Re: appreciate small successes

I think we could all benefit from acknowledging our current/past successes, rather than focusing on future successes (aka failures). After you mentioned this post during our class, I carried the idea with me. No, I don't have all the muscles in the body committed to memory -- yet. But, I have learned certain muscles in the arm, for example. What I am not successful at yet is a work in progress. Whether I count these as failures or not is what matters more.

The Meaning in Medicine

The complexities of biochemical pathways, the differential diagnosis, the embryologic formation of the brain -- these require focus. After long hours of studying, the natural response is to take a break and engage with the world once again.

As medical students, we develop a pattern of intense, reason-filled studying followed by forays back into the real world, where emotion often reigns over rational reasoning. Isn't this the world we know and love? Going to the movies and getting lost in the plot, though we know it is not real. Driving 45 mph in a 40 mph speed zone, just because we think we can probably get away with it.

So we keep our modalities (intellectual reasoning vs. everyday life) separate and incomplete, as if invasion of one into the other would cause a catastrophic event. When does the vacuum of knowledge we come to understand finally live in the real world?

For me, these domains collided first not through human interaction, but guided by horses. The horses forced me to examine emotionally, then intellectually, then emotionally again. Rather than through an immediate burst of understanding, the lines between scientific thinking and intuition blurred over time.

Horses are an unexpected reminder that the meaning in medicine stems from connecting with patients on the deepest level. This involves not just mastering medical knowledge, but using emotion and intuition to best care for others. As future medical professionals, it is not enough to derive emotional meaning from activities outside of medicine. We should allow ourselves to fully engage with patients, to live in the real world.

Last meeting

The therapeutic environment was extremely impressive and I can see myself referring my autistic patients to the ranch.
thank you Beverley.

Appreciate small successes

Many thanks goes to my team partner (during our second class session), who I at first thought was a a little too forthcoming in expressing success when our horse only cooperated about 50% during a horse leading exercise. After the exercise I was frustrated, yet my teammate was excited. Hmmm... interesting.

I had set out to accomplish the horse leading tasks given us by Beverley and I was not satisfied that our horse did not get the message. While we processed our thoughts after the exercise I wondered why my teammate was happy with our less-than-successful results, yet I wasn't. I realized then I had some personal homework to do that involved not being so hard on myself. I needed to start seeing and appreciating the small successes and things in my life (the journey) and not just be focused on the end results (the destination.)

I must have done my homework pretty good because I achieved an "aha" moment today, during our fourth class session. Something clicked for me about appreciating those small successes.

What occurred: My teammates and I weren't 100% "task" successful with our horse. We had to get our horse to walk through two posts which involved stepping on a shiny solar blanket and walking past balloons and misc items, which Mr. Horse felt was absolutely unnecessary since they all looked scary and foreign to him. We managed to get him comfortable around the hanging items but never got him to walk over the blanket. He walked around it, but not over it. Surprisingly, after the exercise, I found myself feeling good with the small successes that we were able to achieve. I was truly happy and grateful today for the shift in my being.

I think the personal lesson for me is... the solution to a problem may not come on my first attempt, but if I am willing to stay open to possibilities and appreciate (any and all) small successes while continuing to add knowledge, employ patience and persevere, I will be as successful as I can be in that moment. And in the end, it's those "moments" that add up to the milestones in life.

Leave It At the Gate 2 - "Presencing"

Medicine and Horsemanship 2010 is well out of the starting gate with the largest class we've had to date--a very heterogeneous group of medical students, practicing physicians, psychotherapists, an occupation therapist and adult education specialists.

Since our last entry almost a year ago, Medicine and Horsemanship has spread to several other programs nationwide and in Costa Rica, where it is used to teach veterinary students!

Respect and Trust vs. Ego

Watching the horses enter the corral on the first day of class helped me understand that age, size or experience of a horse doesn't make one horse better than another, nor command leadership, among the herd. Rather it is the respect and trust that has been “earned” by the lead horses (and can change on a daily basis) that has put them in the position of protecting the herd and making them feel safe in their inherent vulnerability.

Unlike humans, horses don't choose, judge or criticize their herd based on titles or credentials. But humans, unlike horses, can easily get caught up in the initials after their name and have a tendency to doctor more with their ego than with their skills. I think we need to appreciate the example of the horse who lead by earned respect and trust, not ego, and let that be our goal in working with our patients & clients. Those who do will be the most successful and sought after doctors.

Your Stanford diploma will earn you the MD or PhD initials after your name, but it's the trust and respect you build with your patients & clients that will earn you the title of being a great Doctor.

Feeling small

A 1,000 pound horse can certainly be intimidating and make you feel small if you're not used to being around them. During my first M&H class I was feeling exactly that way, and the fact that more than half the class had a greater degree of experience and comfort around horses than I did wasn't helping matters. I found myself wondering if this was going to be a handicap for me during this coursework.

As I processed those feelings, I was thinking... if horses are able to empower us so much then my horse experienced classmates should be as enlightened as Buddhist monks by now. Hmmm, maybe they are, I'll have to wait and see. ; ) But what about the crusty ole' cowboys who lived on the backs of horses their whole life? They seemed to have missed a lesson, or two or three, from their horses. The obvious conclusion here is that riding or being around horses doesn't 'automatically' generate a learned life lesson, unless of course you're looking for one. I'm really excited to see how this Medicine and Horsemanship course will help me.

Leave it at the gate

As a heath care provider it is most important to be fully present with our patients. From the moment we walk into the exam room, throughout the patient visit, and until we say good-bye. This is critical in patient care and diagnosis. There is so much we miss both verbally and non-verbally when we are not present in the moment.

I have always attempted to be totally present but to be honest my mind is a busy one and it often wonders. The chatter in my head does stop when I am listening or talking with with a patient, it really can do more than one thing at a time. I must also say calm and centered is not my usual modus operandi.

The practice of "leaving it at the gate" is a consious quieting of the mind so that one can be available and present with the beings and job in front of you. This type of practice has always been a challange for me. You see, I am a multi-tasker and my mind is very chatty.

For these very special patients we would be working with, I decided I would "leave it at the gate" and do my best to be totally present for them. Well, to be honest these imposing beings demand it. The patients of the Medicine and Horsemanship class weigh at least 1,0000 pounds. These horses, like humans, can be very unpredictable and I knew I better be totally present for them and for myself. Their every move, sound and smell captured my full attention.

The practice of "leaving it at the gate" being present and calm created a strong feeling of connection with the horse. For me it was a feeling of oneness, it felt wonderful. This new practice and skill I now take with me to the children and families I care for.

Thank you, Dr. Kane, Liz, Lucia and M&H classmates


An entry on how I chose that horse, or how we chose each other.

This was the second class of the day. There were 3 horses. And we were each asked to say hi to each horse and choose one that you wanted to work with.

There was this broad male horse that was young, active, dominant, healthy and energetic.
There was this other horse, a submissive tender female horse that seemed really nice and gentle.

Then there was this smaller horse, off by itself, really restless, seemingly bored and anxious at the same time, hooving at the gate as if waiting to get out of the ring.
He immediately reminded me of myself. I too was hyperactive, comfortable to be doing my own thing away from the pack, and at times anxious about the situations. I nicknamed him ADDY, because he seemed quite ADD (attention-deficit disorder), and I chose to work with him.

In retrospect, I think what drew me to him was the fact that he seemed complex. I wanted to figure him out, help him out by easing his anxieties. Perhaps its no surprise that the other two medical students also chose him.

Turns out he was an older Ararbian horse, a breed of horse that gets bored easily, is very intelligent, and he was also past his prime so he didn't care much about trying to mate with the female horse who was in heat. Can't say the same about the broad young male horse.

We are drawn to other people who are similar to us. We also tend to see qualities in other people in terms of ourselves- how are they similar and how are they different? As a budding psychiatrist, I think its important to keep these in minds. The one person we know best is ourselves, and understanding ourselves, our personality and traits can help us understand the human mind and how other people are. But at the same time, this can blind us as we think from a subjective perspective, an egocentric one perhaps, that is framed by who we are and who we are not. Something to keep in mind.

How playing with horses for 2 months left a strong impression on me

I would like to echo the special thank you to all the course facilitators.

I joined the course as a way to get off campus and have a relaxing Wednesday afternoon off from medical school, but the course has been much more than that. It has opened my eyes to the possibilities of different treatment modalities, especially in relation to mental health. Equine-assisted therapy is truly a fascinating subject I hope to learn more about and engage in later in my career as a child/adolescent psychiatrist.

Horses have also taught me a lot of social dynamics, the importance of strong leadership, nonverbal communication such as body language, intention and emotional tone of our words. Experts have often said communication is 90% non-verbal, and I believe it. I think the class has made me a much more aware and effective communicator, and even a more strong leader.

Thank you!