Bravery is leading a life of purpose undaunted by adversity

September 29, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Bravery doesn’t require you to run into a burning building or risk your life. Being brave is much simpler than that. Bravery is leading a life of purpose undaunted by adversity. You don’t have to have superpowers to be brave, you just have to be you.

Bravery starts with an awareness of our thoughts, emotions, and feelings. Another word for this is mindfulness; however, true mindfulness is not just awareness; it is the ability to be the unaffected observer of one’s mind. For example, let’s say someone cuts you off on the road and you get startled. Worse, you get irritable. Mindfulness is the ability to experience one’s mind like someone watching clouds passing over the sky. Emotions, thoughts, and feelings come and go, but compared to the heavens (the true mind) they are insignificant.

Practicing mindfulness grounds us. It helps us make healthy diet choices and get on the exercise bike. Mindfulness makes us put down the video game controller and not binge on Netflix. It makes us call an old friend and check on a neighbor. In short, mindfulness makes us do what is hard and right rather than what is easy and average. It gives us the ability to mentalize with others (to see the world through their eyes), and become more compassionate and less selfish in the process.

Because the mindful person is driven by compassion and the benefit of others, their every action is done with integrity and purpose. Because they act with purpose, they lead from the front and rally others to their good example. Because they are unafraid of failure, they are undaunted by adversity. Mindfulness is the superpower of the brave and every one of us has it.

Karma and Acceptance

September 27, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Karma is the Buddhist law of cause and effect. Tied into karma is the concept of reincarnation, where one is born again-and-again in different forms and across different realms as a result of past actions. Nifty.

In Buddhism, the goal is to break the cycle of rebirth and be free of suffering. This is the Hinayana path also called the “lesser vehicle” because it is meant to carry the practitioner alone to enlightenment. In Mahayana Buddhism, or the “great vehicle” the practitioner postpones their own enlightenment to ferry other beings to enlightenment, hence “greater.” The goal (if it can be called that) of the Mahayana (and Vajrayana) practitioner is to become a Bodhisattva–a Buddha-like being who vows to remain in samsara (the cycle of rebirth) until all beings are freed. Intense.

For those of us who believe in karma it can be a two-edged sword. When things are going well, karma is great (those past beneficial actions are coming to fruition), but when bad things happen, we think, “Ugh, why can’t I catch a break!”

The truth is many of you (like me) are not enlightened nor are we fully-realized Bodhisattvas. Our karma is good enough to be born human in a time and place where a Buddha existed, and we have the intellect and leisure to practice the Dharma (a pretty profound set of circumstances when you contemplate it). Yet, even with all the many things we should be grateful for, we get upset when things don’t go our way.

Breath. Accept it.

Next time something bad happens: a relationship goes sour, a financial opportunity disappears, a job is lost, an illness occurs, or any hope and prayer is not answered, transform it into the path. Remind yourself that negative events are the result of past karma and renounce future negative actions. Reflect on how most beings, in their ignorance, repeat negative actions over and over again without any conception of the results. Generate compassion for these beings, and immediately vow to act positively for them and ourselves.

If one practices in this way, the path of the Bodhisattva is in reach.

Free Maria Kolesnikova!

September 27, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

It’s been a sad year for democracy. 2020 marked the end of democracy of Hong Kong where China’s communist government now rules. Around the world, democracies are being undermined from within. In Turkey, Poland, and Hungary, authoritarian policies are creating one party states. Even in the U.S., the institutions that ensure a government “by the people, for the people” are being threatened by short-sighted, arrogant leaders, who care more for their positions than their oaths of office.

On August 9th, the people of Belarus voted for a new president. Amid widespread claims of real voter fraud, Alexander Lukashenko, often referred to a “Europe’s last dictator,” claimed victory amid widespread protests.

One of the protestor organizers was Maria Kolesnikova. Kolesnikova, a conductor, flautist, and teacher, became a political activist after a friend, Viktor Babaryko, attempted to run against Alexander Lukashenko and was jailed and barred from running. She would later join activists Veronika Tsepkalo and Svetlana Tikhanovskaya in a group that would form the primary opposition to Alexander Lukashenko’s authoritarian claim to power.

On September 7th 2020, Ms. Kolesnikova was abducted and brought to the Ukrainian border where it is reported that she tore up her own passport to prevent deportation. Since then, she has been jailed and charged with incitement to undermine national security.

Today, Alexander Lukashenko has maintained his grip on power despite massive demonstrations and a violent crackdown. Let us stand with Maria Kolesnikova, the people of Belarus, and all democracy activists against tyrants, thugs, and authoritarian strongmen like the coward Alexander Lukashenko.

Remembering Adeline Fagan M.D. and Other Courageous Healers Lost to COVID-19

September 26, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Match Day is a magical day for a medical school graduate. That’s the day a graduate finds out where they will go for residency, which is post-graduate training for medical doctors. The process involves applications, interviews, and a whole lot of angst.

On March 21st 2014, I found out I matched into my #1 choice for residency at the University of Hawaii (aka Hawaii Residency Programs). After four years of studying, and two difficult STEP exams, I was elated. I felt like my life as a healer was just beginning, and I was excited for the challenges and opportunities to come.

Six years later, I have graduated residency and serve as a psychiatrist in the Army and Veteran’s Administration. The work I do brings me great fulfillment, and I strive to improve the lives of everyone under my care.

When I first read about the death of Adeline Fagan M.D., I thought about what a tremendous loss it was for her community and for all of medicine. The love and work she put in to become a OBGYN resident was profound, and her journey was cut short before she could experience the full benefit of her sacrifice and service.

And yet, as a physician myself, I can’t imagine Adeline Fagan M.D. choosing a different life. Despite her short career, I know she touched the lives of her patients for the better. Her life, and her legacy, will go on through her patients, her fellow residents, and all medical providers.

Let us take a moment of silence to honor the lives of Dr. Fagan and all those healthcare workers who’ve died from COVID-19. May their courage give us strength to work hard for the benefit of others lest their sacrifice never be forgotten.

Above: Opening the Match Letter
Below: Match Day 2014 UB Graduating Class

Hate Has No Home in Medicine

September 26, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

I recently read an article on Medscape Psychiatry about a medicine resident who was permanently barred from from the practice of medicine for Anti-Semitic Tweets.

The statements posted were deeply disturbing. How anyone could aspire to be a physician and have an intention to inflict harm on a patient is impossible to imagine. As a physician myself, I care deeply for my patients. I want everyone under my care to reach the highest levels of personal health and wellbeing. Their diversity teaches me how to be a better healer, and I honor and respect them as I would a member of my own family.

There is no room for hate in medicine. Trust is the cornerstone of the doctor-patient relationship. This is true in medicine and in psychiatry where patients have suffered traumas or experienced the stigma of their illness.

We are not born with hate. Hate is taught, nurtured, and perpetuated. All physicians should equivocally condemn hate in all forms. Our moral character, ethical standards, and integrity should never be in doubt. The covenant of “do no harm” binds us all as healers. Let us never forget our oath.

Persons of Integrity

September 25, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

C.S. Lewis is one of my favorite writers. He is also the author of one of my favorite quotes about integrity…

“Integrity is doing the right thing even when no one is watching.”

I think there are still persons of integrity in the world; those fearless beings who are willing to sacrifice everything for a just end; individuals who are not corrupted by hypocrisy and greed. All of us should aspire to be persons of integrity; and, for those we elevate as leaders, integrity must be unwavering and demanded above all else.

It is a truly degenerate time when leaders can display blatant hypocrisy and breaches of integrity and are voted back into office again and again. Whatever one’s position, whatever one’s beliefs, the ends cannot justify the means. If you perform an operation with a dirty instrument it infects and kills the host. In just the same way, the corrupt leader, bereft of integrity, infects and destroys their community, their state, and their nation.

C.S. Lewis is right, integrity is what we do when no one else is watching, but it is also what we do when everyone else is watching. If you must be pro anything be pro integrity.

Decreasing Impulsivity

September 20, 2020February 11, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

Impulsivity is the cause of so many of our woes. It causes us to eat junk food, to binge watch television, or become hopelessly lost in the latest video game. Acting on our impulsive desires may bring a temporary sense of fulfillment, but it never leads to the lasting satisfaction we seek.

In fact, impulsivity leads to suffering. The accumulation of impulsive acts over time leads to financial instability, disease, accidents, and other negative outcomes. Desire begets desire, and we become slaves to its whims.

Through mind training, humans have the power to decrease impulsivity and increase activities that can bring lasting contentment. Key to any mind training is mindfulness–an awareness of thoughts, emotions, and feelings.

Mindfulness is a tool to tame the mind; however, any tool is only as useful as the master who wields it. Therefore, all of us should reflect on three very important questions. Who am I? What do I want? Where am I going?

Reflecting on these questions will help cultivate long-term goals. Our impulsive actions rarely lead to growth, so bringing our minds back, again-and-again, to our long-term goals, buffers us against the momentary fancies of the mind.

As with any meditation practice, the goal is not perfection. The mind will wander. Bring it back, over-and-over again to the object of focus: the goal(s). If you act on your impulsive desires, reflect on it, and try to change the conditions which caused it to occur. Don’t dwell in regret and repeat the behavior. To err is human. Forgive yourself and move on.

If one practices in this way, impulsive tendencies will decrease in strength and frequency, and positive goal-directed habits and behaviors will take their place.

The Cost of Justice: A Eulogy for Justice Ruth Bader Ginsburg

September 20, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / 3 Comments

Justice Ruth Bader Ginsburg, fearless advocate and champion for equal rights, died at her home in Washington, D.C., on September 18, 2020, at the age of 87.

Justice Ginsberg worked tirelessly for the benefit of others. She believed in selfless service and advocated that lawyers not just use their law degrees to “turn over a buck” but to “make things better for other people.” Throughout her career, her progressive and expansive view of the constitution brought hope into the hearts of many minorities, including myself–a gay man.

Despite explicit and implicit acts of bias and discrimination against her, Justice Ginsberg refused to fall in line with the bigoted and narrow cultural views of society. Her work on the court moved the world, and so many of us have benefited from her hard-work, humility, and sacrifice.

As we take a moment to reflect on the life, achievements, and heart of Justice Ruth Bader Ginsburg, let us remember that freedom is never free, rights are easily lost, and all of us have a part to play in building a better world.

Hold Your Oaths Above Your Titles

September 17, 2020February 9, 2021 / Jame A. Agapoff, MD, MS (she/they) / Leave a comment

In medicine and in the military we take oaths. These oaths shape our behavior. Oaths are often accompanied by titles. Over time, titles may grow. For example, after I took the hippocratic oath in medical school, I later became a medical doctor, then a chief resident, and later a board certified psychiatrist. Our titles help define us, but they should never be held as more important than our oaths.

Leaders should reflect on their oaths regularly and use them to guide their speech and actions. A leader should never preserve their title or position at the cost of their oaths; persons who do this are not leaders, they are sycophants. A sycophant does not serve the public good. They are in it for themselves.

Selfless-service separates the sycophant from the true leader. Leaders use their positions to lift up others; sycophants use their positions to lift up themselves. The sycophants motivations may include status, adoration, or capital gain.

In public health and in medicine, silence is equal to harm. There are a few things we know about COVID-19. It is more contagious than the flu. It is more deadly than the flu. People who are older, heavier, and have chronic medical conditions are most at risk for developing serious complications and death. Minorities appear to be disproportionately effected. The best way to prevent infection is social distancing and mask wearing. To state any less is immoral, illogical, and inarguable.

As a medical doctor, I stand by my oath. Demand your leaders do the same.

The Writings of Jame Agapoff

Always. Ever. Dragon.

Month: September 2020