Kitchen Table Wisdom (the book) Archives

The pit crew of wounded healers

What do physicians have in common with NASCAR racers? What are the 3 essential skills today’s doctors need that don’t have anything to do with medicine? Read this from the New Yorker and find out.

Why is the Republican party no longer a comfortable fit for many doctors? Why do many doctors now support health insurance mandates and no longer care so much about limiting their own liability? Read this from the New York Times and find out.

As an aside, I’m always drawn to articles like these, partially because my paternal grandfather was a physician from the 1930s-1970s, but mostly because my mother was a RN in the 1960s-70s and told me countless nursing stories while I was growing up, which were far more enthralling to me than any story book she could have read to me. I suppose it’s not surprising that while I was in high school I picked up brochures from the guidance counselor’s office about anesthesiologists, oncologists, nursing, EMTs and physician’s assistants and fantasized about those sorts of medical careers. My father worked in insurance and those stories weren’t nearly as interesting, so that wasn’t on my list of things to do when I grew up.

Somewhat ironically, the closest I ever came to working in the medical field was when I worked part-time for an insurance company, of all places, during most of the 1990s. I was a unit leader and helped make sure the claims processors did their job correctly. I was certified as proficient in medical terminology and knew the most common procedure codes and ICD-9 diagnosis codes by heart. If only I had a dime for every 401.9 (hypertension), 250.00 (diabetes mellitus), 311 (depression) or 473.9 (sinusitis) claim I processed. I haven’t worked in that field for more than a decade but still remember many of the numbers and have visions of rattling off such numbers when I’m old and can’t remember the things I did five minutes ago. “Do the doctors think I have 290.20?” I’ll probably repeatedly ask my daughters. ;-)

Anyway, as dry as all that sounds, there were times I was able to glimpse the patient behind the insurance claim. When a claims processor in my unit would come upon a difficult claim that was as thick as a doctoral dissertation, he or she would usually slip into despair because processing that claim would take so much time it would make their speed percentage plummet (claims processors had to maintain high accuracy and speed percentages or, eventually, get demoted to the mail room). As a unit leader I was exempt from maintaining such percentages so I would usually take the claim off his or her hands and process it myself.

There were a few times I discreetly cried while processing those claims because the story the procedure codes and diagnosis codes told was a medical nightmare. I would feel terrible for the patient and his or her family. I carefully read those procedure codes and DX codes as if I was reading a novel. Page after page after page the story unfolded through the numbers. I made sure to process such claims with extreme care so that the claim would be paid correctly and the patient wouldn’t receive an erroneous bill, which would only have added yet more stress to their lives. It’s the closest I’ve ever come to taking care of a patient.

So I can see why the doctor in the New Yorker article I cited above says it’s pit crews today’s patients need. It can’t all fall onto the physician’s shoulders. And as Dr. Rachel Naomi Remen said in Kitchen Table Wisdom, “We are all providers of each other’s health… we are all wounded healers of each other. We have earned the wisdom to heal and the ability to care.”

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Tick Tock

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Late last night I read a post by one of my favorite bloggers, Andrew Sullivan, in which he linked to living will documents for all 50 states.

This was part of an ongoing discussion of his about how it would be wise if more of us gave some thought to living wills, as it would help reduce health care costs, among other things.

I clicked on the Wisconsin living will document and felt a bit overwhelmed while thinking about which instructions to choose. I quickly closed the browser window and went to bed with thoughts of persistent vegetative states dancing through my head.

Shortly after waking up this Good Friday morning I happened upon a poem by Mary Oliver:

When it’s over, I want to say: all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.

When it’s over, I don’t want to wonder
if I have made of my life something particular, and real.
I don’t want to find myself sighing and frightened,
or full of argument.

I don’t want to end up simply having visited this world.

Later this morning I drove past a funeral procession that blocked traffic for a while. One of the cars had a license plate that said “TIK TOC.” How appropriate, I thought. Funeral processions are a reminder that life is tick tocking away. I recalled an afternoon when I was eight-years-old and sat down and contemplated death for the first time. I thought to myself then, “each day I’m one day closer to my death.” Tick tock. Death seemed so far away and I was more content to live in the present then.

Pascal said:

The present is never our end. The past and present are our means, the future alone our end. Thus we never actually live, but hope to live, and since we are always planning to be happy, we are never actually so.

Actually living vs. hoping to live… As I pondered that while running on the treadmill this morning, it became clear that filling out a living will won’t be so hard after all.

And as Dr. Rachel Naomi Remen says in her book Kitchen Table Wisdom, “Human being is more of a verb than a noun.” Be-ing vs. being. “Be — and at the same time know the implication of non-being,” said the poet Rainer Maria Rilke. That makes the living will questions easier to answer too.

I’ll close with one more quote from Dr. Remen:

Death has been referred to as the great teacher. It may be the great healer as well…All life paths may be a movement toward the soul. In which case our death may be the final and most integrating of our life’s experiences.

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How to earn interest on your books

Several months ago I gave a copy of Kitchen Table Wisdom to my daughters’ pediatric endocrinologist.

Yesterday she told me she loved the book and will ask some of her staff, medical students and daughter (who is a pre-med student) to read it. She is also checking to see if the medical school here is one of the medical schools in the US that uses Dr. Remen’s curriculum.

After the conversation I figured that I’ve given away about 5 or 6 copies of Kitchen Table Wisdom in the past six months. Almost all of these people told me they have turned around and given copies to people with cancer, a cancer center library, etc.

A book discussion group I’m part of talked about this book earlier this year.

All of this because I discovered the book in a footnote in this book. It was several months before I finally checked Kitchen Table Wisdom out from the library because, judging from the title, I feared it might be sappy. Happily I was wrong.

I say this not to make a sales pitch for the book (although you’re more than welcome to read it) or to show how generous I am (used copies only cost $5 or less, including shipping) but simply to encourage you to do the same with books that have changed you.

You can do so by:

*Writing a blog post about it.

*Writing a review on Amazon about it (a confession: three years ago I wrote a review of Tim Gunn: A Guide to Quality, Taste and Style (Tim Gunn’s Guide to Style) and am pleased at how my review is still the #1 review there, with 219 helpful votes. Now if only I could have lunch with Tim Gunn someday… but I digress).

*Giving a copy to someone.

Or you could be weird and have a “book group” discussion like a friend and I have had. While reading Losing Mum and Pup: A Memoir by Christopher Buckley a year ago I kept thinking of a friend of mine because the dry wit in the book made me think of her. She lives at a distance so there was no way to discuss the book with her in a normal book group setting so I underlined my favorite parts and wrote notes in the margin directed to her.

I mailed the book to her and she read it, underlined her favorite parts, responded to my margin notes and also wrote her own margin notes. Then she mailed it back to me and it was so much fun to go through the book and look at her comments. I can’t think of a more engaging way to read a book.

Whatever you do, don’t forget that whenever you read a book that changes you, there’s the potential to change someone else’s life too.

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When I check my blog stats I see that a number of people find this website by searching “Kitchen Table Wisdom discussion questions” and “Kitchen Table Wisdom quotes.”

So I thought I should devote a post to that topic.

First, feel free to download my mind map of Kitchen Table Wisdom. It contains important quotes from each section of the book and helps give the big picture.

Next, glance through the posts I’ve written about the book. You might get some good ideas for discussion topics.

A book like this tends to generate much discussion on its own without having to ask questions. You could go through each section and discuss one or two of the stories that made the deepest impression on you. So it helps to write down a list of your favorite stories if you’re the leader of the discussion.

For me, the biggest takeaways from the book were the following (these might make for good discussion points):

* Approval is as damaging as criticism.

* Death is the great teacher and the great healer. Dying people have the power to heal the rest of us in unusual ways.

* We don’t always have to run to the experts. We are wounded healers of each other.  We won’t truly have universal health care until we realize that we are all providers for each other’s health and value what we have to offer each other as much as we value what the experts say.

* Wholeness rarely means we have to add something to ourselves. It’s about freeing ourselves from beliefs about who we are.

Here are 10 of my favorite quotes from the book:

“Prognosis may not be the reality anymore than the map is the territory or the blueprint.” p. 13

“Stress may be as much a question of a compromise of values as it is a matter of external time pressure and fear of failure.” p. 76

“We do not see things as they are. We see them as we are.”

“Wholeness is never lost, it is only forgotten. Integrity rarely means that we need to add something to ourselves. It is more an undoing than a doing, a freeing of ourselves from beliefs we have about who we are and ways we have been persuaded to “fix” ourselves to know who we genuinely are.” p. 108

“I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it’s given from the heart. When people are talking, there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it. Most of us don’t value ourselves or our love enough to know this.”

“We are all wounded healers of each other. We have earned the wisdom to heal and the ability to care.”

“I do not think that we will be able to attain health for all until we realize that we are all providers of each other’s health, and value what we have to offer each other as much as what experts have to offer us.”

“Death is the great teacher and also the great healer. Death may be the final and most integrating of our life’s experiences.”

“Cleaning up one’s act may be far less important than consecrating one’s life.”

“Joy seems more closely related to aliveness than to happiness.” p. 172

Enjoy your book discussion! Feel free to post your favorite quotes in the comments.

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On early spring gardening and spores

Today was the first day I worked in the flower garden since last fall.

There was something satisfying about clearing away the last of the dead plants from last fall and making way for the new blooms already peeking through.

As I cleared away the remains of last year’s peony bush I was very happy to see the new red shoots pushing through:

The last bit of the hibiscus stems, which reach 6 feet high or so when in full bloom, look and feel very hard and sturdy. At first one might think one would need a saw to cut them away. Yet I’m able to twist them off with my bare hands.

There’s something symbolic about that, I suppose.

As I worked I thought about how almost every plant and flower in my garden was chosen by someone else.

My husband went through a rose bush phase some years ago and there are several shrub roses in the garden.

I don’t especially care for shrub roses and sometimes I get annoyed at how I’ve now been stuck with their upkeep. They take up a lot of space and their thorns always prick me, even when I wear gloves.

Also, I prefer the look of the old-fashioned tea roses.

Here’s our Elizabeth Taylor tea rose, which belongs to my oldest daughter:

But last December the shrub roses were still in bloom in the flower garden, even long after everything else had died (the Elizabeth Taylor rose only bloomed for a couple of weeks):

So I have a new respect for these shrub roses and will keep them. Anything that retains vivid color in harsh conditions is worth hanging onto.

My father selected and helped plant most of the other plants. He’s not so mobile anymore and can’t help me in the garden like he used to. I wouldn’t ever consider ripping out anything he had planted for me.

Then there are the hostas on the east side of the house, planted ages ago by a previous owner, which require shade and bloom in August.

Seven years ago we chopped down the two trees in the front yard and these hostas have struggled ever since. I tend to forget about them because they aren’t in the front yard with the other flowers.

Constant full sun has been hard on them. Yet somehow they continue to bloom every year. I haven’t managed to find the time to dig them up and plant something different.

Also, I know what it feels like to be in full sun when you are in dire need of shade – there have been areas of my life where I have felt just like that.

So I kind of like these hostas, imperfect as they are.

Working in the garden in early spring like this, before the new plants have grown, reminds me of what Rachel Remen says about spores in Kitchen Table Wisdom:

One of the most dramatic manifestations of the life force is seen in the plant kingdom. When times are harsh and what is needed to bloom cannot be found, certain plants become spores.

These plants dampen down and wall off their life force in order to survive. It is an effective strategy. Spores found in mummies, spores thousands of years old, have unfolded into plants when given the opportunity of nurture….

But a spore is a survival strategy, not a way of life. Spores do not grow. They endure. What you needed to do to survive may be very different from what you need to do to live.

No wonder she likes to compare the practice of medicine to gardening instead of to carpentry. Helping someone to live and thrive is very different from helping someone to merely survive. Gardening is a nice reminder of that.

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It’s not how many people you know but how many kinds

In this age of social media it’s easy to get caught up in how many “friends” and “followers” you have.

But while reading June Singer’s Boundaries of the Soul: The practice of Jung’s psychology, I noticed she said the best way way for psychology to have a positive impact on our life outside of the analyst’s office is to interact with many different kinds of people in our everyday lives.

She goes so far as to say that to have an impact on society we shouldn’t first turn to experts. Instead we need to listen to the less vocal parts of society…

“These people watch and listen, they observe and reflect. They know far more than most people give them credit for. It is time to ask them what they see, what they need and what they can contribute.”

She listed 7 types of people we should listen to:

1. The ordinary person just struggling to get along in the world.

2. The elderly in your community. They have watched history unfold. Those that continue to have a lively interest in the world have much to teach younger people.

3. Indigenous people. She mentions people who are native to a country but I also like to think of indigenous people as people who have lived in a neighborhood or community for a very long time.

For example, in my neighborhood are two sets of neighbors who have lived in this neighborhood since the 1960s.  They always have a lot of information and stories to share.

4. Recent immigrants. They help us remember the importance of retaining our uniqueness while blending in with the whole of society.

5. Wisdom teachers. Religious leaders, ministers, etc.

6. Gay and lesbian people. She says we can learn from them because they tend to be creative and because they can teach us how members of a community can support one another through difficult times.

7. Families who live in rural settings. We should be interested in what they are learning about life and their natural surroundings.

She goes on to say that she approves of how psychology has also made inroads in the medical community and that it is generally accepted today that diseases have both physical and psychological components.

Of course this made me think of the work of Dr. Rachel Remen and her book Kitchen Table Wisdom. It became apparent while reading Boundaries of the Soul that Jung’s psychology has obviously had some influence on Dr. Remen.

Both Jung and Remen seem to share the same optimism and belief that wholeness and healing are possible. June Singer’s Boundaries of the Soul is considered the classic introductory book about Jung so that’s the book to read if you have any interest in learning more about Jung.

At any rate, it reinforces all the more how if we just listen to each other, including people who are different from us, and share empathy and stories, we won’t need to turn to the “experts” as often.

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How to harvest your failures and stop seeking approval

Perhaps the most thought-provoking section of Kitchen Table Wisdom by Rachel Naomi Remen is the section on judgment, in which she says:

Judgment does not only take the form of criticism. Approval is also a form of judgment. When we approve of people, we sit in judgment of them as surely as when we criticize them.

Positive judgment hurts less acutely than criticism, but it is judgment all the same and we are harmed by it in far more subtle ways.

Like all judgment, approval encourages a constant striving. It makes us uncertain of who we are and of our true value. This is as true of the approval we give ourselves as it is of the approval we offer others.

Approval can’t be trusted. It can be withdrawn at any time no matter what our track record has been. It is as nourishing of real growth as cotton candy. Yet many of us spend our lives pursuing it.

It had never occurred to me before that approval is a form of judgment just like criticism. Since reading that I have spent a lot of time thinking about how we trade wholeness for approval.

Because I’m self-employed and don’t have a boss or co-workers there have been times when I have been desperate for someone to tell me what to do, especially when I was first starting out.

Even today, now that I have a track record and have written successfully for dozens of clients, I feel a deep sense of dread at times when I submit a draft to a first time client. I marinate in anxiety about what they will think and avoid checking email for hours because my client’s approval matters too much to me.

Yesterday I asked a colleague for some advice but before doing so I paused and made sure that what I was asking for was advice and not approval. It’s important to know the difference between the two.

This colleague has more knowledge about the topic I needed information about than I do and he alerted me to a fact that I wouldn’t have known otherwise. As a result my marketing campaign will be more successful as a result.

So advice is cool. Approval… not so much.

I also thought about this when my daughter’s teacher asked me to write down a couple of goals I have for my daughter prior to parent teacher conferences.

I didn’t want to encourage a constant striving on her part. She has to choose her own goals so I wrote down my “goals” for her with this in mind. They weren’t really goals, but just affirmations that encourage her to be herself. My “goal” was to make her smile as she read them and I accomplished that.

Dr. Remen ends her section on judgment with wise words that, as a middle-aged person, I appreciate:

But judgment may heal over time. One of the blessings of growing older is the discovery that many of the things I once believed to be my shortcomings have turned out in the long run to be my strengths, and other things of which I was unduly proud have revealed themselves in the end to be among my shortcomings…

What a blessing it is to outlive your self-judgments and harvest your failures.

A blessing indeed.

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It’s about showing up rather than shopping

In Kitchen Table Wisdom, Dr. Remen says that a trip to the grocery store might tell us everything we need to know about our lives.

She said that Jung would often ask his clients what activity they were engaged in right before leaving for their appointment with him.

His theory was that analyzing an everyday action like that told him volumes about the person.

I thought of this while reading Marry Him: The Case for Settling for Mr. Good Enough by Lori Gottlieb.

Some of the key problems in today’s dating and marriage culture can be discovered by examining how one shops, she says.

She cites sociologist Barry Schwartz’s theory that people are either maximizers or satisficers.

A maximizer is someone who is never satisfied and constantly second-guesses their decisions.

When a maximizer shops for a new sweater, for example, she has to explore all the options and spend eons in the changing room trying on multiple sweaters.

If she finds something she likes a lot and fits well she hesitates. It occurs to her that maybe the store across town has the exact style she wants instead or might have a better deal.  So off she goes, continuing her never-ending quest for the perfect sweater.

A satisficer breezes into a store and finds a sweater that mostly matches her criteria. It might be a bit more expensive than she was prepared to pay, or perhaps it’s not be the precise shade of green she wanted, but she buys it, maybe without even trying it on first (gasp!), and moves on with her life.

Not surprisingly, maximizer tendencies in a culture that instructs us to approach everything like a shopping excursion can be problematic, even for satisficers.

This shopping mentality and constant striving for the best means we often don’t notice and appreciate what’s right in front of us already.

Lori shared a story about a man she refused to date at first because he wore bow ties. But when her dating coach made her realize how ridiculous it was to rule a man out based on that one thing, she relented.

After several dates the man told her how his late grandfather had a huge bow tie collection. He looked up to his grandfather as a kid and felt so honored when he found out that he had inherited the bow tie collection after his grandfather died. The bow ties remind him of the good traits in his grandfather that he hopes to emulate and that’s why he wears them.

Her attitude about bow ties abruptly changed, of course. If she had persisted in her maximizer shopping mentality she never would have had the opportunity to hear this cool story.

As Dr. Remen says, “Joy is a willingness to accept the whole and show up to meet with whatever is there.” So I guess it’s best to show up rather than to shop.

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A bright sadness story

Rod Dreher is one of my favorite bloggers. I’ve read his daily posts for several years now and this post is the most profound post he has ever written.

He describes a three hour conversation he had with his sister, who was recently diagnosed with stage four non-smoker’s lung cancer at age 40.

This conversation happened a couple of days before she was to begin treatment – treatment that will debilitate her and from which she will possibly never fully recover.

His story of their conversation is a moving one. It reminds me of what Dr. Rachel Naomi Remen says about death:

Dying people have the power to heal the rest of us in unusual ways.

And:

Death is the great teacher and also the great healer. Death may be the final and most integrating of our life’s experiences.

Do read the whole thing. It’s always a privilege when someone shares profound and deeply personal stories like these –  stories that seem to only happen when standing on the very edge of life.

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Mind map of the book Kitchen Table Wisdom by Rachel Naomi Wisdom

I created a mind map of the book Kitchen Table Wisdom and you can download and/or print out a copy here.

If you’re discussing this book in a group, or just want a concise summary of the book for your own use, then check out this mind map. I prefer mind maps over conventional outlines because they are more visual.

Even if you’ve never read the book you might enjoy taking a look at it.

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