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Even before I truly understood how vital sleep is to health, I cherished it. During my years as a college student, then medical student, resident, and new mother, I was often sleep-deprived. As a family medicine physician, being “on-call” every third night only added to the fatigue, nay exhaustion. I’m still making up for lost sleep—if that’s even possible.

Now, sleep has become a kind of Olympic sport for me. I have no trouble practicing the sleep hygiene I preach to my patients. Every morning, I get up at the same time—5:15 AM. I anchor my body clock by stepping outside before 9 AM for several minutes. I don’t have caffeine past 9 AM. I make sure to exercise throughout the day to build up “sleep pressure.” I stop eating three hours before and use blue light blockers or turn off screens two hours before bedtime. My phone charges in another room instead of on my nightstand. I have a consistent bedtime: stretching, deep breathing, and prayers of gratitude. I take magnesium and then hit the hay at the same time every night for a restful eight hours.

Why? Because sleep is good medicine. It’s when and how the body clears out the toxic byproducts of stress and the countless biochemical reactions that occur automatically in the brain and body throughout the day. It’s the time for restoration, repair, and recharging. People who prioritize sleep and sleep well live longer with less chronic diseases.

I love to sleep.

So these last several days of poor sleep have been especially troubling for me. And I know exactly why I’m not sleeping well—I injured my neck during a recent quilting marathon. I was determined to finish whipstitching the binding on a quilt for my mother, and I thought quilting during the drive to Bend would be the perfect use of time. In reality, being hunched over in the back seat for three hours like a body contortionist was a disaster for my neck. I fall asleep fine, but whenever I move and turn my neck, I wake up in excruciating pain.

Worse than the pain, though, is waking up and worrying.

Worrying at night isn’t new for me. I often fret about finances, perseverate about projects, obsess about obligations, or dwell on disputes. Typically, I can coach myself off any cliff and get right back to sleeping like a baby.

This time, however, my usual strategies—thought dumping, deep breathing, visualization, prayer, and meditation—aren’t working. My mind keeps spinning, and restful sleep mocks me. Even an insomniac would empathize with my sleepless nights.

This time, I am worrying about my daughter. She was recently engaged to be married.  And of course, I am over the moon happy for her. Interestingly though, being the mother of the bride is altogether different than being the mother of the groom. Sure, I am more involved in the wedding plans. There are so many decisions not to mention complicated relationship dynamics. I had a vision of Elena’s dad dancing in front of her like a whirling dervish. I tried to protect her from the clouds of commotion that were brewing, but instead I got caught up in them and caused more commotion myself. Poor Kenny had to anchor down me by tying a rope around my waist while Tosh did the same for Elena. I laugh.

That is certainly taking up some of the real estate of my night watches. But it’s not the half of it.

Elena is getting married. Have I done everything for her that she needs. As her mother, I mean.

While Jacob’s engagement and wedding brought up grief that gently asked for tender loving care, Elena’s engagement is uncovering even more layers that are screaming for attention. Grief often wants to point the finger of blame. What was that saying when we were kids?” When you point fingers, there are three fingers pointing back at you.”

I did not act swiftly enough when Sammy fell ill very suddenly, and he died. If only I had…. That powerful “if only” belief that has been pushing me around and haunting me is now at play with Elena.

This is what screeches at me when I wake up in pain. I think about all the ways I have fallen short and all the things I could still do that might still make a difference. There is still time for me to be her mom. I conjure up the perfect scenario and search for the perfect words. And I rehearse them over and over.  So I can undo what I did wrong and do now what I didn’t do then. So I can rescue her. So I can save her.

And I sit straight up in bed, heart racing, face flushed, in a cold sweat.

She does not need saving. She’s not dying.

I glance at the glowing red numbers on the clock: 3:33am. I lay back down and stare at the ceiling until the alarm goes off.

After a week of this madness, I decide to reach out for help. I call my sister and schedule a session with my coach. They are so skilled at active listening, reflecting, and asking questions with curiosity and not criticism. They help me stay observant, objective, and open.

Another picture comes to me. I am on the sidelines of Team Elena, running up and down the field. God is the coach and I am chomping at the bit. “Put me in, Coach! Put me in!”

My own coach wisely inquired, “and what is God saying?”

Perhaps Jeremiah 29: I know the plans I have for Elena (and you, beloved Julie).Isaiah 55:8-9 For my thoughts are not your thoughts, and my ways are not your ways. Philippians 1:6 I have begun a good work in both of you and I will be faithful to complete it. John 14:27 My peace I give you. Do not let your hearts be troubled and do not be afraid.

“Beautiful,” the coach responded and then offered Psalm 84:3 Even the sparrow has found a home, and the swallow a nest for herself, where she may have her young – a place near your altar.

I see God smiling and I hear God reassuring me that He has always been and always will be, “I’m right here and I’m letting Elena call the plays. Let’s you and I cheer her on.” And rather than resisting, I stand in wonder that I am not in control and that’s the way it’s supposed to be. I stand in amazement at the beautifully imperfect human being I am. I could never be a perfect mom, not for Sammy and not for Elena. And that’s ok.  Actually, wow, that’s such a relief! And Elena does not have to be perfect either. Instead, in our humanity, we are lovingly invited to live in the grace of God, the compassion of Jesus, and the comfort of the Holy Spirit.

“The beginning of love is to let those we love be perfectly themselves, and not to twist them to fit our own image. Otherwise, we love only the reflection of ourselves we find in them.” Thomas Merton.

I am happy to report that though I still have some neck pain, I am sleeping peacefully through the night once again. I will lay down and sleep in peace, for You alone, O Lord make me dwell in safety. Psalm 4:8

The following story is based (loosely) on true events. Names have been changed to protect the innocent.

Once upon a time, in a quaint little PNW village that overlooked bountiful blueberry fields and a slough, there lived a doting mother named Jewelee. Her children were grown and gone so Jewelee doted over her dogs, her flowers, and her husband. One day her beloved son announced his engagement to a fair maiden. Delighted, the mother set out on a quest to find a festive frock for their wedding.

Jewelee freely admitted that she spent too much time brooding over a dress, scrolling through websites, visiting shops, buying and returning gowns of various styles and colors and lengths, exasperating salesclerks, friends, and family, especially her poor husband. Finally, a month before the event, she found “the one.” It was elegant but not overstated, it coordinated beautifully with the wedding hues, and it fit well.

“I have made up my mind,” she declared decisively to her husband who simply smiled back at her, wisely saying nothing but secretly wondering if it were really true.

Yes, she had decided… until she was informed of a color change. She deemed her color choice a little too close for comfort and well, she didn’t want to be matchy-matchy with anyone. No problem. She ordered the same dress, in the same size, but in the navy rather than the stormy blue. And she waited.

Every day Jewelee checked for the gown’s arrival and every day it did not come. She checked the front porch, the side porch, and the mailbox. She checked around the corner of the house on the patio where the delivery person hid packages from time to time. Still nothing. Twice a day she checked the Amazon app on her phone and on her computer. “Out for delivery,” the tracking system teased. She willed the little dotted line from the warehouse icon to the delivery truck icon to connect to her house icon within the promised fourteen-day period. Finally, after twenty-five of the longest, most laborious days of waiting, the gown arrived, just one short week before her planned departure.

No matter, she reasoned in her mind as she sighed with satisfaction. The dress was here, and she could hardly wait to finish her workday and try it on. Jewelee was bursting at the seams with anticipation. Little did she know that she was about to burst seams literally.

Panic struck as she gently coaxed the unforgiving chiffon over her ample hips. “ARE YOU KIDDING ME?!!!” She screamed a string of expletives loud enough to wake the neighbors’ napping newborn. The long-awaited dress barely fit. It was so tight she had to walk with her knees pressed together taking short, dainty Geisha girl like steps across the tiled bathroom floor. She stood in front of the mirror and tightened every muscle as if her body was silly putty and she could somehow magically morph her shape.  There was no way she would be able to sit comfortably in it.

Aggravated and acrimonious, she attempted to remove the dress over her head. Beads of sweat formed on her forehead and in the center of her back as she shimmied the dress a little further up her torso to her shoulders trying desperately not to tear it.  She was stuck! Claustrophobia set in and she stumbled around her bedroom, her arms flailing in the air, the dress half on half off, like a mediocre escape artist whose straight jacket malfunctioned. She yelled for help, but the gown was around her head now and muffled her voice. Her husband was nowhere to be found, so her youngest son came to her aid and rescued her from the costume’s clutches. She prayed he wouldn’t be scarred for life.

When her breathing eventually slowed, and oxygen returned to her body and brain, she doubled-checked the confirmation emails and then read the dress label. Had she made a mistake when ordering? Both displayed the same size as the previous dress. But when she laid one dress on top of the other, even her untrained eye could perceive that it was cut smaller, by an entire inch she estimated, maybe more. How could this have happened?

Jewelee envisioned a dark, crowded sweat shop, where a newly hired and therefore inexperienced employee stumbled under the weight of the mountain of material he was charged to carry through narrow aisles, depositing fabric at each workstation and bumping the shoulders of every dressmaker seated at archaic black trundles sewing at fever pitch. The girl working on what would be Jewelee’s dress must not have realized that her hands swerved, and she got off track as she mindlessly guided the material under the sewing machine, unknowingly stitching the seams a little too wide and therefore the dress, Jewelee’s dress, a little too narrow.

Jewellee blinked away the images with feigned forgiveness, embracing the reality of the situation. There was no time to order a new dress. Besides, there was no guarantee another one would be the correct size either.  Her next thought was to have the dress altered. She called the only local seamstress she knew and explained her dire situation. “Happy to help,” the dressmaker exclaimed exuberantly from the other end of the line. “Hang on Honey while I check my calendar.” Her first opening? Not for three whole weeks!

Jewelee tried the dress on the next day, this time with the shapewear she stole away to purchase in the dark of the previous night. She stared into the mirror ruefully. It helped, but not enough.

So, she determined to do what any God-fearing red-blooded American woman would do in her situation.

“I am going on a diet,” she divulged sheepishly to a dear friend, minutes before their weekly podcast espousing the benefits of sustainable lifestyle changes in nutrition, movement, sleep, and stress management to improve health.

“A diet,” the friend repeated the word with a downward inflection to her voice, scrunching her eyebrows in concern and confusion. “Are you sure,” she said very slowly, as if trying to persuade Jewelee from jumping off a cliff.

A diet was the exact antithesis of what Jewelee had been preaching and teaching for ten plus years now. The exact opposite of how she lived. Lifestyle is the better way, the upper road, the journey. DIET was practically a four-letter word in her world.

“I can’t help it,” Jewelee rationalized. “It’s the dress. The dratted dress is making me do it,” she explained in hushed tones as if through a screen to a priest in a confessional.

Oh, the shame of it! The hypocrisy! Still, she had to do something. Shapewear alone wasn’t going to shave that inch and a half off those hips.

Vexed by vanity, Jewelee dug deep into the recesses of her mind rummaging through the myriads of diets that were filed in her mental library. Cabbage soup? WW? South Beach? It was no use. There was a reason she stored them in her brain’s banned books section.  

She eventually concocted a version of intermittent fasting mixed with protein-sparing modified fasting, and a dollop of clean keto, just to stir things up. She measured her food. She measured her ketones. She measured her hips.

Every day she rode the recumbent bike HIIT style and pumped iron every other day. She added Pilates exercises to target crucial areas and even used a near infrared light box on said areas to persuade her mitochondria to their increase energy output.  

With the willpower of an Olympic body builder, she ate white fish and nonfat cottage cheese and cucumbers. She was a woman on a mission, focused on one thing and one thing only: she was going to sit comfortably in her dress at her son’s wedding a week from Saturday.

Jewelee’s plan seemed to be working until Monday when her right foot swelled up for some unknown reason. Probably a stress fracture from all the jumping rope. Yes. She jumped rope, too. There was no way her foot would be able to fit in, let alone dance in, the three-inch heels she planned on wearing. With ice now strapped to her ankle, Jewelee fussed and fumed like one of Cinderella’s ugly stepsisters after forcing her fat foot into an unwilling glass slipper.

The proverbial third strike struck Tuesday morning when she woke up with a painful, blood-shot eyeball! Now what?! Pink eye? Iritis? An allergic reaction to the eye makeup she had to practice wearing?! Even if the dress and shoes somehow miraculously fit, her red eyes would ruin the pictures! Now she’d have to take precious time away from food prep and exercise to go see an indifferent doctor then stand in an interminable line at an out of the way pharmacy for whatever magic potion was going to make her eyes better.

If her ketotic breath was bad, her mood was worse. She cried silent tears of mental anguish like a spoiled toddler whose balloon just burst.

Yet, when the departure day arrived, she faced it with the equanimity of Queen Esther and the voice of Doris Day. “If it fits, if fits. Que sera sera,” she sang in her mind as she boarded the plane to Atlanta with two dresses in tow along with an additional pair of sensible flats, and Visine. To get the red out. Just in case.

The day of the wedding came, and Jewelee found herself running errands and doting on her children rather than thinking about her dress dilemma. She picked up her daughter’s dress from one location and delivered it to another. She carefully ironed the creases out of her son’s pleated wedding shirt. She drove over hill and dale to fetch the wedding rings. But time grew short, and she could put the inevitable off no longer. She had to get dressed.

Standing in the closet staring blankly at both gowns, she wondered what to do when three of the most lovely and talented god-sisters appeared. “Don’t worry, we can fix it!” they humbly proclaimed with great assurance, producing a sewing kit from thin air. They poured over the gown’s construction with keen attention to detail. After a few precise snips to let the seam out here, and expert reinforcing stitches well-placed there, la voila! Jewelee could sit!

The wedding was beautiful, and Jewelee was so enraptured by her son and his bride she didn’t notice herself or her dress at all. The lovely couple were married, and they would live happily ever after.

Jewelee went home to reclaim her healthy habits and reflect on her foolishness. She sighed at her silliness and chortled at her childishness.  Starving for style? Good health is the best fashion. A dress may dazzle for a night, but a healthy lifestyle is your lifelong light.

 A hungry heart won’t fill a dress. Better a nourished soul than a fleeting fit.

….and that’s why it’s called Weigh Different.

I don’t know much about Waco’s past, only that he was rescued and living at a dog shelter called Brightside in Redmond, Oregon. He was part of a pack sent from Oklahoma to be adopted. All the other dogs had been snatched up quickly, so he was there by himself for some time. My sister Amy’s daughter, Gabby, had seen him on Brightside’s website and asked to meet him.

Gabby told me that the first time she met Waco she sat in silence with him on the floor of the “meeting room” for the better part of ten minutes. She said he never looked at her; he just stood there with his nose to the ground. She turned her body away and held out her hand. He sniffed apathetically and again, just stood there. She didn’t push but carefully took his leash and gently guided him to the yard on the premises. She went back to the shelter three times over the next two weeks to try to gain his trust. Apparently, other families were interested in him as well, but the shelter staff observed he would not allow any of them to come near him. The last time Gabby went, he snuggled up to her. She adopted him in January of 2023 at the age of two.

We all steered clear of Waco in the beginning with the understanding he had lots of triggers. But his transformation over these last two years has been remarkable. He has gone from being skittish and nippy around everybody save Gabby, to at least tolerating being in the room with people, and off leash no less.

I noticed this specifically while visiting Amy at her home in Tumalo where Gabby lives with Waco.  Beth, my Texas sister, was there too. It was a sisters’ weekend.

We were all chatting in the family room catching up on all the details of each other’s lives.  Amy sat in a chair across from me. Gabby sat on the floor to my right with Waco who sat on his haunches between Gabby and Amy. Beth chimed in from the kitchen.

Waco, looked like a regular happy dog, tongue hanging out, one black ear standing up straight and the other black ear permanently flopped forward, peacefully enjoying the company of others, and seemingly wanting to show and receive affection.

He let me scratch his chin.  That was a first.

I was so excited at this new spark of acceptance into Waco’s world that I became overly confident and went to scratch behind his ears.

Waco let out a singular jolting bark. Only one. But that one bark was so full of pain and anguish it cut me to the quick. His one bark was so piercing, I saw stars, a flash of light so bright I winced and recoiled.

I had no knowledge of his past but, in that instant, it felt like I saw through a portal right to the exact spot in Waco’s brain where abuse and neglect were recorded and an automatic response was activated.  Even though all he had experienced from his new owner in the last two plus years was love and affection, safety and structure, care and concern, that specific trigger spot along with the automatic response remained intact. I wasn’t fearful. Waco did not snap at me. He wanted love and affection, but he could not NOT respond any differently in that moment to that touch.

That bark seemed to rip the galaxy and I saw into my own psyche and my trigger areas and automatic responses. I saw how my own “bark” had been manifesting in so many reactions toward people who may have been just trying to show me love or were just there and unaware. I felt overwhelmingly remorseful for my reactions and at the same time immensely compassionate toward myself and others.

Paul recognizes this aspect of our shared humanity in Romans 7: 19-25, when he states,

” For if I know the law but still can’t keep it, and if the power of sin within me keeps sabotaging my best intentions, I obviously need help! I realize that I don’t have what it takes. I can will it, but I can’t do it. I decide to do good, but I don’t really do it; I decide not to do bad, but then I do it anyway. My decisions, such as they are, don’t result in actions. Something has gone wrong deep within me and gets the better of me every time.

It happens so regularly that it’s predictable. The moment I decide to do good, sin is there to trip me up. I truly delight in God’s commands, but it’s pretty obvious that not all of me joins in that delight. Parts of me covertly rebel, and just when I least expect it, they take charge. I’ve tried everything and nothing helps. I’m at the end of my rope.”

Sometimes, it seems like I cannot NOT respond any differently than to bark. When I am overly tired or overly committed or have had a hard day, old tapes begin to play, lies bubble up in my brain and melt away the cement that I thought was permanently covering my old painful neuron pathways. I bark. And usually, it is directed at my husband or my kids or the poor customer service person on the other end of the phone just there to do a job.

There were so many layers to that moment that day. I experienced a cinematic telescoping time warp in which in a flash backward I saw all the wrongs done to me and the wrongs I have done to others, my family’s unique generational sin, all the way back to its inception in Noah’s tent in Genesis 9, and incredibly simultaneously, the flash forward of God’s long suffering and compassion, His way of redemption, not stopping at the cross but pushing forward to glory yet to be revealed. It was a nanosecond but so powerful that I could not move.

I sat trembling and weeping, trying to take in the whole experience. I could see the pain of sin all the way back through the ages and the wonder of Jesus as He is described in Hebrews 1:3, “He is the radiance of God’s glory and the exact representation of God’s nature. Jesus upholds all things by the word of His power. When He had made purification of sins, He sat down at the right hand of the Majesty on high.”

I am playing that bark and that other worldly glimpse over and over in my mind and am awestruck by the tender mercies of God.

Simply put, I saw Grace.

Maybe you feel at the end of your rope. You recognize your bark and don’t know what to do. You have tried everything: self-help, therapy, medications, books, distractions, hobbies, alcohol….food. And nothing is working. Maybe you are asking is there no one who can do anything for me?

The answer, thank God, is that Jesus Christ can and did and does. 

I sat on the exam table waiting under the bright lights of the room. I felt overly warm, even though I was only covered by the customary thin gown, the kind that opens in the back leaving the rear on display. My bare legs hung over the edge of the table. My feet dangled.

Menopause had broken my personal rheostat. I felt moisture creeping out of my pores in the usual creases, my armpits, the back of my neck, the backs of my knees, my groin. The frayed gown was now absorbing the perspiration below my breasts like an ratty wornout sponge. I could feel the paper sticking to my skin as I shifted on my hips. The mask made matters worse. I pulled it down under my chin and blew out a hot puff of my stale rebreathed air to mix with the sterile smells of antiseptic lingering in the room.

I was waiting for the doctor to see me for a preop exam, to determine if I was healthy enough for surgery. I stared at my toes. The orange nail polish had chipped on some. I rubbed one foot on top of the other to cover the most unglamourous of them. I examined my legs and discovered a few rogue hairs that apparently ducked and dodged my razor that morning. They glistened in the bright light now. I knew he would not notice. As a physician myself, I never noticed except to attend to patterns of hair growth or skin issues behind the hair. Still, I felt vulnerable. Conspicuously unkempt.

The doctor arrived presently. After minimal small talk, he established the reason for my visit. He quickly reviewed my supplements, allergies and prior surgeries. He started in on a perfunctory examination of neck, heart and lungs while he went on asking questions. “Any night sweats, chills, fevers?” He clicked off the usual list, moving his stethoscope from over my chest to my back.

I could see him checking imaginary boxes and making notes in his head like a quality assurance inspector as he performed the exam robotically. Then he came to immunizations.

The red tab on the electronic medical record flagged me overdue for two. I smiled and nodded agreeably to one, and calmly shook my head no thank you to the other.

This was a record scratch for him. He asked me why, genuinely shocked that I had any other response than complete compliance. I explained that I had reviewed the literature, weighed the evidence, and because I lived a healthy lifestyle and had a healthy immune system, I decided that for me, the risk outweighed the benefit.  

He shook his head in disbelief as if I had checked my brain, medical training, and years of experience at the door. “You’re a doctor and you’re refusing an immunization.” Clearly, we were not having a shared decision-making dialogue like the one I had previously with the surgeon discussing the risks and benefits of surgery and whether it was the next right step for me.

His tone was condescending. “What side effects are you talking about!? You know you are putting yourself and others at risk,” he continued as if the science was settled. There was only one way to interpret the data. In these last short months, the vaccine had proven itself safe and effective for everyone everywhere in every situation no matter what no questions allowed. I could not tell if he was truly concerned about me or if he was annoyed that I was not taking his advice. Maybe he was in the running for most vaccinations and Krispy Kreme coupons handed out that day, and I just broke his streak.

He completed the exam in pin drop silence.

I sat up pulling the gown tighter around myself, like a child clutching a blanket, desperate for a sense of safety that the flimsy fabric failed to provide. I felt his burning disdain creep over me making a mockery of my earlier hot flash.

“Dr. Smith was healthy as a horse, and he died last just last Tuesday.” He paused for effect, his hand now on the doorknob ready to rush off to the next room. “Get. The shot,” he commanded with all the authority the MD embroidered on his starched white coat carried.  When I declined a second time, he scoffed, “Good luck, you’re going to need it,” and closed the door behind him.

I felt my flushed face, retrieved my sense of self, and wondered why I was so surprised. It wasn’t as if other colleagues hadn’t chided me spitting the science in my face and talking about me behind my back. The medical school where I had been an esteemed clinical preceptor for their lifestyle medicine track let me go.  The hospital where I was on associate staff for twenty-five years practically made me sign in blood that I would not darken their doorstep; but interestingly, they were quick to schedule surgery for me as an unprotected patient. It made sense, and it didn’t make sense.

Driving home I wondered if I had ever humiliated a patient in this way. It did not take long for conversations to flash across my memory banks, like lightning bolts across a stormy sky.  I winced as I recalled a few of my least favorite moments as a doctor.

Clap! went the first bolt. I braced for the thunder.

The day after Obamacare passed, I declared with exasperation, “Maybe Obama can help you,” to a patient who had come back a fourth time for the same petty problem which my treatment had not cured.    

Crack!

“Today is the day. Put a stake in the ground. You have diabetes.” I said that to a person who was battling breast cancer and was not registering the reality of this new diagnosis and the impact on her health.

I closed my eyes as if to lessen the unpleasant cloudburst of memories.

To a woman who chose not to vaccinate her baby according to my regimen, I replied, “Your children are well because my children are immunized.”

Yes, I know it is hard to believe. I said those things. To my patients. And those are the ones I remember. And no, I’m not proud of it. I wish I could take those words back. The first part of the Hippocratic oath is “do no harm.” That included do no harm with my words. I still felt the sting of conviction even though I had long ago apologized.

Let me ask you a question. What horrible thing has a doctor said to you?

I have heard some doozies from patients.

“No surgeon would ever touch you with a 10-foot pole at your weight.”

“Did they take you to the back to weigh you on the industrial scale?”

“If you would only try to lose weight, your condition would get better.”

“Your cervix must be the smallest part of your body.”

“And then what did you do”? I asked my patient after she related her story to me.

“I went out to my car and cried.”  Tears rose behind my eyelids for so many reasons, acknowledgement of her pain and resentment, the doctor’s shortcomings, my own failings, our collective humanity.

The providers who say those things don’t understand obesity or their patients who have obesity. They don’t know how hard the person in front of them has tried to move the needle on the scale. They don’t know how to help. And they don’t know that their words are doing harm. Truly, they don’t know what they do.

So, here’s the next question? What are you going to do with it?

Ok, I get it, fire the doctor if you are able. We deserve it. And yes, write us a letter. We need to hear what you have to say. But what is your ultimate power move, even when we don’t apologize?

I am going to ask you to do the very hardest thing: forgive. Not for the doctor’s sake, not because he or she deserves it, but for your sake, because you deserve it. You deserve to be free from the bondage of those words. Forgive because it is a way to reclaim your power. In releasing the grip of negativity and pain the provider caused, their words can no longer dictate your emotional state or sense of well-being. You get to oversee how you act and feel. And you deserve to be at peace. It is not easy. It takes time. That’s ok. Break the curse and forgive.

Knowing what it is like to have a hard day, knowing that that doctor just did not understand me and where I was coming from, and wanting those patients to whom I said those horrible things to forgive me, I forgave that doctor.

Someone somewhere once said “Forgiveness is unlocking the door to set someone free and realizing that you were the prisoner. And like Jesus taught his disciples to pray, “Forgive us our trespasses as we forgive those who trespass against us,” I am endeavoring to adopt his posture of forgiveness, for others as well as myself. I am accepting my inability and the impossibility to do no harm one hundred percent of the time, but maybe I can be part of the remedy for peace.

It wasn’t a day off. It was an “off” day.

I was at my Reach Out Weight and had been there for at least the last week. I didn’t know exactly how long because I stopped weighing myself the previous month since the scale reflected my Refocus Weight. I chose to start this day with curiosity, however, considering the consistency of my rhythms in the last month. What had changed?

I decided to fast. Not as punishment to be sure. But I had not fasted since January. Maybe my system just needed a break from food.

I shrugged my shoulders shaking off the frustration and determined to make it a good day.

For the next eight hours, I carried on as usual, listening to my patients talk about their areas of confidence and motivation. Together we identified specific barriers that come up again and again. I supported them as they shifted their thinking, uncovered new approaches, hung on to hope, and chose not to give up.

In between appointments, I struggled to fight voices in my head crying,  “You Charlatan, who do you think you are?!?!” I could feel the curiosity melting into criticism. Why did the scale still hold so much power? It’s only one data point and an incomplete one at best.

Memories of weight recurrence throbbed in my brain like a debilitating migraine. I had worked hard for several years to gain and lose the same thirty or forty pounds. I tried all sorts of fad diets. WW, Zone, Southbeach. The calorie restriction worked, but only for a while. I could not bear the weight of the unforgiving dietary laws.

I spent 2014 learning a different way: lifestyle change. Lifestyle change brought a freedom from the oppressive focus on calories to the guidance of practices, not only around nutrition, but around sleep, movement and stress management as well. This was effective for me, and I lost the forty pounds one more time, and I thought, for the last time. It was so effective, I was compelled to make a major shift in the way I practiced medicine.

But in the first three months of starting a lifestyle and weight management practice, I regained ten pounds. Ten pounds! I had learned from an esteemed mentor that an increase of five percent from realistic nadir weight seemed to trigger exponential regain.  Adipose cells have memory, and they will fight for the higher set point. Who is going to go to a lifestyle medicine doctor who is gaining weight? That’s like going to a cardiologist who smokes and needs a heart transplant!

Despite implementing every tool I had learned about leveraging weight without dieting, I stayed stuck for two years. I was running circles around the scale and getting nowhere.   

As I recalled the battle, I fretted. Was weight recurrence threatening once again?

My “off” day brought other discouragements as well: news of a beloved one’s cancer, disagreements among family members, and bills. It was always the bills that reminded me that even if I wanted to throw in the towel and give up, I couldn’t.

My husband tried to console me. “You look fine,” he said with real sincerity, “you are beautiful.”

It didn’t help. When I get to this state, there is no encouraging word, no mound of ice cream, no vat of wine that drives out despair. There is only sleep; and I could not get to bed soon enough to put an end to this “off” day.

My dream world took me to a courtroom setting where I played all the roles: relentless prosecuting attorney eager to expose the crime, smug judge eager to enforce the law, biased jury eager to convict the criminal, and indifferent executioner eager to carry out the obvious guilty verdict. I was on trial again, and it was not looking good for me. There I stood in the witness box, swearing an oath to tell the truth, the whole truth, and nothing but the truth, so help me God.

The prosecution directed my attention to Exhibit A. “Describe to the jury, Doctor,” she began, emphasizing the word “doctor” in the most mocking voice, “what you see in this picture?”

He directed the jury’s attention to an image of an empty yellow box ten times its Costco size projected on to a screen. Incriminating crumbs appeared defenseless around the box’s perimeter.

“Wheat thins,” I replied meekly, my head hung in shame as the salty words left my parched lips.

“A little louder please, so the jury can hear you,” the self-righteous judge scolded me.

“Wheat thins,” I said again, pleading with and leaning toward the jury, “but, please, I can explain. You see, it was my anniversary and…” A lone cracker flew out of a fold in my sweater, landed on one of its corners on the white marble floor, and spun like a top until it fell flat on its face. Damning evidence for all to see.

The jurors sucked in gasps deep enough to create a vacuum and strong enough to draw the next breath from my lungs leaving me speechless. They jerked their necks side to side eyeballing their neighbors. Like a tempest wind, indignant whispers rippled, then surged among them. “Everyone knows wheat thins don’t make you thin! Everyone knows wheat thins don’t make you thin!”

“Order in the court!” the judge cried banging his gavel all the while glaring at me as if the ensuing commotion was my fault too.

The prosecutor cut me off, not interested in my explanations. “No more excuses, Doctor! This picture clearly shows a lack of restraint. And isn’t that what got us here in the first place!?” Even my defense attorney had no objections.

My heart sank. This courtroom, this trial, it was all too familiar. I knew the routine well—the self-accusation, the guilt, the endless cycle of blame. I imagined, even in my dream state, my defendant’s assistant bursting into the courtroom, her right arm lifted high, waving new evidence to sway the jury’s verdict: a faulty bathroom scale, a better body composition, there must be some rational explanation.

But then I took a moment. A deep breath. I reminded myself that this was a dream, a manifestation of ancient fears, not my new reality. Life happens. Weight happens.

I looked again around the courtroom and saw the people in the dream soften as they morphed into my family members, my friends, mentors, and even my patients—each one representing a piece of the puzzle that was my life. They weren’t judging me; they were symbols of support and understanding.

As I faced the jury, I began to shift my perspective. Yes, there were moments of weakness, and still would be, but there were more moments of strength, perseverance, growth and reasons for celebration. Even celebrations with food. I remembered the countless times I had overcome obstacles, how I had guided others through their own struggles, and how much I had learned along the way.

The prosecutor’s voice faded, replaced by a sense of clarity. This wasn’t about punishment. It was about acknowledgment. Acknowledging the journey, the ups and downs, and the progress I had made despite the challenges. Acknowledging that data is information, not ammunition. And the scale is never the only measurement of health.

With renewed resolve, I rose from the witness box, no longer the defendant, but the advocate for my own journey.

Yes, weight happens, and it’s going to be ok. Progress, after all, is not always linear. And every step, whether small or large, contributes to a healthier, more integrated life.

P.S. My sincerest gratitude to Donna and Melissa, who spoke words of encouragement over me and chased my fears away:

This is the original text from the book where Desiderata was first published.

Go placidly amid the noise and the haste, and remember what peace there may be in silence. As far as possible, without surrender, be on good terms with all persons.

Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story.

Avoid loud and aggressive persons; they are vexatious to the spirit. If you compare yourself with others, you may become vain or bitter, for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism.

Be yourself. Especially do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment, it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be. And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.

by Max Ehrmann ©1927

It was a lazy Sunday afternoon. That morning, Kenny and I had enjoyed a beautiful worship service at a church in Portland we recently started attending, and then a leisurely lunch discussing the challenging sermon we just heard, and then, a luxurious nap.

It was now 4:30pm and the sun hung low in the sky patiently awaiting its disappearance below the horizon. Kenny was across the street finishing up a few chores.  I relaxed in our living room in the brown leather chair with a glass of pinot in one hand, a book in the other, my feet up on the hearth in front of a warm fire, endeavoring to practice the ancient rhythm of Sabbath. I found my thoughts shifting from God to my patients and the upcoming work week as I read my book, Practicing the Presence of People, by Mike Mason.

The author explained how he was inspired to write this book after studying Practicing the Presence of God written by the seventeenth century Catholic monk Brother Lawrence. I had been drawn to the book desiring to do a better job at my job. Having recently overcome a few financial hurdles, I was wondering about slowing down a little, to spend more time with people, namely my patients, and to make that time more quality time, staying fully present, really listening and reflecting, rather than thinking about what was coming next. I had even commented to a friend a few weeks earlier that I felt the Holy Spirit was leading me to “practice the presence of people over profit.” I was not sure what that meant or what it looked like exactly, but I was curious to find out.  

The blaring ring of my cell phone jolted me from my thoughts and brought my Sabbath to an abrupt end, even preempting the setting sun. I heard Kenny’s weakened voice on the other end of the line. He was gasping for breath. “Call 911- I drove – the tractor – over the bank – call 911 – you won’t- be able – to get – me out – of here.”

I ran as fast as adrenaline enabled, yelling into the phone, “I’m coming! Where are you!  I’m coming!” I sprinted the half mile across the street, down the hill, and over the gravel road, first spotting the upside down, mangled tractor and then arriving upon my mangled husband.

Old training kicked in. There was no blood. He had an intact airway, was breathing, all be it shallowly, and he had a pulse. He was moving all four extremities as he flailed in pain.  I could feel the fractured clavicle but was unsure of internal injuries.

I spoke calmly to the 911 operator who suggested I put a blanket over Kenny while we awaited EMS. Our friend and neighbor, Terry, appeared, seemingly out of nowhere, and laid his coat over Kenny.

The ambulance arrived presently, and five paramedics went to work. They quickly placed a C-spine collar on him, assessed his vitals, lifted him onto a backboard and then onto a gurney. Each bump over the gravel elicited wails of increasingly excruciating pain from Kenny and jerked anguished  tears from me. Clearly this was more than just a broken collar bone.

I drove behind the ambulance but could not keep up. I made a few phone calls and asked for prayer. “It’s 5:15pm now,” I calculated, “With CT scans and all, we’ll get back home before midnight.” I remained naively hopeful, “I’ll still be able to get enough sleep and see my patients tomorrow.”  

I realized we had experienced a miracle. The injuries were not as bad as they could have been, not by a long shot. He was not dead or maimed. He had no head or neck injury and no major internal hemorrhaging that would require surgery. Even so, the injuries were worse than I expected: fractures of the clavicle, eleven ribs in several places, and three vertebrae, as well as a small pneumothorax, a hemothorax, multiple contusions, and skin lacerations.

He needed to be admitted to the hospital. I needed to cancel my Monday patients. Yet I chose to keep family and friends up to date. That in itself was a full-time job.

Kenny finally made it to a room and fell asleep, exhausted from the trauma and drugged by the pain medications.

I went home to take care of the dogs and sleep in my own bed. I wrestled with myself but still did not reschedule my patients. Instead, I woke up the next morning and after my ritual water and black coffee, planned to race to the hospital to make sure Kenny was ok. I would be able to exercise, rush to the hospital, check in with Kenny’s attending physician, and rush back in time to start seeing patients by 9:30am. I felt almost prescient having reworked my schedule with late start Mondays about three months ago.  I can do this. I can do this. I coached myself.

I walked down the dark hallway into the waiting room of my home office where my treadmill beckoned. Before I could even turn on the light, I was slapped in the face by a horrible stench. One of my dogs aberrantly left a pile right in front of the entry door. No, there was no way I would be able to get rid of that awful smell in time to see patients. I finally gave in.  I guess I am canceling patients for today. Practicing the presence of people over profit apparently started with Kenny.

Rachelle conveniently texted a random question. I informed her what had happened. She wanted to help. I conceded and she cleared my day.  

At Kenny’s bedside, I had lots of time to ponder. I realized it seemed ridiculous that I would even contemplate going about my normal day when my husband lie broken in a hospital bed with multiple fractures and internal injuries. It’s a no brainer that as his wife, this is where I needed to be. Why was this such a difficult decision for me? Just as I observed myself running to Kenny, was I now seeing myself running away?

Instead of judging myself for even considering working, however, I stayed curious. What was I afraid of? What story was I telling myself? I talked with my sister, Amy, and she stayed curious with me.

Practicing the presence of people, as I was to find out, reading further in the book, actually started with me.  I first had to be open and honest with all my thoughts and feelings.

“I do not judge myself,” states Paul in 1 Corinthians 4:3. As I explored my various emotions, “taking every thought captive” took on new meaning.  There was space at the table for all of them: fear, worry, anger, uncertainty, as well as faith, hope, love, and trust.

I recognized that some of my own past traumas were resurfacing, particularly when my son, Sammy, became ill and was hospitalized twenty-seven years ago. This was not that; but it sure smelled like it.

I observed that the memories were not threatening to take me down; they were asking for help. I allowed them to resurface and invited the Holy Spirit to shine His compassionate light, to sort out truth from fiction, and start a deep, healing work.

Practicing the presence of people. If I am not able to truly come to grips with my own thoughts and feelings, positive and negative, especially in the face of curve balls, withholding judgment and leaving space for compassion and curiousity, how would I be able to do this well with others.

Kenny’s injuries are well on their way to recovery. And so are mine.

I feel very fortunate that my husband and I are on the same page about so many things. And I am not talking religion or politics, though we agree on most issues in those areas too.

We share similar interests in recreation. We enjoy hiking, kayaking, gardening, walking on sandy beaches in Hawaii, and most recently, pickleball. We have similar tastes in décor, furniture, art, shows, etc. We like gathering around the table with family and friends, making and sharing a meal. We love spending time with our children and  grandchildren.

One of the most important values we both share is ageing well which means we both enjoy eating healthfully.

It was not always this way. Early in our marriage, neither of us paid much attention to food quality. And we were not necessarily in agreement with what constituted healthy food.  We both had bad habits, nostalgic tastes, and wrong thinking.

Kenny held fruit juice as an excellent source of vitamin c and served our kids orange juice or mixed fruit juice every day for breakfast and then packed capri suns in their lunches. My version of healthy Kraft mac and cheese included adding tuna and broccoli to the powdery chemicals.

He threw away my diet coke and I hid his karo corn syrup (which he poured on top of the inch coating of jam and butter that he slathered on the Krusteez pancake made with egg and vegetable oil) in the trash.

As we both dove deeper into the big wide world of nutrition, we picked up the good with the fads, eventually getting away from the promise of finding the fountain of youth in any one supplement or diet and embracing the fact that food – high quality food – has to be our main source of nutrition. After all, our bodies are constantly turning over cells. That is, we are getting rid of old dead cells, and making new ones. We make the new cells out of the food we put into our bodies. The better the food quality, the better the cell quality. And the better the cell quality, the better the health.

Over the last ten years, we have moved from packaged foods, convenient meals, and fast food, to being very picky about restaurants, spending more time in the kitchen, more money on groceries, experimenting with new recipes, making our own mayo, dressings, even crackers. We have gone from grocery store produce to organic to growing our own or foraging from local farmers.

We are not perfect. We are still in process. And we trip each other up at times. I buy the occasional “healthy” cereal. Kenny buys Haagen Daz bars or tortilla chips or processed cheese. Or beef jerky. Or licorice.

Most of the time when I open the cupboard or refrigerator and see foods that don’t serve me, I see them with imaginary labels stuck on them reading “Not My Food” or “Kenny’s food.” I tell myself that Kenny has different nutritional needs than I do He is physically active on the job from sun-up to sun -down. He is a guy. Etc.

Most of the time, I can overlook his culinary temptations. But sometimes, when he brings his bowl full of yummy goodness to our den where we kick back and unwind before bed, when he is reclined in his lazy boy, chomping away on whatever delicacy he has cooked up, way after the kitchen was closed, it’s hard not to want to share that with him. So. Sometimes. I do.

I feel for my patients who are not on the same page as their significant other or family members about a healthy lifestyle. They end up making two different meals a lot of the time, or choosing the best they can, which is so hard. I have so much respect for them as we work together to help them stick to their new habits with or without family support.  

I have also seen time and time again how healthy living can have a ripple effect.  I love to hear patients report their spouses are losing weight too, or are seeing improvements in their blood sugar or blood pressure or sleep.

The process of making changes can be a kind of wellness evangelism. Not by judging or proselytizing like a reformed smoker, but by patiently inviting friends and family to come along for the wellness ride, by modeling new ways of experiencing life and health.

It must be Spring I mused, examining the crop of weeping vesicles on my right posterior thigh. I tried not to scratch. Spring is when my beloved husband, Kenny, moves from spending most of his waking hours inside the shop to outside in the dirt. He is not as sensitive to the oils from poison oak as I am. Even doing his laundry leaves me vulnerable. Where did I put the Technu?

When that rash was finally drying up and starting to scab over, I noticed three smaller red dots forming a linear pattern on my left thorax. Breakfast, lunch, dinner. The saying I had learned at the clinic where I completed a dermatology rotation as a fourth-year med student echoed in my mind, followed by the working diagnosis of… bed bugs. I stared at the new rash again.  Bed bugs?!? My skin started to crawl. I bristled. Not because I was above bed bugs. Ok, there is that. But the last time I had an encounter with bed bugs, I ended up with a reprimand from HR. I was only trying to defend the dignity of the bed bug victim. It’s a long story. I shook my head and moved on to the second diagnosis in my differential of localized, pruritic rashes: contact dermatitis.

The new laundry detergent my husband had bought may have been too harsh for my delicate skin. I was having an allergic reaction to it. I stripped the bed, washed the sheets in hot water and vinegar, and shoved the ridiculous notion of bed bugs way down on my list of differential diagnoses. The huge hassle that would ensue to get rid of them was too much to think about just now.

I slept fitfully that night, uncomfortable in my own skin. I itched everywhere. My husband was skeptical and underwhelmed watching me strip the bed again the next morning. “I don’t have a rash,” he reasoned.

“Well, you did not get poison oak either,” I said curtly as I shoved the sheets in the washing machine and poured in the hypoallergenic detergent I made him buy.  In any case, we were headed to Texas for a week to help my mom’s big move. Whatever was causing my new rash would be gone by the time we got back.

The work of packing and moving and an unexpected night in the ER with Mom completely eliminated all physical – and mental – traces of  skin irritation .

Home again Tuesday, we were in bed by midnight. I was exhausted from flight delays and thinking about working the next day and fell fast asleep. The alarm went off way too soon, but I was determined to jump right back into my exercise routine. I hit the showers by 7 streaking past the bathroom mirror. What did I see out of the corner of my eye? Was I imagining things now? A new rash very similar to the last one, on the other side of my rib cage.

I freaked.  The bed bug hypothesis marched back into full view and sent my hysteria into full throttle. This time everything was put in bags, and I begged my husband to call the exterminator. He easily capitulated and then made no fuss when I suggested we sleep upstairs, in a different bed, with sheets that had never been washed in the alleged offending detergent. The exterminator came and went without finding a trace of anything malevolent. Still, I fed the dryer like it was a voracious cookie monster, but instead of cookies, I fed it loads and loads of bedding which it spit out after churning them through the highest heat possible.

That Saturday morning, as per usual, I met with my accountability partner. When I hesitantly showed her my rash and recounted my story, she matter-of-factly remarked, “Looks like spider bites to me.”

Instantly, my dread, fear, and shame disappeared. “Oh…right…spider bites…of course.”

She chimed in again. “By the way, why are you afraid of bedbugs?”

Good question. And we started exploring. It was an eye-opening conversation and a healing opportunity.

The mind can be a funny thing. Our thoughts can get the best of us. I am glad for the safe people in my life who are not afraid to tell me what they see, especially when I get stuck in one point of view.

Those safe friends and family help me process thoughts and feelings, discover their source, differentiate them from reality, so I can deal with them in a healthy way.

My sessions with patients at OWW enter this kind of gentle, grace-giving exploration. And I am so glad to offer patients coaching with our Certified Health and Wellness coaches, Rachelle Mathios and Meghan Hess. They are both highly skilled in this self-discovery approach to lifestyle change. With genuine curiosity, they ask honest, probing questions which help people know themselves better. Why don’t you like to cook? When did you start believing you did not have time for yourself? Why is it selfish to take care of your needs? What does it mean that you gained weight this month? They reflect what they see and give positive, nonjudgement feedback.

Sometimes the questions get to the place where we feel uncomfortable in our own skin. But if we delve into the discomfort, staying honest and vulnerable, this kind of adventure frees us from old patterns of thinking and doing to discover new ones that change our health and our lives.