3 Foolproof Ways to Build Resilience During the Coronavirus Pandemic: The Three Marks of Existence

3 Foolproof Ways to build resilience

As we move through the Coronavirus pandemic, there is so much uncertainty, so much change, and so much difficulty for many. Especially in healthcare, the level of hardship is unprecedented.  As I coach physicians across North America, I’m struck both by the impact of the pandemic and also by the impact of the difficulty we can have in accepting all the uncertainty and change.

I’ve found myself thinking about something called the three marks of existence. Never heard of these? Well, here goes:

I had the very good fortune to study in a two-year intensive mindfulness meditation teacher training with world renowned leaders Tara Brach and Jack Kornfield. Amongst the myriad things I learned, I heard for the first time about the Buddhist three marks of existence. The three marks tell us that suffering and difficulty occur for all of us, that change is a part of life, and that human beings tend to bring a great deal of ego to everything they experience. I feel foolish that I didn’t understand these previously but I’m very grateful that I do so now. They have provided a very firm foundation for me, as a physician, as a physician coach, as a mother, and as a human being. In this blog, I’d like to unpack these three marks and think about how they can help you build resilience to healthcare and physician burnout, and to the stress of this time.

1. Build Resilience by Understanding that Pain and Suffering are a Part of Life

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The first mark tells us that pain and suffering are part of the lot of all human beings, and probably all living beings. This probably does not come as a surprise. When you consider your life thus far, have you experienced suffering and difficulty? I suspect that you have. With the pandemic, certainly, there is, suffering aplenty. So, you know that difficulty and challenge are a fact of life. But do you still find yourself railing against the difficulties that life presents you? 

Or thinking something like “This really isn’t fair“ or “Why do I have to struggle in this way when others don’t?” or “Why do all these bad things keep happening to me?” Perhaps, with all the comparisons that Facebook and other forms of social media so readily offer us, “Why is their life or marriage or family so perfect when mine is a shambles?” 

When we lose sight of fact that everyone struggles, we can feel singled out by the difficulties we face, with a sense that our problems are greater than other people’s. When we think about the first mark of existence, though, it helps remind us that everyone struggles in one way or another. We just don’t get through this journey of life without hardship. 

Illness, accidents, loss, a toxic boss, difficulties in our kids, or public health crises. Whatever form it comes in, everyone encounters difficulty. When we keep the first mark in mind, we can develop a more flexible perspective about the difficulties that we encounter, and greet them with greater ease.

It’s not that the first mark means that difficulties become easy, but perhaps our experience of them can become somewhat less burdensome.

2. Build Resilience by Understanding that Change is the Only Constant

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The second mark of existence is that everything changes and nothing is permanent. Our bodies, our relationships, and our environment all change. Leaves fall off the trees, our skin ages, seasons pass, time never stands still. Look at how different the neighborhood you grew up in looks today. 

Examples of change abound. But do we accept change gracefully and with ease? Most definitely not! And we’re a bit fussy about it to boot. We want the things we like to stay exactly as they are, and the things we don’t like to transform into something else as soon as possible. But we suffer unnecessarily when we hang on tightly to the ephemeral good things, and uselessly rail against bad ones that are bound to pass. 

I know that I certainly struggle with change. Because of the Coronavirus, my 23-year-old son has been home unexpectedly for this time. It’s been an unbelievable blessing and silver lining to this difficult period. But now that he’s planning to leave for his final semester of college, I find myself distressed, fretting that the time will soon come when he leaves, and wishing that somehow he could stay home longer. 

I can get so caught up in this train of thought that I am more tense in the time I do have with him, almost bracing myself against his inevitable departure. But when I can remind myself that it’s the natural progression of life for a grown child to leave the nest, and that change is the norm and not the exception, I can relax a bit and resist less. And I can lean more into gratitude for the time I do have with him. All of which help me build resilience. 

And with the growing societal awareness of police brutality against Black Americans, we see that change and impermanence can be highly positive, and, in fact, essential.

The second mark can help us gain more comfort with change, large and small.


3. Build Resilience by Seeing that the Mind Revolves Around the Self

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The third mark of existence is a lot to take in so please be sure you’re sitting as you read this next sentence! 

In strict Buddhist terms, it’s that there is no self. That’s right: no self. Now, I’m not going to try to tackle that complex existential concept, but what I want to draw attention to is the idea that we all live with a lot more emphasis on the self than may actually be in our interest. In truth: the universe doesn’t revolve around us, and the narratives we craft about ourselves aren’t always true.

Mindfulness can help us build resilience by becoming more aware of what’s going on inside and around us, in the present moment and with compassion. When we pay close attention, we can get to know our minds and the stories our minds tell us. We can begin to see just how many of our thoughts revolve around “I, me, mine…”:

 I’m not as smart as my peers.” 

“Why did that person say that to me?”

 “My child is a star athlete.” 

I’m not a good enough parent, spouse, friend …”

We begin to recognize that our mind perceives our reality with us at the center. This makes sense, as our minds need a reference point for understanding our world. What’s important, though, is realizing that this lens is not necessarily the most accurate one. When we become too attached to the lens of I, me, mine, we can lose our ability to focus on the wider lens of difficulties others may be experiencing. 

And haven’t you found, when you’re off in your own preoccupations, that you are less present with others? Perhaps more irritable and short tempered?  And we can become preoccupied with small details about our existence. Details that are not truly all that important. For myself, I’m aware of how much better it feels when I step out of my small, preoccupied, self-focused state. On days when I do so, I feel a sense of pride in myself and my actions.

The third mark reminds us, as the saying goes: Don’t sweat the small stuff.

What’s happening to others may be of more consequence than the small matters we often preoccupy ourselves with. 

How do we do so? With practice, we can work to question our beliefs about ourselves, and think more fluidly about who we are. We can learn to approach conflicts from other perspectives. We can move out of a self-focused reality into a wider lens. Most importantly, we can remind ourselves not to take ourselves and our problems quite so seriously!

Resilience Training Equals Flexibility Squared

Paying attention to the three marks can reduce the strife we experience, yet it requires a great deal of flexibility to develop this resilience. And training in the form of practice. Flexibility to loosen the reigns on what we want and expect to happen. Flexibility to roll with the punches life throws us. Flexibility to embrace the lens that others bring to the disagreements we have with them. And with greater flexibility we become more resilient.

Build Resilience Everyday

Did you enjoy today’s blog?

I’ve been fascinated by these themes for some time and have a book coming out on the topic this summer! It’s been a long time in the making and now it’s going to be birthed into the world. It’s a short book and an easy read where I guide people to understand what resilience is, know that we all have it inside of us, and provide many tips and practices to build and foster it in your life. One of the major themes I cover in the book is flexibility. 

With a countdown of just 9 weeks, I look forward to sharing “Everyday Resilience” with you very soon.

4 Keys To EQ and Resilience During COVID

Emotional Intelligence and Resilience During the CoronaVirus Outbreak min

As I coach physicians and healthcare leaders from across North America, I’m noticing that themes are shifting. In March, it was lack of PPE and fear of contagion for themselves and their families. In April, it was concern about when the surge would hit and, for many, the burden and frustrations of having kids at home 24/7. Now, the focus is shifting to grief and sadness for losses, and trepidation about what healthcare and healthcare employment are going to look like moving forward. What these all have in common is the difficult emotions many in healthcare are experiencing right now. Fear, sadness, anger, grief, loneliness, frustration, guilt, and others are all normal aspects of the pandemic experience.

All of these emotions are part of the spectrum of what we can experience in a difficult time like this. Like it or not, emotions are part of what it means to be human. We all have them, yet most of us don’t learn how to manage them. Yet, learning to do so is part of what helps us dealwith uncertainty and change—in other words, resilience in healthcare.

We may have seen anger handled poorly in our families, with parents erupting in late-night arguments when we were supposed to be asleep. We learn that sadness is for a character like Eeyore, unbecoming when we experience more than the tiniest amount. In medical training, physicians learn to push away all emotions as we’re supposed to be strong, all-knowing, and always the captain of the team. And in almost every male physician I’ve coached, it’s become clear that what’s reinforced is not showing any emotion whatsoever. If you do, you’ll be labeled a sissy, or worse.

Our emotions are regulated by several areas in the brain. While the neuroscience of emotions is not yet definitive, we know that the amygdala, hypothalamus, and insula are key regions. These are the same brain regions that fuel our fight/flight/freeze instinct and that helps us appreciate the intensity our emotions can generate! Just like with fight/flight/freeze, emotions like anger, sadness, guilt, and grief lead to a cascade of sympathetic hormones being released leading to an elevated heart rate, facial flushing, and even that sense that our head might explode if the emotion stays too long. But when we engage our prefrontal cortex (PFC,) we can ‘cool down’ our emotions, bringing executive function to bear, engaging the parasympathetic nervous system, and steadying ourselves from the storm.

All of this leaves us struggling in a time like this where such a wide array of emotions can be present. Because we don’t learn how to manage them, we may find our emotions managing us! At times we can even feel like we’re a slave to them. But it doesn’t have to be this way. With emotional intelligence, we can build our mastery and resilience over our emotions, gaining comfort with them.

Resilience and Emotional Intelligence in Healthcare

When we think of emotional intelligence, there are five components: self-awareness, social skills, motivation, empathy, and self-regulation. While all are important and interrelated, the key components are self-awareness and self-regulation. Self-awareness starts with the recognition that an emotion is present, even if we can’t exactly pinpoint what it is. Simply having this awareness engages the PFC and helps us see our experience more clearly. We can then remind ourselves of something like:

Wow, my sympathetic system is active right now! Let me take a moment to calm myself down.”

In a sense, this takes us out of the thick of an emotion and creates just enough space to keep us from being swept away by the intensity. And that’s self-regulation—being able to work with the emotion so that we stay present and grounded. It is definitely easier said than done! Here are four strategies that will help:

Get to Know Your Emotional Weather System

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Just as there are patterns to the weather, we all have patterns to our emotions. There are sunny days when the weather systems of our emotions are in balance and we’re calm and at ease. There are also days when it’s stormy, and we’re bombarded by a variety of emotions. Just 2 weeks ago, I found out that my father died. He was a very bad actor in my life and I hadn’t seen him in 20 years. To say that I experienced a storm of emotions around his death would be an understatement.

But I was able to recognize that a storm of emotions was par for the course. I anticipated having some bumps along the road, which made it that much easier to cope and be gentle with myself when emotions arose.

With the pandemic, for any of us, difficult emotions are to be expected! Understanding our patterns of emotional response and anticipating what reactions are likely to occur during a time like this can help us be more resilient.

Further, our emotions can be likened to clouds in the sky: arising, passing through, and dissipating. With self-awareness, we can become the observer of our emotions, and thus less swayed by them. When we engage our PFC, we can train our minds to stay steady no matter what cloudy emotions pass through.

Learn Your Triggers

A key strategy in resilience and emotional intelligence is beginning to understand what triggers strong emotional reactions in us. This can be a host of things, but for many of us, there are a few common triggers. Top of the list are a sense that someone is not respecting us, that we’re not being listened to, or that our needs are not being taken into account. Another big one is seeing someone else being treated unfairly. For a cardiologist I was coaching recently, the trigger during COVID was feeling disrespected by his administrator when he said he needed better PPE. When he asked her repetitively to provide an N95 mask, he saw her roll her eyes. He immediately felt disrespected and it was such a strong trigger for him that he lost his temper and started yelling with patients and staff overhearing his lapse.

Sadly, that type of reaction is what had landed him in coaching in the first place. We’ve all had the experience of our emotions taking us from 0 to 100 in nanoseconds, and the subsequent sense of being out of control is never a good one. But we don’t want to let this emotional escalation translate to hostile actions in the workplace! I helped this client pay attention to his triggers and pretty rapidly he was able to see them in action. Once he did, he could remind himself that he was being triggered and that reminder alone helped quiet the emotional storm.

Build Resilience by Building Self-Compassion

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How many times have you experienced an emotion and then judged yourself for it? We can be fairly harsh with ourselves with self-questioning such as:

Why am I feeling this? What’s wrong with me?”

Everyone else seems so happy, why on earth am I feeling sad?”

I don’t know why I get so angry with my kids. If I were a good parent, I would be patient all the time.”

It’s challenging enough to experience the emotion in the first place. This pile-on of judgment can then escalate things to the point where we’ve dug ourselves into quite a bleak hole. But where does all this self-judgment get us, anyway? With my father’s death, I could see how judging myself for feeling both angry and sad just made me feel worse for having the emotions I had. And for the hundreds of physicians I’ve coached, I’ve seen that this kind of self-flagellation just makes them feel worse and worse.

It’s important for us to understand that these emotions are coming up for a reason. We can’t control the emotions that arise in stressful situations; we can only control our response. So why respond with more tension, negativity, and judgment?

To build resilience, a different approach is self-compassion. It’s very challenging when strong emotions visit us. Is it possible that applying compassion to ourselves may actually make it easier to manage the experience? For the cardiologist who was triggered by his administrator, part of his initial experience was berating himself for letting her get under his skin. As he became more aware of his triggers, however, he was also able to remind himself that his emotional reactions were a normal experience. As he shed the self-judgment, he found that the emotions passed more rapidly.

Remind Yourself that all Emotions Pass

What an emotion hits, it’s often overwhelming. We’ve all had those moments with sadness, anger, and grief. These can be powerful emotions, and it can feel like we are going to be overwhelmed by them. But in truth, our emotions typically dissipate after a couple of minutes. If we can pause and remind ourselves of this fact, we heighten a sense of safety in being with the emotion. While they can feel so powerful that we wonder if we can survive, if we stay grounded, we can watch our emotions arise, pass through us, and fade away. Just like clouds in the sky.

The irony is that the harder we try to push emotions away, the more they stick around. Thus, the adage: “What you resist will persist!” The more we push challenging emotions away, the more they can dog us, sometimes erupting when we least expect them. The more we accept the emotions that come up, the more quickly they subside. Emotional intelligence involves letting our emotions be, as this is the way they most readily pass through.

The Purposeful Pause for Building Resilience and Emotional Intelligence

When strong emotions take hold, we need tools to remain in the here and now. I’ve written in the past about what’s called a purposeful pause and how it can build healthcare resilience. Here’s a simple protocol for pausing that can help you stay grounded when emotions hit. It goes by the acronym S. T. O. P.:

S: STOP everything you’re doing; hit the pause button and still yourself. Freeze the frame.

T: TAKE three slow, deep breaths. Focus on the sensations of breathing, and feel your body slowing down.

O: OBSERVE yourself and whatever generated your emotional response. Imagine that you’ve stepped out of yourself, and are observing the situation from the stance of a neutral third party. Now, imagine that this observer has full compassion for you and what you’re experiencing. From the vantage point of this compassion is observer, what do you see?

P: PRAISE yourself in any way you can, small or large. Remind yourself of your strengths. Congratulate yourself for choosing to de-escalate this situation. Then think about what your next step should be, now that your mind is clearer.

Next Steps

The key to developing greater emotional intelligence and resilience is self-awareness and self-regulation. This is particularly important in the setting of this pandemic when uncertainty challenges us all to maintain emotional balance.
See if you can get to know your emotional weather patterns and triggers. Remind yourself that all emotions pass. Instead of self-judgment, utilize the S.T.O.P. protocol, and try a strong dose of self-compassion. I suspect you’ll find more calm, steadiness, and ease.

Managing Workplace Conflict (15 minutes)

Managing Workplace Conflict min

Working in healthcare there are so many responsibilities, so many worries, and so many people to take care of. And with times of increased stress, emotions are running high. We can find ourselves in a reactive state and not acting at our best. We can be easily irritated by the people we work with. We can say things we later regret. In this practice we’ll work with this type of difficulty helping you find greater ease within yourself and in how you relate to others.

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Befriending the Body (15 minutes)

Befriending the Body min

In healthcare, we’re in the business of caring for the human body. Yet, as healthcare providers, many of us have learned to tune out our bodies, ignoring areas of discomfort and pangs of hunger.

We tend to power through our days, ignoring whatever physical sensations arise, assuming that our body will cooperate with whatever we ask of it. Yet our body is our natural home and caring for it is vitally important. In this practice we develop more kindness and compassion toward our body, building our ability for self-care.


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Becoming The Observer (9 minutes)

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The human mind is busy producing thousands of thoughts a day. The thoughts themselves are not a problem, it’s more how we relate to them. Many times, a thought takes us on a journey. A journey away from the present. Back to the past, we drift down the stream of remembering, finding ourselves replaying an argument with someone or a conversation where we wish we’d said something different. Or we move into the future, planning our next vacation or what we want to say in an upcoming meeting with our boss. Without realizing it, we’re time traveling, far, far away from the present. Somewhat aimlessly, our mind is flitting about. And often, we’re on autopilot. Not actually living fully in the moment we’re in. Not here in the present.

From the stance of the observer, we can develop a healthy degree of detachment from our thought processes. We may be able to see things much more clearly, and we can then decide how best to respond. We see that we have a choice. We can go on the journey to the past or future, or we can remain focused on what we’re doing, here in the present. Once we develop this habit of becoming the observer, we develop much more autonomy over our experience. It’s this autonomy that helps us become resilient

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