How to be grateful when you are not a grateful person [PODCAST]

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Gratitude is easy to preach and hard to feel on a bad day. One physician spent a 40-year career learning to practice it on purpose. Scott Abramson is a neurologist and author. This episode is based on his article “A physician’s three lessons on gratitude in medicine,” published on KevinMD. You will hear the patient in a wheelchair who pointed out that his shoes never wear out, the colleague who still savors every sip of a Coca-Cola because he got one cup a year as a boy in Ghana, and what Paul McCartney’s approach to singing Yesterday has to do with explaining the same diagnosis for the thousandth time. You will also hear the tool he calls the positive power of negative thinking, the index card he kept on his office computer, and the sentence his parents’ generation repeated about shoes and feet. Press play for three stories that make gratitude feel less like advice and more like something you can practice on your next bad day.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Scott Abramson. He’s a neurologist and author. Today’s KevinMD article is “A physician’s three lessons on gratitude in medicine.” Scott, welcome back to the show.

Scott Abramson: Thank you, Kevin. It’s great to be back. Thank you for having me.

Kevin Pho: All right. Before talking about this particular article itself, just tell us why you decided to write it in the first place.

Scott Abramson: Well, Kevin, in my 40-year career at Kaiser, I gradually learned that I was seeing so many people who, under the most challenging circumstances, under the most horrific diseases, sometimes kept such an upbeat and positive attitude. And I realized in getting to know them better that that positive attitude, in spite of all the circumstances, was based in gratitude.

It’s such a beautiful concept, gratitude. And honestly, it didn’t come easy for me. I am not naturally a grateful person. I’m kind of a bitch-and-moan person. I’m kind of a “Why me, Lord? Why did this happen to me? My car window got stuck” kind of person. So when I’d see these people, it was just amazing to me to see how they handled these difficulties in their lives, and the tool that they had, at the bottom of this, was gratitude.

Kevin Pho: Now, what would be some examples of that? We talk a lot on this podcast about the many obstacles physicians face, and like you said, there are a lot of reasons why physicians should complain. But during your career at Kaiser, you’ve met so many physicians who did the opposite and were more upbeat and positive. So what exactly did that look like?

Scott Abramson: Well, here’s an example that I didn’t write about in the article, because there are so many. I had this patient, a guy in his early thirties. He was a pipe fitter for PG&E and had a good job, but he had MS, and it was a bad MS, and he went downhill over a couple of years. He became disabled. He became confined to a wheelchair. His wife had to go back to work, and she’d come home after commuting two hours and working eight hours a day as a cashier at Safeway, and she sometimes would get so frustrated she’d take out her frustrations on him. I mean, he tried to contribute. He tried to do some ironing or some dishwashing to help out, but even so, he had three teenage sons, and they started looking at him not as a father but as a family burden.

I remember he came in to see me one day, and in spite of everything, he still had this kind of upbeat attitude. I know he was kind of using dark humor, but he said, “You know, doc, the one good thing about being in a wheelchair is that your shoes don’t wear out.” And when he said that, I started thinking to myself, wow, how many of us, including myself, go around every day and are not grateful that our shoes do wear out, that we can walk, that we can jog, we can play golf, we can play pickleball? That’s the kind of thing I would hear over and over again that showed me the power of gratitude.

Kevin Pho: So we’re not talking about just the staff and physicians at Kaiser, but of course a lot of the patients as well. And that really just opened your eyes to a different perspective. No matter how bad our lives as physicians are, sometimes walking in the shoes of our patients is infinitely more difficult. It really just grounds you, right?

Scott Abramson: It does. And I think that for me, and for a lot of people, the challenge is how we get to that place of gratitude, that place where, however bad our day is, we can think, “Wow, I am so grateful to still be here, to be able to get up in the morning, to be able to walk with my white coat on”? And like I said, gratitude did not come naturally to me. So one of the tools I use to do this is what I call the positive power of negative thinking. Can I demonstrate this with you?

Kevin Pho: Absolutely. Sure.

Scott Abramson: OK. Let me ask you to close your eyes.

Kevin Pho: My eyes are closed.

Scott Abramson: OK. Now, for the next ten seconds, I want you to think silently. It’s about 11:30 in New Hampshire. It’s 8:30 where I am. Think about all the bad things that could have happened to you from the time that you woke up this morning until right now. Just think, throw out a few things that could have happened to you.

Kevin Pho: So I went to the gym. There could have been something with the drive. Setting up for these podcasts, there could have been something wrong with the internet in preparation, which sometimes happens. Or if a guest goes long and the next guest is waiting. These are all small things that could have gone wrong this morning but thankfully didn’t, right?

Scott Abramson: Right. So open your eyes now, and guess what? You drove to the gym, and guess what? You didn’t have a flat tire. You didn’t have a wreck. You didn’t have to take your car to the shop. You didn’t injure anybody. Your people showed up on time. The internet worked. Wow. None of that stuff went wrong. Isn’t that great? Isn’t that something to be grateful about? Are you feeling better now?

Kevin Pho: I felt pretty good before, but yes, I do feel better compared to what I was.

Scott Abramson: Yes, that’s right. Hallelujah. Because that’s the power of gratitude. All those bad things didn’t happen. So like I say, that is the positive power of negative thinking. And the expert on that, who has taught me this, is that great philosopher Woody Allen. Woody Allen says life is divided between the horrible and the miserable. He says the horrible are things like starvation in Africa, or children born with birth defects, or this tsunami in Nepal. He says that’s the horrible, and everything else in life is miserable. So every day you should be grateful that you’re miserable. That’s the positive power of negative thinking, and if you have that mindset, you’re going to be a lot happier.

Kevin Pho: When did you start to incorporate that mindset? I know that you had a 40-year career as a neurologist. Did you incorporate that mindset during difficult days as a physician?

Scott Abramson: Yes, I tried to. Like I said, it didn’t come naturally. So what I would do, Kevin, is on my desk computer in my office, which I had to go to every time a patient came in, I would have a little card that sat on that computer. This card said, “I am so grateful I don’t have a toothache today,” because I’ve had a lot of toothaches in my life. I had a lot of dental work, and implants, and crowns, and all that stuff. When that happens, it’s a terrible day. No matter how bad my day was going, I’d go to my computer, I’d sign in, and I’d see this sign and say, “Man, this is great. I don’t have a toothache today. I don’t have to be in pain and think that every bite I take is going to be a painful bite.” So that’s the positive power of negative thinking, and I would try to use that as my pathway to gratitude and to happiness.

Kevin Pho: So give us some examples that you could share with other physicians. It goes without saying there are a lot of physicians who are miserable today, and it’s just becoming more miserable. I see it every time on those physician boards, right? So maybe give us a case scenario of a sample physician that you would talk to, to instill some of that gratitude.

Scott Abramson: Well, this is something I wouldn’t necessarily talk to them about, but actually somebody talked to me about this. I have a colleague who went to see a Paul McCartney concert, and he came back and said, “I don’t understand it. When McCartney sang ‘Yesterday,’ it was so new and fresh and tender. I can’t understand how he has sung this song a gazillion times. How does he keep it so new and fresh and tender each time he sings it? It felt like he was singing to me personally.”

Later on, I read an interview that Paul McCartney gave to Rolling Stone, and he said, “Before every concert I look out at the audience, and I say to myself, I am so grateful these people have come to hear my song.” If you transpose that to us in clinical practice, look, we give concerts every day as physicians. We give concerts about irritable bowel syndrome, or smoking cessation, or why antibiotics don’t work for viruses. We give those concerts every day, and it kind of wears us out. We’re bored saying the same thing over and over again. We don’t really appreciate what we’re doing. But if we had the attitude that Paul McCartney had, that these people are coming to us for healing, they’re coming to us to hear our song, then when we give that song again and again, we can make it fresh and new and tender, because we are grateful for the people who come to us for our healing and to hear our song.

Kevin Pho: You shared a couple of stories in your article from colleagues who grew up in Ghana, and another story that you shared from a student nurse. I love these stories when I read your article. So maybe share with our audience and give a glimpse of these small slices of gratitude.

Scott Abramson: All right. Well, good. I love that story too, about Douglass. He’s one of our hospital physicians. He’s from a small little village in Ghana, where he grew up. Very poor. He said the one thing he looked forward to every year happened at Christmastime, because every Christmas, young Douglass would get a Coca-Cola. And it wasn’t even a full cup. It was like a quarter cup of Coca-Cola. Nowadays, of course, he can have a Coca-Cola whenever he wants to. But he says, “I’ll always remember those days growing up in that poor African village, and I’ll always remember that gift every Christmas of a Coca-Cola.” And he says, “America is a great place. I appreciate everything I have, and I still savor every sip of every Coca-Cola that I drink.”

Then the question comes again: How many of us savor every sip of our Coca-Colas? And what happened to me shortly after he told me that story was that I was in my office, and my wife brought me my favorite, the pastrami on rye. Fifteen minutes later, I looked around, and the sandwich had gone, and there was no one else in the room, and no one had come in and stolen it. The fact is I ate the sandwich and didn’t even realize I ate it. I didn’t savor every bite of my pastrami on rye. How many of us don’t savor those things, don’t feel gratitude for the things that we have? We take it for granted.

Kevin Pho: I think that’s really key, what you said. A lot of us take it for granted. And hearing these stories, hearing what you have to say, really gives a lot of perspective on some of the perceived troubles that we face every day.

Scott Abramson: Yeah. And sometimes it’s hard. You’re having those bad days, and patients are stacked up, and you’re way behind. You’re not going to get home on time, or the kids are not going to have a bedtime story. It’s tough, and sometimes the key is just the positive power of negative thinking.

Kevin Pho: You said earlier that you always had trouble, when you were younger, seeing that bright side and having that gratitude. How did you change, and how long did it take you to really change your mindset?

Scott Abramson: Well, Kevin, I’m still trying to change. I’m still trying to get to the promised land, let me tell you, because I still have these days where it’s “Why me, Lord? Why did this have to happen to me?” And I’m bitching and moaning with the best of them. But I keep trying. One time, I thought I was having success. I was leaving home for work, and I had driven about 10 minutes, and I realized I forgot my beeper. Boy, 10 minutes to come back and 10 minutes to go back again, that’s important, because the traffic is worse then, and 20 minutes out of your day is terrible if you have a busy schedule. So initially I started cursing. I said, “My God, why am I so stupid? How could I do that?” And then within about 30 seconds I said, “You know what?” Because I drive over the San Mateo Bridge, and this happened right before I got to the San Mateo Bridge. It’s a 12-mile bridge. And I said, “Wow, what if this had happened after I was on the bridge, and I’d have to go back 30 minutes to do this?” So maybe that was a little bit of a success right there, that things were changing.

Every day I keep working on this, Kevin. There are people for whom it’s natural, the default setting of their brain, but for a lot of us it’s not. And like I said, one of the tools I use is the positive power of negative thinking.

Kevin Pho: We’re down to Scott Abramson. He’s a neurologist and author. Today’s KevinMD article is “A physician’s three lessons on gratitude in medicine.” Scott, as always, let’s end with your take-home messages to the KevinMD audience.

Scott Abramson: I don’t know if your parents or grandparents said this homily to you, but when I was growing up, my parents were older and they lived through the Depression. They were very poor. The saying that they and their generation would say over and over again, and I heard this all my life, was “I felt sorry for myself because I had no shoes, and then I met a man who had no feet.” That was the mantra of that generation, and boy, they were the greatest generation. So the take-home message, I think, would be this: The secret of happiness is attitude, and the secret of attitude is gratitude.

Kevin Pho: Scott, wise words. Thank you so much for sharing those stories, your time, and insight. Thanks again for coming back on the show.

Scott Abramson: Thank you so much, Kevin. I appreciate it.

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