Friday, March 29, 2024

Replacing Self with Others

I attended my first meditation week long retreat and had a transformative experience (New Kadampa Tradition Mountain Retreat, Williams AZ, founder Kelsang Gyatso). Like many others, I was grappling with balancing work, family, and personal life. Despite being in a much better position than countless individuals worldwide, the elusive concept of work-life balance remained a challenge for me.

The week long meditation retreat transformed the way I thought, specifically it introduced the idea of how to reframing my approach to the world. One of the primary teachings was the idea of replacing self for others. This means to put my attention on the needs of others instead of putting that attention on myself. This shift in focus has begun to transform my approach to daily challenges.

Object of Attention: Replacing Self for Others

The concept of "Replacing Self for Others" marks a major shift in the way I/we think.  The more attention/concentration we put on an object, the more our mind and bodies channel our energy around that object. So much of the way I thought prior to the Meditation Retreat was about what I needed to do to achieve my personal goals. Take, for instance, my aspiration to advance from Associate to Full Professor. This goal required me to align research, education, and other activities to satisfy the criteria for promotion—a pursuit that was inherently self-centric and a significant source of stress, given the pressure to publish papers and secure grants. However, the retreat inspired me to view my goals through a new lens, focusing on how I could serve others, particularly my students, trainees, and colleagues. Instead of seeing promotion as an end goal, I began to consider how I could contribute to the advancement of those around me. This shift in perspective transformed my approach: aiding my students and trainees in their career paths, with publication efforts emerging as a natural outcome rather than the sole aim. This reorientation not only redefined my objectives but also imbued me with a renewed sense of purpose and energy.

Both goals (#1 full professor vs #2 helping others) achieved similar outcomes, but tapped into very different sources of energy. The energy source that came from Helping Others (#2) was positive, self-energizing force rather than stress/burden from the former (#1). When we frame our efforts and goals towards helping others, the source of energy transforms into something much more powerful and limitless. A mind shifting statement that I read during that one week meditation retreat is the idea that when we are in the service of others, we will never be lonely. This concept suggests that when our thoughts and energies are invested in helping others, feelings of isolation become untenable. Loneliness, along with other feelings such as sadness, depression, and burnout, stems from a self-focused perspective. Redirecting our attention outward effectively dispels these sentiments, anchoring us in a mindset geared towards communal support and connection. It's a very simple idea but execution is much harder. Yet with small practices that I've been able to do in reframing my efforts, the benefits that I've reaped have been tremendous. I'm no longer worried about all the things that I have to do and get done as part of my obligations / commitments. Now I think about what can I do to help those that I can help and how can I do that. Through the latter lens, I become liberated and my ideas are more free flowing and my efforts become more natural.

It's crucial to understand that prioritizing the well-being of others doesn't mean neglecting our own. A fundamental aspect of Buddhist philosophy is the harmonious balance between Compassion and Wisdom. Compassion motivates us to serve others, a hallmark of a fulfilling life. Yet, this must be tempered with Wisdom, recognizing that not all acts of service hold the same weight in terms of importance or impact. Distinguishing between what is essential and what is not allows us to channel our efforts effectively. Taking care of our bodies, health, and overall well-being is imperative. It is only by ensuring our own health and happiness—mentally, physically, and spiritually—that we can genuinely support others. The idea isn't to forsake self-care in favor of altruism; rather, it's to understand that the most effective way to assist others is by maintaining our well-being. This approach not only maximizes our capacity to contribute positively to the lives of others but also enriches our own experience.

If you want to read more, a good starting point is Kelsang Gyatso How To Transform Your Life. You can get a free pdf version online. I got the Kindle version, and used the "Text to Voice" function on my phone to have my phone read the book to me (audiobook version).

Acknowledgement: ChatGPT helped provided edits to the contents.

Friday, February 10, 2023

Interview Tips for Prospective Residency Applicants

As a prospective resident, the interview process can be nerve-wracking and overwhelming. With the rise of virtual interviews, it's more important than ever to be prepared and make a great impression. Here are five tips to help you ace your residency interview:

  1. Keep Your Responses Brief and Specific: During an interview, it's important to keep your responses brief and to the point. Use concrete examples that are relevant to the profession to illustrate your point. Avoid tangential or generalizable examples, as the interviewer may lose interest. If the interviewer needs clarification, they will ask.

  2. Ask Good Questions: Be prepared with thoughtful questions to ask the interviewer. Examples of good questions include "What differentiates the best trainees from poor performers?" and "What do you suggest for preparing for residency?". Avoid asking poor questions, such as "Do you have questions about my application?" or "Will the growing practice mean more work for residents?".

  3. Be Authentic and Spontaneous: While it's good to have an idea of what to respond in terms of common questions, try to be spontaneous and authentic with your answers. Don't over-practice or read off a screen during virtual interviews, as the interviewer can tell.

  4. Minimize Distractions: During virtual interviews, it's crucial to minimize distractions. Make sure you're in a quiet, well-lit space with limited background noise. If you have pets, try to keep them out of the room.

  5. Do Your Research: Before the interview, take the time to research the institution and learn about it online. If you're really interested, visit the institution. Being able to articulate why you're interested in the specific place can set you apart from other applicants. Personal responses that include having vested interest in the area due family, friends, connections to the institution, or recent visit to the area, or relevance to your interest and aspirations are good examples of illustrating genuine interest.

By following these tips, you'll be well on your way to acing your residency interview. Good luck!

Acknowledgment: #ChatGPT helped me put this together (I gave a summary of key bullet points I wanted in the blog, and then asked it to put it together; and then, I edited it).

Sunday, December 4, 2022

Residency Interview Process: My Proposed Design

 I recently read Daniel Kahneman book Noise, as he clarified for me limitations about applicant process interview that I've observed. The residency interview process (or in actuality, most professional job interview process) is subject to so much variability, and depending on the interviewer, applicant, and various uncontrolled conditions, the applicants can do well or not so well. Having experienced a couple of the resident applicant interview cycles, I realized how flawed it was. I felt validated when Kahneman went into depths in his book about exactly the flaws that existed in human judgement that contributed a lot of randomness into the interview process. He then discusses Google's approach to interviewing applicants, which completely resonated with me. What I learned were the following:

  1. Only up to 4 interviewers needed. Anymore beyond 4 interviewers is minimal added value.
  2. Use structured interview questions, specifically behavior questions, rather than questions about past projects, items on CV. Tailor questions for what the applicant can become (rather than what the applicant currently is capable of).
  3. Criteria should be judged independently. At Google, it sounds like the interviewees do video interviews, and response to each question is judged separately / independently, and then an aggregate summary is used.
  4. Use ranking instead of score based review. If there are 10 applicants, then the interviewers should rank them 1 to 10, instead of giving each interviewees scores per criterion. Humans are better at ranking than scoring. 
  5. Use aggregate scoring (only after independent review). 

In addition, based on Adam Grant's book, Think Again, he discusses the Dunning-Kruger Effect and the inverse relationship between confidence and competence. This is especially problematic with residency applicant interviews because I think applicants who come off as confident, agreeable, and extroverted are often scored highly. However, if the goal of the interview process is to find the applicants who will be the best fit the program, then the current approach may sorely lacking. The Dunning-Kruger Effect suggest that 4th year medical students who are highly competent applicants may have low confidence. In fact, if anything, we want to keep our eyes and ears on high alert for individuals who show humility rather than confidence because humility is associated with competence. This process forced me to rethink my own process which I am developing to figure out how to spot and identify individuals with potential for greatness (the diamond in the rough). 

The process that some of my colleagues in other fields deploy is asking applicants to rate themselves on proficiency is various aspects of the jobs, and then testing them. For example, for a business analytics position, the applicant may be asked to score their proficiency on SQL, Tableau, Power BI, and other tools. Then the applicant is provided the software, and then asked to create / write a few codes. This approach tests both the applicants' self-reported humility, and then competence. 

Sometimes I play a thought exercise and wonder what I would do if I could design a residency applicant interview process, and I would probably do something along these lines:

1. Train and validate an AI model to work alongside to sift through hundreds of applicants and compare /contrast my findings with AI, so that we are reviewing ALL the applicants that would be good fit for the program. The AI would also surface known biases in the program for program's awareness. Often times, we can superficial and shallow filters which can overlook individuals with very high potentials.

2. For the interview process, I like Google's approach and would probably pilot a variant using panel interviews with standardized behavioral questions, with maximum of 4 interviewers. 

3. I would ask interviewers to rank (not score applicants) on key criterion, and then aggregate results to generate final rank list. 

4.  If it was doable / feasible/ permitted, I would ask all interviewees to report their proficiency on key diagnostic radiologists' skills, and then have them generate mock reports of a few radiology studies, and review the reports. 

5. After trainees match and have gone through the early experiences, I would regroup with the interviewers on the outcomes and learn from our strengths and weakness, and make changes accordingly to improve the process, and keep iterating. 

6. At some point in the future, I would train/validate an AI model to read facial expressions (according to Paul Eckmann's line of research) to predict outcomes (e.g. good fit, eventual competence, etc) and use AI to work alongside interview committee members to provide comparative information / data.

Friday, June 24, 2022

A Perpetual Gift of Happiness and Peace

A teaching by Gen-la Kelsang Dekyong at the Kadampa Meditation Center Phoenix on virtuous mindsets had a profound impact on me. Many of us think that if we work hard, then we'll earn a lot of money and we'll be happy; or if we find our soul mate, then we'll be happy; or if we get our dream job (dream home, dream body etc), then we'll be happy. The reverse can be true also. If we never have to seen this [individual, job, object...], then we'll be happy. What happens when these wish(es) come true? We find ourselves not has happy as we thought we'd be. The big house didn't make us happy; neither did the dream job, nor the dream partner.  However, we can adopt mindsets that are perpetually giving and the more we cultivate these mindsets, the the happier we become. We can practice these mindsets now, everyday, and all the time. One of these mindsets is compassion. Compassion is to understand another being and then act in a positive way to improve their well-being. How do we do this? A simple compassionate act we do is to wish them well. I've come to learn that this simple mindset (to wish someone well) has been so effective in improving both the relationships I care about, and more importantly, this mindset has helped with relationships that create discomfort for me. Sometimes, we don’t jive with for whatever reasons with someone, and you might avoid interacting with them because of the awkward nature of those moments. For example, I work with a colleague at work. We are cordial to each other but there is some tension that exists because of a shared project that didn't quite go as expected.It’s  easy for me to get upset, disappointed, or rationalize in my head why the ball got dropped, and point the fingers. However, none of these thoughts help me, the other person or the project. Now, instead, I say in my head "may s/he be happy, may the project success to achieving its goals, and may we move forward together, and with ease". After I say that compassionate statement to myself, all of the sudden, the tension ease, the frustration softens, and mind clears.  If someone cuts you off in the freeway, then instead of cursing or flipping out,  you can cultivate compassionate thought "may s/he be safe, be happy; may the desire that led them to cut me off turn out to be okay for them." You can do this all day long and with all interactions, good or bad, neutral or borderline. When you find yourself passing a judgement/ harboring  a negative thought/ boiling up with  anger, then you can replace that with a compassionate mindset.  This approach helps you, helps others, and gives peace and happiness every single time, with every act, every word, every thought, and every actions.  Over time, the cumulative effect on this simple habit can transform us and bring inner peace and joy that unparalleled to none. All involved share in on the benefits. Now, when I find myself tense thinking about someone, or witness an unpleasant action or hear dismissive words, then I pause, and wish them well. 

Cultivating these positive mindsets is critical because I think people can sense and know how we feel about them without having to say a word. Our thoughts somehow sends an invisible but very palpable vibe to those around us, even when we are not directly interacting with each other. The mindset that we adopt often gets translated in our body language, tone, and our demeanor.  Sometimes, when I'm passing a judgement, I often feel like the other person can read my mind and I get nervous  even though I've said nothing. Now, when I adopt the compassionate mindset, then my body, expression and demeanor relaxes, and I bet the same invisible but positive vibe is felt by the individual.  This approach has completely transformed my day to day interactions especially with the challenging ones. When I interact with a trainee at work that I used to feel equivocal about, instead of adopting a semi-avoidant behavior, I say to my "may I be the best teacher possible, so that this individual may learn, and be effective, etc". My mind and feeling shift immediately, and I feel comfortable around the trainee, and inevitably, the interaction turns positive and productive. When I don't get a request that I've submitted at work, then I say to myself "may this person have the resources s/he needs to be an incredible leader, and to support all those s/he leads.". I even do this with strangers, like our cleaning crew.  I try to wish them well and send them compassionate and positive thoughts and vibes as I pass them by. The power of compassion is endless. With each cultivation of compassionate thought, the happier and more peaceful we become. Try it out. Replace your negative reactions with positive compassionate thoughts; replace your judgements with well-wishing; replace your neutral position with active well meaning  thoughts; share and spread your compassionate vibes to people you know and don't know, and do it with every interaction, and everyday. You'll transform yourself and will increase your peace and joy immediately, with cumulative effects that magnify over time. 

Thursday, June 23, 2022

Reframing Life as a Suitcase to prioritize what matters

 Burnout, over commitment, and stress are epidemic, especially among working professionals. Too often we are told to prioritize, focus and say no to anything and all things we do not care for. This approach can be challenging, especially for junior and inexperienced folks. It's easier to agree and then suffer from the over commitment later on. We take our time and our bandwidth for granted; we overestimate how much time and headspace we have and over inflate our abilities. We expect a lot from ourselves, and all of this comes at a cost (lack of free time, underdeveloped relationships, estranged family, etc). When we become stressed, we try to increase the efficiency. We'll cut out our lunch breaks, multi-task, work longer hours, work harder etc. 

I read an article on efficiency, and the article compared Life to a suitcase. We can roll up our clothes, and squeeze in every nook and cranny of the suitcase, but efficiency can only go so far. The space is fixed, and at some point, you'll have to sort the things you want to take, and leave the rest behind. Frequent travelers are pro at packing. They know what the bare essentials and unforgivingly leave behind all things that do not serve a purpose. In the same way, if we reframe life as a suitcase with limited time, and the prospect of travel as experiences in our life, then perhaps we will have a better sense of what to take with us and what to leave behind. What are your bare essentials? If one suitcase equated to 1 year of life, then we only have 80 suitcases to fill, which is not much. Life is short. When I imagine my day, week, month, year in terms of life suitcases, I find it much easier to see clearly what is important, what's borderline, and what definitely is not worthwhile. For example, one consideration I've entertained for sometime is the idea of decreasing my work full time status. If/when I cut back on work (which is easy to say and hard to do), then we can free up time and give ourselves space. But, it comes at the cost of decreased income and the associated cringe that comes with that idea. If instead, I imagine my life suitcase full of money and no free time vs less money but more free time, then the right answer is more obvious to me. Time is a non-renewable, fixed and invaluable resource. The image of packing my life full of work and no time to play sounds unpleasant; instead a suitcase containing just enough while also making space and time to explore, learn, travel, develop relationships seem so amazing. Next time you're stuck and unsure how to move forward, ask you self  what would you take with you in your Life suitcase today, this week, this month? Anything you take means less space for something else. What would an amazing day, an amazing week, an amazing year look like?  Then, pack your life full of all the goodies, and let go of the rest.

Thursday, March 24, 2022

Back to Work (In-Person): Reflections

One of my goals is to live and be in the place of abundance...of time, energy, creativity, space, love, compassion, mindfulness. 

In the last two months of working hybrid model, I was fortunate to be able to work in a hybrid model (half on site, and half remote). We've been back on-site fully for a couple of weeks after COVID subsided. 

I've made an interesting observation about myself since transitioning back to traditional on-site model. With hybrid work, I felt like I had more energy after work compared to fully on-site work. I'm attributing (and I could be wrong) the difference in energy levels due to the work space and environment. 

With remote work at home, my workstation is in a room with two large windows with plantation blinds that allow the beautiful, spring warm sunlight to cast its rays in my workspace. The window looks out into my backyard, which is borders Arizona Open Nature Space, full of wild Arizonian flora and wildlife. The room has direct door access to the backyard, and I keep the door slightly ajar throughout the day to allow the wonderful Arizonian desert air with aromatic pollens from the flowering plants to flow into the the room, and chips from the birds resonate into the room. The walls in the room are decorated with photos of my family and friends, and a large canvas of Arizonian succulents. I felt great and after work, I had the vigor and motivation which often led me to go for a run or hike on the trails leading to the nearby mountains. 

With on-site work, well, it's a radiology reading room. The room is dimly lit, and it's in a clean, nature and sunlight-free standard office with dark blue/grey walls. That's it. 

In the book Joyful by Ingrid Fetell Lee, the author discusses the power of ordinary things that create extraordinary happiness. In her book, she discusses the importance of nature and sunlight contributing to our happiness, peace and joy.  She says nature provides a form of mental abundance due to the open space and variations in sensory stimulations we experience. In contrast, being in closed quarters with stagnant air and lack of surrounding nature (artificial or real) make us feel confined and can sap the joy and vigor in our lives. When I spoke to my mother about this phenomena, she drew an analogy to plants. She said humans are like plants, we need nature touches (sun, wind, smell, etc) to thrive.  Otherwise, we slowly wither like a plant deprived of these necessary elements. The effects are more pronounced in children. The effects of nature exposure to children improved cognitive function (increased concentration, greater attention, higher academic performance), better motor coordination, reduced stress, increase social interaction (Strife et al).  Shankar Vedantam deeps dive in to the the idea of how nature improves our lives in his NPR Hidden Brain podcast "Our Better Nature: How The Great Outdoors Can Improve Your Life" In Chicago replica housing projects, high-capacity high rises with green spaces led to 15-20% drop in incidences of violence and police calls compared to housing projects without nature spaces. Artificial sounds of birds projected from audio system embedded in landscapes in high-violent neighborhoods led to a drop of violence by nearly 10%. Breathing air in the nature led to increase in NK cells, which contributed to healthier immune systems compared to air from urban spaces. Research from Well Living Lab, a Delos and Mayo Clinic collaboration, shows that offices with windows improve workers' productivity,  and satisfaction. Centers have coined the term "biophilia". "Bio, life. Philia, meaning love. So we have a love for nature," says Dr. Bauer. Areas with windows which provide natural light and views of the outdoors improve cognitive performance and increase well being. Exposure to nature led to calming effects. Contemporary cultures such as Japan advocate for Forest Bathing to offer an antidote to burnout.  Large tech companies like Facebook are designing work spaces that integrate nature, sunlight and green spaces to improve the well-being of their employees and staff. 

I think the workspace made a significant contribution to the difference in experience. I think days when I have more access to sunlight, view of natural spaces, and other natural sensory stimulations, I feel good all the day long. After I finished work, I felt light, and energetic, and often went for a walk/hike, and in the evenings, I was fully present with my daughter in the evenings. I logged in many more steps. I felt Virya, the Buddhist term for energy and enthusiasm that led one to pursue wholesome activities. In addition, I was in a state of abundance.  When I work in dimly lit, nature-free spaces like the reading room for 10 hours a day, I feel less good after work...and in fact, not infrequently, irritable / stressed.  

Obviously, different people will have different experiences from hybrid working. Some people appreciate the commute-free day, and others benefit from the flexibility.  A good friend told me she went to a yoga class in the middle of the day after she caught on her work. She felt so amazing from the yoga class and came back to the work list feeling great. The yoga time completely transformed her experience. She ended a busy work shift a little healthier, flexible and a lot more happier. Arun Krishnaraj from University of Virginia delivered the New Horizon lecture at 2022 Society of Abdominal Radiology meeting in early March and shared with the audience the need to provide our workforce a hybrid work option, and its importance to promote a healthy and sustainable workforce. Early adopters including New York University, and Cleveland Clinic have offered remote working options due to recruitment needs, and a few of my academic powerhouse friends have moved to these 100% fully remote working models, which have dramatically improved their quality of lives.  There are also negative sides to hybrid working (limited social interactions, potentially suboptimal educational experiences for learners, etc). However, I think the benefits could potentially outweigh the risks if the schedules are designed thoughtfully and iterated to preserve important interactions. 

Having had a taste of how amazing hybrid work option is, I'm super excited about how radiology will be unfolding over the short and intermediate term. I am going to unabashedly put a plug for the RadioGraphics invited commentary I co-authored with a good friend pre-COVID, in 2018 about this topic ( When we provide work options, we provide people with an opportunity to live and work in a place and be in the place of abundance. 

Sekhar A, Tan N. Invited Commentary on "Navigating Generational Differences in Radiology". Radiographics. 2018 Oct;38(6):1679-1681. doi: 10.1148/rg.2018180197. PMID: 30303787.

Saturday, February 5, 2022

Mental Immunity

I read The Book of Joy by Dalai Lama and Desmond Tutu and I am currently reading Daniel Kahneman Thinking, Fast and Slow. A common theme emerged among the two books that impacted my own views and perspective. Specifically, I've come to develop my higher levels of control through practicing mindfulness through meditation, which then allows me to regulate my emotional range and mental well-being.

More so in the past, and especially during residency, fellowship and early years of clinical practice, the successes and failures impacted me significantly. When I decided to switch from urology residency to radiology residency, I had major doubts about myself, confidence, and competence which created a fiery amount of stress and pressure to work harder, be better, and to "succeed". When I got rejected by the first several grants, I got down and discouraged. Eventually, I came to secure successes with clinical excellence, papers, grants and awards. With each success, I got elated, excited and encouraged. The ebb and flow of career (and perhaps personal) life feels like riding the hamster wheel. It felt like a trap, a dungeon of sorts, being influenced by the successes and failures of my efforts, and being like a boat in the open waters, controlled by the tides.

Over the past year, I came to learn a Buddhist teaching about the value of staying calm and still. Instead of letting mental well-being depend on the pendulum swings of various challenges we face and successes we achieve, we practice control of our natural emotions. By doing so, we can graciously accept both our success and failures equally, recognize the merit in both with the same amount of respect and thought. We no longer suffer disappointment with failure nor do we live with the highs of our success. Instead, we treat both as equal, stay unperturbed and adjust our course as needed.

In the Book of Joy, the Dalai Lama describes "Mental Immunity" which is controlled by our higher level thinking. In Kahneman's idea of fast and slow thinking, he defined systems 1 and 2, and the latter (system 2) can support the Dalai Lama’s idea of mental immunity. System 1 is our automatic, subconscious, intuitive mental state, controlled by our limbic system brain…our “fight or flight” system. Some refer to system 1 as the “lizard brain” and reacts unconsciously to things like threat and other intense emotional states. For example, if you see the tiger, your system 1 will kick in automatically and you’ll react. System 1 is flawed and has many pitfalls in our lives. For example, if you get a nasty email with degrading words from a colleague, system 1 will kick in and we may respond in ways that we may regret later if we don’t override our natural tendencies. In contrast, System 2 makes up our higher level, conscious thought, and is regulated by the prefrontal cortex. In the email example, we may decide to wait 1 day to let the emotions subside so that we can let system 2 think through the best way to respond and ensure we preserve good relationships. Perhaps, we decide to meet the individual in person or talk over the phone instead of an email response to resolve the concerns. The emotional center, our amygdala, is like the traffic control and supports our emotional reactions or responses to events and signals.  We can strengthen the signals and tracks that connect our amygdala to prefrontal cortex (higher level thinking) and limbic system (fight or flight thinking). 
The Dalai Lama draws an analogy of physical well-being to mental well-being, and coined the term “mental immunity”. We develop good habits (eating well, exercising, sleeping, etc) to be physically healthy, to boost our physical immunity to fight off colds, sickness and feel good. In the same way, he urges us to develop mental immunity, practicing our mental state to develop and focus on attention and concentration through meditation, so that we can develop mental immunity to struggles we will encounter. The mental immunity refers to system 2, our higher level control center of mindfulness. Activation of system 2 requires focused attention, concentration which ultimately yield mindfulness and awareness. Mindfulness is defined by two components: attention and concentration. When we have mindfulness, we can pause, reign in our intuitive and natural tendencies, and redirect our attention and concentration to the productive path, free of emotional swings. Practicing mindfulness through meditation allows us to strengthen our ability to access and control system 2.

We have different intrinsic ability to control our mental state, system 2, and more importantly we can develop this ability through practice. The famous Stanford Marshmallow test of a bunch of 5 year old kids illustrated our intrinsic ability to control our behavior. Each kid was put into an empty, boring, white, and bland room with a marshmallow on a plate, placed on the table. The rest of the room remains void of toys, or any other attention seeking play things (e.g. iPad). The kids were told to either wait 5 minutes and get 2x marshmallows, or eat 1 marshmallow within 5 min. In a series of hilarious and cute videos (check out YouTube) of little kids doing various maneuvers to delay gratification for a bigger reward (e.g. licking the marshmallow without eating it, and distracting themselves), we see something more profound emerge decades later. The minority of the kids who successfully delayed the 5-min collectively achieved higher level education, higher pay and higher successes than the majority, who failed the marshmallow test, and gave into their system 1 natural tendency to eat the sweet and delicious marshmallow immediately. More importantly, and the key message of the study was the 2nd phase of the study. The research team taught kids mental hacks to help redirect their attention, and practiced these exercises with the kids. In subsequent studies, the kids who received the attention training did significantly better in all the measures compared to their baseline. Nowadays, this study has major implications on the attention of kids growing up with iPads and uncontrolled access to YouTube, where their attention and concentration is drawn to most attention-seeking videos often displaying behaviors that taps into our natural, hard to control tendencies (system 1).

Our ability to control our attention and direct our concentration is the engine that drives our mental well-being. We have baseline levels of control we are born with, and we can cultivate the control through practice. Mindfulness is housed in System 2, and can be easily hijacked by system 1. For example, if something disastrous happens (e.g. our child was in an accident, or fall in love), then we can no longer think coherently and rationally. Our system 2 (higher level thinking) malfunctions due to a tremendous amount of signal from system 1 (lizard brain), suppressing any ability of system 2 to regain control. In the same way, extreme and intense emotional experiences (e.g. anger, depression, love) can make us vulnerable and lead us to make poor choices, say unintended words, entertain terrible thoughts and take regrettable actions. 

Acknowledging this Achilles heel common to all of us, how do we protect ourselves? How do we strengthen system 2 (higher level of thought) and protect it from being hijacked? A simple and easy way is to practice meditation. Meditation consists of putting our attention on a fixed object, and then concentrating on that object over a period of time. A timeless fixed object is our breath. The advantages of the breadth is that it's accessible, and always with us. Others focus on the heart beat, the ticking clock, the feel of the air on your skin, etc. You can also focus on things beyond our senses too, like loving kindness, empathy, compassion. The basic concept is to sit, cross your feet, close your eyes, and set your attention on something (e.g. your breath) and sustain it (concentration). Meditating is like running, remember to keep your expectations appropriate to your level to avoid being discouraged. With time and practice, we can develop our stamina and gain benefits from this exercise. The endurance, speed and stamina will develop over years, not hours. We know meditation works. After 6 weeks of practiced meditation, functional MRI studies demonstrate both increased activity AND volume in important brain centers like the amygdala (our emotional traffic control center).

The benefits of practicing mindfulness are subconscious, and not apparent to conscious mind. When I lift weights, I can feel the muscle pain after a work-out; however, we do not have the same sensory receptors in our brain, so we do not have the same tangible bodily sensation after meditation. I started meditating during residency. I was studying for the radiology boards, and my stress was 11/10. I came across the book, The Art of Learning by Josh Waiskin. His thoughts of performance resonated with me, and I found out that he's a devout meditator. He and other other high performers like Ray Daylio, Steve Jobs, John Lennon, all regularly meditated. Even though Buddha vehemently advocated for us to meditate, the activity in itself is free of religious connotation. I started meditating for 1 minute. Meditation is.the.most.underwhelming activity for a novice. I am accustomed to the feeling of getting things done. Meditation did not give me that rewarding feeling. I guess if you want to know if meditation is working, you can get a functional MRI exam before and over time like the Hopkin group did when they studied the effects of meditation. In addition, meditating is really hard. Keeping my attention on my breath for a period of time took practice. Thoughts, to-do lists, ideas floated into my head. When distraction happens to you, remember that meditation benefits the most distracted minds (that's me, you, and everyone like us). Guided meditation, for example offered through Headspace app, is another way to get into meditation. Headspace is a good app. After a while, I abandoned the app and was able to practice on my own, no longer needing to put the extra steps to find my phone, and turn on the app.

Since starting to meditate about 7 years ago, I can now practice meditation for about 20-30 min everyday. To give you a comparison, the Dalai Lama meditates for 5 hours every day, the first thing in the morning. He wakes up very early (like 3 or 4 am), and meditates till 8 or 9 am (read his Joy's amazing). I've benefited significantly from the positive impact of meditation and would argue the inflection point in my life and career occurred after starting this habit. The slope was gradual and very subtle but over the past 7 years, the trajectory has been striking.

Just as we have different levels of running (5k, 10k, half marathoners, marathoners, ultrathoners, etc), I came to realize there are increasing levels of mindfulness. In Indian and Buddhist traditions, "Samadhi" refers to the highest of the 3 states of self-collectiveness, a luminous mind which is "equanimous and mindful". The first stage is Dharana, being able to hold your attention on an object over long periods of time free of distraction. For example, being able to focus on the breath. The second stage, Dhyanam, occurs when there begins to be a relationship between the mind and the object of attention. You gain insights about yourself from concentrating on the object. For example, by meditating about loving kindness, you gain insights about your ability to process these experiences. The third and final stage is Samadhi. With Samadhi, you and the object become very close, as if they have merged. At that point, the mind sheds its conditioning and the object shines forth as it is. For example, if you meditate about loving kindness in the state of Samadhi, you take on the qualities of loving kindness. At this point, we can see things for what it is (neither good nor bad) and see ourselves for who we are. Ultimately, meditation is about removing our conscious and unconscious biases, and refining our perception like wiping of the dust surrounding a transparent crystal (reference

Regarding Mental Immunity and the pendulum of emotions, what we know is that through practiced mindfulness, we develop our system 2 (self control, emotional regulation, etc), and can develop a mental immunity, of sorts, to the fluctuations of life, and reign in our system 1 (natural, automatic, reactive tendencies). We can narrow the swings of the pendulum a little bit over time and develop our higher order systems (calm ourselves), and rise above these struggles, and recognize them for what they are, rather than become emotionally linked and reacting to them (which we naturally do due to system 1). All of this feels unnatural and takes conscious effort. Eventually, we recognize failures and success as equals, and stay level headed and calm, like the stillness under the surface of the ocean during a thunderstorm. Major struggles no longer cause us emotional harm, and major wins no longer make us elated and high. We remain grounded, at peace, and immune.

Friday, February 4, 2022

Move On and Move Forward

These two past COVID years have been among the most formative years of my life and tremendous amount of growth that occurred. Up until then, we lived predictably and in someone constant state. After COVID struck, so much changed and most importantly, the pandemic tested us, our resiliency, our agility and adaptability.  As with challenges in our lives, when we can overcome them, we grow and become stronger.

As with many other parents, school closure meant our young (and older) kids now at home, isolated from their friends and away from the playgrounds. The first few months of my daughter's virtual online school period created chaos for me. She was 8 years old and completely disengaged from the multiple hours of zoom.  I get fatigued after 1 hour of zoom and the thought of my daughter spending multiple hours everyday online crushed me. In addition, the energy she would otherwise have been venting in the playground got transformed indoors into difficult and restless behavior. Instead of understanding, I became frustrated, exasperated and some days, angry. At some point, I had a shouting match with my 8 year old. That night, I paused and reflected. What is wrong with me? She is a child. I needed to get help and I did. I googled and found out there are parent coaches, paid psychologists who help parents identify and use effective tools.  I found and got a parent coach and we started weekly coaching sessions to help me draw boundaries, set expectations, and improve my interactions with my daughter. It helped about about 30%. We skipped morning class so that she can get outdoor playground time, and set activities in the afternoon to keep her active. We set routines to help develop good habits. My frustrations improved too....also about 30%. But, I was still very highly tense, and well above my pre-COVID baseline.

Around that time, my daughter had been taking the Buddhist class on Zoom over the weekends (previously in person), and I listened in on the teachings and became curious.  I bought the Dhammapada book and started reading it. Ever since, I've completely transformed. One month after reading the book, I stopped needing parent coaching altogether. It was amazing. My parent coach couldn't believe how quickly I transformed after a couples weeks, even though little had changed after many weeks she had been coaching me. All the negative feelings completely dissipated. One of the key teachings the Buddha taught that changed my perspective on my situation was a story he told. Imagine that a catastrophic event happened, perhaps an accident, or in our case, COVID. The event has taken place and that itself is terrible. Then, you hear about the event and all of a sudden, you react negatively and severely to the event. The emotional/mental response inflicts major harm on you (e.g. sadness, depression, despair, anger, etc). It's not the event that inflicted the harm; it's us and our emotional reaction to the event that caused us harm. Buddha explains that you can disassociate these events. Although the event and response are linked, we can unlink it like unlinking a chain. We have control of how we respond to the event.  In my case, my daughter was doing virtual learning which leads to various changes in my daughter's physical and emotional wellness. In addition, I let all of the changes cause me frustration, impatience, and anger because she was not meeting my expectations. This latter component is under my control.  Instead, the better alternative is to accept that things are bad and it is. COVID sucks.  In addition, I can choose not to let it affect me, disconnect the event and my emotional state. This simple understanding rescued me from the rabbit hole I was going into. I recalled this whenever I find my emotions welling up and then, intentionally let it go, and dial down that part of me which I control.  Impatience, exasperation, and anger only lead to poor outcomes and there is no place for it, even if it is justified. It's like the quote, darkness doesn't take away darkness, only light take away darkness. These negative emotions are like darkness and only keep us deeper in the dark spaces. Even when justified, these negative feelings will never bring us peace and joy just like darkness will never shed light. So, let it go. Move on and move forward. I did. Now, I'm grateful for COVID because it forced to learn and apply this simple yet profound teaching which has transformed my life. 


Sunday, May 31, 2020

George Floyd: The Need for Shared Identities

Shankar Vedantam and the team from NPR Hidden's Brain delivers another informative and salient episode on How Our Identities Shapes Health and Educational Success in the context of another act of recent racist violence that has surfaced to national attention. In the podcast, Vedantam addresses the value of how a common race can propel a successful outcome. For example, Vedantam cites health studies that address patients’ compliance with medical doctor recommendations. When a black patient receives the recommendation from a black doctor, the patient is 20-70% more likely to follow medical recommendations compared to recommendations from a non-black doctor. The reason for the dramatic increase in the success is attributed to how patients feel with doctors of the same race: shared understanding. The same findings are seen with white patients and white doctors. The same phenomenon is repeated in education. Elementary black students who have black teachers have a 20-30% increase in test scores. These positive outcomes persisted over decades. The young black children with black teachers have an increased chance of continuing their education, less likely to drop out of school, and more likely to sit for standardized national exams such as the SATs.  A similar pattern emerges with gender. Female high school students with female Calculus teachers are more likely to succeed in math and go into STEM careers. A shared identity (race, gender, etc) is critical for engendering trust and inspiring individuals to follow up and follow through. The shared identity can also reduce negative behaviors. In one example, Vedantam interviewed researchers who demonstrate that willful defiance is markedly reduced when young black high school students have black teachers compared to white teachers. When the teacher asks the student to quiet down, for example, some students will willfully defy the teachers. This defiance may lead the teachers to escalate the interaction and send the student to the principal office. However, when black students have black teachers, the incidence of willful defiance dropped by over a half.  The reason is traced back to the black student feeling of a sense of trust with a black teacher because of shared race and common understanding. One black interviewee remarked, and I paraphrase, “a white person can tell me they understand, but when a black person tells me they understand, I know they really understand.” 

This begets the question about addressing important social issues such as education and health by matching patients/students with doctors/teachers of the same race or gender. Some may interpret this matching as intentional segregation. We’ve spent centuries overcoming gender and racial segregation and strong scientific evidence support racial / gender matching to help us get our desired outcomes. Here, Vendantam makes a great point. With these types of important outcomes (e.g. education success of our children, health wellness of our communities), peoples’ willingness to be active participants of their lives is dependent on trust with the providers of the services. As Ruth Bader Ginsberg stated in her book "My Own Words" addressing Affirmative Action for college entrance, the common theme is about the intention. When the intention of the policy is to connect people, and build trust, then these interventions are necessary. This type of racial matching is distinct from the historical racial segregation because the intention is to connect people and promote a sense of community (NOT segregate people based on sentiments of intolerance or discrimination). When the providers come from a shared background, patients connect with providers on a deeper level that will engender trust and increase the chance of better health.  “Like begets like” adage holds true because “People Like Us” help bridge trust and empathy. 

In the midst of recent alarming racial police violence and xenophobia capturing our national attention, how can we effectively mitigate and address these social issues? We all want to feel safe and protected and we want this for our friends, family, community, and country. It's possible that we can achieve these goals by engendering more trust among people. What can we do to promote trust during these highly charged, high-risk interactions such as interactions with law enforcement? The answer may be “like helps like”. In addition to racial sensitivity training for all personnel involved, maybe we can increase trust and decrease these egregious acts of racism by matching our law enforcement personnel with perpetrators/victims by race? What if the police officer charged to address George Floyd’s case was a black police officer? How much different would the outcome be? Being sensitive to the larger role of trust and empathy which are at play can help us work towards a more peaceful society, connected by shared interests and similarities rather than differences.  Having more ethnic diversity in our law enforcement, health providers, educators, policymakers, etc, and levering this diversity to connect individuals with similar demographics (e.g. backgrounds, race, gender, age, etc), may help us achieve our desired outcomes more effectively if we desire to live in a more psychologically safe and peaceful place.

Sunday, May 24, 2020

Cleaning 🧹Out the Closet: Making Space

I happened to come across my closet organizer tucked away deep in the corner of my closet. I purchased it many months ago and never did anything with it, until the day I happen to come across it randomly. So, I unpacked it and somehow managed to make just enough space in my stuffy closet to fit it in. My closet is a double-decker with two hanging rods stacked on top of each other to accommodate as much clothing as possible. The original design of the closet was a single-decker and I converted into a double-decker a few years ago after getting the idea from a Pinterest post. I had moved back home from my apartment after finishing fellowship and had more clothes than I can fit into my new room. I had so many clothes in my closet that I had to shove the hanging clothes to get a few inches of space to find a dress. I had a lot of clothes, but I could never find the one I wanted or needed. I had the same problem with my dresser. My dresser was so full, sometimes I couldn't close it completely. It was insane. But, when I needed a pair of shorts, I could never find it in my dresser. 

Now I have a hanging organizer which had compartments, I started to organize my shoes into a few compartments, my scarfs, and accessories into others. It was nice. When I needed my scarf or shoes, I could easily access them. The good feeling led me to slowly go through my closet and dressers over the next several weeks. As I slowly went through my closet, I realized I had not worn many of the clothes for over a year. I had purchased new clothes but never spent the time to re-evaluate the older clothes I had, so I kept adding to my closet. So, I started going through my closet. I made a rule that I will donate any clothing item that had not been worn in the past 6 months. Then, the cleaning started. When I finished, I ended up with 8 giant trash bags worth of clothing, which I dropped off at the donation center. After I cleaned out my closet and dresser and limited the items only to the clothes I wore regularly, I felt like a new person. When I opened my closet in the morning to get ready for work, I realized I could find my work clothes a lot faster than before. I have plenty of room in my closet to move things around. I no longer had to search through the massive amounts of hung clothes to find the one dress I wanted. I felt happier because I could find the right clothes, every time. The funny thing was, I looked forward to opening my closet. It was just a closet, why did I experience such a huge shift? I think it's because I had to use my closet every day. Now, finding my clothes was simplified; I had fewer items to search for. The even funnier observation was that I started looking forward to opening my closet because I knew I could find what I wanted, do this easily and quickly. Letting go of 80% of unused clothes in my closet led me to quickly find the 20% of the clothes I loved and wore routinely. 

This made me think. What if I re-organized my life the way I've re-organized my closet? What if I can unapologetically set a rule to spending my time on people and experiences that I loved and enjoyed, and let go of responsibilities/people/service work which I didn't love?