me the courage to step beyond my self-imposed comfort zones.

So, I found myself in the winter of 2016 looking for a place to stay in Princeton, and I posted my travel plans onto the site. This lovely family offered me a place to sleep, and the opportunity to get to know them. In return for their kindness, I had the chance to meet and fall deeply in love with this family from France who have become very dear friends. This one-off hosting became a regular stay as I came back, again and again, to their house to stay with them, getting to know them a little better each time. Their children teaching me very deep lessons about kindness and love that I might not have learned if I had not stayed. This chance encounter with strangers has become an extension of my family, and I have become an extension of theirs. It was an act of bravery to put my name and plans out into the world, and an act of bravery for them to offer me space in their home, and over these last two years, we have all been richly rewarded for stepping beyond our comfort zone, for trusting the goodness of others, and for bravely welcoming strangers into our lives. I imagine how wonderful it might be, if we all did this just a little bit more as we went throughout our days and look forward to the next weary travelers who cross our path and change our life.

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

‘I am curious about your use of the word allow.’

My breath caught in my throat, tightness grabbed at my heart, and for a second the sense of vertigo was there, I was on the precipice looking down. What had she seen, what had I shown, and why did she hone in on that phrase.

‘I want to offer you some words… notice what happens when you hear them…. It’s OK to allow yourself to be loved.’

I turned in, felt the instability in my seat, felt myself twisting just a bit as I looked into that place where it felt scary. I could see how I interacted with love, how it was a commodity in my life. How I let some people love me in whatever way they could, and for others, I had to have in just this way, or it did not count. It felt unfair, and that rattled me even further, the little kid in me was really familiar with unfair and did not want anything to do with it.

‘It seems like there is a lot going on in there… what do you notice?’

I noticed the turmoil inside and got curious about it. What was this turmoil? Where did it come from? With gentle work, things began to become clearer, the ways in which I restricted love became apparent. I could see how I was trying to water a field with a garden hose when there was a firehose next to me ready for use, and that garden hose had been in use since I was 4 years old.

Like many things in life, this interaction with love was unknown to me. It takes place beyond my conscious ‘knowing’ and it was being run like most unconscious programs and strategies, behind the scenes, on automatic. I just went through my day, and never once gave consideration to the way I interacted with love. Why would I, it was coming from somewhere, and enough of it, so I did not feel like I was suffering, what could be wrong? It is like walking with a limp after the cast comes off. Your ankle is repaired, and for the most part does not hurt, yet the limp is still there. Somehow it has been incorporated into your system, so you just do this without thinking about it, or at times, even noticing. Here I was doing just that, not noticing what happened automatically.

My interaction and history with love was ‘complicated’. Being an adopted child, there was some part of me that carried around a feeling of rejection early on, colouring how I interacted with love. For the longest time, I felt like love was something that had to be earned. I was good at earning the positive attention, I learned that when I did well, the adults in my life rewarded me with affection. It is a pattern that has persisted until more recently. It is not terrible, it has led to a very productive life, but productive at a cost. Productive because anything less would lead to a withdrawal of the love in my life from me (or so it seemed).

In 2015, I had a dramatic shift in the way that I saw love, a shift as a result of seeing something from a different point of view. As a result of this shift in my view point, I was able to allow myself to be loved without producing and being productive, sometimes. I began to see how love and productivity had nothing to do with each other. But still, there was this fear when she contacted this place within me, this place that reacted to ‘it is ok to allow yourself to be loved.’ What lay within this phrase that held such fear?

‘Let’s just hang out here, in this place that feels so complicated…. Just hang out and see what wants to happen.’

There is something unexpected that happens when you simply hang out with someone at a place of discomfort, in a place that scares you, just sitting there with someone who indeed wishes you well, who holds your heart close regardless of what you do, or how you are doing. It is in this relationship, that magic happens, that possibilities open that were not there before, that you begin to see into the potentials that you would otherwise be too afraid to notice. So, she sat with me, not saying much, but letting me know she was there, that I was not doing this alone, and in that space something new began to unfold, a possibility that had not been available.

I allowed myself to be loved, could that mean I also disallowed myself to be loved? How did I do this? And why? Just hanging out, hearing her reassurance, things began to move, to shift, I could see how I was loved, and I could see how I allowed love in. I could see the filter that was in place that love had to come through depending on the source and seeing that filter broke my heart just a little bit. I could see a little boy who could only hear love in a certain way, a father who did not speak that language, and how that filter had remained in place despite the many years. I began to look at the language he spoke, and to see within that language the ways in which love was expressed. In that moment that I turned to this little one inside me, to talk to him of the many languages of love, and the ways that our parents spoke that language. We talked of the reasons that he did not speak our language, of the ways this language had not been a part of his life, and that like any language, it is easier to learn when you are young and so much more difficult when you get older. We talked about choices, the choices we make, and whether or not they are ‘forever’ choices, and if they are not, we could choose something else, we could we choose to listen to the language with new ears.

‘It seems like something has shifted in you.’

Still with me, she reached out through the shifting sands of my mind to touch upon the change that was taking place, this change she had noticed as she tracked my actions, reaction, and silent expressions. She had seen this shift, and in naming it, I felt it slide into place. I could choose to see the love that was there, to see it without requirement for translation or alteration, to see it as it is, in this moment, right now. Small tears slide down my face as I felt that love that I had held at arm’s length for so long, and felt it stretch back across the years.

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

‘Well, I guess it is time to go back to reality…” Hearing those words, my heart sank, I felt sad. I heard longing, longing for a different life, longing for change, a desire longing to be met. I heard the voice of someone who did not expect the world to be different than it appeared, and I imagined someone who felt a little powerless to make any difference. Within me, there was a voice of rebellion to this statement, a voice that wanted to call out, to shake them out of their expectations, and it is the voice that speaks to me often.

This world can present in many ways, and for any given situation there are thousands of ways to view it, if not more. I have learned that the way that the world appears to me is not the way it appears to others, that the limitations I see, the difficulties I have are not the same for everyone, and I have been curious about this difference for a while. I have watched with envy as others completed a task I struggled to begin. I watch others labor over decisions that I find simple to make, and for years I wondered why there were such large differences, why I could see things other could not, and why I had troubles seeing what others perceived easily.

Part of this process I have come to see is one of expectation, and that the expectations that I hold will constrain the options I see before me. In Zen Buddhism they speak of Beginner’s Mind, the mind that is open to all the possibilities, which is not limited by expectations. Each of us can see this easily when we notice how much longer a trip seems as we are travelling some place new for the first time. Retracing our steps on the return, the distance unchanged, yet the perception is often that the travel is quicker. Our mind bookmarks the landmarks along the way but does not understand the relationship to the destination. As we return, those landmarks serve to mark the passage of time and indicate how much closer we are to the finish. Our brains project into the future with greater certainty and the result is that the return seems quicker. It is not really the truth, the distance travelled is the same, the perception has changed, nothing more.

Perception changes what happens. My perception changes what happens to me. My expectations guide and hone my perceptions so that I begin to see what I expect to see, and my expectations for what will happen are more likely to be fulfilled. But I wonder, is this because I expect it, does my perception set this outcome? Do I influence the system to create the outcome I expect? My experience indicates that this often occurs.

Over the last 5 years, I have worked diligently to understand my own unconscious strategies that influence my perceptions of what is happening in my world. As I have uncovered more and more layers of behavior, unconscious to me, I have changed the way the world looks on a daily basis. Uncovering my unconscious biases and expected outcomes, the unconscious voices offering critic and advice throughout the day, the automatic behaviors that prompt action before thought (or without thought), changed my expectation of the world in which I live. The possibilities available to me are greater, and the flexibility of my actions is wider, changing the perception of what there is in any given moment. In doing this, I have come to see that ‘reality’ is what I make it far more often than it is static and unchanging. True, I am unlikely to make the sun rise in the west and set in the east because of my expectation, but the way I feel about the rising and setting of the sun can change in the blink of an eye.

So, what is this reality that we ‘head back to’? Is it really any more than the reality of our own making? Is it the truth of what is to forever be, or is it just a reflection of our current state of mind, our current expectation, and our current perception? My heart is sad when I hear these words in the world, because I know how they feel to embody, I recall the defeated feeling that accompanies these words the hanging head, the slumped shoulders, the feeling that I am the ox leaning into the traces pulling the plow across a deep muddy field, again and again. I know how narrow the point of view is when the blinders are on and all you can do is pull. I can see how my expectations, in this frame of mind, limit the reality that lays before me, limit the options I can see, and constrain the system so that it produces only what I expect of it. I

But the beauty of this life is that each moment is indeed new, it is a moment we have never had before. It is a moment that has our entire future stretched before it, and we get to choose how to spend that moment. We can choose to do what we have always done, or we can begin to be curious, and in that curiosity change can happen as the possibilities become endless.

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).

The moon, large, yellow, rises slowly above the trees, sounds of the jungle can be heard in the early evening, strange and foreign to my ears. Sitting on the cement flooring that marks the porch edge for the school we are building, I have a moment of clarity, my place on the earth. I see it on a globe, glowing brightly, so far away from everything I know. Rising with the moon, an urge in my heart, to walk into the forest, disappearing from all that is known, into a place where everything familiar to me no longer exists. Into a place where everything unnecessary, unessential, is stripped away.

Sitting on this porch, my life rolls out before me, a road I can follow along, expected, going where everyone always goes. The urge beckons me into the forest, to leave the path completely, to step fully into the unknown. Excitement and fear stir in my heart, feeling life propel me into a nexus from which I will emerge, changed. Unknown to me, in three short weeks I will face death at the hands of something so very small it takes a microscope to see it. The malaria parasite will take hold, bringing me to my knees. A moment of indiscretion, a break in the usual pattern of protection from mosquito bites, a night without netting, to sleep in a gentle breeze that can make its way to my hot skin. I am not alone in the indiscretion that night, and when the malaria comes, I am not alone in my suffering.

Sitting on the school porch, none of this is known. Listening to the evening sounds of the jungle, I consider walking into the forest but do not rise from my seat. I feel the distance home, feel the space between all that I know and all that is foreign. A white face in a sea of color, I am outside myself and outside my understanding. This village we are working in is poor, poor in a way I have never seen. Cinder blocks made of dirt, sand, and cement are fashioned together as we work. The dirt comes from the well we dig by hand deep into the red earth. Ten meters down, heat and humidity are somehow heavier, digging and filling one bucket at a time, raised and lowered, filled and emptied. In time, the footing becomes wet mud, then water. We are standing knee deep in water, soon waist deep. The water is cool, and when we are done, it is clear and clean.

The Ghanaian way is to sing as you work. They teach us their work songs to lighten the effort. The songs are happy, joyful, and seem to stand in contrast to the poverty surrounding me. In my mind, happiness comes from the things that you have, the comforts of life, yet in this place, with these people, I am happier, more content than I have ever been. They have relatively little yet share what they have freely. We are guests, and they treat us with all the kindness that a person can possess. In my mind, this dissonance reverberates, shaking loose patterns of thought, patterns of belief that guide my life. I find myself looking into the forest wondering which path I will take, which way I will go, feeling lost without map or compass, curious as to what I will do in my life.

The crises that is coming is outside of my view. Not knowing the degree to which I will be tested, I am content to ponder where happiness comes from, why the Ghanaians are so happy, with so little, and such hard lives. The joy and satisfaction I see in the children running around outside the school, in the parents as they go about their work, do not fit with my world view, they do not fit my patterns of understanding. I find myself drifting along wondering what it all means and feeling the pilings that support my point of view begin to shift.

Sitting on my cushion, sunlight beams through the window, the stained-glass glows brightly, there is warmth where it lands upon me. The old cat maneuvers herself to the perfect place so she can get the warmest spot, her old bones seem stiff this winter. It happens like this, one day you notice that you cannot get up from the cushion as easily, the knees make sounds that you have not heard before, sounds heard more often from the stairs as they creak under foot. I find myself remembering those days in Ghana, where I did not yet know what would become of my life. From this place, this time, I see how Africa changed my life forever. I can see how my brush with death opened up doors unseen, how my confusion over the happiness that surrounded me amidst such poverty propelled choices to understand where happiness comes from, and how my time as an outsider in West Africa opened up my point of view so I could set out upon my walk through the jungle of self-exploration. A smile crosses my face as I find myself humming one of the old work tunes, words long forgotten, but the melody and the lessons remain.

If any of resonates for you, and you happen to be curious, and wish to know more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).