When my father first went into practice as an internist, he took over for a doctor who was a maximizer. He would tell his patients, ‘this is the worst case of degenerative disk disease (for example) I have ever seen.’ Often, the case would be no more severe than is typical for generalized back arthritis, but this did not deter his comments. His patient’s loved him for it. It gave validity to their experience, my pain is real! This doctor is listening! Something is very wrong, which explains what I am feeling! But like most narratives it created a self fulfilling prophecy, and now those with mild-moderate degenerative disk disease were acting like those with severe back problems.

One of the trickiest parts of my job is attempting to meet someone on their personal maximizer/minimizer continuum. Trying to assess how much input a patient wants from me is a difficult process, and let’s be clear, both work up and diagnosis are affected by patient personalities. And advocacy does not always equate to a more accurate diagnosis.

For example, you enter a room, and there’s a 20 year old patient sitting huddled on a chair. They are complaining of chest pain, intermittent, sometimes with activity and sometimes without. They look frightened, small, and so young. So you go in guns blazing- labs, stress test, EKG, the works. You figure if I work this up with every possible modality, I can assuage their fears. They leave the exam room crying, more scared than when they entered, as you have validated their worst concerns. Switch to the same scenario, same patient, but you choose a casual approach. The pain lasts seconds! You’re young! I can reproduce it by touching your chest wall! We’ll grab an EKG but I’m really not too bothered. And then they leave, crying, because you didn’t take them seriously.

In general there tends to be a complicated dance in every exam room, while I put out some feelers to see how stressed a patient is, how much they want done, and what I feel would be most appropriate.

This brings me to my first question. How will artificial intelligence manage the divide between the minimizer and the maximizer? If medical care becomes algorithmic, wouldn’t you lose that interplay between assessing someone’s feelings about their symptoms, their actual symptoms and the true concerns of the doctor? Wouldn’t this result in more diagnosis, more boxed answers, without assessing true impact and treatment?

Because ultimately, isn’t the feeling you have  about your symptoms one of the biggest parts of the equation? Sure, if you’re ignoring your crushing substernal chest pain that’s probably not a good idea. But how many people truly do that? Honestly, not many. If anything most humans tend to maximize. And with maximization comes its counterpoint, anxiety. When I look at a person, really look at them, if I am lucky, I can see how scared or bothered or unconcerned they actually are. I can gauge if we need the xray for medical reasons or emotional support reasons. I can hopefully guide towards a plan, a feeling of control or reassurance, and not just an algorithmic diagnosis.

I have a big fear about everything in medicine becoming diagnostic. As I said above, we humans tend to be maximizers. We want to dig more than is necessary, and AI allows for more digging versus more reassurance. And with continued digging, not only do you get swept up in the industrial medical complex and the cost of medical care, you are also more likely to get a name for what’s going on. A name that may or may not be valid. A name that may become a piece of your identity and who are. A name that may not be necessary, and may ultimately, impact your perception of self. See the patient above with moderate back dysfunction and a perception of severe disease, and see how they chose to limit their lives. I don’t want that for my people.

This brings me to my final point, I would argue that for most people with a big diagnosis (think cancer, major mental health, degenerative neurological conditions), people want to remove their identity from the diagnosis. The hope is to separate the soul from the disease in the best way possible. ‘I am much more than a diagnosis, I am still me.’ You can read beautiful articles everyday about how people have connected with their illness, but learned how to keep pieces of their pre-illness self alive.

Yet with AI, I see more people coming to see me with a predetermined diagnosis. I have X. It is who I am. I followed the diagnostic criteria on-line, and this is the name for my ills. Certainly, this can be reassuring (names are always reassuring! Just two weeks ago I was delighted that Hattie got a diagnosis of Hashimoto’s thyroiditis as I had an explanation for her behavior. I get that. Sometimes we need the label, because, well, we need the treatment.) But I worry the symptom hodge podge leading to diagnosis is becoming too easy. We are too quick to label and box and package. As we see humans as algorithms and not people, we miss the nuisance of how they relate to their symptoms, and if the symptoms themselves are worthy of diagnostic criteria.

Because frankly, if it’s not really bothering you, do you need to change your life to accommodate a label? I don’t think so. Breathe in, breathe out and move on. I’ll keep tabs on the things we need to monitor, just trust me, it’s literally what I do all day.

I am reminded of a party I went to a few years ago where I ran into a man who I didn’t know, who asked what I do for work. When I explained I am a primary care doctor, he laughingly informed me that ‘I’m not like the rest of your patients.’ ‘In what way?’ I responded? ‘I’m not fat, I don’t eat McDonald’s all day.’ I was extremely offended (seriously? As an aside, having a panel of patients is a bit like having children. I can give a little side eye and eye roll every now and then, but the second somebody else speaks badly about my people, I develop a touch of homicidal ideation. You have no idea what these people are going through and how complicated their lives are. Back off). This man also had substantial financial resources, followed a strict self imposed dietary and exercise protocol, and had me really wanting to check his medical chart to see if his LDL and BMI were quite as pristine as he was touting. I then wanted to compare it with my some of my single moms or elderly athletes, just to demonstrate that everyone has a place in the health and wellness sphere. But I’ve always been competitive with my tribe. Just ask my mother (and my son).

Just for fun, let’s compare Bryan Johnson with Dolly Parton. One spends their days self focused, meticulous, regimented, monotonous and boring. One spends their days authentically aligned, bedecked in rhinestones, generous, altruistic and extremely talented. One passed away at 80. One is shooting for 150. Which of those lives feels more meaningful, joyful and rich? Does the number of years change that assessment?

Physicians have been trained to ask questions to ascertain certain pieces of data. There’s the standard OPQRST format for an office visit (onset, provocation, quality, radiation, severity, time frame) followed by certain known red flag symptoms (eg. you have back pain and it’s numb between your legs and you just lost control of your stool? Please go to the emergency room). Patients have been trained to ‘track their symptoms,’ often to answer these questions. But now we’ve gone too far. We wear devices that track our symptoms, both subjective and objective, mental health, food, sleep, steps etc. You can always gain more data. More numbers to crunch, more symptoms to discuss and more data points to dissect. We are losing the forest through the trees (or, in this case, I would extrapolate that metaphor to something smaller, like losing the forest through the leaves).

For the majority, this is fine. It can even be fun. For a while I liked to track my sleep score, until I had a bad night, and then felt like I had failed myself. And I think this sentiment may be true for others, who of us hasn’t looked at their exercise minutes or stress levels or sleep score and never felt a pang of fear? Am I worsening my health outcomes by living my messy, somewhat chaotic, but real, life? I have certainly had patient encounters based entirely on optimizing data feeling less than optimal.

Very early in my career, I had a young man present to my clinic with a meticulously detailed 11 page document describing every symptom he had had in the past week. These symptoms ranged from needing to urinate to slight pain in his hip from walking to a sore in his mouth from eating a piece of candy. I told him to pick the top three things from the list he was worried about to discuss that day. I also told him I would see him again in two weeks, but instead of a symptom journal, I wanted a journal of things he had done since he had last seen me. I wanted documentation of life, not documentation of health. I’m pretty sure I offended him, as he promptly fired me and never came back.

At this stage in my career, I would have handled that visit differently. But I still feel that the sentiment is the same. Don’t ignore your symptoms, but stop tracking every one. I promise you’ll feel better out in the world than writing lists of problems. Not every piece of data needs to be analyzed, and by extension, managed.

We will all get sick, from Bryan Johnson to Dolly Parton to you, me and all of my fabulous patients. Sometimes we will get sick as a result of our lifestyle, think tobacco or inactivity. And that’s okay, we aren’t perfect beings. And sometimes, we shoot for perfection, track our symptoms meticulously, and still get caught in life’s tides. And that will feel incredibly unfair, but in those moments, maybe we should try to embrace our inner Dolly. Have a big heart, enjoy the moment, put the tracker down,  and give your time, money and resources to something, or somebody, else.

Not tracking our steps

While there my father in law sent me an article about HRT, or hormone replacement therapy. I struggled to read the title, as I am, horrendously, profoundly, sick to death of anything and everything related to hormones. This is not to say HRT doesn’t have excellent utility in helping women transition through menopause, providing relief from night sweats and sleep disruption and some mild improvements in mood and cognition. This is also not to say that there aren’t other wonderful benefits from HRT, that extend to cardiovascular risk mitigation and decreasing bone density loss. But I am just exhausted by the conversation. Exhausted.

It’s a conversation I have several times a day, oddly, often with women who are in their thirties. Yes, their thirties. Discussing their perimenopause and brain fog and fatigue. I can’t look at a social media feed without being told I need HRT (I am 43, after all!), and I just can’t help wondering, am I the only one who remembers the years of, ‘I don’t want to be on birth control because I want to allow my natural rhythms to cycle,’ and how we have now all jumped ship to ‘everybody, everywhere, needs a pill between the ages of 30-65 because changes are happening in your body much like they have and will continue to do your entire LIFE.’ Am I the only person who finds this contradiction a little curious?

The other day I was inundated by a social medial influencer who works as a PCP, and made the claim that ‘women everywhere are dying because of their untreated menopause.’ Ummm, what? Unfollow, please. I did read through a bit more to see that she was referring to hip fractures increasing morbidity and mortality, and that HRT could decrease that risk. But like, wow. Am I the only one who feels as if that’s going a bit too far?

Optimization culture is wearing me down. Every shift, every change, every ‘natural,’ fluctuation is being treated as  a symptom to be managed. We are animals, not robots with a switchboard to be rebooted and upgraded. We have lost the joy in just living.

This is not a new topic for me to discuss, but I’m a bit obsessed. I see it everywhere.

In many office visits I love to ask people, what they are doing for fun? And the answers, they are so varied, but frequently, so depressing. I would say my most common answer is, ‘fun? What’s that?’ Literally. If I probe on that further I usually get something like, ‘when I used to have fun, I liked to do (fill in the blank), but I don’t get to do that anymore. Because, well, you know, life.’

That is not okay with me. Where is the fun? Where is the joy? When was the last time you were unbridledly happy? Feeling like you were living in the moment, living that life you aspire to live? Why have we made it okay that adults, and particularly the elderly, don’t seek out that type of joy? Because you can have it. Just go out there and do what you love. Now.

HRT is not going to solve your fatigue, overwhelm or moodiness. It might help you sleep a little better because you won’t be waking up with hot flashes. It might even minimize your risk of hip fractures down the road. But it will not save this psychic weakness of the soul.

If I knew how to save that, I probably wouldn’t be writing blog posts on Substack.

The calm before the ware wolf

Yesterday, I was on a walk with my dog in the evening, talking to a neighbor who works at a dental office. She asked me if people are being extra extra right now, more demanding than usual. I answered in the affirmative. In just one day I had several my chart messages demanding immediate answers, all written overnight or in the wee hours of the morning or on a weekend. And when I say overnight think midnight, 4 am type of times. Excluding our quick jaunt to Canada last weekend where we stayed up till midnight watching tennis matches, I don’t think I’ve been awake for the dawn of a new day in several years.

My friend explained that some of her office staff were leaning into the solar eclipse in Europe, new moon in Leo energy to explain the rabid panic among the populace. As I had just come back from a cacao meditation and sound bath in honor of said Leo new moon, this jived quite well with my mood.

This week, my family is in New Hampshire. As I often do when I have a period of alone time, I get ideas of things I want to explore. Recently, I’ve been reading a lot about spiritual connections with the natural world. In the minutiae of laundry and LMS modules and needing to finish those last couple journal articles to recertify my boards and cleaning the house and getting in my exercise and organizing kids fall extracurricular schedules, I rarely, rarely feel connected to anything spiritual. We go to church sometimes, usually in the fall, because that’s when we get a burst of energy to stick with something new. But that intention often fades out by the new year, after the Christmas pageant, and we start going about once a month when they do kid parties, as my children are motivated by snacks. And, I’m not great at church. Teddy actually nailed it when we were at Hobby Lobby the other day surrounded by a cornucopia of Jesus paraphernalia, and on his own, articulated that he believes in God and spirits, but ‘I just struggle with the whole Jesus thing.’ Same dude, same. For some sad reason Jesus, who was probably a really great guy with a lot of good intentions, has become associated in my mind with quotes written on plywood that people put up in their houses saying things like, ‘all I need is coffee and Jesus.’ And that really doesn’t resonate with me.

So, in an attempt to enjoy some alone time with a goal of spirituality, I signed up for some shit (see previously mentioned sound bath). I also made a goal to meditate for 10 minutes a day, which for someone with my personality, is akin to meditating for 4 hours. Or at least that’s how it feels. On my first night of meditation, I set an intention that I wanted some proof of spirituality. I realize that’s kind of terrible, and so western and scientifically minded, but I just wanted some damn evidence that what I was doing wasn’t just lying around talking to myself pretending I was having a religious experience.

Then yesterday morning, I went for a run before work. A quick run, through the woods near my house. I left my phone in the car, I mean, how can you connect with yourself if you’re listening to an audiobook on connecting with yourself? and set off. About one mile in, as I was running along, a massive flurry of giant wings took off directly in front of me on the path. And there, not more than 6 feet away,  now alighted on a low branch staring me down with its giant moon saucer eyes and swivel head, was a glorious Baird Owl. It tracked me, seeing what I was doing for about 3 minutes while I, being a natural talker in all situations, chatted with it, and told it how beautiful it was (it was).

I have always felt a strong connection with birds as spiritual connectors. Maybe it’s the flying piece, maybe it’s that I had a vision about getting pregnant in a cave guarded by eagles while doing a guided meditation with a shaman in residency (no ,I was not on drugs) only to go home, again go for a run, and be led home by an eagle for about a mile. I took a pregnancy test ten minutes after I got inside my house. Hello, Teddy.

Here was my sign, a giant, exquisite Baird owl who was both kind and imposing (I somewhat regretted not having me phone, that guy could have gouged out anything with those talons). It almost felt like this God character or spirit or whatever was poking fun at me, you think I can’t show you a sign? I can create the whole world, you dumbdumd. I can do this.

This is all my long winded way of saying, there is something in the air. Energy is high, the otherworldly is present, and people are feeling things. Leo energy is just that, energetic, and if properly harnessed can be powerful and purpose driven, but if not, well, maybe then you write angry my charts at 2am that nobody is writing you back RIGHT NOW.

So here’s my little reminder to pause, and look for those signs. They’re pretty amazing, and perhaps, all around you.

Morning light can be pretty magical, even in winter

When we came back from Italy in April, I wanted to write about how there are no drive throughs in Italy, and the effect of drive through culture on our health. Can you imagine how much less inclined to ordering fast food we would be if we had to park, get out, walk in and pick up our food? Not only would this step place a larger emphasis on healthy food choices, but it would also foster connections between ourselves, wait staff and other patrons. Compare these connections to the dearth of human interaction involved in ordering on-line and asking for a contactless delivery. It’s an hour long piece in and of itself.

Then I wanted to write about our cultural obsession with health tracking. It’s gotten completely insane. We are tracking everything, from macros to steps to VO2 max works outs to supplements to sleep to saunas to stress. Besides the mild frisson of joy in seeing a-ha! I destroyed my sleep number last night! Are we getting any happier? As my friend’s father in law says, ‘life is meant to be enjoyed.’ Is there enjoyment in doing ten push ups before dinner so you hit some (relatively) arbitrary number of strength reps for the day? Doubtful. And if that increases your life a few weeks, is the whole plot of those few weeks going to be layering on more push ups? Sounds like a snore.

And I have plenty more thoughts, from the connection between spirituality and health found in nature to the fun of the World Cup and its celebrations of different cultures. There are so many health related, connection related, joy and lack of joy related thoughts in my head today.

But, apparently, I feel like complaining. I’m worried about something, something that will probably make me sound like a patronizing assh*le.

Patients, yes, I’m talking to you, need to stop sabotaging their healthcare in the name of self advocacy.

We have lost the plot on the role of the physician. There are many days when I come home, and complain to Ben that my job has been reduced to that of ‘an order bitch,’ who basically just clicks in order requests as provided by chat GPT. Often, these orders are asinine, checking something that will, undoubtedly be within range, and if it’s not, won’t change one moment of management.

If I deflect with a gentle, hey, you sure about this? It is not met with kindness and curiosity, but a rabid display of self advocacy, ‘I have been doing me research/reading/talked to my friend who is in healthcare, and this is important and should be checked. Insurance is dumb (fair point) and using insurance guidelines is not ideal in regard to ordering fill in the blank testing.’ If I casually remind that, hey,  I don’t disagree re:insurance, but it will cost you, people are generally quite angry. At me. I’m not really sure why. I think it may be a case of blaming the messenger.

Although annoying and wasteful, this is rarely dangerous. But, alas,  we are now more frequently dipping our toes into the territory of self advocacy blocking care. And this is dangerous.

I would venture that this has been the case with the anti-vaccine movement for a long time, ‘my n of 1 study is vastly superior to several hundred controlled randomized trials to the contrary, and I’m advocating hard over here with these essential oils in my fight against measles,’ but it’s bleeding into other areas as well. This week alone I had three people decline standard, routine testing for concerning symptoms (think mammograms for breast lumps type of routine testing), based, squarely, on the principle of SELF ADVOCACY. (‘I do not believe this is the right test.’ ‘Why?’ ‘Because it does not feel right to me. And I know best.’)

As I have joked many times, if you met my son at age three, you would have learned quite quickly that my nature is not that of a disciplinarian. At all. I’m much more of a live and let live kinda gal, sometimes to a fault. If someone doesn’t want to take a medicine or do a test, I rarely get upset. But when your own thought process is supplanting the best resources we have to help diagnose something early, so that we can treat it with the most minimal intervention available, let me do my job. Please don’t go and develop stage four cancer out of spite. Please, please, please get out of your own way.

Oooo- this is a naughty rant. Thankfully I write for myself and friends who are mostly healthcare professionals themselves. Thank god, because I would get slated for a lack of compassion.

But honestly, all I’m trying to say is, I have compassion. For YOU. And for people who get cancer and would have been so grateful to have it found early. We have that opportunity for an early diagnosis, right here. I want to help you. Please, get out of the way and let me try.

"That could be the name of your new book, We All Have ADHD."

Some people, such as the aforementioned Teddy, have a more noticeable brand of ADHD than others. As his teacher described at his recent parent teacher conference, sometimes watching him enter the classroom is "painful." And it is painful, there is always a flurry of loose papers in his hands, currently graph pads with chicken scratch detailing "advanced math equations" (his words, not mine). Then there's his coat, which is never on, despite a record setting freezing Maine winter. Not a zipper is zipped on his backpack, and his water bottle falls out of its pocket about as regularly as it stays in place. 

Less obvious are the several patients I have seen within the last few weeks asking for a diagnosis of ADHD given trouble with concentration, focus, and staying on task. These patients appear in outfits congruent to the weather, on time, and with nary a piece of graph paper in sight.

To some extent, ADHD is currently a popular diagnosis to explain away certain life challenges, much like "balancing your hormones" (don't even get me started on this hypocrisy, please, tell me, when in life are your hormones ever "balanced?" What does that even mean? That you have equal amounts of each hormone? Well, that will effectively result in you feeling like 7 pieces of shit as well as the end of the human race, since nobody can get preggo with "balanced hormones") is used as a battle cry for women to explain why they don't feel well, from ages 35- 60. A diagnosis of ADHD explains, quite literally, why we can’t ’do it all.’

Certainly, there are people who truly cannot focus at a necessary level. But, perhaps, aren't there also cultural and societal pieces at play in this dearth of attention felt by so many?

One patient asking for a diagnosis of ADHD spent much of the visit texting. Another complained of feeling overwhelmed with the responsibilities and focus of motherhood, which, unbeknownst to me (sorry Teddy and Hattie), require you to throw a toddler birthday party with a petting zoo. The expectations people place on themselves are truly astounding, you must respond immediately to every request and electronic message, you must create a menagerie in your backyard, you can never take a day off work even if your child has barfed on you and you have no other reasonable caretaker in the near vicinity, and somehow, this is entirely YOUR fault, your ADHD brain, and your personal inability to properly multitask the impossible.

I just finished the book Flow, a book which details the importance of concentration. The author goes so far as to state that without concentration, one cannot achieve flow, and thus, not achieve enjoyment and satisfaction in life. This certainly paints a bleak picture for all the patient's I have recently seen.

A few years ago, when I did some therapy for myself, the therapist suggested that I might have ADHD. She predicated this idea on the fact that I "always feel like I have several tabs open in my brain," that I am "bored easily," , "strongly seek novelty" and have a lot of trouble "sitting still."

I would like to clarify that I do not think I have ADHD. I think I have Modern America. For all I have tasks and to-do's, I frequently lack true challenges. I have a phone that constantly distracts. I have to manage an active family that requires many "open tabs" in my brain. I have a strong desire to slot in experiences that feel "right," much like a birthday with livestock, although to be more on 'Maggie-brand', manifest as skiing trips although I hate to ski.

As a doctor or a wife or a mother, I cannot cure Modern America with a pill. But, by eliminating distractions (ahem, phone), by taking on less (ahem, cutting some extracurriculars) and leaning into those activities that cause joy (I'm looking at you tennis court, dance floor and international adventure of any kind and away from any deathtrap mountain designed to purposely make you slip), I think I can improve my concentration. And I think my patient's can, too. Even though, inevitability, some of them will need a little Adderall. And that's okay, too.

(So it’s back to minimizing my phone use, blocking distractions, focusing on one task at a time, and that old theme of congruent energy).

Death trap adventures

I may be one of the few people out there who likes Valentine’s Day, but I do. It’s a brightly colored, chocolate and candy filled holiday in the middle of a dark, cold, lonely time of year. When people go on about “a Hallmark holiday,” I tune them out. It’s only a Hallmark holiday if you make it one. Shape it yourself, and it can be anything you want.

But I digress.

I spent a month (and a few extra days), tracking my energy levels. It was really simple, just logging what gave me energy, what sapped energy, and what kept me neutral each day. Consistently, I was given energy by movement, social interactions and real fun. You know what I mean by real fun, that stomach churning, exciting, laughing, bubbling feeling you get in your chest when you are just delighted by the moment. Common fun moments were spent laughing with friends, singing silly songs as loud as I could in the car, and playing sports. I may also have a slightly unhealthy obsession with tracking Teddy’s tennis progress, but I am going to attribute that to motherhood. Having kids is as crazy making as it is exciting. Neutral energy involved “activities,” drawing quietly with Hattie during Teddy’s piano lesson, folding laundry and listening to a good podcast, walking the dog early in the morning and seeing a sunrise. These are moments I can’t live without (I mean, maybe not the laundry part, but we do need folded clothes), even if they aren’t moments filled with unbridled joy.

Energy sappers range from poor patient encounters, anticipatiation of poor patient encounters to the torture of logistics. Packing bags, organizing my schedule with Ben’s new work schedule, getting everyone out the door, properly fed, dressed, washed with snacks and water bottles. It’s boring, yet oddly stressful, and the mental load of managing these nuances consistently makes me want to take a nap. Plus they are Sisyphean, so just when you feel like, I’ve got this, there’s another moment to plan.

But honestly, I think the most unifying principle of all the energy “sappers,” is the ultimate fear of being disconnected from who I am, or want to be, at my core. Some of this takes the form of judgement, not getting the kids properly ready and to the right activity on time so being judged as a poor mother, not feeling like I am a competent enough physician to manage the nuisance of a complicated patient interaction without getting snarky, so being judged as a lacking physician. But ultimately, it’s the fear that the life I’m living doesn’t embody the person that I aspire to be.

It’s why, personally, travel is such a balm. Last weekend we went to Quebec City for Carnival, and I had so many moments of feeling in sync with myself. Yes, we are a family who can go to fancy dinners and eat intricate meals (I’m looking at you, Teddy), and we can be outside in the air exploring winter ice castles. This is the family narrative I want. But, we can’t just travel 365 days a year. I have a job (that can give me a lot of good energy, in the right context).

Looping back to Valentine’s Day, it’s not cool, or edgy, or woke or unbasic to like Valentines Day. It’s completely lame. It invokes images of women with matching shirts and black leggings and wine cups that say things like, “It’s Wine o’Clock Somewhere,” ideally with a “Live, Laugh, Love” picture in the background. These images are ultimately balanced by the “couple photo,” if we’re really going for it, posted to social media by the man, saying something akin to “the love of my life, “”or “queen.” I realize I’m being judgy as hell, but I am attempting to invoke an image.

Why do things like Valentines Day have to create these mental narratives? They don't. You can love Valentines Day for your own reasons. Maybe you really dig going out to dinner with your man friend and getting flowers. Cool. Why does that have to be lame? Or maybe have a movie night with 30 female friends the night before Valentine's Day (not based on anything that happened last night, honestly), as a simple way to get out in February? Or maybe you say, this is my time to go hike up a mountain and ski down with myself because I’ve never done it before, and I want to celebrate how much of an awesome badass I am? Why can’t that be the narrative? Why does the brain just create these other images?

Is it because of our phones? I feel like it’s really gotten worse with iphones. And social media. And influencers. And seeing everyone else in matching outfits and feeling like, am I supposed to like matching outfits? I thought we hated matching outfits? What the hell is going on?

Energy is sapped from all of us, when we don't lean into our identity visions. Lame, nerdy, dorky, super hip, altruistic, kind, environmental, I don’t care. If you like it, it’s not inherently harmful, go for it. And maybe do it in a silo, so you stick to the pieces that work for you.

As I push forth into February and beyond, I am going to continue to explore my own quirky likes, with love and joy. I’m continuing to develop hobbies. I’m continuing to explore energy producers and neutrals, and trying to figure out ways to block the disconnect that is created by the energy sucks.

All while trying to stay off my iPhone.

As previously written, the goal for January is to find my energy. I am keeping a loose energy journal, writing a daily list of things that sap my energy, grow my energy and keep my energy neutral. Primarily my goal is to cultivate those things that grow my energy, while minimizing those things that cause energy droop. Writing them down allows for reflection, and, the exploration of the unexpected.

Prior to my journal keeping, I have been slowly observing my energy over the last week or two.

Perhaps unsurprising to anyone, I've noticed that my phone is a massive energy drain. I can waste hours on my phone. Looking up the intricacies of trips, reading social media posts about tennis players, plotting scenarios to the NFL playoffs and the probabilities of certain seeding, and following Chat GPT exercise plans on how to elevate my tennis game through strength training and match play all result in wasted hours.

Honestly, a lot of this superficial research feels super fun. It inherently feels productive,( look at me learning new things or making new plans and goals! ), without actually having to engage in any of the boring details of plan execution. It's fantasy fluff that allows me to feel like I'm making progress.

So, in order to honor my energy journal before even starting my energy journal, I decided to work really hard on cutting back my phone use in 2026. I am removing my phone from my bedroom (check out my sweet sunrise alarm clock!), I have moved social media apps to hard to reach places on my screen,  and I am consciously tracking my phone use for true productivity. This means minimizing a lot of picks up and email checks throughout the day. 

It's been three days, and  I've already learned a few things.

The vast majority of my energy draining activities are spent in fearful anticipation of a future event. For example, my worst offender over the last three days have been the haunting reality of facing a certain patient in clinic on Tuesday. I do not want to see this patient. I do not. She is new, so the relationship isn't there, and she has already proven to be both demanding and argumentative on MyChart. I catch my mental narrative slide into an abyss of, "this is what I'm going to say when she says x," whenever my brain has a spare moment, which destroys my energy, and, for that matter, ruins any interest I have in going to work on Tuesday.

Alternately, I have become fairly obsessed with what we did before we had iphones. Seriously though, what did we do? When I was twenty, I studied abroad in Australia.There I made the decision not to have internet or tv in my house. There was an internet cafe down the road, where, because I was poor, I went about once or twice a week. I would save up my money for an email party, then go home, with no opportunity to send or receive email for days. For school work I walked 45 minutes straight up a hill to my university, so work that required the internet was batched into specific sections of time. And my phone itself? It was essentially a burner phone of today, with capacity to make calls (expensive, so rarely done) and send text messages that involved pressing the number key several times until you hit upon the correct letter. Texts were direct and succinct, and always related to making plans. There was no text related to daily musings, it just wasn't the done thing.

As I have been thinking, I decided to enlist some support. I asked my good friend from Oz, what did we do? How did we fill all of that time around the time, all that time that today we listen to podcasts and read news articles and, yes, sometimes stalk social media? Her response was, "we got drunk," (love ya, Brookie) which sure, was fairly accurate to some extent, but not the whole picture. I have never been a drink all day, day kind of girl, and even in Oz couldn't sustain several nights in a row on the trot. So what did we do?

I asked my best friend from grade school if she could remember that pre-iphone time, and her response was a bit more wholesome, we read, we drew, we hung out, we wrote. But I can honestly say this Substack is probably the most writing I have ever done excluding my nightly journal, and I have never drawn, really, anything. And I still read now, and it doesn't feel like that has changed dramatically.

So maybe it was the socializing piece? But honestly, isn't that time in your life, your early twenties, somewhat of the pinnacle of social connection, regardless of phones? With two kids, a job, a 100 hours of housework to complete and workouts to do, I just don't feel like I can sustain a ten hour/day social habit. Call me crazy.

In my last post I discussed how we, as a collective, have lost hobbies. I was quick to point out that I, personally, have not lost hobbies, as there is so much I want to do. And there is. But how much of that can be accomplished without a phone, or, perhaps more realistically, while only using my phone for logistical planning? And also, are many of these so-called hobbies truly fakes, for am I really engaging in a new exercise plan or trip research, or, lightly reading something to follow for a week and then get bored and move on?

I will march along with my energy journal. I will continue to monitor my phone use. It will all be a new experiment in wellness and hobbies.

And if anyone can tell me what we actually did in the dark ages, I'd really appreciate it.

I have been thinking a lot about energy lately, in a variety of different contexts. This time of year, with the cold and the dark, all lend themselves to a strong desire to hibernate. Sometimes I allow myself the space to appreciate that drop in energy, we are mammals after all!, but typically, I find it frustrating. I like energy. I like fun. I like having things I am excited about and awake for. As the kids say, I find it very important to live a life that ‘lights me up.’

Last week, I had a tricky day in clinic. I saw two young men who had, what I would describe as, failure to launch syndrome. Both men lived at home, didn’t work, don’t have a partner or close social network, and spend much of their days in time filling, not time using, activities. Attempting to use the visit as an opportunity to explore their social situation from a more medical perspective I tried to think broadly. Was this depression? Anxiety? Agoraphobia? Thyroid disorder? Chronic fatigue syndrome? I asked questions about their interests and hobbies. What gives YOU energy. Neither could answer. So I changed tactics, what is something, anything, that you are curious about? Something you would love to explore or learn about? Crickets. So I tried to backtrack, what did you love as a child? What was a fun day or an exciting activity at age 8? One claimed he liked to go outside. When I asked for elaboration (what about going outside? Would you like to spend more time outside now?), he couldn’t say. I have been a parent long enough to know that unsolicited advice is just that, unsolicited, so I stayed quiet. This was despite being full of ways to get him outside and engaging in his world (join a birding group at the Audubon! Do a sauna session on Popham beach! Plant an indoor garden to tend to during the winter months!). But, let’s be honest, none of these so called ‘ideas’ would have lent itself to any behavioral change. Curiosity and joy seeking behavior must come from within, or otherwise, it is simply another chore on the to-do list of life.

These visits are not in a vacuum, but are examples of office encounters I face every single day. We spend so much time discussing the epidemic of loneliness (which is very important!) that we miss the epidemic of decreased vitality. Energy is at a low, and with it, creativity, curiosity and joy.

As a person, I have always been on the ‘energetic’ side of the spectrum. Maybe with a slight bend towards hyper. It is not a stretch for me to think of ‘energy stimulating activities.’ Yet, like many, I am often tired. I often feel like I don’t have the time or motivation to engage in activities that provide a jumpstart to a Tuesday night. Who has the time to plan a soul affirming girls night or train for a tennis tournament or learn about the history and culture of a specific region in Italy (all things that hold my interest, and provide energy for me) when there are so many Christmas cards to write and toilets to clean and MyChart notes to respond to?

If my provider asked me the very same questions in an office visit, how would I respond?

So, I will begin 2026 by keeping an energy journal. What provides the spark, and what dampens the flame? How am I spending my days? Mostly in energy depleting activities? Energy neutral? Or with flurries of fancy? And to clarify, energy providing does not have to be only the big things, like a trip to Europe. Reading a good book by the fire can be extremely energy producing in the right context.

There are so, so many interesting and fun and cool and exciting and calming and relaxing things I want to explore, without fear of failure and without fear of embarrassment at having a weird hobby. It is time to bring these idiosyncrasies to the light with concerted focus.

A little smattering of energy activities:

Something that does consistently provide me energy is writing this little blog, so I am glad to get back to it.

And as I often say in clinic when I’m frustrated by the 15th MyChart message on the same topic, it is time, for ALL of us, to go get a hobby. Go get yours. I’m off to get mine.

It’s been a long time since I last wrote anything. Contrary to my notes, I feel like I did execute on my creativity pledge in August, what with painting a shed, camping in the woods, making fairy houses and starting a fire pit project. There have been seeds of creativity, and plenty of opportunity to bring them to fruition. It’s a fun project, and one to continue this month.

But now we are here in September, the ‘start of the year month’ for so much and so many.

When I was in high school, the start of the school year began, for me, on August 20th. It was the official start of preseason tennis, my least favorite part of the year. I came from a family where the expectation, not the hope, was to play 1st singles for four years. Given I was following in my brother’s footsteps, and he didn’t lose a match in four years (Ned, you stinker;), I had a lot to live up to. For gods sake, my family jokingly called the 1st singles court the ‘Wheeler court,’ before I had even started high school.

I switched schools from a small, all girls school to a larger (albeit, still small), coed school my freshman year. It was a cultural shift, as well as being, frankly, terrifying. Going to my first day of preseason felt like walking to my execution by firing squad. Our first day it rained, so we practiced in the field house, hitting serves loudly against the gym walls. I remember playing next to the girl who was slated to play 1, who promptly informed me her serve was ‘too big’ to hit against a wall. Mine was not. But honestly, I didn’t really think hers was, either.

The day of the 1st singles player to be vs the freshman challenger match happened three days later. Given I had a reputation for being a player, but this girl was known as ‘good,’ it became slated as the match of the afternoon. The team got to sit on the sidelines and watch. This included my opponents dad, who took the afternoon off work for the big showdown, adding an extra complication to my already terrified little mind.

So let’s set the stage-  a new freshman, with no friends,  against a ‘popular’ upperclassman, with her dad present (who, in complete fairness, was actually a really nice guy), surrounded by a group of girls ready to cheer and watch, who had already picked both an expected winner and a favorite player (of which I was 0-2).

It was something made for a teen movie, or, perhaps, an actual nightmare.

The match was set up as an 8 game pro set, first to 8, win by 2, tiebreaker at 8-8.

I went down 2-7. Quickly, and without a lot of fanfare. Unable to move my feet, hit my backhand, my forehand, or do anything needed to extend the point. It was ugly, and I was both disappointed in myself and frustrated by my play.

And that’s when I said, probably out loud because I did talk to myself out loud a lot those days, ‘fuck it, Maggie. What do you have to lose?’

And then, like the teen movie it was slated to be, I came back. Winning one game after another, pumping myself up, going for shots, working hard.

It got to 7-7. At this point, the audience was on their feet, cheering, clapping, acting more interested than they did during most of the entire regular season (as it would turn out).

And I took it, 9-7. I was elated, until I saw my opponent burst into tears, throw her racket and storm off the court, followed by the rest of the team providing verbal reassurance she’d get me next time (ahem, she did not). And I was left, alone, on the court, at the scene of what felt like a great triumph, without anyone to share the moment. And when I got home at the end of the day, my mom (love you mom, you’re just a winner and can’t help it), was basically like, I knew you’d win. As if I hadn’t just almost lost, probably should have lost, and, committed social suicide in the process. To say me and that girl never really became friends would be accurate.

All that said, that memory was, and is, a moment in my life that I conjure when I need resilience. Girl, that patient yelled at you for twenty minutes about something? Did you not come back when down 2-7 with an entire team routing against you? You’ve got this. Don’t take things personally, very little is directed at YOU you, simply the idea of you (the battling 14 year old or the middle aged PCP).

I realize this all probably sounds ridiculous and a tad pathetic, like the men who relive their one high school touchdown every time they watch a football game. But honestly, I think we all need these moments in our lives. These sort of horrible, pretty uncomfortable, fairly unpleasant moments where we rise, to remember, we can persevere.

Here comes the concept of a misogi. If you aren’t familiar with a misogi, I recommend reading the ‘Comfort Crisis’ by Michael Easter. The idea behind a misogi is exactly what I seek to achieve, a hard challenge, one with a 50% chance of DNF, where I put my resilience on display. Another moment to say, you gave it your all, and you have more to give than you ever knew.

So that’s my plan for September, in honor of an epic tennis match played in Rhode Island on August 23, 1997, I will plan a misogi for the month of September. Suggestions welcome (they can be absurd, that’s part of the fun!).

As a footnote, part of the magic of a misogi is NOT to share, on Instagram or Facebook or, gulp, Substack. So I won’t be sharing the full experience. Hopefully just some feelings gained, or lost, along the way.

Perhaps this is slightly off topic for a true ‘wellness’ trend, or wellness piece, but I think it plays a big part in general health and bonhomie. The issue of money.

I will be the first to admit that I love money. I think money is fabulous. I wish I had more money. Every day. I recently read that the average person thinks they would achieve ‘financial happiness’ if they made 2-3x as much money annually as they typically do. This included people making 40K/year and people making 40 million/year. It’s all the same. And honestly, when I think about my own financial house, that feels about right.

That said, when I really dig deep, what I love about money is the experiences that it provides. I’ve never been much of a stuff person (I currently rent most of the clothes I wear), and I am certainly not a gear person (the second something becomes slightly technical I dissociate in boredom), but I do aim to collect experiences. For example, the trip to New York with my daughter to see Six would not have happened without an up front cost, but the joy of the trip was found in singing along with my six year old to some very risqué tunes. Similarly, my trip to the Miami Open with Teddy was not about purchasing Miami Open swag (although I am slightly bummed I didn’t buy a single thing, but honestly, those prices!) and instead about the fun found stalking famous athletes with my son. It was money that allowed these adventures, but the connection with my respective children that generated meaning.

I am also extremely judgmental about how others spend money, as I honestly think many of us are. There are so many strong feelings about the ‘right’ ways to spend money, based on your backgrounds and goals and familial history. For example, I will mock a fancy tripped out new car with glee and copious eye rolls, and if you buy your kid a bunch of plastic toys on a Disney Cruise, I’m going to laugh about it for hours. Yet if you spend money on an adventure to Europe where you hike the Dolomites for a week, I am inevitably dazzled. Judging how others spend money is probably not a nice a way to be, but it is, ultimately, my realty (I’ll work on it;).

In a lot of ways, wellness culture has, itself, been commodified. There are so many ways to buy wellness, with wellness retreats and infrared lights and holistic counselors etc etc. And don’t get me wrong, I would love to try all of it (I mean, who, honestly, doesn’t want to have someone cook you a nourishing meal and get to sashay around in a cozy robe with breaks for body work? Sounds pretty sweet.) But, the financial reality of that lifestyle is certainly out of my reach, and out of the reach of many.

For me, true wellness will always come from something internally generated, an accomplishment, a feeling of peace, a social connection where I felt I had the opportunity to truly know someone. True wellness cannot be bought, just as true experiences are related to those present, and not the money spent to cultivate an event.

My goal for August will be to focus on the self-generation of wellness. And by that, I mean a focus on creativity, without spending money to ‘create’ an outcome. My initial thought was, of course, I’ll run a race to generate an organic feeling of wellness (and I did sign up for one!), but I am going to attempt to push the idea forward, by creating newness among my daily life.

It is an ambitious goal. I have never been a ‘creative.’ I do not draw, I do not paint, I do not make music. Besides the magical novels I wrote as a middle schooler in the style of Francine Pascal’s ‘Sweet Valley Twins and Friends,’ this is the most writing I have ever done.

But it is my goal to ‘create’ something daily that I am, if not pleased or proud of, ok with. Starting tomorrow I will attempt to post pictures of or comments about these ‘creations’ on notes.

It may only last a day (today!), but I’d like to separate wellness from spending. And this is my idea for the month of August.

First, I literally spent so much time editing my last post, only to realize after it was published, that I had a typo in the TITLE. Completely classic. Sorry.

When you are a primary care doctor, you get used to a lot of repetitive comments (I’m confident this is similar to other jobs, this is just the job I know best). A few classics are, ‘I have a really high pain tolerance,’ (red flag for a low pain tolerance, as anyone with a truly high pain tolerance wouldn’t know, as they wouldn’t be in pain), the always delightful, ‘I do my own research’ (cue for we might be in for a wild ride this visit), and the mildly offensive and slightly rude, ‘I hate doctors,’ (which usually means, I never go to the doctors and we may be running the risk of finding 18 undiagnosed problems in the next 15 minutes).

Snark aside, I always agree, very wholeheartedly, with the ‘I hate doctors’ folks.

And it’s not that I hate doctors. I am one! What I truly hate, and I honestly think most people are trying to express when they declare they hate doctors, is their hatred for being a patient.

Being a patient is the WORST. Waiting. Anxiety. Feeling judged. Pain. Worry. Dismissal. Feeling like everyone around you has missed the plot. Going into an exam room wearing a paper gown and having someone rapid fire questions at you. Wanting to appear sane while also wanting to advocate for help. Confusion. Dependence. It’s not a good feeling for anyone who enjoys a strong internal locus of control.

So, I rarely go to the doctors. I haven’t been for an acute visit or follow-up visit with my primary care in over 17 years. I acutely realize how lucky I am to be well enough to avoid regular follow ups.

I have been to see a few specialists. OB with pregnancies. Twice to neurology, both times because I had convinced myself I had a different, life altering or life ending neurological condition. Both times of which, I was completely fine. And both times, seeing the same poor neurologist, who I actually went to medical school with, so spent the visit alternately reminiscing about 80’s night at Bubbas Sulky Lounge sprinkled with discussions of profound dizziness (phantom MS) and fasciculation's (phantom ALS). Thankfully, he didn’t have to diagnose me with either, and hopefully, I won’t go kooky again and ask to see him.

So for me to see ann orthopedist last week was quite out of the ordinary.

I have been having chronic pain in my left foot since November, right in line with when we got a dog and I started walking more, and also began playing tennis with a 26 yo girl who is, drastically, better than I am. I want to keep playing with her because it’s FUN, so I run around like Nadal in the Wimbledon final circa 2008 (well, that’s the goal anyway).

I have tried PT, some environment imposed breaks, stretching, icing, new shoes, sneakers at work, analgesics etc etc. And it just won’t get better.

The visit was fine, as visits go, but the answers were interesting. He is pretty sure I had a stress fracture back in November, and through lack of rest, have not fully allowed my foot to heal. When I asked in horror if I had to stop exercising, he responded I needed a break from tennis specifically (so I get to jog in the woods still!), but more importantly, I need to manage my lifestyle. Stretch more, and eat more protein, vitamin D and calcium.

Well, isn’t that timing just perfect?

So I have been attempting protein consumption a la Peter Attia style, 2g of protein for every kilogram I weigh. That’s like, 115g of protein A DAY.

I feel like a 14 year old boy trying to get swoll to ask his girlfriend on a date. Protein bars. Protein shakes. Eggs. Lean meat. Nuts. Cottage cheese. I feel like I am eating more than I have ever eaten in my entire life. I’m not hungry for my snacks. I’m not even really hungry for desert, which is insane, because I live for desert.

I have no idea if this will help my foot. And I highly doubt I can maintain this protein consumption for very long (I’ve already fallen off the wagon once, and it’s been a week. And I have yet to break 102 g of protein in one day).

But I think the learning piece is useful. If you want to feel full, eat lots of protein. If you want to minimize desert cravings, eat lots of protein. If you want to, maybe, help your bone health and heal from a stress fracture, eat lots of protein. But I still go back to balance as the key to diet. Maintaining this level of consumption, consistently, is hard. I know I would not be successful with this diet long term. I can work on increasing protein here and there, and I will, but a true 115 grams of protein a day? Every day? For the rest of my life? That would result in a new phantom neurological disorder and third visit with my poor neurologist.

I’ve been really daunted about doing a month focused on food. When I think about food, I think about diets, and I utterly loathe diets. And once you mention food, there is, inevitably, a discussion of weight. With weight comes connections to white privilege, thin privilege, financial privilege. It becomes a much larger conversation than one focused simply on healthy eats. So, apologizes for the future ranting.

And honestly, I’m really angry with food culture. Which may seem like a strange comment, but hear me out.

I’m angry at the food industry. I’m angry at their ways of completing controlling us humans into buying their delicious, crappy food. I am angry that even with any amalgamation of the above privileges, I am far from immune to food marketing and processing. And I’m angry for those who lack my privilege, and are more susceptible to this control. I’ll use an example to describe what I mean. Last weekend, my children and I went to explore a new swimming hole. On the way back, we stopped at Dairy Queen. I rarely eat at Dairy Queen, so hadn’t looked at the menu in years. Well, the sugary treats? They’re magnificent. There was one treat, which we all ended up purchasing, a combo of ice cream and slush. Literally a Maggie dream desert. Heaven. I keep thinking about it. I want to go back to the pond, not for the pond, but so I can justify another stop at DQ. I’m angry my brain has been hijacked by a desert I didn’t even know existed one week ago. I’m fighting as best I can, but it’s a fight.

I’m angry at the pharmaceutical company for getting in cahoots with the food industry. I am angry at Ozempic, for its promise of, at a mere $400-$1200/month, the ability to ‘silence the food noise.’ Like the call I can currently hear, loud and clear, from DQ. Why do I have to pay a pharmaceutical company to manage my thoughts? Why has food been orchestrated in such a way that I need a medication, that you inject, into your body, weekly, for LIFE, to protect me from food? Why, as a society, have we deemed injectables a reasonable option to take back food control, when we are, ultimately, handing out more power (and dollars)? Yet, I also understand why people need the help. And I am okay with people using injectables as a way to protect themselves from developing (or worsening) other chronic diseases. Like diabetes or sleep apnea. But seriously, just take a step back and look at what we are doing, from a cultural standpoint. We have made such deliciously shit food that we are addicted to it, so need a very expensive medicine, complete with several side effects, to manage our addiction. It’s wild.

I’m also angry at diet culture, for creating a myriad of impossible to follow diets, from keto to plant based to the carnivore diet to following programs like Weight Watchers and Jenny Craig. Are you kidding me? How are we supposed to decide what to follow? How do we avoid the trap of calorie counting or watching our macros or any number of other, frankly, BS methods of controlling our stomachs, our minds and our wallets?

Why has food become so complicated? I mean this without shade and with privilege acknowledgements, eating well is easy. Eat food you can name, simple food with simple, identifiable ingredients. Buy food that was grown or caught or picked. Buy local. Make sure it’s varied. Don’t eat fast food, of any kind, ever. And follow the Japanese rule, never be more than 80% full. Do that, day in, day out, and you’ll be okay. Yet our food industry has made this an impossibility for many, by preying on convenience and cost and taste and ‘instant fixes,’ for the damages done to our pallets through processing.

So yes, for me, a month focused on food feels like succumbing to the dark side. I’ve also never been a diet girl (or, by extension, perhaps I’ve been on a low key diet my whole life), and the thought of becoming a ‘diet girl’ just feels like garbage.

So, I need a plan.

I decided to start by trying intermittent fasting. I’ve had patients who have had a lot of success with intermittent fasting, so I thought I’d give it a go. Hattie had to have a dental procedure Wednesday, so was NPO until noon. Perfect. I’d support her in solidarity. We would fast together, until noon.

Well, no thank you on that lifestyle change. Fasting is not for me. I eat the same breakfast, every day, yogurt, berries and nuts. Then around 10, I eat a protein bar. Every single day. My whole chi was off without my routine. I felt hungry and moody, just ‘off’. And after I ate? Oh my god! Exhausted. Like profound fatigue. I’m guessing I didn’t help matters by breaking my fast with a milkshake, as we had gotten milkshakes for Hattie after her surgery. I’m pretty sure I gave myself a glucose tolerance test, like when you’re pregnant and evaluating for gestational diabetes, and had the expected crash following that testing. Maybe next time, if there is a next time, I’ll do it right. Regardless, I think I’m better suited to small, little meals, throughout the day. I felt lazy and tired and irritable for the entire day. What a waste.

So what to do, now? We already eat pretty ‘plant slant.’ The two ice cream treats this week are an aberration, not the norm. I haven’t eaten a fast food meal since my age was in single digits, so that’s not worth giving up.

I will begin by focusing on protein. I’ll try to up my protein intake. I’m going to focus on 75g grams protein/day for the next few weeks. Maybe I’ll even throw in a true plant based week or two. Just to try it. And then, maybe once more, a fast. A fast that won’t end with a massive consumption of sugar. Because, go figure, that’s horrible for you and makes you feel rotten. But I probably could have told you that before trying it.

And then, come August, I’m going back to eating real food, when I want, and not stuffing myself. Period. Because I honestly believe that’s the best diet out there. And I don’t need to pay money for a book or buy a supplement or take an injection, to teach me that. I just have to do it. Even though it is, honestly, hard. And there is a lot of ‘food noise’ out there, right DQ?

This morning, it was pouring rain. Hattie, my mom and I had planned to do a one mile fun run, but given the rain, I just wasn’t sure Hattie would be motivated. So I turned to her at about 7:45 and asked,  “Hattie, it’s pouring, do you still want to do your race?”

“Ummm yeah! I want to run!”

So we went. It was chilly, a massive drop in temperature from the enormous heat wave here last week. The weather was legitimately bad, real rain, not just mist. Yet there they were, a crew of runners, trotting down the road, fully immersed in their road race. One guy stood out to me, a man of the Clidesdale variety, coming into the home stretch with a giant smile plastered across his rain soaked face. He looked happier than if he had been belly up to the bar in the Caribbean enjoying an oversized Pina Colada. That kind of joy. He made me smile just looking at him.

Hattie, my mom and I showed up at the start of the fun run. We were the only ones there. Just the three of us (and if you want to injure any aspirations you have to be an athlete, I highly recommend doing a 1 mile fun run, alone, in the rain, essentially through a field). But ego aside, it was excellent. Hattie was happy. My mom and I were happy. We were the only warriors brave enough to battle the elements, and we had fun. We pushed Hattie along with rain and laughter. And yes, I’m counting this race as Hattie’s first running victory, as showing up is, after all, half the battle.

This is far from the first time I’ve been one of a few to show up for an event. In my post baccalaureate pre medical program, I had a similar experience. About 30 people in the program of 75 signed up for a 5K race, that was partly organized by a few classmates. On the day of the race it was a torrential downpour, the kind of rain that hits you sideways and leaves your feet weighing ski boot numbers. I showed up to the meeting spot, expecting a group of students ready to brave the elements, to be met by the 3 organizers, and, ironically, my future husband. It was one of the first times we hung out, and I remember thinking, not only is running in the rain fun and joy producing, this dude’s kind of cool. He’s the only one around here who isn’t a weenie.

Which brings me to my point-  I have never, in 42 years, regretted exercising. Even on times I’ve gotten injured, times I’ve lost a brutal tennis match against a horrendous pusher (I’m looking at you, Maggie, circa May 2024), I have never regretted the movement. And my brain and mood have never once worsened from being active. Not ever.

As a provider, I always ask patients about their movement during their annual exam. I try not to call it ‘exercise,’ as I realize the image of the gym rat or roadrunner may be a real turn off to certain people. I’m also cautious about shaming those who don’t exercise, forcing them to answer, ‘I don’t’ when I reference an exercise routine. But we all engage in movement. Cleaning the toilets, walking the dog, running through the sprinkler with kids, we all move. And we all need to move. Every day. More than we are. As a fun fact, ancient man walked 20,000-30,000 steps on average a DAY. And we celebrate 10,000 steps. It turns out we are all weenies and need to get out there more (except for you two, mom and a Steph;).

June has been the month of movement. Daily, consistent movement. Running, walking, tennis, elliptical, strength training in the basement, you name it, I did it. Did I run a marathon? Did I play Wimbledon? Of course not. But I was consistent. And it has not been an easy month. The advent of summer vacation, kids at home, major life shifts and bombs dropped (both metaphorically and literally) on our world. But the daily movement has kept me anchored and provided me with those big, cheesing grins during a rainy road race.

I don’t regret a single second of the time I have spent exercising this month. And that is, perhaps,  the most important statistic for anyone to remember whenever they are feeling lazy or unmotivated to get moving.

2025 has been a fun year. I’ve enjoyed this whole process so much, thinking and writing and trying new things. I’ve also had a trip planned practically every month with New York and Miami and Costa Rica and my college reunion. And January is always a bit of a wash, right? I mean, we can all basically ignore January.

Well, now it’s June. I don’t have a trip in June. I don’t have a reunion to wax poetic about. (As an aside, reunion was great. The beginning felt a tad disorienting and I questioned if the friends I had in college only existed in my memories and not in real life. But the second night class of ‘05 party? Fabulous. Humans that I love and that I care about, literally, everywhere, even if I haven’t seen them in 20 years. And I didn’t drink too much, which was a massive accomplishment).

So back to June, the season of pouring rain and 60 degree weather mixed with bright sun and 90 percent humidity. And kids still in school, yet this inherent summer vibe in my heart, that as a doctor with a real job, I can’t embrace. Summer is a lie to all those not in academia, it’s a time when work becomes HARDER. The snowbirds return to Maine, and the snowbirds are rough. For unexplainable reasons, the Floridian doctors like to check lipids every 3 months and provide antibiotics to all patients with ten minutes of upper respiratory symptoms. No shade, Floridian doctors, but seriously, I would love to meet for a cocktail and a chat so we can get on the same page. There are also provider vacations every week, so several inboxes to cover. And a plethora of summer annuals when people share their wackiest health rituals (like a daily vomiting plan to clean out their stomachs. No, my friend, that’s bulimia, not a clean pyloric sphincter). Ooo, I am failing at not throwing shade. I am getting an F in June.

So what do I do? I don’t have an ‘anchor excitement’ project. I have kids who will be home from school with little to do in 1.5 weeks time. My house, which feels relatively clean, will be filled with rocks and mud and no break from small humans to actually clean the toilets and mop the floors. So any semblance of clean will become a distant memory.

What do I love doing? I love spending time with people I love, but I did that last month (and still can continue, but the newness shine is gone). I love to travel, but I’ve used up my travel cache (and budget) for at least a few months. I love watching the Bengals play but it’s not football season and they are refusing to sign Trey Hendrickson,  which will ruin next season. It is a tragedy in the making for my autumn football joy.

I love to exercise. I do. I love it. I love to move. Even though my hip aches constantly and my left foot only works about 30% on the time. When I am feeling moody and irritable and tired, the only way out is to get moving.

So I guess I’ve got to get moving. I am going to work out every single day in June. This includes ‘a walk,’ which I know, mom and Steph, just doesn’t reaaaaaaaally count. But I’m going to count it, because of the aforementioned foot and hip. I can’t hit the high days without recuperating. I’m going 30/30. My VO2 max will have to improve. My body fat composition can only decrease. And maybe,  just maybe,  this will get me out of my June blues and judgmental mindset, so I can be that kinder, more peaceful version of myself I have been cultivating.

This weekend is my twentieth college reunion (that’s really wild).

When I think about cultivating community, I think about our life in Maine. Our work community, the kids schools, our neighborhood and close friends. I think about shopping locally and knowing the store owners and farmers personally. I think about a small town where I cannot go to the grocery store without seeing several patients, sometimes for better and sometimes for worse. I love feeling like I ‘know everyone,’ even if I do also love to leave regularly as reminder that I do not, in fact, know the whole world.

But when I think about my deep friends and deep connections, like many of us, I often return to old friends. The best friend from middle school, who can tell you the name of the first boy you kissed yet also stood beside you when you got married. The college friends who made inside jokes a second language, so that to this day you can fill in text sentences with such marvelous sayings as ‘twat walking’ (looking at you, Lanie) within seconds of each other. And then there’s the medical school friends, who still live in your phone as ‘doctah bitches,’ yet you ask for evidence based support on complicated patient’s.

Those varying friend groups were all cultivated by various versions of myself. I am certain that the 11 year old Maggie who became best friends with one girl has ample similarities to the medical student of the early 2010’s and the attending mom of two who currently inhabits my body. Yet there are also some massive differences, forged by time and work and family, and there is, at least for me, some trepidation in merging the old with the new.

As a young child, I always felt friendly and extroverted. Through college and medical school that extroversion persisted, but waned. I now feel like a very outgoing introvert, who is often more happy at home, by myself, than at a neighborhood gathering trying to muster up topics to discuss that don’t solely revolve around the magic of other peoples children. How will this more introverted human interact with a reunion that favors the extroverted, prior version of myself? Will she re-emerge? Or will I spend the weekend slightly off kilter and with a sheen of awkwardness? I joked a lot in college that I was hard to embarrass, and in an unfortunate turn of events, I am now quite embarrassed by some of my old behavior. How do I reconcile that?

I have also always loved to tell a story. Perhaps my favorite college memories of all were not the big nights or adventurous activities, but the retelling of those stories in the Ratty (nice name for a cafeteria, Brown), the morning after. I lived to laugh about what had just happened, and honestly, put a lot of energy into the creation of a story, for the sake of the story, itself.

As I have attempted to cultivate more community this month, I have been reading ‘How to Know a Person,’ and have been trying, so hard, to be the listener and not the storyteller. At least not all the time. Yet this weekend I will be thrust back into a time when the story was the goal, at least for me. I am hoping to stay curious about others without getting sucked into a vortex of ‘one upping’ others hilarious tales.

As you can see I have some swirling thoughts for reunion as I attempt to build on old community infrastructure. Will I be the Maggie of 20 or 40? Will I listen well, engage appropriately, have fun and not become too dazzled by my own light? Will I manage an extroverted environment as a more newly minted introvert?

Regardless, I’m excited. I loved college for what it was, and look forward to reconnect with history.

So, I’ve been reluctant to write this post. In complete transparency, April was a bit of a bust. Sure, I walked inthe woods at work during lunch without my headset. I started the day with natural light. I tried to get out in the woods, but it was freezing in early April. I feel like it rain/sleeted for 14 straight days, and my nature attempts were weak at best.

But then, we went to Costa Rica. For eleven days. Which is, frankly, a lot of days. And kind of ended the month.

I made sure to hike with Teddy each morning at the nature reserve in the cloud forest. I enjoyed seeing native critters on our night hike, like the eyelash viper, scorpion and sloth. Although, seeing the tarantula walking into our breakfast spot the next day was almost more magical, as we weren’t ‘hunting’ animals that moment and just “saw” one. And its furry body was actually kind of cute.

Then we went to Santa Teresa, where you are, somewhat, always in the jungle. The monkeys were at the beach. We rode an ATV through town because the dirt roads don’t navigate very well with a traditional car, so there’s no barrier between the open road, and you. Nature is everywhere.

As a result, I feel like I wasn’t intentionally focused on ‘nature.’ It was just, yup, there she is. Here we are riding an ATV over a mountain and there’s an iguana and the sun is strong and the ocean water is coming towards our feet. It was all achingly beautiful in a jungly way, but so pervasive I didn’t feel a clear demarcation between nature and non-nature. I showered outside every day. I don’t think I ate a meal indoors. Ben took the house down with a yell one night when a frog jumped on his back during one said shower (I think the eyelash vipers from the night hike were still fresh in his brain). We were outside almost all of our daylight hours.

Perhaps, given Santa Teresa is on the Nicoyan peninsula, one of the lauded ‘Blue Zones,’ with one of the highest densities of centenarians in the world, this blur between nature and non nature is part of the longevity magic. But for me, as a true blue New Englander, I had trouble with my experiment. There was no control group.

As many know, Pura Vida is, essentially, the slogan of Costa Rica. Loosely translated to the good life, it is a phrase for hello, how are you, how’re you doing and everything in between. It is the embodiment of living in paradise and enjoying simple pleasures. The celebration of the joy of a gorgeous sunset or sand between your toes or saying hello to a friendly neighbor, Pura Vida. It is the embodiment of relax, chill, enjoy.

As an aside, I struggled a bit with Pura Vida, especially when we got stuck in ATV bumper to motorbike bumper to bus bumper to car bumper on a stretch of muddy dirt ‘road construction’ in 90 degree heat and 90% humidity, with no traffic patrol in site. Ben kept saying ‘Pura Vida’ but all I could say was, I think the good life would be better enjoyed back at the pool in our Air BnB. But that’s me. By now I doubt there’s any surprise that I wouldn’t find Pura Vida in a smelly, hot, traffic jam. More power to those who can.

Regardless, I have decided to adopt a touch of the Pura Vida mindset in Maine, by being less rigid about my ‘rules.’ Thus I will continue the nature vibe pursuit in May (as I still feel like I haven’t really crushed it, here, in Maine, away from the jungle), while also adding another layer.

The month of May will focus on community. Community indoors, community outdoors, and everything in between. But truly, a focus on live community. Not texting, not social media, but the connection that comes from live, in person interaction.

It’s my 20th college reunion this month, so a good time to explore relationships. It is also my birthday, my son’s birthday, my mother’s birthday and just a socially active time of year. Perhaps my nature girl alter ego will catch a spark from those around me.

So, in conclusion to April, Pura Vida to you. May you enjoy the good life, the simple life, the outdoor life and the social life. May sounds like a whole heck of a lot of fun, gussied up as a ‘wellness’ experiment. Let’s go.

Am I the only one, or does anyone else have altar ego versions of themselves?

I have a few common alter ego personas, versions of myself that are incongruent with my daily life, and skill set and personality type. I don’t know if these personas are so much identities I aspire towards, or versions of myself I have not yet fully actualized.

Regardless, I have always had an alter ego identity who is a true ‘outdoors woman.’ A woman who can hike independently, camp solo, and be fully comfortable in nature. A woman who knows the names of trees and plants and flowers, can track an animal by its footprints, and can identify a bird by it’s distinct call. A woman who will swim in any ocean, river or lake, hike any mountain, and end her day by lighting her own camp fire and setting up her own tent. In these visions there’s usually tan skin, a slight tinge of salty sweat, and some warm mug of either coffee or soup. There’s also  floating music and laughter, because although this identity is fully capable of being alone, she’s often in more of an outdoor community setting, with other strong and competent nature minded people.

Sadly, this identity has not reached lifetime fruition. I cannot set up a tent, start a fire or, frankly, be of any use on a camping trip. We have been camping as a family the last two summers, briefly both times, and my heart wants to love these trips. I want the magic that others feel communing with nature, but I keep getting hung up on why we have chosen to be homeless and filthy when we have a perfectly nice, comfortable home, with beds and running water, just a few hours away. It just confuses me.

I could even go so far back as to remember my first experience camping, in the ‘Brown Outdoor Leadership Program’ (BOLT), my sophomore year of college. There were moments of joy on this five day camping trip, like playing games, summiting a mountain, the ravenous hunger that comes from being active and outdoors all day and seems only to be satiated  by GORP. But there was a lot of misery, too, like sleeping under a tarp, in the rain, with college aged men who hadn’t washed their feet in four days. Or, the fact that I got lost in the woods for five hours on our solo hikes, which was such a disaster the program director called the NH State Guard so they could send in the helicopters. I subsequently transformed the story from one of embarrassment to a bit of legendary lore, but honestly, it wasn’t fun being lost in the woods for 5 hours. I knew that if I wasn’t found, I was f*cked.

But back to the project at hand, and back to my alter ego dreams of being that mythical, confident, capable outdoors woman that I would like to be.

So, for the month of April, I will work on cultivating a connection with nature. Forest bathing is the trendy term, and I will attempt some element of forest bathing.

For the primary goals, I will awaken to natural sunlight. I will go outside, without the distraction of headphones, for a daily walk in nature. I will make a point to do some actual forest bathing, mindful time in nature, for at least 30 minutes a go, at least 4 times this April. We are off to Costa Rica later this month, and besides Japan, I cannot think of a place with a stronger connection to forest bathing than Costa Rica (think Eugene Levy in the Reluctant Traveler, if you need an example).

I will seek out nature, seek out opportunities to learn about bird calls and tracking, and maybe even challenge myself to learn how to set up a tent.

As I move through these ‘monthly challenges,’ I love seeing how they stack up on each other. Ben and I are definitely drinking less. Not by conscious choice, more by casual omission. Just last weekend we had a sauna sisters reunion with hot and cold therapy. And I continue to engage in my ‘five minute’ mornings and my daily meditation practice. My hope is that April’s focus on nature will tie in nicely with the mindfulness of last month. I also have some outdoorsy friends, both sauna sisters and beyond, who can help nudge me in the right direction.

So, here begins April Showers, a focus on nature bringing positive changes. That is, provided it stops sleeting sometime soon. The recent weather has not aided my outdoorsy intentions, or helped me cultivate any new alter ego versions of myself. But alas, April Showers……

Last weekend Teddy and I had the magical experience of going to the Miami Open. For those of you not familiar, the Miami Open is a masters 1000 level tennis event, both men and women, played in Miami, Florida. It’s basically the equivalent of a US Open or a Wimbledon but with slightly less crowds and better access to all the top names (non- biased opinion over here;). For a tennis person, it was two days of pure heaven, sauntering around fan girling on players and matches.

I have spent a lot of my life watching tennis. My brother is 6 years older than me, and I spent the first fifteen or so years of my life at various tennis courts, raptly watching him from the sidelines. My mother could always rely on me for a score update, as there wasn’t a minute I wasn’t intently watching. I began playing myself in grade school, and started competing more formally by middle school. I love sports, which I realize isn’t always a popular opinion, but the drama and competition connect with me on an emotional level.

Tennis is an inherently mean sport. It’s a 1:1 battle with no clock. There is no opportunity to decelerate. You can be up 6-0, 5-0, 40-love on your serve (which is tennis speak for absolutely annihilating your opponent) and still, ultimately, lose the match. This is different from say, football, where if you’re sitting on a 30 point lead with five minutes to go, you can pull your starters and drain the clock. In tennis the starters are the team, there’s no clock to drain, and no teammate to offer support. You must fight to win every single point, as every single point can ‘turn’ a match.

Sorry to belabor tennis strategy in detail for non tennis folks, but I have a point.

When I think of a match, I think of a marathon. Each point, grinding, pushing, attempting to summit that mountain of victory. I often see a match as a slow and methodical summit, a bit Sisyphean in nature. This metaphor did not hold true with what I saw in Miami.

The players I saw were not marathon runners. They were like panthers on the hunt, moving in for the kill. There is a hush to tennis, a sense of a predator stalking its prey, moving both slowly and deliberately between points before accelerating with power and precision in an attempt to win one moment in time. The collection of moments, ultimately, unite as a match. It is incredibly beautiful.

And when that point is over, it’s over. Forget if you won or if you lost. You are allowed one second of celebration, before it’s time to focus on the next kill. Every hunt matters, and by extension, every hunt doesn’t matter. Focus on the one in front of you, give it your all, then slink back to calm before accelerating to success (or failure) again.

For my month of mindfulness I have been working so hard at being in the moment. This continues to be a real challenge for me. The 5 minute mornings help. Putting my phone away at work, so I don’t get distracted by text messages, helps. The meditation has helped. The yoga and body presence has helped. The walks at lunch, the respites from my computer, the attempts to quell the never ending furnace of efficiency and tasks, have helped.

But I am, most certainly, not there yet. I have not come close to the level of mindful intensity I watched this weekend. And interestingly, as a spectator, I could watch the losing players’ mindfulness deteriorate with failure. I watched their focus falter, their attitude change from optimism to frustration, their ability to stalk the next point wane, as they became distracted by a missed opportunity or fearful of a new challenge.

I have really enjoyed this month. To date, it’s had the most true impact on my ‘wellness.’ I feel more calm, more joyful, more able to handle the challenges of a particularly shitty day (like on the night Teddy and I got home from Miami, exhausted by a long day of travel, to be greeted by my little one with a throw up bug. Certainly a dampener on the fire of fun).

This months challenge will not end with March. I am going to continue to cultivate my inner panther, much like the magnificent players I saw this weekend. The value of presence mastery is awe inspiring . It can take you from the grind of PCP land in Maine, to managing a vomiting child with grace, to the heights of the Miami Open. It is, the ultimate, practice of control.

And the tournament was just really, really fun.

Before I gave birth to my son, I had a vision of new parenthood. In this vision I would saunter around in a maxi dress (it was May), waking in the early mornings in a sort of sepia colored dreamscape, snuggling and nursing my baby. Yes, I would be tired, but it would be a hazy, nice sort of fatigue, where I could relax and snuggle a baby and take little cat naps when I needed to. I was honestly looking forward to seeing the sunrise in a drowsy state of new motherhood bliss.

This was dramatically different from the reality of my first few months of parenthood. I thought I knew tired from working q3 24 hour calls when I had been on the OB service, or working weeks of nights when on the medicine service, but I had no idea. When working q3 24’s, every third day, you sleep. This doesn’t happen with a newborn. My mornings were not sepia, blissed out mama, drinking coffee in a cozy nightgown social media posts, but surgical lighting, slightly tearful mama, bouncing a baby while he screamed like his very life depended on it after a full 2 weeks of not sleeping, reality. I would then stumble around, hair dirty and uncombed, milk stained pajamas and not a maxi dress in site, with the intention of handing my son off to my husband for a few hours rest. Fifty percent of the time I would then be seized by some unnamed panic, exhausted yet wired, lying in bed, tortured by lack of sleep.

To say I am not a newborn person would be an understatement.

I have always struggled with lack of sleep. Sleep is delicious. It’s nourishing. When done right, it’s the perfect temperature and perfect fresh, clean scent. I could go two weeks eating the same food, or run until my toenails fall off (which I have, grossly, done many times before) but one night of no sleep, and you’ve got a monster on your hands.

This is why, when people talk about the value of mindfulness in the morning, I want to rip my hair out. I will never join the ‘5am club.’ I will never forgo sleep in the pursuit of a mindfulness practice. I have tried consistently waking up to exercise, and I love to exercise, and even that doesn’t stick. When bed is calling, it is calling.

I knew that tacking on an early awakening for my March Mindfulness journey would only weaken my zen. Could I try a small habit? Small changes lead to large results, right?

So, I have been waking up 5 minutes earlier. Adding a 2 minute morning stretch to my morning, followed by a 2 minute practice of gratitude, ending with one detailed goal for the day ahead. ONE goal. Not a laundry list of tasks, but one goal.

And maybe I’m losing it, but it’s working. I’ve been happier at work. I have felt more available to both my patients and my family. I have persisted with nightly meditation and a daily yoga practice, but I really think it’s the 5 extra morning minutes that have been the most helpful. 5 extra minutes in the quiet, alone, before the incessant ‘moms!’ And ‘Dr Wheelers!’ begin.

This week, I even did the wildly unthinkable and heretofore never seen before action of seeing not one, but two, patients during my lunch hour. Both patients had scheduled earlier appointments, but had been too late to be seen. So, I offered them my lunch break.

Both times it caused me a lot of stress, stomping around the office dropping eff bombs to my medical assistant about ‘why did I make such a horrible decision, I have things to DO!’. Yet, after both visits, I felt good. I felt like I did ‘the right thing,’ whatever that is. And after both visits I left the computer, and did a 15 minute walk outside for my lunch break. I felt more refreshed after those 15 minutes walking around our old hospital than I ever do after working on desktop all lunchtime with a side dish of reading Instagram posts.

So I will continue this practice, honestly, hopefully, longer than this month. My five minute mornings. They’re mine. And they aren’t lessening my sleep.