Does the language of health care matter?

Disclaimer: Dammit Jim, I’m a nurse, not a linguist!
 
 
We’ve been arguing over the language of the healing professions for a long time. Providers. Midlevels. Doctors. Physicians. Physician Extenders. Do the semantics matter to the development of the roles? To the patient experience? To the politics and payment?
 

  In a 1951 article from the Medical Library Association, Thelma Charen took on the task of tracing the etymology of the word medicine. According to Charen, the latin roots of medicine are easy to follow, from medicina, to medeor or medicor: to heal or cure. Tracing the root back further to an ancient Indo-European root (MA, MAD —> MED), we land on “to think or reflect, to give care to”. This links medicine to meditate. Over time, language crystalized from the general idea of considered reflection to more specific applications, eventually to specifically caring for the sick. Interesting. Noble. Relatively free from baggage.  

What, then, about nurse or nursing? The line is less straight and narrow, and more fraught. Thomas Long takes us through it. Nutrice, latin for wet nurse (and also related to the word nourish), morphed into a more general term for caretaker of children— a female caretaker, specifically. In the medical context, Long notes, nurse first appears in Shakespeare. (I’ll leave aside the meaning as it relates to bees, though that might also be interesting to the sexual politics). So nursing, the profession, is linguistically linked to nursing, the act of feeding the child from the breast. And thus linked also to female-ness. Of course, just tracing the history of a word doesn’t capture its full meanings, but it’s not irrelevant. Not at all. Those of us who practice nursing will tell you that there are persistent biases related to power and gender that plague our profession. The health professions (notably medicine) have been slow to understand nursing as a mature, serious, and independent profession with its own ontology. Nursing’s metaparadigm includes the concepts of person, environment,health, and nursing— note the absence of “disease,” “orders,” “bedpans,” or “hospitals.”

The language isn’t neutral. It’s steeped in meaning and history. And it’s part of our cultural understandings of professional roles. These days, people like to say that health care is a team sport. Some organizations (you can guess) want to append that to say “and a physician is the team captain”. But that’s not always wise— physicians make great captains, in some contexts— but so do nurses, counselors, pharmacists, or physical therapists, in others. It doesn’t need to be a turf war or a hierarchy. Let’s all stick to the roots of our roles, evidenced in the language of medicine: Reflection. Caring. Let’s carry it forward into our professional practice, our praxis, and our teams. Let’s think about our unique bodies of knowledge and our relationships to our patients, and let that guide our teamwork. And let’s be careful, considered, and kind with our language. Do we all have to agree? Of course not! But let’s agree to be willing to listen and reflect.

From fun to FOMO to frustrated

Watching friends, old acquaintances, and perfect strangers do epic things on social media can be super fun. Woah, people do all kinds of crazy cool stuff! Trips and ultramarathons and insane workouts and grad school and babies and, and, and. It’s fun to watch— but there can be an insidious kind of creep from fun into FOMO into frustration. There will always be someone more accomplished, more intense, stronger, faster, than you are. Don’t let this belittle your accomplishments! And don’t let it stop you from trying, either. It’s like pendulum between these two poles— can you balance challenging yourself with honoring yourself? Being inspired to excel with being proud of what you’ve already accomplished?
My long run last weekend was 7 miles. Whether that’s crazy intense, or borderline lazy, depends on who you ask.  An ultramarathoner might say “that’s cute,” whereas a non-athlete might say “that’s insane”. I don’t think it’s lazy or insane. I think it’s a little bit of a stretch beyond “easy” and it felt great. You don’t need to feel bad about yourself because other people do more. There’s always more. More isn’t always better. Sometimes more is injury and bad moods and burnout.
Then again, I was proud of myself for biking the six miles to work a few times recently. But the other day, it was pretty cold and possibly going to snow, so I took the bus instead. Students and coworkers of mine biked, though. I could have, I realized. Am I afraid of being cold? Wet? Am I worried about being unsafe, or uncomfortable? Or am I just making excuses? I need to have actual conversations with myself to tease this out. Lucky for me, circumstance forced it— the train I was going to take on a sleety morning was running super late. My choices were to also be super late, or to bike. I biked. And I lived to tell the tale. It wasn’t even all that hard. The worst things that happened to me was that my fingers were kind of cold for half an hour. So, I needed that kick in the pants from mother nature. More was, in fact, better, at least that day.
I recently read (listened to, actually) David Goggins’ book Can’t Hurt Me. He’s famously spoken about the way our minds trick us into thinking we’ve met our body’s limits. I can’t do more, you think, when you’re at about 40% of your potential. This is super cool to think about. It’s inspiring. It helps to challenge that voice that says “I can’t”, when another voice says “I wish I could”. And there’s the key, I think: do you wish you could? Or do you feel like you should because someone else does?

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I ran this 8-miler with killer hills slower than a lot of other people did. I don’t care!

Is eating healthy hard?

People ask me about what I eat a lot, since I work in the health space. I don’t know that what I eat ultimately matters to anyone else’s health, but hey, it’s a conversation starter. I eat a vegetarian diet. I actually eat vegan probably 80% of the time, but I always hesitate to say I’m vegetarian, or to even talk about veganism, because there can be a lot of unfriendliness and absolutism in this space. Some folks get very worked up about it, and it can really be a flashpoint for drama. Some of this stems from the fact that people tend to associate diet with identity (I AM a vegetarian, rather than I EAT vegetarian food). Certainly, some people identify as vegan and they extend this to other aspects of their life including clothing, personal care products, etc. This is a choice with a lot of valid reasons to support it, but everyone who chooses to eat a certain way is not necessarily also doing this, and that’s OK. People make different choices for different reasons. Diet is complicated because it isn’t only about nutrition, it’s also about culture, socioeconomics, ethics. I want to talk about what I eat, though, so please recognize that there’s a lot of issues that I think about but am not going to get into right now (but if you want to, we can talk about it later).


I make choices for myself, and I also give advice as part of my professional life, about diet. And while I eschew hard and fast rules, I do have some general principles that I believe are healthiest. I base this on a combination of evidence, common sense, and experience. Scientific study abut diets is plagued with challenges, which is part of why there’s so much confusion. So I say, keep it simple. I like to eat mostly whole foods, mostly plant-based, and mostly easy-to-make stuff– so I mostly cook my own food.  The more I stick to simple patterns, the easier it is.

What I eat: fairly accurate.

So what are my go-tos, my day-to-days, what I like to eat when I have the time and flexibility to do it my way?

  1. Coffee. Whether you buy the health hype or not, it’s a ritual that makes me happy. I brew french press and add steamed/frothed unsweetened soymilk (sometimes Oatly, or almond milk) to make an au lait (or a faux-lait, if you prefer). This is usually before I work out or do anything else, really. I think there’s value in having comforting habits and rituals.
  2. Breakfast is usually one of two things:
    1. A smoothie. I mix it up, but a common combination is kale/spinach, mixed berries, half a frozen banana, peanut or almond butter, hemp or chia or flaxseeds, sometimes cacao nibs, and unsweetened almond milk.
    2. Steel-cut oats with fresh fruit (berries, bananas, stone fruit, apples. . . whatever’s good), nuts, and almond milk.
  3. Lunch. I don’t usually have a morning snack, but if I do, it might be nuts or a Larabar. I eat lunch on the early side. I like to have either:
    1. A grain-based salad. These hold up well in the fridge and travel well. I take a whole grain (farro, quinoa, millet, wheat berries, sorghum, barley), add some combination of vegetables, nuts, or dried fruit, and a flavorful dressing (often citrus is a good fit).
    2. Leftovers from dinner. Especially things like curries and chili tend to get even better when they sit in the fridge.
  4. Snack. I usually have one in the afternoon, especially if I was active or am going to the gym or eating late. This could be an apple with nut butter, or whole-grain crackers or carrots with hummus.
  5. Dinner: My favorite is a big bowl with a grain (brown rice or quinoa), a green (kale, or broccoli rabe is a favorite), a bean or other protein-rich item (tempeh, tofu, homemade vegan sausage, pinto beans, black-eyed peas), with a flavorful and creamy sauce (a cashew-cream with tomato and red pepper, a peanut-soy sauce, red-hot tahini). Often with a glass of wine.
  6. Chocolate. 70% is a good starting place for me, and I might like it with sea salt, or ginger, or chili, or something else simple.
  7. Beverages— you’ve already met my friends coffee and wine. I also regularly drink green and herbal tea, kombucha (I make it at home), plain old water, and bubbly water.

 

Obviously it isn’t like this every single day. Some days there’s work lunch. Sometimes there’s the airport. Sometimes there’s takeout, or meeting friends. And sometimes there’s pizza (and it’s often vegan pizza!) But the closer I stick to this basic plan, the better I feel.

Do you have a regular routine around food choices?

Active Commuting Adventures

Since my recent relocation to Portland, my commute has changed. A lot. Instead of a mile to campus for teaching, or driving to different neighborhoods in Tucson for the mobile clinic, now I’m heading from NE Portland to Marquam hill most days. It’s no fun to drive, and parking is a non-starter. And I hate spending a lot of time driving in the city anyway. The trip takes a while, either way, so I have to make my commuting time count for more than just transportation. Those two-ish hours every day count against the 24 I’m allotted, no matter how you slice it. Is it coming out of my exercise time? My professional reading time? My sleep?!? So I’ve been testing out my commute options! So far, I’ve been. . . Continue reading

Strategies for SAD

SAD. I haz it. Well, I have had it, anyway. After a few decades of dreadful winters in Philly, Ohio, and Boston, I lived in Arizona for 10 years, and not by accident. Longer days and plenty of sunshine are good for me. So my recent relocation to Portland, OR, was a little scary. I love the city, but in winter, the sun isn’t up until 7:30, and it’s pretty well dark around 5. When it is daytime, it’s often pretty gray. I’m not dealing with any active symptoms now, but I know I have this tendency. Wellness isn’t something you can put off until you are unwell. What do I need to keep myself healthy, knowing that darkness and indoors are my arch nemeses? 

  • Science says it’s pretty likely that light therapy is beneficial. I got this for Christmas (thanks Amy!!) and I use it for 20 minutes every morning, while it’s still dark outside (dude, until like 7:30). I drink coffee, do my brief journaling, plan my goals and schedule for the day, and do any other lingering desk chores while I sit by the light.
  • I get outside. The light still works (remember when your mom said you can still get a sunburn when it’s cloudy?), but so does fresh air and moving your body. Sometimes it’s as simple as having the right gear to make the outdoors friendlier. Remember, there’s no such thing as bad weather— only insufficient gear. (See my previous post about running).
  • I’m keeping up good relationships with my family and friends in San Diego and Tucson. Mid-winter escape route! People aren’t like solar cells, but, well, experience suggests that a good break somewhere sunny can carry me through.
  • I remind myself to go out— both for exercise and for social time. Does it always sound great? No. Is it usually great? Yes. 
  • I eat well. Of course it’s tempting to face-plant into a bowl of mac and cheese when it’s dark, damp and cold. I’m not above it. But if most of my plate is vegetables, I feel better. And if I feel better, I’m better at doing the rest of the stuff on this list.

What else helps you sun-lovers out there with a long winter?

It’s January. Are you running?

It’s January, and I just moved from Tucson to Portland, OR. Winter is peak running weather in Tucson— sunny in the daytime, and cool in the mornings and evenings. In Portland, it’s. . . dark. From 4:30 PM until 7:30 AM. And wet. I’ll treadmill it if necessary, but it sucks the joy from my life. So what’s a girl to do? Adapt. Here’s what I’ve tried so far:

  1. Gear. Since Ragnar last year, I haven’t had much use for my reflective vest  but now I do. I also needed a better headlamp. Now I’m visible, and I can see. Safety? Check. Add that to toasty tops and tights and something to keep my ears warm, and I’m feeling pretty good. I’m still figuring out which shoes are best for slick sidewalks (any advice??), but I’ve got muddy trails covered. 
  2. Adjust expectations. Yes, I can run in the dark. In the rain. I won’t melt. The rain is often kind of misty and drizzly— almost pleasant, in a way. Portlanders aren’t phased the way Tucsonans are— I used to joke that people stayed home if it looked a little cloudy. Here? Bring it on. People are out there. I also thought it would suck running before it’s light out, remembering pre-dawn runs of yore before early hospital shifts. But 6 AM is way better than 4:45, even if it’s dark. 
  3. Learn to love the mud. Pippi, Max and I ran on some Forrest Park trails last weekend and we had a blast— it was sloppy, but who cares? There’s a distinct joy in getting dirty. Own it.
  4. Back up plans and cross-training. Some days it’s too nasty. A gym membership was in order— so I got one. I can use the treadmill, sure, but maybe a functional training class (kettlebells! boxes! bodyweight!), a rowing workout, or some cycling, too. Cross-training has its own set of benefits that I’m starting to enjoy, like feeling stronger on hills.
when you gotta, you gotta.

What other tips to you have for me to help me run all winter long?