Routine Vs. Ritual

Confession: I have a strong tendency to rebel against structure; structure and order simply are not my default modes of living and working.  Yes, I’ve learned to do work within structure and in a way that is orderly, though that is primarily a way of controlling the chaos.  If you look at my weekends when I’m truly off, about the only things you’ll find on my calendar will be “run” “yoga” and (during the appropriate season) “symphony”.

Someone recently observed that I’m reliable about getting my runs in, about writing, about walking Olivia, about going to yoga, amongst other things, and that demonstrates that I am committed to structure and order.

I, of course, argued against that idea, with my argument founded in how I differentiate routine, which is definitely about order, from ritual in my day-to-day life.  See, a routine is defined by pattern and regimen, and it’s characterized by a certain ordinariness (drudgery even?). Routine is doing the dishes after supper, or putting the recycling can out on Sunday nights. Routine is that weekly meeting that you are obligated to at work.  Routine is fixed and rigid, and I had a moment of joy when I saw that Merriam-Webster defines it as “a boring state… in which things are always done the same way.” Routine, in my mind, is obligation.  It’s the “must do” stuff.  It’s what sometimes gets referred to as adulting, which is an activity I’ve come to realize is completely overrated.

Why do I think of ritual differently, when it has some of the same characteristics in terms of patterns? Ritual’s word root is shared with rite, which has a spiritual or religious overtone. It’s more ceremonial, and rites can be part of a celebration. If you look at those habitual things that I’m reliable about, they are things that bring me joy, that I don’t consider drudgery (okay, there’s that rare run, but generally speaking…). They are activities that leave me feeling better than when I started them, that often challenge me, that are the foundation for (hopefully) making me a better version of myself. While I still tend to treat them as obligations, they aren’t the obligations that I see on my calendar and start secretly hoping that they’ll be cancelled.  Yes, there is structure around running on Saturday mornings at 7 with my running tribe, but there’s no question that it’s a challenge that I love. There’s structure around hurrying home after my run for a quick shower and snack before Restore Yoga, but there’s no question that I always leave yoga feeling better than when I got there. There’s structure around walking Olivia every single morning when we get up, but there’s such shared joy in our outdoors time together that I would be foolish to not be part of it.

I suppose the challenge becomes in trying to turn some of those routine things into ritual, which is entirely about changing mindset. Maybe tomorrow I’ll look for some joy in doing dishes…



I’ve been posting them for about a month now, so it’s probably time for me to do some explaining about #SurgPostIts. Where did they come from? What are they? And, for the curious, why?!?

For several years I have had a life-list goal of post-it note “bombing” somewhere in my travels. The idea behind post-it bombing is to plaster a limited area with positive post-it note messages; my intention was to leave inspirational messages in my wake. But where?

Me, hard at work on the Post-Its during our Council meeting.
Me, hard at work on the Post-Its during our Council meeting.

The week before October’s Association of Women Surgeon’s meeting I realized that I had a prime opportunity to post-it bomb the entire MEETING- it’s a relatively small meeting, usually with about 150 in attendance, so it was a manageable idea.   It would mean getting some mini-post-it notes and (legibly) writing messages on them then leaving the all over the conference room. We all know that I love a challenge, even a small one, so the plan was made.


Choose Joy!
Chase Joy!

Saturday morning as the meeting got started, I wandered the room and left post-its at each place that was set. None of them were anything that I thought was a huge deal on their own, but what struck me the most was the number of people who told me later (when they figured the whole thing out) that the message I randomly left in their place was exactly what they needed in that moment. A resident who promptly attached it to her phone picked up this note. I was grateful that she “got it” because I do remember how hard it can be to remember your joy when you’re in the challenges of training.

You can do hard things
You can do hard things

This note was apparently perfectly timed for an attending surgeon who just moved across the country and is settling into a new academic position. I was flattered when she Tweeted that it would be the first thing to go up in her new office- and knowing her as I do, she can (and will) do hard things, and will do them gracefully.

Based upon the reactions to the post-its on that day, I started a year-long project on Twitter with #SurgPostIts. Every morning at 7 am I post a positive message (confession: yes, I am scheduling them so I don’t mess up). On Saturdays I assign “#homework” as part of the #SurgPostIts project to help keep us all grounded in the craziness of our lives. And at the behest of a good friend who is an anesthesiologist, I have now started to include the hashtag #ORPostIts. Joy shouldn’t be confined to one group, right?

I hope you’ll enjoy the #SurgPostIts, and that they will serve you on a day when you need it the most. It’s my small part in helping us all remember that we have everything we need- we just need to remember to access it.




Looking for joy

Days like today, when I’m a little tired and a little disappointed in my morning run and a little at-loose-ends, are the days when I’m circumspect enough to think about happiness.  Don’t get me wrong- my life is a pretty amazing place and I am definitely in general filled with gratitude for almost all aspects of it (in other words, I’m not in that place where you are asking friends to share their favorite cat video to cheer you up).  I simply sometimes find myself wondering if I can do a bit better with the whole “being joyful” thing, consistent with my ongoing wondering if I can do a bit better with…well, everything.

I started with this list from Jeff Haden, who is an “influencer” on LinkedIn, and someone whom I often find provides high-value content.  From this list, the only one I probably should do a bit more is spending time doing things that I excel at- though there is a devil on my shoulder asking if this can be a recipe for boredom at a certain point.  I admit it- I like taking on new challenges, and I do derive pleasure from succeeding at something that is not easy for me (see: running half marathons).  Maybe moderation on both sides of that particular equation is best.

If you are familiar with the work of behavioral economist Dan Ariely, this interview with him really resonated with me.  His response to the question about the thing that consistently gets in the way of his happiness?  Oh, my, do I know that one.  I’m spending more time these days before I agree to do something thinking about, “Will I spend the night before this is due/ this happens stressed out and regretting saying yes?”  If the answer is that I likely will, then my answer is no.  Graciously, of course.

And, of course, Gretchen Rubin‘s observation about, “Unhappy people don’t have fewer happy experiences as happy people, they just think about them less.”   I think modern culture and modern life make it so hard for us to be IN a moment and realize that it is pretty spectacular.  Ferris Bueller was wise beyond his years when he said:

Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.

And perhaps miss out on some happiness too.

Happy weekend, friends.  I just got done enjoying an evening walk with Olivia in weather that is better than we deserve for July.  If that’s not a recipe for a bit of joy, I don’t know what is.


‘Tis the season, right?  Besides, we know that gratitude is a key way to mitigate burnout and improve job satisfaction.  There’s also a clear link between joy and gratitude.:

I do have an ongoing gratitude practice.  Sometimes I manage to write down two or three things at the end of the day, sometimes I’ll pause in the midst of a stressful moment and find something I’m thankful for about in spite of the present events, sometimes I just make sure to think of a thing or two as a crawl- completely exhausted- into bed (that was last night).  A couple of years ago I started the week-ending practice of “TGI” every week on my personal blog, which stands for Trust- Gratitude- Inspiration.  When times are tough it’s always good to back up and focus on those things.  Please note that I referred to it as a “practice”, much like I refer to my yoga time- I will never have a gratitude recital or a yoga recital (thank heavens!), but they are things I immerse myself in and strive to make part of my routine because I know that they make me feel good.

So, where am I finding gratitude as we come to the end of 2014?

  • I’m grateful for friends, family, and colleagues, who support me in my endeavors…even when they are convinced that I’m pursuing my craziest idea yet.
  • I’m grateful that I had the opportunity to unplug for two weeks this summer with my trip to the Yukon, BC, and Alaska.  It turns out things ran just fine without me.  It also turns out that I’ve been reminded of my love for the outdoors and wilderness, so there will be more of that on a routine basis.
  • I’m grateful for the teams that we’ve built for the varied aspects of my professional life.  I have a burn team, a research team, and an education team here at Utah, all of whom are amazing and wonderful.  I consider myself fortunate to be a part of their communities.
  • I’m grateful for social media and the connections it has brought for me professionally and personally.  Personal learning networks can be digital, and my digital one never ceases to amaze me.
  • I’m grateful for this collection of rescue animals who fill my home with their spirit and their affection.  Olivia is at my feet and made me write that.
  • I’m grateful for those of you who haven’t just stuck with the blog this year, but have actively encouraged it.  I’m also grateful for those who have commented- either publicly or privately- on the many issues I’ve raised about our profession and our lives.  My goal when I started writing was to normalize all of our experiences, and it seems I’m doing that (sometimes better than I hope).

With that, I’m headed out to dinner with my Mom- whom I am grateful to have here from South Texas keeping my house running while I’m on service- before the next admission arrives.

“For it is not joy that makes us grateful, but gratitude that makes us joyful.” – David Steindl-Rast