Who Does It to Me?
What Does It to Me?
When Does It Tend to Happen?

The patterns of your signs of trouble can also give you clues about the negative effects of your fatigue. In addition to recognizing who might be imposing their fatigue on you, it’s wise to start thinking about who is feeling the effects of your fatigue. Who is at the bottom of your downspout: your spouse, partner, colleagues, children, the woman behind the counter at the dry cleaner?

Relationships may falter not only because of toxic interactions, but also because of absenteeism. A celebrated innovator and president of a think tank told me about the night he returned from a continent-spanning string of speeches. His teenage daughter set the dinner table for three—herself, her brother, and her mother. She hadn’t even noticed that her dad was home! He got the picture, and he decided that very day to step down from the presidency. He wanted to be present for his family, not just for his office and fame, and he saw how at odds his lifestyle was with his real purpose. Like him, awareness may come to you with all the subtlety of a thunderbolt.

Sometimes awareness means examining comfortable patterns to see if they are serving you well. Often, for example, what you assume is a groove (a good thing) is actually a rut (a not-so-good thing) that is lulling you into complacency.

A few years back, California Pacific Medical Center’s Values Action Committee described grooves and ruts. Members decided that being in a groove gives you a distinct sense of flow, like the flow of water over and around a rock. You stride. Things fall into place. It feels good and you feel good about yourself (not complacent but good). You look forward to going to work, to climbing the next hill. You have the sense that even little steps are an accomplishment. Joy travels within you when you’re in a groove. Life feels like an expedition, a spirited undertaking full of swoops and wheees rather than a plodding journey weighing you down. When you are in a groove, your attitude is up.

A rut makes you slump. You can get three hundred emails a day and have eight meetings on Tuesday from dawn into the night and still be in a rut—a very, very busy rut. You can’t see over the edge of the rut; you’re afraid even to get close to the edge. Ruts are restricting. A rut may be comfortable, but it’s a pinching, diminishing place, an attitude downer.

STEP TWO: REFLECTION

The results of reflection may amaze you. You will be able to understand and integrate more about yourself and why you do the things you do. With reflection, you may decide to forgive yourself for mistakes you have made. This will unlock waves of energy that will refresh your very being. As you think, your purpose will clarify. Reflection will help you refine your purpose, and with it, options and strategies will generate to push you forward.

Setting Yourself Up for Reflection

Reflection methods vary. I suggest you start in the appealing space you created to use with the Prescription. You might engage in formal meditation, shut your eyes and breathe deeply, or gaze at treetops or waves lapping at a shore. If you can’t arrange a perfect spot to sit and reflect, fantasize yourself there instead.

Reflection is a new undertaking for many, so lower your expectations and be considerate of yourself. I got comfort from a session on meditation that the Dalai Lama led at Stanford. As he described his technique, he acknowledged that it was hard for him to meditate for much more than twenty minutes. “I start to itch,” he reported.

Being practical, you can think when you are on the run, in the car, between meetings, on line at the bank—anywhere! Carry a notebook with a cover design that appeals to you so you’ll be more likely to pick it up. Attach a click-top pen to it. Make sure these are small enough to fit in your pocket, purse, or briefcase. If you don’t want to use “old fashioned” paper and pen, all kinds of electronic communicators can be great reflection-storage devices as well.

It’s easier to think when you set boundaries that give you time to do so. Just because every phone message begs for a speedy return call and every incoming email has two exclamation points doesn’t mean you have to reply right then. I have a friend with four children who needed quiet time, so she got a lock for the door to her bathroom, her only refuge. If you have an office door, shut it during your reflection time. Oliver Dutton, a colleague of mine at the American College of Physicians, has an automatic email response message that says: “I check my email every hour on the hour. If you need to contact me before that, here is my phone number.” Think about these and other maneuvers that free you from having to be immediately available to everyone at all times.

Subject Matter for Reflection

Without some guideposts, I could obsess or wallow indefinitely in the alcoves of my mind and then wander off into the fog. The following topics provide some markers to follow as you think and dream, and as you pull yourself toward the meaning of your life.

Good Things

When you take some time to think, you will discover that if you try, you can stumble across a fair number of good things that are happening in your life—even little things such as finding a nickel or seeing a rainbow. You can be glad for a compliment or soothing conversation, or you can look back at near misses and bullets dodged. Believe me, something is going well for you. Put things into perspective, and then write down some good things. Be specific.

SOME GOOD THINGS GOING FOR ME

Reflecting on good things isn’t cheesy or sentimental. It can carry a lot of weight. When a physician friend found himself at a crossroads a few years ago, spinning his wheels and not enjoying much of his life, he spent time thinking about two things: what he loved about medicine and something wonderful that happened every day. He realized that what he loved about medicine was the patients—shutting the examining room door and taking care of people. He re-arranged his practice so that younger partners took on more administrative responsibilities and resigned from a couple of committees. He was also very disciplined about writing down one wonderful thing per day. Some days his standards had to be fairly low, but he always found one wonderful thing. About six months later, he told me, “I am a new man.”

People

Some people stick by you; others stick to you. Who adds to your life? Who detracts? Who energizes you? Who tires you out? One of the best definitions of friendship I know was given to me by a woman who had been a refugee: “A friend is someone who will take you in in the middle of the night when you are running away.” Using that description, most of us have rather few friends. Since it takes time to make a friend, tending to them is important. (I’ll furnish some time-honored pointers on getting and keeping friends in Chapter 8.)

Priorities

When you reflect on your values, what you consider good and bad and right and wrong, you can start to set priorities. This is crucial, since when everything is a priority, nothing is a priority. Your priorities become not the power sources that give purpose to your life, but rather fuel that you consume, draining your energy bucket until there is not a particle left.

After you spend some time reflecting on your values, make a list of things you love and a list of things you despise. Doing what you love, within reason, helps overcome fatigue. Eliminating things you despise helps simplify, and simplifying restores energy. Of course, paring down loathings can be a problem since some tasks, like taking out the garbage, must be done. You may be able to recruit help with onerous tasks (for instance, learning how to keep house is good for children). You may find other items on your “hate” list that can also be dispersed, and this will decrease your fatigue.

THINGS I LOVE

THINGS I DESPISE

Experience

Experience provides tools you can use for the rest of your life. It helps remedy fatigue only if you bring it to mind, however. Recalling your experiences, you can recognize your strong points and your weak spots. You may set some learning agendas; you may get a better sense of your motivation and others’.

Relax and think back to three significant experiences in your life that jostled or catapulted you in a new direction. They don’t have to be the biggest transitions, just significant ones. They may be associated with relationships, ceremonies, school, work, emotions, geography, or health. The transitions may have been positive or negative; they may have been chosen by you or imposed upon you. Keeping in mind that what helped or didn’t help in the past is likely to do so again. This includes people.

TRANSITIONAL EXPERIENCES

What helped?
Experience #1
Experience #2
Experience #3
What was difficult?
Experience #1
Experience #2
Experience #3

Capturing Reflections

Take a moment to preserve your reflections before they fly away or evaporate. Just think of what has come to your mind—your good things, your passions, your transitions and more. In your quiet times, you may have decided to do some exploring. You may have made major discoveries or started to shape some new ideas. This is the time to save and savor your excitement.

This is not the time to make lists of pros and cons. Good choices are as much poetry as they are science. Your instincts are as likely to help you make good decisions as is your intellect. The problem is that the more training you get, the more you dismiss your gut—but you can resist. Sue Wilson, an obstetrician and gynecologist, wasn’t sure why she kept checking on one new mother who had just delivered a baby. Sue just felt uneasy. She visited and revisited her patient’s bedside, checking the vital signs and examining her. The young woman was content and a bit drowsy, as expected. On her last visit, Sue found her patient pale, with a weak and racing pulse and a tense abdomen. It turned out that during the delivery, the woman’s uterus had ruptured into her pelvis. Sue’s instincts had told her that something was wrong. She paid attention to them, rushed the patient to surgery, and saved her life.

While you are paying attention to your own feelings and instincts, take this opportunity to write about your reflections in your reflection notebook.

Letting Go

To move forward, you will need to release some things. This may be uncomfortable, but remember, if jugglers didn’t let go, the show would be over before it started.

Letting go may not be instinctive if you like to fix and control things. You may be reluctant to risk losing power or influence, or you may think that no one else could do the job as well as you. But letting go can actually generate energy, because it will give you more time for what matters. Dispensing with hurtful emotions, attitudes, and schedules frees you to fly.

Use the worksheet below to list the things that you could let go—and who could help you with them.

CAN I LET GO OF ANYTHING?

CAN SOMEONE ELSE AT HOME, WORK, OR IN THE NEIGHBORHOOD TAKE ON A TASK OR TWO?

Name	Could do what?

Reflection and releasing responsibilities will get you open and ready for the next step: conversation.

STEP THREE: CONVERSATION

What does conversation do for you? You acquire support and feedback, new facts and perspectives. You have less isolation, more resilience, and make better decisions. Conversations will get others involved with your fatigue-ducking maneuvers. Don’t be too amazed if your conversation companions restore their own energy, health, and life along with you. Renewing spreads from person to person quite regularly. In fact, that’s part of the whole idea.

You can get great advice in conversation. Your scope of feelings and wisdom could be enlarged. I’ve learned about recovering from the death of a child or spouse while talking with friends who are going through those ordeals. After a chat with an observant visitor to a nursing home, I was able to make recommendations to improve patients’ care.

Ground Rules for Good Conversations

If conversations hold such promise of inspiration and caution, what actually goes into a worthy one? For one thing, a conversation is not a rant, speech, or argument. “Conversation” is a particularly delicious word. Con means “with” and versus means “turn.” When you enter a conversation, you are willing to “turn with” one another. Former British Medical Journal editor Richard Smith introduced me to an entire book on conversation called, appropriately enough, Conversation . Its author, Theodore Zeldin, defines the term like this:

Conversation is a meeting of minds with different memories and habits. When minds meet, they don’t just exchange facts; they transform them, reshape them, draw different implications from them, and engage in new trains of thought. Conversation doesn’t just reshuffle the cards; it creates new cards.

A friend added a down-to-earth comment: “Conversations remind me that I’m not alone or crazy.”

Good conversations follow some ground rules:

To start with, have an open mind and an open heart; you don’t even need to be like-minded. A good conversation needs to be held in confidence, so that people feel safe. Limit complaining. Nagging issues may need to be aired in order to relieve pressure—but if they dominate, gloom and anger win. Tell the truth. You do not need to tell everything, but you do need to be honest. This builds trust. Listen carefully because it shows respect. When people are shy, distracted, or tired, they may need to be given open space or a bit of prodding. Strangely enough, silence can also help conversations. It may be uncomfortable, but silence allows thoughts to emerge and clarify.

Conversation Partners

Conversations usually take place between people who have some sort of relationship, although there are plenty of opportunities to have meaningful conversations with strangers. Having good, deep chats leads to good, deep relationships and vice versa. Perhaps one explanation for the bereavement effect—the increased risk of illness and death after a partner’s hospitalization or death—is that the remaining person has no one to talk with.

With whom would you like to have a tête-à-tête: A dependable friend? A child? A brother, parent, or aunt? Someone you work out with? A colleague? A mentor? You want to talk with people who don’t mind hearing you tell the same story over and over again; people who share your inner sanctums and are honest with you. People who challenge you or make you feel safe because you know they’ll stick around when you are in trouble or sad.

STEP FOUR: PLAN-AND-ACT

The purpose of this last step is to regenerate, to divest yourself of what is dragging you down, and to start fresh. John Gardner called it re-potting. Another gardener I know says, “Right plant, right pot. That’s it!” Sometimes you need to move plants and pots around. I know that’s not always easy, but I’m going to help you do it.

The first tip is to break things down into small steps. It is best to take them one after the other, but occasional side steps do happen. Taking small steps is smart, not cowardly.

• You can gather allies.

• You build your reputation.

• You gain confidence.

• It is easier to make small adjustments than big ones.

• On occasion, the small steps alone can banish fatigue. For instance, you may not need to change your career but change emphasis.

Two other actions make this last step in the Fatigue Prescription more manageable. One is to simplify and the other is to get organized—at least a smidgen.

What is there to simplify? The spare keys to cars you’ve traded in, books you’ll never read, stacks and files and rubber bands, anything that’s dusty or that you haven’t worn for two years, even shoes. All of the unnecessary stuff needs to go. The clutter can be actual or virtual, physical or mental.

What can you do about it, short of moving house or office? Figure out what is cluttering your life, and get rid of it. A therapist helped herself get into the right frame of mind by changing the word “clutter” to “garbage” as she saved good articles from journals and recycled the rest. Name it what you will and get it out. Peg Bracken’s instruction about leftovers makes a nice ditty for more than just refrigerators: “When in doubt, throw it out!” Others think of recycling stuff as part of the Law of Nature. We collect and harvest, save and enjoy, and then it’s time for old things to make way for new.

Although most feel that a totally clean desk is a sign of a sick mind, a cleaner desk prepares you for your successful take-off. It gives a sense of peace that brings strength.

To help you out, here are Dr. Susan Johnson’s five organizing principles for the office, which can easily be applied to other areas of life:

• Do it now. The key is to look at email messages only when you have time to deal with them. Don’t skip any.

• Work from a clear space. There should be nothing on your desk except a telephone, a computer, an in/out basket, a coffee cup, and the one task/project you are working on at that moment. When you are pressed for time, take everything (except the aforementioned items) and put them on the floor.

• Keep track of all your work commitments. Keep a single list of every task that you cannot complete immediately. When you finish a task, cross it off. When two thirds of the items on the page are crossed off, tear off the page, re-record all the undone items on to the new page, and keep adding.

• Use a single master calendar.

• Plan by the week. Daily planning leads to frustration. Stay flexible [but] do not over-schedule.

Be gentle with yourself as you start figuring out what needs to be scaled back or tossed. If you need help, call on an objective friend to help you sort and shovel more effectively.

Start small, of course. What needs to go? When? Whom can you ask for assistance?

Once you get underway, clearing out your clutter and getting organized will get easier. You will be pleased to learn how good it feels to have a clean slate.

STEP ONE: AWARENESS

STEP TWO: REFLECTION

Setting Yourself Up for Reflection

Subject Matter for Reflection

Good Things

People

Priorities

Experience

Capturing Reflections

Letting Go

STEP THREE: CONVERSATION

Ground Rules for Good Conversations

Conversation Partners

STEP FOUR: PLAN-AND-ACT