In November of 2020, my son and I toured the Southwest US. One of our stops was at Zion Canyon National Park, where we were excited to experience the Narrows. It seemed a great way to escape the pandemic and get away. Spend a few minutes on the journey with us!
Driving, we arrived late in the day at Zion lodge, in darkness. We saw this improbable sight outside our cabin in the morning: canyon walls rising thousands of feet overhead, just outside our door.
We had rented dry suits from Zion Adventures, and laid out our clothing that evening for the hike ahead. In case you’re wondering about the hyperlinks, no this is not a paid post. Just a joyful recollection of an aging parent…
Double boot liners, grippy-soled rubberized river boots, an impervious suit with rubber-gasketed pants and sleeves, and a huge diagonal waterproof zipper across the chest. Hard to wrangle but exciting! We felt like spacemen. We wore several clothing layers underneath.
Normally the Narrows is a super-popular hike through the spring, summer and fall. We had thought that with the pandemic and with wintry November weather, we would have no trouble booking a shuttle ride from the Lodge in the park up to the entrance of the Narrows, 3 miles away. Suffice it to say, plan ahead. Fortunately, we found a last-minute shuttle option with seats remaining. Whew, disaster averted. Otherwise, the lodge had offered us “bikes to rent and ride up there, suits and all.” That would have been more adventure than I needed.
We walked the paved path for the 1st mile. Giddy and nervous, we passed a number of casual hikers who stared at our gear, our dry suits, our 6-foot wooden walking poles, our backpacks. Here, with the residual heat deep in the canyon, the last remnant of fall colors contrasted with the snowscapes outside the park.
And then: the pavement ends. Into the stream! I can feel the cold water sloshing around inside the boot. Hey! my feet stay dry! I don’t care about splashing because I’m sealed in up to my neck, and my backpack has a dry sack inside with food and water. The cyanobacteria poisoning warnings do not deter us. Upstream we went.
Did I mention the incredible geology? We feel puny in its presence.
I was surprised at the grip of these rubber soled river boots. Crunching upstream over large and small rocks was easier than expected. Where was all the slipperiness, the unstable rocks, the twisted ankles? The equipment smoothed that away. I grinned at my son; this was a blast. The water depth was up to a foot and the going was not hard. The current ran a couple of miles an hour.
As we saw fewer hikers, the enormity of the cavern became apparent. At one point, it appeared that the walls were maybe 3 football fields tall, 1000-feet-high sheer walls of stone. These walls plunged right down into the river with no shore or beach to speak of.
From there the river got deeper and faster. In about an hour and a half we arrived at the fork to observation point on the right, with photographers set up to catch the changing light in the canyon. Then we took the left fork to “Wall Street,” presumably named for the impressive sheer walls narrowing in.
At times, the water rises to the hips. Some hikers with only waterproof pants turn back. One couple raised their jackets, exposing bare midriffs to keep their clothes dry, and gamely walked through the first deep crossing. That must have been cold, with the water at 40 degrees. It is sunny, but also snowing.
At a rock outcropping, we paused for lunch. We find a few larger boulders, unpack and have our bagels. Suddenly ravenous, we savor the calories, noticing snowflakes drifting down 1000 feet into the canyon. The light is peculiar: in shadow, with sunlight bathing the Canyon just around the curve, blue sky overhead. It looks like indoor light because of all the bounce and reflection.
This is our turn around point. We rest, recharge, hear the stream burble, feel the snowflakes, our hunger sated, snug in our dry suits, we smell the fall giving way to winter.
It feels – cold, but I’m sweating from effort. The canyon appears unforgiving, but we have supplies and equipment up to the task. Flash floods and cyanobacteria poisoning are a risk, but we have mitigated them. Unlike more extreme adventure-seeking adrenaline junkies, this is the degree of risk and adventure I’m ready for.
It is time to head back. Downstream, like downhill, would be quicker. My main concern was balancing Seeing with Photography.
There is the disappointing idea that the more photos one takes, the less the brain experiences. Or maybe not. Yes, there’s more to show off when you get home, but were you really present? Or did you just line up and frame the shot? But, if you don’t take photos, how interesting is your blog post later? #FirstWorldProbs.
I tried to do both. Who knows.
Downstream was a pleasant splash. Yes, it was 1.5 times easier and slightly faster. There was little resistance to swinging the shins through the water as it flowed with you.
There are great speedway-sized curves to this river, as the millennia of water microscopically carry away molecules of rock every day. The views are magnificent.
It is a hike that promotes mindfulness. Your focus is required for not-stumbling, for pushing upstream, for awakening your senses. The constant, echoed river babble precludes idle chatter.
It is: exploration, sightseeing, photography, companionship, escape, reflection, effort, appreciation for dry-suit and photographic technology, wonder, mindfulness, pure sensation, focus, curiosity, pride of offspring, joy. All at once. Each in turn.
We emerge from the river, dripping and yet perfectly dry. We make our shuttle home.
Sometimes it is good to get away. Mind you, this photo is more than a year old (before pandemic), but it makes a few points…
Remember to get some exercise. Just … not with 3 super-fit members of your family. Notice everyone having a good time running, except Dad with the barely suppressed grimace of pain and facial mask of determination.
Remember, family members are supposed to support each other. And not run too fast for old people to keep up.
This is the beautiful Forest of Nisene Marks. I have to say, those articles about Forest Bathing? Yup, they’re right on. That time spent in the woods? When I wasn’t gasping for air, it was a spectacular place, a place to recharge.
As always, I had agreed to go for a “leisurely jog” with the kids and with my baby sis. We would run up the path for maybe a mile or 2, then “It’ll be easy, coming back down! Come on! It’ll be fun!”
Grasping my iPhone with a death grip, I set off. Because, if you’re going to go for a run, your iPhone HAS to track your exercise, doesn’t it? As quippy daughter always says:
“Dad, it’s NOT about the steps. IT’S ABOUT THE LIFE.”
I disagree. If my exercise app doesn’t track it, what’s the point?
Nevertheless, we get to the top (barely). I sprint to the turnaround sign (because, Dads have to make a point). This causes nausea with imminent vagal response.
After some time spent with arms tripod-ed on the knees, gasping for air, concerned looks from the sister (the kids are immune to these cries for sympathy) and an extended period of hands-on-hips walking back down the trail, we commence our downward leg.
I was promised an easier time headed down. This was a complete fabrication.
It was several hours later (or so it seemed) we got back to the car.
CMIO’s take: I do have to admit, the smells, the sights, the laughter were a wonderful respite. Yes, we did bathe in the forest (with our clothes on). And it did refresh my spirit. How do YOU recharge?
Well, it is time to update my resume. It has been a year, I have failed at more things. I’ve read more failure resumes, and I like some of the newer ideas, for example, listing your NON-skills. I’ve added mine.
Here is a new term for you: Doomscrolling. I am guilty of this, until I become aware of it and have to wrench myself away. It is a like car-crash in slow motion and you want to know how this horror story ends.
Virtual meetings are draining, and I’m on them up to 8 hours a day, even busier now with all the EHR modifications, keeping up with policy changes, what Covid-testing is available, how we admit, treat, discharge, follow, track patients.
At the ends of long hours, long days, long weeks, our nerves are frayed.
I’ve observed that interactions between people have everything to do with the interpersonal skills of the individuals. Sometimes the conversation does NOT go well. Whether it is by email (worst for crucial conversations), by phone (slightly less bad), by online video meeting (slightly less bad) or in person (best, when possible), it is certainly worsened by the pandemic situation.
I’ve been taking a Story Skills Workshop (by Seth Godin and Bernadette Jiwa) that recently concluded. I have to say that I’ve learned quite a lot, and not what I was expecting to learn. I highly, highly recommend it. Seth and Bernadette offer a series of online lessons, released over time. There are about 6 expert coaches, and the instruction is to sign up for an interest group or ‘accountability group’. You’re given a story structure (the 5 C’s: Context, Catalyst, Complication, Change, Consequence) and then specific lessons to write and polish specific elements of your own story in this framework. The cool part is the instruction to ‘first write your own story, and then go comment on at least 5 others.’
I learned that it is possible, in an online-only course, to develop a sense of community and collegiality in a short 30 days.
I learned that it is crucial to be gentle in first contact with others online. For example, when giving feedback on others’ stories, DO NOT start right in with ‘why don’t you add more Emotion to that moment in your story?’ You’ll learn (as did I) that conversation either stops or becomes defensive. Remember that online conversations carry ZERO nonverbal: no Kind tone of voice, no Friendly posture. All you see are the words, and it is automatic to imagine them coming from a frowning critic with crossed arms, shaking his brutish head. [Pause for self-reflection amongst my blog-readers, as well as from myself…]
Instead, try something my theater-trained son taught me:
‘I like… I wish… What if …’
My highly emotionally intelligent son
Framing any response this way allows your recipient to hear something positive, then a neutrally posed concern, followed by a tentative suggestion. Having been on both sides of such a well-formed critique, I can say: it is EASY to write, doesn’t take longer, and on the receiving end FEELS COMPLETELY DIFFERENT. It FEELS like a close friend, reaching a hand over to pull you up to a higher step.
FOR EXAMPLE: Take one of my story-critiques of a co-participant in the story workshop, not done well on my part: “Why don’t you add more emotion to your story? It reads like a timeline, but nothing about what you felt, or how that impacted you.” I thought I was clever, to point out one of the main points of that week’s lesson. What I received was… no response. Hmm.
Rephrasing the reply using this framework, when I replied to a different participant’s story, sounded like this: “Hi, Joe! I liked your story, especially the unexpected part about running away from home at 16. I wish I could be there at that moment when you made the decision, everything boiling-over, and then a crucial moment. What if you paused in your story and told us what you were thinking and feeling right then? I would be riveted.” Guess what? We had a great online conversation after that, and he re-wrote his story, and I WAS RIVETED. Win-win.
CMIO’s take? Story telling: cool. Gentle, effective feedback: cooler. Don’t we all need to get better at this?
If you’re not getting away enough from all things Pandemic, here’s a nice long-exposure photo from my iPhone 7. Yes, a CMIO with an iPhone 7. And I still love it. At least I have a smartphone, unlike one of my informaticist colleagues.
Forest bathing is a thing in Japan and increasingly worldwide, and perhaps we could learn a thing or two. OR, try Norway’s Slow TV (YouTube, almost 10 hours! Surprising how compelling it is, try it full screen), as highlighted by CBS Sunday Morning (8 minutes, YouTube). Don’t miss it!
I’m so proud to be part of a multi-disciplinary, talented group of clinicians. Our Department of Psychiatry is gearing up for what may become the second surge of our pandemic, as we relax the stay-at-home orders in Colorado:
Mental Illness. Depression. PTSD. Panic. Suicide.
These terms must no longer carry the stigma they do. There is no shame in reaching out for help. Appropriate and timely treatment can aid a person’s innate resilience and return him or her to health.
We have not experienced a pandemic of this scope for more than a century … We are psychologically inexperienced.
C. Neill Epperson MD
Read more of Dr. Epperson’s ideas and initiatives in this fight for mental health and the major investments UCHealth will be committing to improve the well-being of all residents of the State of Colorado. Welcome to the fight!
Executive Summary: We have a global pandemic, daily policy changes, we work from home, have new video tech, and we are learning to communicate and build relationships in new ways. It is easy to forget that there may be a scared patient on the other end, counting on us. How might we improve the patient experience? Some ideas:
Secure Chat with your MA
Scrub your schedule together, days ahead for patients more appropriate for telehealth vs in-person visits, med rec, troubleshooting, visit focus
Arrange your room, self
See tipsheet in Epic “Demonstrate Professionalism.“ How is: your room, your light, your clothing?
Eye Contactand, put a sticky note on PC cam to “LOOK HERE!”
Arrange the camera at eye level if possible. For some, looking down = frowning? Eye contact on video visits is EVEN MORE important. “If I look away it is because I’m looking at information in your chart”.
Avoid running late
If you DO, inform your MA by Epic secure chat & they can inform patient
Greet the patient
I like to raise my arms in surprise when we connect: every human connection now, is amazing. Maybe thank them for connecting with you. Ask if they’re in a safe private spot (eg: advise patient NOT to be driving!)
Talk, human to human
Ask: how are you coping (aside from medical concern)? Scared? Worried?
Even more important now in this time of anxiety. You can reflect or say back Data, Ideas, Feelings, Values. It strengthens connection: for example DATA: “It has been 5 days of worse symptoms?” IDEAS: “so you think it might be gout?” FEELINGS: “you’re worried about work? Hmm.” VALUES: “so, what’s important to you is your family.”
Some clinicians may have taken the Excellence in Communication course. The PEARLS acronym can also be helpful. Some examples: Partnership: “We’ll get through this together.” Empathy: (reflective listening, as above) Apology: “I’m really sorry that happened.” “I’m sorry for my part in it.” Respect: “You have worked really hard on this.” Legitimization: “Anyone in your situation would feel that way.” Support: “My team and I are here for you. We aren’t going anywhere.”
Physical Exam creativity
Teach them to take a pulse “say beep when you feel it” and YOU can count. Patients may have a BP cuff, Pulse ox, flashlight, thermometer.
Ask for help from family
Others may help add to history or exam findings
They may ask about YOU as a human
“How are YOU doctor? Are you staying safe?” So many surprising comments from patients worried about their doc. Thank them!
Brief LIFE advice
During pandemic, consider: A) Limit news/social media to 30 min/day. B) Exercise daily. C) THREE GOOD THINGS exercise: proven to reduce depression, anxiety if done consistently “What 3 things are you grateful for today?” Can become a great family habit at dinner.
AVS, Open Notes
From My Health Connection, they can see your AVS (after visit summary) and your Progress note (called Clinical Note) to remind them of details of your visit. Maybe at end of visit, ask: “Sometimes I don’t explain myself well. Can you tell me what you’ve heard, so we’re on the same page?”
Reassurance and Hope
“We’re going to get through this!” “Stay in touch with your loved ones.”
Ending the visit
Consider: a handwave OR palms together, nod OR thumbs up OR “You Got This!” Forecast next steps or if your MA will call them after.
Secure chat with your MA
Handoff any items after visit for continuity (referral, next visit, lab, etc)