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Ask Yourself 4 Key Questions Everyday: Redesign Your Wellbeing

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

“Goodbye,” said the Fox. “Now here is my little secret. It is very simple. It is only with the heart that one can see clearly. What is essential is invisible to the eye.” … “It is the time you lavished on your rose that makes your rose so important.” … “Men have forgotten this basic truth, but you must not forget it. For what you have tamed, you become responsible forever. You are responsible for your rose.”’

With these simple words, the Fox in Antoine de Saint-Exupéry’s 1941 classic tale The Little Prince reveals that which makes life truly worth living: appreciating people for who they really are, building relationships based on deep and meaningful connections, and understanding the misplaced value most of us give to superficial and material things.  Hearing the Little Prince recount this story, the pilot who has crash-landed his plane in the desert realizes the need to re-evaluate his own life.

Have you crash-landed in your own desert, your plane’s engine broken, and nowhere to go? Are you hoping for your own little prince to share his secret and guide you to a marvelous world?

How would you begin to design, or re-design your life and your well-being?

The application of design thinking – an approach used in product development to incorporate the end user’s needs and perspective – is not new. A good example is found in the book Designing Your Life: How to Build a Well-Lived, Joyful Life by Bill Burnett & Dale Evans, both professors at Stanford. They guide working professionals through this process to build balanced, productive lives while finding joy and satisfaction in work, love, and play.

We are creatures of habit.  We do many of the same things every day, from the moment we wake up until we go to bed at night, because we’ve trained ourselves – with or without intention – to be that way. It stands to reason that if we are to redesign our lives for better well-being, we will have to retrain ourselves to form new habits. Eleni Hope says that it is much easier to create the changes you crave when your habits empower and support your soul, values, and vision.

My friend Chaplain Dr. Bruce Feldstein, a board-certified chaplain, has developed a compelling approach to implement this re-design for well-being in a gradual, transformative process.  He was an emergency medicine physician for 19 years before deciding that his true calling lay elsewhere, and trained to become a chaplain. He now serves as Founder and Director of Jewish Chaplaincy Services serving Stanford Medicine, a program of Jewish Family & Children’s Services, and is an Adjunct Clinical Professor at Stanford University’s School of Medicine. Drawing on the rich perspective he developed from decades of tending to the medical and spiritual needs of people, and additional insights from research and teaching in medicine, he developed what he terms spiritual fitness exercises to help us form these new habits and re-design our own well-being. 

The key, says Chaplain Feldstein, is to “build practices that increase our capacity for meaning, purpose, and connectedness,” three essential determinants of well-being, and then “engage in these practices to fill our living with well-being.”  Building these practices through repetition creates new habits.

Chaplain Feldstein recommends you begin with Four Questions a Day — inspired by the work of Rachel Naomi Remen MD, professor and pioneer of holistic and integrative medicine, and from research on gratitude. At the end of each day, spend 10 minutes of quiet time to contemplate and ask yourself: 

  1. What surprised me today?       
  2. What touched me today?
  3. What inspired me today?
  4. For what am I grateful?

Consider each question separately. Ask yourself the first question, reflect back on your day until you come to the first thing that surprised you, and jot it down. Then ask the second question, look back for the first thing that touched you, and make note of it. Do the same for something that inspired you, and for which you are grateful. Continue this exercise for three weeks and review your answers to see what you can learn about yourself.  This foundational practice of discovery, wisdom, and well-being gradually “teaches us to live with open eyes and an open heart,” says Chaplain Feldstein, “it increases our capacity for well-being as we develop new ways of recognizing that which is positive and meaningful.”

Through this process, you will learn for yourself what the Fox taught the Little Prince!

The next step in this practice is to reflect on each of these questions as you go through your day. Set aside moments during your day to stop, reflect on the questions, and jot down your response. In doing so, identify and notice the particular response – surprise, being touched, inspired, and grateful. As you continue, you will gradually progress to the stage of noticing these reactions while in the experience, and from there to be able to voice an appropriate comment such as “that’s remarkable,” “I’m touched,” “you inspire me,” or “I’m so grateful you did that.”  In this manner, you improve your ability to focus, sense, notice, allow, appreciate, wonder, reflect and find meaning. You interact with authenticity. This is a pathway to “fashion a world that is increasingly filled with well-being,” asserts Chaplain Feldstein. In addition to the Four Questions a Day practice, he recommends three other exercises to explore: Where Are You? Living Your Questions helps you discover the ‘aliveness’ within yourself; Key Relationships helps you stay emotionally buoyant; and Four Things I Want You To Be Sure To Know assists in healing relationships, finding peace, and dealing with the prospect of losing someone.  

Access Chaplain Feldstein’s Spiritual Fitness Exercises© and begin to redesign your own life today!

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at sukhaminfo@gmail.com

Spiritual Fitness Exercises ©2020 Chaplain Bruce Feldstein MD, BCC.

With sincere thanks to Chaplain Feldstein and the Jewish Family and Children’s Services for this inspiring resource.

Standing Tall As a Brown Boy

Hey M10! 

Please put down that Agatha Christie novel for a minute. You don’t know who I am, so it will come as a huge surprise when I tell you that I’ve walked with you every step you’ve taken. Bear with me – I’m not being mysterious; those are the facts. You’ll get to know me well in a few decades. In the meanwhile, can you take some time now to chat with me? I have something to share.

You are not quite 10 years old. It’s summer, and you’re in Mandya with your parents and sister at your cousin’s wedding. You are happy, enjoying the festivities, and having a great time playing with your other cousins. Suddenly you’re not having fun anymore. I know why!

An adult walking by your little group pauses to poke you in the ribs with a comment that begins to prey on your mind. “Look at that! Even Gita is taller than you are!” It dawns on you for the very first time that other people see you as a short person. Is Gita ‘better’ than you by that measure? Apparently, height matters. Why am I not as tall as Gita? This question rises to the forefront of your consciousness and dampens your enthusiasm and spirits. I see you brooding.  Concerns about your height will continue to nag you.  I want to share some thoughts about this. Before I do, I want to bring two others into this discussion.

Hello M13.

You’ll recognize me someday as that enigmatic voice from the future checking in on you.  Stop hanging from that horizontal bar and drop to the ground. Come join me and M10 on the bench over there. We should talk. You know M10 well, though he doesn’t know you yet. 

Finally, you are a teenager! You’ve spent the last four months fighting and recovering from a serious case of Infectious Hepatitis. You’re even punier now than you were before you fell ill, and you don’t like what you see in the mirror. Shouts of “Arrey Chotu!” from the playground ring in your ears. You are sick of being the first boy on the left every time your class lines up by height in the school ground at the start of PT period. You are determined to grow tall, big, and strong. You’ve heard that gravity compresses our spine and joints, and squeezes cartilage, and contracts muscles. You’ve read in a magazine that hanging from horizontal bars can help fight the effects of gravity. Your lower body is stretched and the spine elongated to promote growth. You are in your ‘spurt years’ and determined to push it along. You want to be six feet tall! 

Your dream will never be realized. All your life, you will have to contend with the unpalatable reality that your sister is taller than you are. Hang in there, M13. There’s more to you than your height. Let’s talk it over as soon as we get one more to complete our quorum.

M42.

Look here! Can I get your attention for a few minutes? You don’t know me, but you know these young men all too well.  Take a break from your busy day to chat with us. I promise to make it worth your while. You do recognize M10 and M13, don’t you?

You recall hanging from the horizontal bars in vain as a teenager, trying desperately to grow taller. Almost 30 years have gone by, and you’ve made do, standing upright and stretching to your full 5’-3½“ frame. You’ve continually struggled with a conviction that people don’t take you seriously at first, because you do not command an imposing presence; that you are too small to make an impression. You feel passed over in social gatherings and mixers, and initially at work as well. There’s a memorable incident during the international-student orientation on Stanford Campus. You’re chatting with local community members there to welcome incoming students and help them settle in a new country. A nice well-meaning lady asks innocently, “are you here to go to Palo Alto High School?” You see her utter astonishment when you say, no, you are enrolled at Stanford; whereupon – and much to your chagrin – she blurts in amazement “wow, you are already an undergraduate.” You don’t have the courage then to tell her you are actually here for the Ph.D. program in Engineering. That incident haunts you for a long time until it gradually becomes a funny story. Over the years, you feel passed over for opportunities at work and play because of your small stature. You feel inferior. You literally feel small. It has been a rough ride at times; then you slowly learn to overcome these feelings, understand your own true worth and use your strengths to flourish.

Good, we are assembled together! Let’s start with introductions.

We are all the same person, guys!

M10, you will become M13, then M42, and eventually, one day in the distant future, you will become me.

I’m M73. I want to chat about our feelings of inferiority and how we’ve come to terms with them over the years. Like most things, it’s been a gradual learning process. It gave us heartache and anguish over the years. We experienced many difficult days; first chasing a dream that was never realized, then struggling with feelings of inadequacy, and confronting unfairness both real and perceived. It took us a long time to understand that physical height was not the only measure of a person’s stature, even if society frequently behaves as though it is, by judging us from first impressions.

We learned that the other qualities and skills we possessed more than made up for any physical shortcoming. We even learned to joke about it; “I’m not short, I’m vertically challenged,” we’d remark to others. We learned that this supposed shortcoming wasn’t really one at all. Our height is determined by a combination of factors not in our control, including genetics, the environment, and the circumstances and conditions in which we grew up. We realized that physical attributes are transient – they can and do change, and what matters most, in the long run, is the heart, the mind, and the attitude that we bring to our lives. We figured out that people’s attitudes changed when they got to know us for who we were, and what we were capable of. In the hearts and minds of those that mattered, we were ten feet tall. Along with our realizations, our stature grew! Guys, look at the bright side; our feelings of inadequacy did not turn into an inferiority complex; we didn’t turn into little Napoleons!

What’s the message for us? We should continue to learn from the experience and counsel of those who are wiser than us. Continue to reflect and learn from our own experiences.  Understand that life can be unfair, and though we do not control the cards we are dealt, we can teach ourselves to play the best game possible with the cards we have. We should continue to make the best decisions we can at any given moment, with the information that we have. A true sense of self-worth, happiness, and fulfillment, and doing what we love with those we love is what life is all about. We must derive that sense from within us, not from the outside.  We can and must continue to learn about ourselves, and consider how to live our lives in the best way possible as we move forward, by reflecting on our past. 

Each of us can learn to stand tall in our own way; look forward by looking back to understand our past. 

I wonder what advice M80 will have for all of us!

Mukund Acharya is a regular columnist for India Currents.

Why Should You and I Care About Palliative Care?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

My wife’s oncologist recommended a palliative-care consultation during one of her checkups. This was the first time we heard about it and my wife, subsequently, received beneficial palliative care alongside her ongoing treatment for cancer. Since then, I’ve continued to learn more about palliative care and how it helps patients living with various kinds of serious illnesses. I’ve also realized that most people know very little, or are misinformed about palliative care. We need to understand this relatively new medical specialty; it can do a lot for us and our loved ones in the event of a serious health issue. 

Palliative care is specialized care for people living with a serious illness. It is a type of care focused on providing relief from the symptoms and stress of different kinds of serious and chronic, progressive illnesses, and is provided in addition to, and concurrent with, ongoing medical care. It supports the patient’s ability to feel better while undergoing treatments which could be intense and sometimes not well tolerated. The goal of palliative care is to improve quality of life for both the patient and the family.

To palliate is to make something – for example, a disease or its symptoms – less severe or unpleasant. Palliative Medicine is relatively new. It has its roots in the work of Cecily Saunders and Elisabeth Kübler-Ross in the 1960s. The term Palliative Care was coined in 1974 by Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital in Montreal, Canada. It was recognized as a field of specialty medicine in Great Britain in 1987, the same year that Cleveland Clinic started the first Palliative Medicine service in the United States. It became a board-certified subspecialty of medicine in the United States in 2006, just 15 years ago.

Let me repeat: Palliative care is specialized care for someone living with a serious or chronic progressive illness, focused on providing relief from the symptoms and stress of the illness, to improve quality of life for both the patient and the family. It is based on the needs of each individual patient and can be provided at any time during his or her illness, along with the treatment he or she is already receiving, regardless of the prognosis, expected trajectory of the disease, or age of the patient.

What, specifically, does palliative care do? It provides relief from pain, nausea, constipation, neuropathy, shortness of breath, or other side effects and symptoms caused by the illness and/or treatment. It helps when patients and their families have trouble coping with the illness and are anxious, depressed, stressed, or fatigued, and enables them to better carry out their daily tasks and do the things they want. Palliative care can also improve the quality of life for both the patient and his or her family. 

What is meant by quality of life? That depends on the patient! He or she defines what is important at that moment and in the future. The palliative care team works with the patient and his or her family to understand what’s important and what matters most to them, and takes that into account to formulate a treatment plan and provide the best possible support to help realize those goals.

I used the phrase palliative-care team.  Care is provided by a specially-trained, multidisciplinary team that typically includes doctors, nurses, medical assistants, social workers, chaplains, and other specialists. This is because palliative care extends beyond a patient’s physiological and medical needs and addresses other factors that may be affecting their quality of life, including psychological, spiritual, and social needs. These needs vary from patient to patient. In addition, they can vary over time for a given patient.

Needs could include: help with figuring out what medications should be taken and when; thinking things through, and weighing options when faced with decisions on a suggested next step in treatment; help navigating the complexity of a large hospital when referred to different specialists or when various tests are ordered. Sometimes stress can overwhelm the patient, caregiver, or another family member, and they could benefit from having a caring listener, or just a hand to hold for a while. The costs of treatment are a huge concern for many of us, so the assistance of a qualified individual to sort through financial questions might be valuable. When serious illness brings up existential and spiritual questions, trained chaplains could provide answers, solace, comfort, and a compassionate presence. Nutritionists who understand the patient’s diagnosis and condition can help address dietary concerns.   

Palliative-care specialists treat people living with many types of serious and chronic illnesses, regardless of their age, stage of the disease, and whether or not they are still receiving curative treatment; these include cancer, congestive heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS), and other life-limiting diseases. Pediatric palliative care is an upcoming specialty. During the current pandemic, it’s an essential part of treatment for those who have contracted COVID-19.

Many confuse palliative care with hospice and believe a recommendation for palliative care implies the patient has a condition that will imminently end his or her life. This is not correct. Palliative care can be very useful for those managing a long-term illness. Quality research provides evidence that the early introduction of palliative care provides all the benefits described above, and results in fewer hospitalizations, a reduced burden on the family, and greater satisfaction overall. Hospice is a form of palliative care for those patients judged to be approaching end of life – and typically have six months or less left to live – who decide to focus on comfort instead of prolonging treatments.

Most private insurance plans, as well as Medicare and Medicaid, cover palliative-care services in hospitals and nursing homes. However, you should always consult with your insurance provider to understand your coverage in detail.

I hope this has helped you better understand Palliative Care and dispel any related misconceptions. 

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at sukhaminfo@gmail.com

Sincere thanks to Drs. Neelu Mehra at Kaiser Permanente, and Kavitha Ramchandran & Grant Smith at Stanford Health Care – Palliative Care Physicians who have contributed greatly to my understanding of Palliative Care.

With sincere thanks to Trung Nguyen at Pexels for the use of her beautiful photograph.

Charting a Course For Renewal

Sukham Blog – A monthly column focused on health and wellbeing.

As 2020 drew to a merciful close, our editor sent me a note suggesting we begin the new year with a focus on renewal and the environment around us. I filed that thought away as I began a break from my normal routine for a few days, but it kept nibbling away at a corner of my subconscious.  Having lived through a crazy, head-spinning, and gut-wrenching year, we were all ready for a reprieve in 2021; aching for relief and deliverance from all that we had endured. We fervently wished and prayed for change, for that time of renewal and return to normalcy. Instead, we were visited by the horrendous events of January 6th and their aftermath. Like so many others, my world stopped spinning for a few days as I watched in horror – and then re-played in slow motion – the brutal assault on our democracy and our very way of life. All the while, news about the pandemic did not get any better either. Did we not turn the page on our calendars? Had we flashed back into the dark abyss? 

It took me two more weeks, but I’ve finally begun to breathe again in the past few days. My usual, optimistic self is peering out cautiously from that dark recess. Now it’s time, I tell myself.  Now it’s time for renewal, time for change, time to emerge from one of the darkest periods in our lifetimes, dare to hope, and strive for a return to normalcy.

Oh, normal sounds so good now!

“Renewal is associated with a Stop,” writes Bob Dunham, “Stopping is not just Pausing. Stopping is open to choose a new path, not just resuming the old one. With Stopping, we don’t just pause and rest to resume the game. In Stopping, we reflect and choose whether the old game is worth returning to, whether there is a new and different game to play – perhaps a game that is healthier, more meaningful, valuable, and loving.” 

I think that’s the perfect mindset for us as we make our way out of the tunnel we’ve been in for so many months, and into that sunshine that awaits us. Let’s not kid ourselves, a steep hill still lies ahead of us, and it will require grit, determination, and collective will to help each other to the top of the ridge and descend towards our new normal – whatever that may be.  However, we can get there if we choose. Of that, I am now convinced.

I associate renewal with the cycles of nature.  There is a rhythm to the cyclic process of creation – the birth, nourishment, and growth of plants and other living species. Let’s take a leaf from Mother Nature’s playbook. Barb Schmidt, a teacher of spiritual practices and author of The Practice, points to Springtime as a metaphor for our lives. We can focus our attention on living in the world and “feel rejuvenated and motivated to make our lives and the world a more beautiful place,” she urges. We need to see “the beauty that is already present in each moment by bringing our attention right where we are: right where we need to be—right here in the now.” We need to train ourselves to build this awareness that gives us access to that inner light, pursue our purpose, find meaning, and thrive. Looking inwards to nurture our inner world will help us blossom in the world outside. And along the way, we can plant a few flowers and trees for the others around us to cherish.

Let’s heed Barb Schmidt’s advice.  Let’s resolve to conquer the hill that remains before us, and in doing so make this our time of renewal! 

How do we lift the weight of the past year off our shoulders, build this inner awareness, find that inner light and begin afresh to pursue our purpose? First, stay away from resolutions. Around 40% of people in the US make resolutions when seeking a fresh start, as at the beginning of a new year. Resolutions create expectations, and can very soon become burdens. Instead, focus on specific outcomes. Pick out a purpose that you care about, that is meaningful and important to you. Whenever you are able to do so, take small concrete steps to achieve that purpose, without focusing on the time it might take to reach that goal. As long as you stay connected to your purpose, you will get there.

Tailor your expectations and demands on yourself. We have all been through a period of tremendous stress that is not going away just because we started a new year.  Reduce the pressure on yourself by focusing on and prioritizing self-compassion. The uncertainty that has plagued us over the past year is not going away soon. We’ve all come to expect some level of predictability in our day-to-day lives, without which we find it challenging to make plans. This makes it extremely difficult to set and achieve goals for ourselves. The way around this dilemma is to set smaller, shorter-term goals. 

Achieving one such goal before setting the next one assures a higher chance of success; it’s a way to deal with uncertainty that helps to build confidence, morale, and a sense of accomplishment. These small wins “add up over time” and keep you motivated, says Natalie Dattilo, a clinical health psychologist with Brigham and Women’s Hospital in Boston.  They help set yourself up for success.  Another key is practicing gratitude; which Ms. Dattilo believes, has the power to bring about positive changes in us. And along the way, do not forget to make the time to do something – however small – that will brighten the day for another – be that a parent, child, sibling, neighbor, friend, colleague or stranger. Bringing light into another’s day will brighten your own.

Find purpose, set micro-goals, practice self-compassion, self-care, and gratitude. Reward yourself and help another.  Dr. Susan McDaniel defines renewal as the state of being made new, fresh, or strong again—to restore, replenish, revive, re-establish, recover.  An appropriate definition in our current context! 

Chart a course for your own renewal, one that is healthier, more meaningful, valuable, and loving.

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. He is also a columnist for India Currents. 

With sincere thanks to Ms. Poonam Singh for the use of her beautiful photograph.

Learning to Embrace Aloneness

I live alone. I’ve lived alone for six years now. In that time, my state of being has evolved from not knowing what to do next, to a mix of daily routine, work, activities, social encounters, plans, travel, fulfillment and a life with meaning. Of late, however, the occasional, unexpected wave of loneliness has begun to wash over me once again, unpredictable in its arrival and in its impact. This is without a doubt a consequence of five seemingly interminable months of ‘sheltering’ in my home; a daily walk in the park my only foray into the outside world.  Do I feel lonely? Yes, sometimes. Isolated? It seems that way! Do I feel sorry for myself? The answer is yes, on occasion, if I’m honest with myself. I’m a “people person,” and being by myself can be quite difficult.

I was ensconced in my couch late one evening, indulging in a little self-pity, when a vague memory straightened me from my slouch. Pushing up, I walked into the next room to scan my bookshelf for a couple of slim volumes of poetry. Thumbing through them, I soon found the verse from Hafiz of Shiraz that had shaken me from my little pity party:

One day
the sun admitted,
“I am just a shadow.
I wish I could show you
The infinite Incandescence
That had cast my brilliant image!”

“I wish I could show you,
When you are lonely or in darkness,
The Astonishing Light
Of your own Being!”

I had been feeling lonely and in the dark. What made me seek out these words? What was the 14th century Sufi Master trying to say? A thought flickered, then flared. Was he telling me that I need not be lonely or feel lonely when I’m alone? Suggesting that I embrace my aloneness? Thrive in it? Exploit it?

Loneliness left unchecked can be dangerous for the body and the soul.  Just a few short months ago, I talked about its ill effects in my article Lonely in a Crowd, describing how this hidden and largely unobserved epidemic had been sweeping through our society long before the coronavirus reared its deadly head. And now here I was, ironically, fighting off its symptoms! I expect some readers will recognize my symptoms.  In that respect, I’m not alone!

What’s the difference between Loneliness and Aloneness? “Loneliness is a lack, a feeling that something is missing, a pain, a depression, a need, an incompleteness, an absence,” says Pragito Dove, “aloneness is presence, fullness, aliveness, joy of being, overflowing love. You are complete. Nobody is needed, you are enough.” 

The Sufi Master, it seemed, was suggesting that I should seek my own light. Handing me the key to turn an absence into a presence, pointing me to the path away from the perceived pain of an unfulfilled want, towards a joyful exploration of an infinity of life and being that existed within me and around me. A universe waiting to be discovered, in which I would never feel lonely even in my aloneness.

A number of writers describe the power of aloneness; of solitude and the opportunity, it provides to draw strength, peace, and connectivity with oneself and with nature.  Introverts thrive on being by themselves, says Sam Woolfe; they feel energized by focusing on their own inner world.  Why can’t we give ourselves the same power? In Walden, a classic account of an experiment in essential living, Henry David Thoreau writes “I find it wholesome to be alone the greater part of the time. To be in company, even with the best, is soon wearisome and dissipating. I love to be alone. I never found the companion that was so companionable as solitude. We are for the most part more lonely when we go abroad among men than when we stay in our chambers. A man thinking or working is always alone, let him be where he will.” Naturalists who spend long stretches of time by themselves have learned about the power of aloneness and the value of solitude.  Some claim that solitude reinforces a secure sense of self, and with that, the capacity for empathy that is so necessary in society.

Those moments when we’ve had a difficult, trying, or exhausting time, or feel that wave of loneliness approaching provide the perfect opportunity to reach within ourselves.  That instant when we begin to feel sorry for ourselves or have the urge to get away from it all, is the ideal time for quiet introspection, to be alone and replenish ourselves. Constant “connectivity” in this digital age has driven many of us to a need to always “be with” or engage with someone; this has become so reflexive that we’ve lost the ability to be by ourselves, focus on our surroundings or turn inward to reflect, and connect to our inner selves. Let’s listen to Hafiz once more:

“Don’t surrender your loneliness so quickly
Let it cut more deep
Let it ferment and season you
As few human
Or even divine ingredients can …”

I’m learning to embrace my aloneness; to find comfort and ease in my own company. It’s difficult. I still have a way to go. I see that light now and then, and experience the peace aloneness brings, as I sit in my front-row seat and observe and absorb the universe within me.

Are you ready to walk on a path towards the astonishing light of your own being?

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community.  Sukham provides information, and access to resources on matters related to health and well-being, aging, life’s transitions including serious illness, palliative and hospice care, death in the family, and bereavement. To find out more, visit https://www.sukham.org, or contact the author at sukhaminfo@gmail.com.  

Just Write, It’s Good for You!

As I push back in my favorite armchair and read, I begin to hear the words rustling across the page in full surround sound:

‘Why does this written doe bound through these written woods?
For a drink of written water from a spring
whose surface will xerox her soft muzzle?
Why does she lift her head; does she hear something?
Perched on four slim legs borrowed from the truth,
she pricks up her ears beneath my fingertips.
Silence – this word also rustles across the page
and parts the boughs
that have sprouted from the word “woods.”’

Lying in wait, set to pounce on the blank page,
are letters up to no good,
clutches of clauses so subordinate
they’ll never let her get away.’

So begins “The Joy of Writing”, a beautiful, evocative, lyrical poem by the Polish poet and essayist Wisława Szymborska who was awarded the Nobel Prize in literature in 1996.

Reading has always given me delight and joy. Other than the numerous technical reports, journal articles and proposals I wrote during my 40-year engineering career, however, writing has come to me only in the past five years. I find myself increasingly drawn to it for the pleasure, comfort, and joy it brings.  Do others also find joy in writing? I wondered. Szymborska’s poem is to me proof positive that many indeed do.

Writing does much more for us than bring pleasure. An abundance of research supports the notion that it’s a very effective learning tool, helping students grasp, organize, and integrate prior knowledge with new concepts. It encourages active thinking and permits an exploration of ideas.  Well before I began my engineering career – when I was a student in high school – I realized that I had not understood something well unless I could write clearly about it. To this day, writing helps me think.

Writing is also an instrument of power; one of the best weapons available to anyone seeking to further a cause. Who hasn’t heard the 19th-century adage ‘The pen is mightier than the sword?’ History is replete with examples. Books can move nations. From Kabir Das to Rabindranath Tagore, from Shakespeare to R.K. Narayan, authors have left indelible imprints on our hearts and minds. Their words lay in wait to pounce on us, as Szymborska says, and once we’re in their grasp, they never let us get away.

I’m writing this article to suggest that you, dear reader, can exercise a different kind of power through writing if you choose – by wielding it as an instrument to heal yourself. Writing can be therapeutic.  Research by Dr. James Pennebaker and his colleagues at the University of Austin shows that writing about important personal experiences in an emotional way for as little as 15 minutes over the course of three days brings about improvements in mental and physical health. Their paper in the Journal of Clinical Psychology shows how “this finding has been replicated across age, gender, culture, social class, and personality type.”

In her article “Writing is Therapy,” Kate Hurley describes other research that suggests writing can improve physical wellbeing by boosting immune functioning as well as mood in patients with HIV/AIDS, asthma, and arthritis. She cites research that shows biopsy wounds heal more quickly in patients who keep a journal.  The concept is simple, explains Leona Brits: just write whatever goes in your mind, with no filters or judgments. “Don’t think if it’s wrong or right, if it’s nice or rude, or if you should be ashamed. Don’t use your mind, write from your heart!”

The use of writing to ease grief and loss is a well-known and popular tool. Books, how-to guides, and workshops abound. Harvard University’s Health Beat suggests just letting go and recording your thoughts and feelings, beginning with writing for 15 to 30 minutes a day for three to four days. They describe research that such writing has stronger effects over longer periods of time in helping individuals cope with grief.

Researchers have also identified the great social, psychological, and physical health benefits that come from giving thanks, especially in these troubled times, by keeping a gratitude journal; a practice as simple as writing one sentence each about five things you’ve experienced in the past week for which you feel grateful. These benefits “include better sleep, fewer symptoms of illness, and more happiness among adults and kids alike.”

Writing can be for everyone. You can write for yourself – to understand yourself better; to clear your mind or get something off your chest. Write to share your stories with friends or leave a legacy for your children or grandchildren. You can write for a multitude of reasons. You don’t have to write the next bestseller or elegant argument or cutting opinion piece in a national newspaper.  Some of my friends tell me that they can’t write, that they are afraid and unwilling to give it a try. My response to them is: if you can tell a story, you can write. If you can remember something from your past, you can write. 

Pick up that pen or sit down at that keyboard. Don’t worry about your grammar, punctuation, spelling, or style. 

Just write! It’s good for you!

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. 

Sukham Blog – This is a monthly column focused on health and wellbeing.  

The Caregiver Crisis

Are you caring for someone – perhaps an elder – who is seriously ill? Do you look after a disabled son or daughter? Perhaps you’re in the ‘sandwich generation,’ raising children while you worry about and care for a parent? If you answered yes, you’re already in the Caregiver Club. If you said no, consider changing your answer to no, not yet.  To quote Rosalynn Carter, President of the Rosalynn Carter Institute for Caregiving, and former First Lady of the US:

“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

The Caregiver Crisis in the United States is rapidly getting worse. Each day another child, spouse, relative, or friend is faced with providing care for someone who can no longer look after themselves because of increased frailty, illness, or trauma. They become responsible for that individual’s physical, psychological, and social needs. Experts warn of the increasing strain this trend will place on society in the coming decades. About 43 million friends or family members in the US are primary caregivers today for adults and children with disabilities, or someone recovering from surgeries and illnesses, or coping with Alzheimer’s and other chronic diseases. Many are themselves aging. Caregivers – primarily women – provide 37 billion hours of unpaid care annually – $500 billion in economic value, according to one estimate. 10,000 baby boomers turn 65 each day. The growing population of people who will need 24-hour personal care has been likened to an approaching “slow-moving tsunami that has no end.”

Caring for a loved one can be enriching and rewarding; the experience creates opportunities for personal growth. Caregiving brings out the best in us; we approach it with love and compassion and are devoted and determined to do our best. However, long-term care demands sustained attention and is physically exhausting and emotionally draining for both the giver and receiver of care. Relationships are affected. Significant changes need to be made in daily lives to adapt to new realities. Caregivers are frequently unable to pursue normal relationships or lead normal lives. Life can become stifling with increased stress and anxiety. Caregivers themselves need support, without which they face burnout or become ill. Caregivers in the South Asian community additionally deal with unique social and cultural issues that need to be addressed in a targeted and sensitive way, making the problem more challenging. 

As we grow older, we all want to “age in place;” live safely, comfortably and independently in our own homes and community, in our comfortable environments. The reality is that we will lose this ability at some point. Many of us also worry if another: an aging parent, relative, or friend can continue to age in place.  We worry about the day when their ability to manage their own lives independently begins to diminish, and about what would happen then. The question is not if this will happen, but when. These concerns are often triggered by changes we observe in their behavior. 

Gerontologists, geriatricians and other aging experts offer excellent advice on how to prepare for such an eventuality – advice we should heed.  The first consideration is the elder’s ability to independently care for him- or herself – to carry out what are known as the Activities of Daily Living (ADLs). Can they feed themselves? Move about on their own, get in and out of a bed or chair? Bathe or shower? Use the toilet? Dress and groom themselves? Next, evaluate other activities necessary for independent functioning, known as Instrumental Activities of Daily Living (IADLs). These include remembering things, cooking and preparing meals, cleaning and maintaining the home, shopping and buying necessities, running errands, managing money and paying bills, speaking or communicating on the phone, and correctly taking prescribed medications. If any of these present challenges for your loved one, then he or she needs some kind of support and/or care. 

When a concern is identified, experts recommend a family meeting with everyone involved, including the elder, to have open and honest discussions with the goal of getting the best possible care for the elder.  Discuss his or her requirements and anticipate future needs. Consider all the available options and constraining factors to meet those needs. These discussions should include financial and estate plans, care planning, and Advance Directives. The costs of keeping the elder at home together with professional assistance if required, have to be weighed against the financial and emotional cost of moving him or her into an assisted-living facility. Perhaps a phased approach could be implemented. If dementia or serious illness are considerations, medical professionals should be consulted and their advice factored into the decision making. The more prepared we are, the more advance planning we do, the less stressful and more rewarding caregiving will be.

If you answered “yes” to my questions above, you’ve already experienced the challenges of caregiving, and I have an important message for you. It’s critical to start with self-care and self-compassion, otherwise, you will burn out. Linda Abbit provides excellent advice in her recent book The Conscious Caregiver. As you take on these roles and responsibilities, she says, it is important that you understand, recognize, and address your emotions. At various times you will feel guilt, resentment, fear, grief, depression, anger, or embarrassment. It is okay if you do. Address your feelings consciously, and discuss them. Be kind to yourself. Make time daily for self-care. Abbit recommends making a happiness list. Put down all the things you like, and make time to enjoy them. Meditate. Adopt breathing practices. Listen to music. Eat healthy and sleep well. Stay active and get exercise. Commune with nature. Practice gratitude. Pamper and reward yourself occasionally. It’s okay to vent; bottling up your emotions will affect your health. It is essential that you accept help – even seek it – from others. You cannot do it all. Delegate to others what and when you can. Be an advocate for both yourself and your loved one. Learn to let go of what you cannot control. By first taking care of yourself, you will be a better caregiver.

The tsunami is coming! Will you be ready?

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. 

Lonely in a Crowd

An eight-year-old boy clutches his ball looking forlornly around the schoolyard at the other children playing, talking and calling out in small groups. People moving by a young woman walking along a busy sidewalk are unaware that she hasn’t spoken to anyone in four days. An elderly man watches passersby from a park bench. Since his wife’s death five years ago, he sorely misses a companion to share his daily ups and downs. 

Loneliness manifests in different forms making it an epidemic that impacts nearly half of all Americans, according to a recent article that quotes former U.S. Surgeon General Vivek Murthy as saying “during my years caring for patients, the most common pathology I saw was not heart disease or diabetes, it was loneliness.”  

“I totally agree,” says Dr. Neha Narula, a clinical assistant professor and primary-care physician at Stanford. “Research has shown us that it’s a risk factor for many diseases and has become a huge problem in the last 10 or 20 years.  Even though we are more technologically connected, the rates of loneliness have actually risen.”

Social science researchers define loneliness as the emotional state created when people have fewer social contacts and meaningful relationships than they would like — relationships that make them feel known and understood. “A lot of people think loneliness and social isolation are synonymous,” Dr. Narula says, “however, social isolation is physically not having people around you, whereas loneliness is a subjective feeling of being alone; of being disconnected from people even though they may be around you.  It’s very important to differentiate between the two and realize that it could be hard to recognize that your family and friends can also have these feelings of loneliness.” In short, if you feel lonely, you are lonely.

Dr. Narula frequently sees social isolation and loneliness in her practice. Urban centers like the Bay Area are melting pots that draw transplants from different parts of the world with different cultures, languages and lifestyles who come there for work, many bringing their families. They face many challenges adjusting to a new way of life, including loneliness. A few patients open up and willingly share their feelings; more often, she finds them either shy or nervous, with some unwilling even to acknowledge loneliness because of the huge stigma associated with it. Spouses and family members who do not work are especially susceptible because they lack even the social aspect of the workplace, and sometimes face additional barriers of transportation and language. Regardless of ethnic, social or cultural background, loneliness is more common in adults over 45; however, there’s a higher prevalence in seniors – those over 65. Studies show that nearly one-fifth of seniors live alone and over 40 percent report feeling lonely on a regular basis.  Family physicians increasingly observe it in adolescents and pre-teens as well, who tend to be very active on social media, but have difficulty forming real relationships.

“Evolutionarily we needed social connection to survive,” Dr. Narula points out, “over hundreds of thousands of years, we humans were able to survive as a species among much stronger animals due to the advantage of our brains and our ability to communicate and work as a collective species rather than as individuals. Fast forwarding to 2020, we need to remind ourselves of the importance of finding those people who will help us survive in terms of our health and life span.” 

An abundance of research shows that loneliness is a risk factor for many illnesses, just as smoking is for heart disease and lung cancer. In particular, a Harvard study that followed people for over seven decades established the inverse: one of the clearest indicators of physical health, quality of life and longevity is how happy people are in their relationships. 

Loneliness is an evolutionary phenomenon designed to make humans seek protection in a group for survival by triggering a physiological response: the release of stress hormones like cortisol. In small doses these hormones help solitary humans be more aware of surrounding dangers. However, repeated long-term occurrence results in damage to health leading to high blood pressure, increased inflammation, a weakened immune system, and consequently a reduced life span. Additionally, without the emotional support of family and friends, people who are lonely often stop exercising, overeat and tend towards substance abuse, further compounding impact on health. Research shows that the reduced life span linked to loneliness is similar to smoking 15 cigarettes a day. Poor social relationships were associated with a 29 percent increase in risk of coronary heart disease and a 32 percent rise in the risk of stroke. The impact of higher inflammation on the immune system is particularly severe on the elderly; immunity declines with age, and this serves to accelerate that decline. Isolation can be especially deadly for seniors in the event of an emergency like a bad fall or a heart attack. 

We should take action at individual, community and societal levels to acknowledge and normalize loneliness, and work to remove the stigma that makes it a taboo topic.  “We can be the medicine that each other need,” says Dr. Murthy. Let’s begin with an honest examination of our own condition. Next, let’s pay attention to family and friends, making sure that they feel like they are connected, are able to express their feelings of loneliness and where needed, help them find solutions. Shaping the circumstances and communities we live in can do much more than medicine can. Recognizing that it was a public health challenge, British Prime Minister Theresa May appointed a Minister for Loneliness to her cabinet in 2018 to implement a cross-government strategy to combat it. More societal and governmental action along these lines is needed.

We are an ingenious people. Let’s work together to develop creative solutions to help each other – especially the young and the elderly – develop and lead more connected, healthy and fulfilling lives. No one in our midst should be or feel alone.  

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. To find out more contact the author at sukhaminfo@gmail.com.  

With sincere thanks to Aziz Acharki at Unsplash for the use of his beautiful photograph.