Kaizen and the amygdala

Our history as humans from thousands of years ago, is still having an effect on how our brains are working.

Thousands of years ago, when we met a big bad wolf in the forest, we had not time to think. So for the purpose of saving our life, our basic brain structures, our amygdala were helping to shut down all other brain functions including our thinking processes, our sexual desires our need for approval, our creativity, and made us fight or flight, run for our lives or try to fight off the danger. The fear for the wild beast had successfully triggered fear and an appropriate reaction for our survival. Since we were not very fast or strong comparing to the beasts preying on us, it was best to learn where it was safe and to really go and explore the unknown. Major changes were readily triggering our amygdala, shut down all our higher brain functions and got us ready to run or fight.

Now if we have to sit for this very important test or we face a major change in our life, our amygdala tend still to respond in such a way. We want to lose weight, but diets are difficult, exercising demands time and causes us to have sore muscles initially at least and instead of effectively going towards the change, our fear sets in and we are in a run or fight mood. Our higher brain functions shut down and no change tends to happen.

Now small incremental changes in what we want to achieve, tends to bypass this primitive response. If we start with one snack less per day, we may not lose a lot of weight in the first week, but we see that change is possible without too much effort and we are encouraged to take the next step. Or for exercising, instead of enrolling a program of half an hour for five days a week, which is very likely to fail we then start with doing a few minutes of exercise every day. No trigger of fear, no trigger of amygdala no run or fight response, no shutting down of higher mental functions.

Good stories from students

I want to share with you two amazing stories of medical students who had spent almost 7 weeks in the pediatric wards. I asked them to share their worst and best moments in these wards. 

Story 1 

    The first story was the worst experience of one of the students. A child with a chronic kidney problem had been admitted. The child was very ill. The mother had not brought the child to the planned follow-up after the initial diagnosis and most likely that lack of proper follow-up was one of the main causes of the quite critical condition the child was in. The child needed to be transferred to the high dependency unit and the doctor in charge had asked the parents in a bit of an angry way: "Why did you not come for follow-up. Look how ill your child is now; we need to transfer him to the high dependency unit". This had left both parents in tears. My student had stayed a bit with the parents but was not trained on how to deal with this difficult situation.

Comments on story 1

     My student had observed an instance of poor doctor communication. The child was critically ill and instead of providing empathetic support, the doctor had just induced lots of guilt feelings in parents who were trying to cope with the critical illness of their child. The parents were shaken and my student as a bystander was shaken by the event too. 

    We had an interesting discussion on how each of us felt the communication could have been better. We  agreed that in the acute phase of the illness, there was no point in putting too much stress on errors from the parents. Rather, a doctor should describe the condition of the child and reassure the parents that we will provide the best possible monitoring and care for their child. We should be perfectly clear on the fact that the condition was critical but we hope that the child would recover with the care provided. Later, much later, when the child will be recovered and be ready for discharge we can stress to the parents the importance of attending follow-up in the future, in order to reduce the chances of the same complication happening again. 

    We discussed also what could have been said to the parents while they were crying. It is quite essential to allow the feelings to flow and handing some tissue paper to the parents and not say anything may be appropriate. If we want to say something, it may be good to express our understanding for their sadness and our understanding that it must be really hard for them.We discussed also the importance for all doctors to not be afraid of their own feelings. Anyhow, these events can help us to reflect and help is in the long run, deal with our won emotions better 

 

Story 2

The second story made me really happy. The second student shared his best experience. He had clerked a four year old boy who was very much interested in a cartoon, the student knew well. At the end of the encounter the student had given to the patient a figure that he had owned since quite long and he felt really good about it. 

Comments on story 2

I really enjoyed hearing this so much. This part illustrates that it is in giving that we receive. Something I myself struggled with for long to fully understand. The student was giving a material thing, and he received a good feeling in return.  This was so important to him, that he had selected this as the best experience of the 7 weeks.

I believe thoroughly in random kindness and the value of giving. I think oftentimes our parents and our teachers are planting the seeds of kindness in our souls and hearts. But it is only through our experiences and the reflection on our experiences that these seeds manage to blossom into wonder flower of a long term dedication to selfless service. 

Many thanks to Nor Athirah Binti Azlan and Ahmad Izham Tasnim Bin Mohd Satar for giving permission to share here their personal stories.

Accepting

 Yesterday evening, I made a long walk on the beach.

A soft wondrous evening sun shone on the breaking waves and on the small individual clouds in the otherwise blue sky. The waves were breaking with most soothing sounds and the smell of the sea was special. We had had a few days of heavy monsoon rains in the past few days with huge waves. Whenever the waves are big, quite a lot of garbage and plastic is washed ashore. This time it was not different. At certain places I had to look where I put my feet in order not to step on any branches or plastics. At other places it was better. 

I decided to focus on the beauty of the sea and the sky, on the breaking waves, on the wonderful clouds. I truly enjoyed the walk. I saw eagles floating through the skies and people smiling. 

There will be always imperfections. If we accept them and focus on the beauty, we can still enjoy the walk!

3 amazing stories

1.       The story of the angry letter

One day a minister was very angry with his personal assistant She had sent a letter to the wrong person, causing him not only a lot of embarrassment but if the other person acts badly, it could cost him a lot of money too. He was very upset.

It was the beginning of a weekend, and she was planning to take leave after the weekend. That was in the time before emails or text messages were available. So, he wrote her a letter. His letter contained the most hateful words and was written in a very harsh way. Then he asked his wife to post the letter

At night he could not sleep and kept turning around in his bed. His wife asked him what was bothering him. He felt very uneasy about the harshness he had used in the letter and was now worried that it would hurt his PA so badly that she may decide to quit, which would be extremely inconvenient to him. He really regretted to be so angry in the letter.

His wise wife reassured him that she knew he would regret and that she had not yet posted the letter.

Lesson: if we are angry, we lose temporary our capability to think clearly. We tend to say or write words that we clearly will regret later on, but once out there it is almost impossible to take them back. Better to cool down first, regain our common sense and only then we address the issue in a calm and cool way.

2.     2. The story of the boiling water

One a day a teenage girl came back from school stating very adamantly to her mother that she will quit school. She had failed test, had been bullied and was very frustrated. The mom said nothing but took three pots, filled them with water and put them on the fire until the water boiled. In one pot, she put a carrot, in the other an egg, and in the last one coffee beans.

After half an hour, she called the girl. See, these three things were exposed to the same stress but each responded in a different way: the carrot was hard but became weak, the egg was soft and liquid but became hard and the coffee beans, they just changed the surrounding into a lovely brew of coffee giving an amazing aroma.

Lesson: if we face difficulties or stress, we can either become weak and easily give up, we can become hardened and lose our normal emotional response to things, or we can try to change the situation and turn it around into something beautiful.

3.       3. The story of the nurse who was not let in

About ten years ago, we started a home-based nursing service for terminally ill patients. During one of the debriefing sessions, a nurse told about the frustration she had experienced when she visited a family with a person who was in dire need of palliative care but she was not welcomed to deliver this care. The family was very strongly believing in traditional healing methods and thought she was just sent by the hospital to deliver more painful treatments to the patient. She talked nicely to the family expressed her sincere intentions and gradually she was allowed to take care of the bed sores of the patient and in the end her work was very much appreciated by the family. 

 

When asked how she had achieved this remarkable success, she mentioned that she got the motivation from the knowledge that this work she was doing was blessed by our Creator. She was confident that our Creator would show the way to her and the family if it was meant to be that she should alleviate the suffering of the patient. 

 

Lesson: I think this is an amazing story of courage and faith. She could have gotten discouraged and may have considered quitting the job if the patients refuse her care. That would have been like the carrot, getting weak. She might have hardened up and become angry with the family, creating a situation more problematic still for the suffering family, perhaps creating feelings of guilt. But she took the coffee-bean approach. Through her faith in our Creator, she persisted gently and managed to turn the stressful situation into a beautiful one.

Forgiveness

 I found some nice quotes on forgiveness on the net

 

"Forgiveness does not change the past, but it enlarges the future."  - Paul Boose

"The weak can never forgive. Forgiveness is the attribute of the strong." - Mahatma Gandhi

 “Always forgive your enemies—nothing annoys them so much.” —Oscar Wilde

 

 “Resentment is like drinking poison and then hoping it will kill your enemies.” —Nelson Mandela

 “To forgive is to set a prisoner free and discover that the prisoner was you.” —Lewis B. Smedes

 The last two quotes are showing very nicely that forgiveness is something we do for ourselves, not for the one we forgive. If we hate someone, it does not much affect the one we hate or have grudges against. 

I can relate a personal story. I was in charge of the neonatal ward in a rural area in Malaysia. One night, many years ago, I was in dire need of syringe pumps. These are essential to give medications to newborn babies. We had so many sick babies and all our pumps were in use. A new baby with a severe condition was born and we really needed syringe pumps for giving him various types of medication in the exact right dose. That time, I knew that a new ward was about to open within our hospital and that all equipment was there already. I talked to the sister on call and requested that she arranged for me to borrow some of the pumps from that ward, that was not yet open. 

She had contacted the Doctor in charge of that ward and he refused to let me borrow the pumps. I asked the sister on call, she wanted to listen to that Doc who sat at home and let the baby in my ward die, or she wanted to take responsibility and let me borrow the life saving equipment that the baby needed. She luckily let us borrow the equipment. 

About 7 years later a new lecturer had joined our university and he told me the story of the pumps. I asked him how he knew. The Doc who had refused to borrow the pumps, had been apparently very upset with me and the sister that was in charge that night, and he was still angry with me about it. I sincerely had almost forgotten the incident and was completely unaware of his anger. Thus anger and hatred does not have an effect on the object of the anger but is just occupying in a negative the mind of the angry or hateful person. 

I really agree hatred or anger is imprisoning the angry or hateful person. Forgiveness is something we do for ourselves, not for the person we hate. It is setting ourselves free from negative emotions that tend to blur our thinking process.

Keys to the future

The past is over.

We cannot change a thing from the past

We cannot change a deed we have done, 

We cannot swallow back a word we spoke

 

But today we have a choice

We can let the past reign our present and future

We can keep regrets and grudges in our heart

We can condemn and hate and be frustrated

Or we can choose to 

forgive ourselves for whatever went wrong

forgive all who wronged us for whatever was done

and start today with a mind and heart at peace and ease

That choice is so important 

because our future is depending on it

just like today is the result of our past

our future will be the result of our choice today

So choose forgiveness 

Choose gratitude

These are the two keys 

opening the door to a better future!

Jake the Grape

On a lighter note, here is a small fable meant for children 

I hope some children get to read and love the story

and perhaps it can give at least a smile to some adults :)

Here it comes:

This is the story of Jake of the Grape

 

You may know that grapes do not live very long

So, every other day they have a birthday celebration

Their desire for fun is extremely strong

 

Now Jake the Grape had a special dream

 He wanted on one of his own birthdays

 To sit on a birthday cake amidst the cream.

 

 The other grapes ware scared for Jake

 You do not want just to sit on a birthday cake

 

 The chance of being eaten is a terrible plight

 Even though sitting on top of a cake is a pure delight

 But Jake sneaked into a bakery at night

 And the next day, he sat on a cake, what a sight!

 

 A whole group of people was singing a birthday song

 Before the cake was cut to pieces oblong.

 

 Jake the grape, was the only grape on the cake

 And he ended up on the birthday-boy’s plate

 Now for good heaven’s sake,

 The boy did not like to eat grapes

 

 He threw Jake silently on the ground

 While none of the other people around

 Were looking and thus were unaware

 That Jake just lay on the floor somewhere

  

The next morning, mother swept the floor

 And Jake ended up among the flower bed

 That was located not far from the door

 That was as good for Jake as it ever could get.

  

Now a wonderful vine is growing near the house

 But except the birthday-boy, nobody knows

 That the vine was made

 By Jake the Grape from the birthday cake.

 

Aufie Zophy