improv | Danny van Leeuwen Health Hats - Part 2

Pausing – A Magic Lever of Best Health

By | Advocate, Caregiver, Clinician, Consumer, ePatient, Family man, Leader, Musician | 4 Comments
Yesterday, my wife took me to Boston Improv for my birthday. My daughter-in-law took me out for lunch. This week I found myself spacing out several times at my desk.  I listened to the rhythms of conversation in meetings at work.  Today, I played some blues on my bari sax. What do these scenarios have in common? The pause: A moment’s break to listen, to reflect, to balance.
During improvisation, comedy or music, players need a second or two to listen and feel the groove while contributing. Otherwise it’s cacophony. The pause, not blowing the horn, not talking, is integral to the rhythm. You could say that the rhythm is the space between the sounds. When work piles up with e-mails, reports, and to-dos, we need desk time with a few minutes to reflect on the purpose and quality of our work. Otherwise it’s disconnected and exhausting. The pause, however brief, settles the mind, allowing it to breathe. During conversation we need a few seconds to digest the message we hear before jumping back in. Active listening requires time for the person to complete their thought.  Often I jump right in, rushing to contribute as soon as the sound from the speaker’s lips stops. Getting my sound in before someone else jumps in. Lord, that’s a tough one. During the chat with my daughter-in-law, we spoke about a different kind of pause: pace of life and balance – allowing the space for music, exercise, family, health appointments.  It’s a challenge for working parents and someone with a chronic illness, or both, or neither for that matter.
Honor the pause. It’s integral to best health.

Doing Less Better

By | Caregiver, Consumer, ePatient, Leader, Musician | 2 Comments

Getting better –  Few magic wands or silver bullets. A couple of steps forward, one back at best. It’s challenging to select when to move forward and when to wait. Does inching forward on many fronts get you better faster than moving a foot on fewer fronts? Does doing less better make sense? I play in a big band learning many charts that stretch my reading skills and dexterity.  I also play in a student combo stretching my music theory and improvisation skills. I can squeak out 1 to 3 hours practice time a week. Not enough, I think, to really improve at anything. I feel so stretched I’ve stopped taking lessons. So I’m getting better too slowly for my satisfaction. On the other hand when Pablo Casals, maybe the best cellist ever, interviewed at 92 years old, he said he couldn’t talk more because he had to go practice. “Practice?” the interviewer said, “but you’re the best ever.” Casals quipped, “I’ve almost gotten it right.”  I decided to stop playing in the big band and focus on the combo.  I’d rather learn more music theory and improvise better. I’ll also resume the lessons. I only have so much gas in my tank. The stress of feeling overwhelmed – too many fronts – consumes fuel. Maybe doing less better with less stress burns less fuel.

Doing less better also has relevance for a team. At work we have many projects inching forward but we’re less than satisfied with the progress on any one of them. The team needs and wants to improve on many fronts, but wants to resolve most of them yesterday. Stress results. It’s more satisfying for the team to reach and celebrate milestones than sense that the foundation is rising by inches. Once again would the team’s health improve more if we do less better? We’ll see.

Mistakes – Finding your Groove Again

By | Clinician, ePatient, Family man, Musician | No Comments
We make lots of mistakes improvising while playing music in my jazz combo – wrong notes, lose our place, no feel for the rhythm. No mistakes never happens. The music is good when the group communicates, recovers and finds the groove again. There is never no mistakes on the health journey.  Mistakes range from missed doses, added pounds, underwhelming exercise, and falls to unhappiness, crabbiness, and misjudged  function. Something hopeful doesn’t work, something makes you sicker.  It’s the human condition – mistakes. Expecting no mistakes is unreasonable. (I’m not talking about never events – wrong sided surgery, neglect, hubris, disrespect). Health can improve when mistakes are recognized and communicated. Lessons can be learned, something else tried.  We find the groove again.

Comedy Improv and the Health Journey

By | Caregiver, Clinician, Consumer, ePatient | 3 Comments
I’ve written before about music improv and the health journey.  Today I’m inspired by Tina Fey.  She says:

The first rule of improvisation is AGREE. Always agree and SAY YES. When you’re improvising, this means you are required to agree with whatever your partner has created. For the health journey this means accept what is as soon as you can. “This sucks, why me” is real and necessary, but agree/accept allows you to move on and deal with it.
The second rule of improvisation is not only to say yes, but YES, AND. You are supposed to agree and then add something of your own. For the health journey this means take charge. Wherever you’re at, build a team, seek information, get help.

The next rule is MAKE STATEMENTS. This is a positive way of saying “Don’t ask questions all the time.” If we’re in a scene and I say, “Who are you? Where are we? What are we doing here? What’s in that box?” I’m putting pressure on you to come up with all the answers.In other words: Whatever the problem, be part of the solution. Don’t just sit around raising questions and pointing out obstacles. This means try stuff.  Follow the advice of your team or don’t – follow your nose.  But try stuff to feel better.

THERE ARE NO MISTAKES, only opportunities. For the health It’s all an experiment.  Professionals give advice from the knowledge they have about populations – groups of people.  You are one person. You are the expert about yourself. If whatever you do works-congratulations.  Write it down. When x happens and I do y, I feel better. If it doesn’t work, write that down too and try something else.  If your working on one thing and it doesn’t get better, try something else.  
If you’re tired of trying,  listen to Robin Williams, Mel Brooks, Jonathan Winters, Tina Fey or whoever makes you laugh. Share who makes you laugh.
Have a good week.

Sounding like yourself

By | Caregiver, Consumer, ePatient, Musician | No Comments
Two musical events for me yesterday: my combo rehearsal and Victor Wooten, Steve Bailey, JD Blair, and Derico Watson at Berklee School of Music. The latter, 2 virtuoso bass players and 2 amazing percussionists, demonstrated energy, experimentation, creative inclusion of the audience, and remarkable unspoken communication among themselves. My combo – not so much. Some of us have played together for 2 years – rank amateurs. Yesterday, a new drummer joined us: we are piano, bass, trombone, and Bari sax. We all listened to each other, but none of us  quite followed the tunes’ form, so there were  conflicting cues, frustration, and much verbal communication. We kept at it, and actually improved some over the 90 minutes. My sax teacher has me working on the basics: chords and scales. Don’t worry about the improv, it will come. I do angst about the improv, constantly criticizing myself.  I hate it when people criticize themselves. I left the Berklee concert, thinking that these musicians sound like no one else and they are unafraid. I certainly sound like no one else.

What do I extract from these experiences for the health team’s journey? 1. Listening isn’t enough, there needs to be a solid frame and 2. Sounding like yourself is good enough. The frame for a health journey comes from the person at the center of care. If listening to each other still feels confusing or disjointed, revert to listening only to the person at the center. Every health journey is unique-some polished, some not. The choices we make work out or don’t. Harping on being right or being good doesn’t help us move forward.

Listen to the music

By | Caregiver, Clinician, Consumer, ePatient, Musician | No Comments

Yesterday I played in a recital with my jazz combo-dedicated amateurs. Musically we have greatly improved.  The devil is in the arranging. Who plays when and where, in what order. Trying to get it right one player sent an email to everyone with the arrangements. We rehearsed one last time in the morning, making a few changes. He sent the revised arrangements out just before the gig.  I printed and didn’t review. One tune was a complete disaster.  The changes were not what we agreed to, I was the only one that printed the changes.  I noticed the discrepancy in the middle of the tune and chose to play as written, not as I remembered what we agreed to. I messed everyone up, the tune fell apart. Disappointment, irritability.

Alignment is tough in music and in health.  Everyone’s talent, passion, and goodwill goes up in smoke when the alignment / arrangement isn’t there. How do we align in health care?  The person at the center and their team knows and agrees on the goals and the action steps. They communicate the inevitable adjustments as they occur. A small tight group that plans is no guarantee that the alignment will hold. Sort of surprising that we expect it to be smooth or flawless. Sometimes if we listen well and hear the mismatch we can adjust and realign and sometimes we can’t. Listening. Anyway, three out of four tunes sounded great. I guess that’s not too bad. But it’s not my health.

Authority and confidence does NOT equal right

By | Caregiver, Consumer, Leader, Musician | No Comments

I play saxophone in a combo – I’m the only horn. I come in with the melody – after we’ve improvised – with authority and confidence. My teacher tells me, “come in strong whether or not you’re right. The band will adjust. Better than hesitating and coming in weak.”

I thought about this when I was in a meeting the other day with a labor lawyer and benefits consultant. They both sounded authoritative and confident – and had opposite opinions. I spent as much time watching the strength of their presentation as thinking about whether their advice was right for the agency.

I recall that my 17-year-old cousin recently expounded about the biology of memory with authority and confidence: “You sure speak with authority and confidence,” I noted. “Sure,” he said with a proud smile, “I’m on the debate team!”

Authority and confidence and being right – not necessarily connected.

As a nurse I watch the expression of authority and confidence often from professionals and see how it affects people at the center of care and their caregivers. It’s hard to separate strength from right. One of the reasons I’ve chosen my doctors is that they can sound authoritative and confident, but they engage me in the question of what’s right for me.

A wise person once advised me, “when someone speaks to you with force, either positive or negative, imagine blue smoke coming from their mouth. Let the blue smoke pass you by before you consider the words generating that smoke.” 🙂

Walking and Chewing Gum at the Same Time

By | Consumer, ePatient, Family man, Leader, Musician | 2 Comments
As LBJ said about Gerald Ford, I can’t walk and chew gum at the same time. Yesterday, while rehearsing and improvising on the baritone saxophone, I reflected on my continued difficulty keeping my place in the tune while improvising. Either I listen and keep my place or I improvise, get lost, and lose my place – so frustrating. It feels like multitasking and I’m notoriously bad at multitasking.   I notice that some others in the combo, don’t lose their place, but they lose the groove. I seldom lose the groove – it’s in my bones – I lose my place. H’m, feeling the groove doesn’t feel like multitasking to me, but does to someone else. Maybe if I play much less while improvising and focus on the chord changes and the structure of the tune I would be less likely to lose my place.

As a catalyst for change at work, my challenge is to listen, feel the rhythm of the work flow and be a catalyst.  The more active and frenetic I become as a catalyst, the less I listen. Not so different from improvising. Listen more, feel the groove, do less.
How about as a patient? Listening to my body, understanding the machinations of the world around me, and picking one or two routines or habits at a time to work on. Listen more, feel the groove, do less. Might work.

First, I Listen – Improv

By | Consumer, Musician | 3 Comments
As I wrote a few weeks ago, First, we listen, is the tag line of Advocates, Inc., my current employer. The power of listening continues to move me in my work and my music. I’m finding it relatively easy to listen 50% of the time, 75% is a serious challenge.  My energy comes out of my mouth – somehow, mouth open closes my ears – must be a check valve. It’s not just opening my ears, it’s pausing my mind. What’s helped is my music. Working on improvisation, I often lose my place in the tune. I’ve been trying to listen to the rhythm and chord changes and play fewer notes. Play a few notes, pause, hear and feel the rhythm and chord structure, play a few more notes. Focus on the space between beats and notes. Play simply. It’s technically easier and makes more sense and I get lost less often. Hmmmm. At work and playing with the combo I get more nods. Nods are good. Some people are master listeners – my wife, my 2-year old grandson, my primary care doc, and Miles Davis. Is listening a magic lever of best health?

Improvisation, rhythm, repetition, and caregiving

By | Caregiver, ePatient | No Comments
I’m learning more about improvisation in my musical life – jazz improvisation. In my early days I had thought that the improviser just let loose playing whatever came through his fingers with the rhythm section in the background. Creating music on the fly. I’m learning – not so much. The structure of the tune – melody, chords, rhythm – provide the framework. Then the improviser draws on a library of note patterns aligned with the chord structure that she has repeatedly played into muscle memory. This library provides the material of improvisation. Much structure, much practice leading to better improvisation. Some minutes I think I’m a better improviser, most hours I think not.

In my health journey improvisation helps me understand the importance of melody, rhythm and repetition – structure, muscle memory, habits in care. The melody is the state of the person receiving care, with the rhythm being the daily pattern of care (activities of daily living). The more challenging the care, the more severe the disability, the more importance the melody, rhythm, and repetition. It seems that even with the most severe disability, caregivers can more easily manage and improvise if the pattern, repetition, and muscle memory is there. It’s when the melody and the rhythm frequently change, when the unexpected constantly occurs, that playing and improvisation becomes too draining and almost impossible in the best of circumstances.
Can we help the helpers better cope and improvise if we explicitly clarify and simulate the underlying melody and rhythm?