Is it just me or does it feel like there is too much day for the time we are allotted each day?
For most of my career, I've been the person who rolls up to the hospital, chugging coffee, ever so slightly more sleepy than alert.
I felt tired all the time working as a PA in CT surgery, so I kept trying to
"prioritize" my sleep, & I would set my alarm at the last possible second I could to still make it to work on time.
I rushed to get ready, rushed to commute hoping to God traffic was good and I could score 5 extra minutes to refill my massive coffee in the cafeteria of the hospital before seeing patients or operating.
I started the day in a rush & the entire day carried that frenetic, over-caffeinated energy.
It was exhausting.
There was never enough time to work full time, rest, stay hydrated, eat healthily, maintain my relationships and my sanity.
My energy levels were in a constant state of deficiency.
Eventually, I burned out but kept working.
The need to do things differently arose, as a means to survive the days.
began experimenting with better morning routines for my wellbeing and energy conservation. I read a few books on the subject, & through trial and error crafted a very personalized morning start-up ritual as a way to hack my energy levels as described in The Miracle Morning & The 5 am club.
What I found was that even after only a few days, of waking up 30 minutes earlier and doing my startup routine I arrived at work, grounded, refreshed and more energized than I had ever felt in my adult life.
Then the pandemic happened.
& Just like everything else it exposed and exacerbated my bad habit of putting myself last. Morning routine went out the window and survival mode kicked on and didn't stop.
Until I crashed.
After taking a sabbatical & getting to the point that I was ready to go back to work I re-implemented my morning routine and came to see it is as an uncompromising part of my day.
Looking back at how I was before implementing my start-up & shut down rituals to now I really can’t believe that I was out here raw-dogging life for so long.
Crafting personalized Start-up and shutdown rituals in life and work have truly added an extra layer of protection to my wellbeing.
I have noticed myself being markedly happier, more organized & even more able to maintain an even keel when the inevitable waves of life start to come at me.
If you work in Healthcare, you probably need this more than anybody.
Pouring into yourself before work by crafting a personalized Start-Up ritual to feel great and perform better, will help you handle the insanity that is to be in medicine right now.
Healthcare Profssionals are the pro-athletes of the pandemic.
You don’t see high performers like pro athletes rolling up to competitions, late, disheveled, and chugging coffee, right?
So why should medical professionals?
I mean we are held to even higher standards than pro-athletes in terms of literally not killing people for a living, right? Few other professions are expected to perform with immaculate perfection at every moment.
If you are fully invested in bringing your best into work every day, part of that is making sure your energy tank stays adequately fueled & maintained so that you have a reserve for when bs happens, which in medicine can be pretty much daily these days.
What’s better is that the more I do it- the more the extra layer of protection seems to thicken.
Equally, doing the same transitioning out of work and establishing a decompression routine has also changed my life for the better, but that's a whole other post that's coming up soon. For now, let's focus on getting you to focus on the start-up.
Especially if you are a super busy person, and feel like you never seem to get enough time alone to recharge or decompress, having solid shut down/ startup rituals will work these right into your every day so that you are pouring into yourself first & last.
The Health Benefits of a Personalized Start-up Ritual
If you are still not convinced you need a start-up ritual, here are some of the massive benefits of having a daily ritual of pouring into yourself first.
First of all, just implementing something that makes you put yourself first can be a revolutionary concept in and of itself.
Especially because medical training indoctrinates us with a self-sacrificial identity and we are taught to pour into others at all times, no matter how it affects us personally.
Medical training doesn't really teach the importance of pouring into yourself, weren’t taught that, and or/ are surrounded by people who also were not taught this, and this puts us at risk for moral injury.
Having a daily practice that gives you a bit of extra time to pour into yourself, assess your needs, have quiet time to yourself to think & do something that fills your cup will set the tone for the day.
It will also make you much better equipped to deal with the uncontrollables in your life.
In addition to the dedicated space and time to yourself, a well crafted morning ritual will have impactful influence in the short term and the long term such as:
✔improve your physical and mental health
✔Increase energy levels
✔Improve your focus, willpower, and resiliency
✔Become an automatic habit after 66 days of consistent practice
The Basic Structure of a Well-Crafted Start-up Ritual
The basic structure of a highly effective startup ritual will have 3 pockets as described in the book The 5 am Club.
Each pocket of time is dedicated to an aspect of your wellbeing:
Mental + Spiritual and
Now here is where it gets really cool and customizable.
How much time you spend in each will depend on you and what you need, so there is room to play around with some different times.
The standard is the 20/20/20 rule, which dedicates 20 minutes to each of the wellness pockets or categories.
Now, this is just a skeleton you can use to craft your own personalized routine, & you can play around with the pocket times in search of what times and ratios will make you feel best.
With that said- from personal experience, I can tell you that the standard 20/20/20 ratio feels absolutely amazing. Like for me, that was the pinnacle timing for feeling the best. Seriously- while experimenting I floated into work feeling really great like
Consider that it's important to take into account how long and intense your shift will be because for me working in surgery on a day where cases start mad early and end late, waking up extra early, and spending an hour doing my stuff, has come back to bite me in the ass later in the afternoon when I start to fade and have to stay sharp for a bunch more cases. So be a good steward of your energy.
For me waking up at 5 am is really great (not at first- it was a painful habit to upload but it was shortlived,) and the 20/20/20 rule works well when I have to be at work at a later time in the morning, but for a while there I had a 7 am surgical start time and together with the commute, it just didn’t make sense for me, especially since the days started early and ended late.
So I began to play around with shorter versions like the 15/15/15 or 10/10/10 and even 5/5/5s and all of them worked similarly for me because it got me to do something, rather than nothing to pour into myself before pouring into other people all day.
My Current Start-up Ritual
Wake up 15-30 mins earlier
7-15 minutes of HIIT (High-intensity interval training) using a free app or other
5-10 minute meditation with my Insight timer free meditation app.
Coffee & 5-minute Journal for gratitude & setting intentions for the day.
Listen to a personal development audiobook while I get ready for work.
There is a thing we do as humans where we tend to throw the whole thing out if we can’t hit all of the areas, but for the sake of consistency and honoring doing what you can on the days where it is extra hard- I found a lot of value in doing even just one of the things in my routine.
So Do you really have to wake up really early?
No. Not necessarily.
But I find it is better to pour into myself before the world wakes up and starts to demand things of me. Also, I find it way more peaceful, quiet, and private.
There are also physiologic benefits to waking up early to do it. For one having the same wakeup time, every day helps set your circadian rhythm to a schedule so that eventually you sleep better which makes you recover better, heal better and rest better.
Sweating first thing in the morning has great physiologic benefits like
✔Mopping up excess cortisol which peaks in the morning
✔Increases beneficial aspects of dopamine
✔Jump Starts metabolism.
The BDNF is particularly interesting.
BDNF is considered an important protein that influences brain function as well as the peripheral nervous system. BDNF influences a variety of functions including preventing the death of existing brain cells, inducing the growth of new neurons (neurogenesis) and synapses, and supporting cognitive function. Low levels of BDNF are often problematic and have been linked to Alzheimer’s, accelerated aging, poor neural development, neurotransmitter dysfunction, obesity, depression, and even schizophrenia.
Other ways to increase BDNF besides intense exercise are Sunlight and Vitamin D, so another hack is to get outside to do your exercise to potentiate the effects.
Implementation- Where to start
Implementing a Start-up Ritual that sticks requires no pre-requisites whatsoever.
All it takes is a willingness to explore what will work for you and setting aside some time to do it.
The best way to implement it is just to jump in the deep end of the pool & do it.
Set time in your schedule tomorrow for an hour and do the 20/20/20.