Five Powerful Questions to Ask When You’re Sick

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Terri: Hello, and welcome to Hello Freedom. I’m so happy that you’re here. Today, I’m going to talk about communication, effective communication, and what happens in our lives when we don’t effectively communicate. When I say effectively communicate, what I really am talking about is expressing ourselves and expressing our emotions. It could be in relationships; it could be a difficult conversation that you need to have; it could be mourning the loss of something. Something happens when we don’t honor the way that we feel, and a lot of the times, as my friend Kris Carr would say, you get issues in your tissues.

I have a really great guest today on the show. Her name is Dr. Neha Sangwan. We were both speaking at I Can Do It! Hay House event, I think in 2013 and I saw her talk. I thought it was great. I feel like I’m attracted to people who have their dark-night-of-the-soul experience. That experience then profoundly impacts what they do going forward, and Neha is that way.

We’re excited to welcome my next guest to the show, Dr. Neha Sangwan. Welcome, Neha, to Hello Freedom.

Neha: Oh, thank you, Terri. I’m glad to be here.

Terri: Me too. There are so many things to discuss. I feel like we should just dive right in because I don’t want to run out of time. I want to start with your background. I want you to tell us a little bit about why, although you are an actual doctor, why have you moved into this communication expert that you are? What had you move from sort of being on track like, “I’m just going to do this thing, make a ton of cash, help the people that I can help”? What inspired you to bring it to a different level?

Neha: That’s a great question. It’s funny, when you live it forward, it just seems like the next thing that needs to happen, but in retrospect, now I can see how it all happened. I’m the daughter of immigrants from India, so I came here being instilled in my upbringing with security, stability, and fitting in. Initially, I was a good Indian child. My first career was mechanical engineering and biomedical engineering, and I realized I wanted more people contact, so I moved into medicine. What I found out was an immense amount of contact with people—and most often at the toughest times in their lives—and I really enjoyed that.

After practicing internal medicine for a few years, I could help them through a stroke or a heart attack or pneumonia. Often, a few years later, I would see them come back through the emergency department, kind of like a revolving door. “Oh, wow, there’s another stroke or another heart attack or someone’s sick again.” I thought maybe I wasn’t asking the right questions. Maybe I was numbing them through this crisis, but I wasn’t actually getting to the root of what was making them sick. These days we know that 90 to 95 percent of all illness is caused or exacerbated by stress.

So I started asking patients a few questions the night before I discharged them from the hospital. I would ask them what was going on in their lives and why this ailment happened and have them journal and contemplate. They’re in the hospital; they have 23 hours until they’re going to see me again. I’d give them this homework assignment the night before they were being discharged, and every single one of them knew exactly why they were sick.

Terri: What I find amazing about this part of this story is the two questions that you said that you asked first were, “Why this?” and “Why now?”

Neha: Mm-hmm (affirmative).

Terri: That is such a game-changer and to me as a psychotherapist, of course, super interesting because it is about asking better questions. Tell us more. When you asked people, “Why this, and why now?” they were able to say from an emotional or a relational point of view why this and why now. Is that correct?

Neha: Yeah. We had a little bit of a discussion about it. Some people took it literally and logically tried to give me a physical explanation. Then it was my job to drill down and help them get to that deeper place. After a while, they certainly got there, maybe five, ten minutes of talking and feeling a little safe. This is one way that I would say that everybody gets it. I’d say, “When your mouth says yes and your heart says no, you get sick.” I mean physically sick, because your body’s busy keeping score of everything, whether you are or not. In the end, if I’m not addressing something on an emotional level or a mental level or a social level, eventually it shows up in my body, and people show up in my office with a physical illness that they can’t ignore anymore. That’s really the pattern I saw with all of these questions and patients. It was so reproducible that I thought, You know what? This is not by chance.

When I say, “Why this? Why a heart attack? Why a stroke? Why isn’t it your left leg or your left arm that has a problem?” they started to get a correlation between the part of the body that was breaking down and what was going on in their life. Really, what I wanted to do was have them start to connect the dots between their physical ailments and the rest of their life, because you and I know it’s all connected.

Terri: It is. What I found amazing about your TEDx talk was when you were sharing different patients’ stories about them being able to tell you why. Someone who hadn’t cried ever was telling you, “I didn’t even cry when my kids were born. I didn’t even cry when my parents died.” Yet, now, after having a heart attack and almost dying, he was able to say he’d been crying for two days straight. It creates this access to some dark night of the soul. Some physical breakdown creates an opening.

Neha: Yeah, you’re absolutely right. Terri, it’s also like your work. When you’re with a patient, it’s like a sacred moment. It’s like this place where they can just exhale and with a little bit of trust and space and slowing down and human connection, this magic starts to happen. I think it’s reproducible in the hospital, because I was a hospitalist, which means the emergency room. People would come into the emergency room and then when they’re ready to be admitted to the hospital, I’m the one who comes and admits them.

Every one of them was pretty sick. Nobody admits anyone to the hospital now that isn’t very sick. The one common theme that I saw was these people were all surprised, like, “It can’t be me, not me.” It’s almost like their world had been shattered, everything that they thought they knew, in that moment, they didn’t know anymore. It’s like their heart cracked open. I saw this as an opportunity to help them not only get better physically, but also help them transform and make meaning out of this so that when they walked out the door, there was alchemy and meaning tied to how they would show up in the rest of their life once they left the hospital.

Terri: Right. That is such a great point, because it’s about sustainability or the difference between change and transformation. Change you change back. Transformation you wouldn’t fit in the box, as Deepak would say.

I think that’s what you’re really talking about is how do you, by asking the right questions, help people logically, emotionally, and intellectually connect the dots between their physical wellness or sickness and their ability to be authentic and to authentically communicate in their life. One thing that your book covers is looking at the symptoms in your own physical life all the way to how you’re avoiding telling the truth about the way you feel.

Let’s talk a little bit about that. People who are listening know if they’re good communicators or bad communicators. They know if they act out their feelings instead of talking out their feelings. We have all kinds of words and phrases in our American vernacular, let’s just say, to describe these people, “Oh, they’re quiet. They’re not the emotional type. They’re not open. They’re closed, they’re private.”

Neha: Or they are a loose cannon. The opposite end of that which is like, “Oh, they don’t know how to contain their emotions. They just kind of let it out anywhere.” It’s the other end of the spectrum.

Terri: Mm-hmm (affirmative). So what are the telltale signs that you’re not speaking authentically in your life? How have you seen it show up physically for people?

Neha: The first way that you notice is people are really aware of their five senses, what they heard, saw, tasted, touched, smelled—anything outside they’re hyper vigilant about, but much less vigilant about how their own physiology talks to them. What I’m talking about is the physical signals, their physical intelligence inside their body, like their own heart racing or stomach turning or muscles constricting or shallow breathing or jaw clenching. Your physiology is the first one to tell you, before you even know sometimes and before anybody outside you knows. It’s the first one to signal you, almost like a fire alarm that’s picking up smoke.

Your physical signals are the first place to recognize when something’s changing or doesn’t feel good or does feel good. Most people are really good in our Type A world about overriding that discomfort and saying, “Can I have a double latte, please?” Something will happen in a meeting or an argument with their partner, they’ll grab a pint of ice cream. They’ll numb that physical sensation.

I think that’s where we go off track. Mindfulness is everywhere now: mindfulness at work, mindfulness at home. Why I think mindfulness is so important is it means slowing down and tuning in. It happens when you breathe slowly, when you do yoga, when you do any form of mindfulness. It gives you an awareness so that you’ll know when you’re being inauthentic. Some people, when they do that numbing and blocking out strategy, which I have to tell you served me very well in med school and residency…

Terri: Yes. I remember you talking about a big fat Snickers bar and some super-caffeinated drinks.

Neha: Mountain Dew. Absolutely. Every 36-hour shift, I took two ice cold, 16-ounce Mountain Dews and a king-size Snickers bar. I had an equation. I knew what the equation was to get me through these almost mini traumas. I had to override my body’s circadian rhythm, my wake-sleep cycle, in order to do it. Sometimes survival has us doing that. If it goes on long enough, you’re going to get sick because it’s not the natural rhythm of the body. The body doesn’t get a chance to sleep, and during sleep, when we’re young, that’s when we grow and it’s also the time where our immune system heals us and repairs us. Without that, we’re clearly going to get sick.

So that’s the first and most important way that people will know. You have to tune in, because each person’s physiological signals are all different. For me, it’s throat constriction and stomach turning. That’s usually how I know I’m not saying what I need to say. Do you know any physical signals that you tend to feel inside your body?

Terri: Yes. I feel a constriction in my chest and my throat. I will have the same thing. If I’m not speaking my truth, my fixed chakra feels like there’s literally an ache or a pain in my throat.

Neha: Yep. Mine actually feels like I’m gasping for air, like I’m trying to take a deep breath in but I can’t. Yours feels more like an ache, and that’s what I mean. We may have similar symptoms. In medicine, what we say is, “You have globus hystericus.” That really doesn’t help anyone. We give you a big, fancy name. We write it on your chart and then we say, “You know, here’s some stress management exercises”—except what does that really mean?

When you get signals from your body and you don’t know how to decipher them, you figure out ways to numb them. It’s the equivalent of having a fire alarm go off in your house and instead of looking for the fire, you just climb up there and take out the batteries. That’s the equivalent of what we’re doing when we numb out the signals. It’s like a headache—one thing we know for sure is it’s not an Advil deficiency.

Terri: It’s very true. What I think is super helpful are the five questions that you would ask clients. Do you want to say the five questions?

Neha: Sure. I call it the Awareness Prescription. What Terri is talking about is that night before I discharged my patients, I would pull out my prescription pad—because it was what was in my pocket, but now I realize the bigger meaning of it—and write a different type of prescription. I would write, “Why this? Why this ailment? Why this part of your body that’s giving, that’s trying to get your attention? What’s the relevance of your headache? What is the relevance of your heart?” For some of my patients, it was a heart attack. What is it trying to tell you?

An example would be if someone had back pain, they often would say, “Oh, why this? Because I’ve had the weight of the world on my shoulders for so long,” or “You know, my back pain is because I don’t stand up for myself.” The area of the body often correlates to what was happening for them in life and helped them make that connection. If the connection is not becoming clear, talk it out with somebody else, and that often helps you get clear.

The second question is, why now? Why is this experience happening at this moment in time? Why wasn’t it two weeks ago? Why wasn’t it two years from now? What is the message that your body wants you to get in this moment? Start to think of these signals as friendly, like your fire alarm is trying to alert you. It’s trying to say, “Um, there’s smoke here. I just want to give you a heads-up.”

The third question is, what might you have missed? A lot of times, people will think that some ailment hits them all of a sudden. Sometimes it does. If you get in an accident or something like that happens, but most of the time the body starts to give you subtle signals, almost a whisper. Then if you’re not listening because you’re too busy and you keep moving on, it progresses into talking a little louder.

It would be like a little annoyance in your right shoulder that would then turn into your neck and your shoulder and upper back giving you trouble. If you don’t listen, suddenly you’re going to have a headache or a backache, and you’re going to find yourself in bed, calling in sick to work, wondering how this all happened so suddenly. It’s about how early you pick up signs and signals.

The fourth question is, what else needs to be healed? The body often reflects the pain, suffering, miscommunication, disconnection, and imbalances in somebody’s external life. The physical world is not separate from your mental, emotional, social and spiritual arenas. They’re all connected. You want to ask yourself, “Where is it that you feel out of balance, and how might other areas of your life also be connected here?”

The fifth question is, “If you spoke from the heart, what would you say?” This was probably the most powerful question. It was almost like I had given these patients a ticket or permission to say what was in their heart. Often, they had been keeping it hidden even from themselves. It wasn’t like they were trying to lie or not tell the truth. It was like, “No one’s ever asked me that. No one’s ever allowed me to speak that way.” That’s when I’d hear things like, “Wow, you know, if I reconnected to my son, this burden that has been on me for the last three years would be lifted, if I found the courage to do that.”

I started to hear all these pieces of their lives that they could see had brought them to this moment. In that TEDx Berkeley talk, I say, “It brought us metaphorically to our knees, realizing that all of these pieces of our lives were intimately connected.”

Terri: I love that prescription so much because I feel like it’s very accessible and yet these are so poignant. The questions are so right to the heart of the matter. The last question, “If you spoke from the heart, what would you say?” I do a similar intervention therapeutically when people say they don’t know how they feel or don’t know what they want. It’s a tricky question. If I ask it quickly and say, “But if you did know what you wanted, what would it be?” then the truth comes out. Because so much of the time, the not knowing is afraid of disappointment, afraid of asking too much, afraid of setting themselves up, and afraid of wanting. Sometimes you’re raised in a family in which wanting was dangerous or asking for anything was dangerous. I love that last question because it really does give people permission to say what’s on their mind.

I wanted to talk a little bit more about the book, and I have a couple of questions I want to ask you, so I don’t want to run out of time.

Neha: Sure.

Terri: Why don’t you just tell me, instead of me telling you, what inspired you to write TalkRx?

Neha: So many things, really. The first one was that I started to see the profound experience that I would have one-on-one with patients. I realized, obviously, there’s not enough of me to go around and do that. So I thought, If I sit down and take a few years to put pen to paper and make this happen, then put it out in the world for $25, or whatever price, the world can have access to this without meeting me. That was one of the big things.

The second one was that this is a little radical in the medical world. What I’m saying, that there isn’t just a physical solution for a physical ailment, that’s not always where we need to end, is a bit radical. What I knew was that my patients, they always got it. They knew exactly what I was talking about. My colleagues would argue with me and show me the science and tell me how this happens. Physicians are schooled differently. We’re schooled in a way that teaches us the rigor of blinded, placebo-controlled trials. I started to realize that we’re not valuing so much more. What are we leaving out? Where do we have stigmas around the other aspects of our lives and how might they be relating to our physical health?

The last piece is that I grew up for the first 33 years of my life a pretty closed child. My mom says of the three daughters, I was the one who was the hardest to communicate with and the most defensive. It’s funny, because the moment I found communication and started to discover how I could change that, it was a sense of freedom in me. I thought, Gosh, nobody else should feel what I felt. Maybe this is why I burned out. Maybe this is why I didn’t feel well and these are the answers that we need to get to people.

I wanted to open up the dialogue. I want medicine and our health to be about all of our health. I want all of us as providers to be one, where we are different parts of the system and we all collaborate and work together. My attempt here is to show people my experience and my patients’ experience. Here’s the science. Here are some practical tools and now you don’t have to say that these are soft skills. I want to put rigor around it. I want to show you that it’s real and explain to you how you can do it in your own life.

Terri: That is so awesome, and it’s so needed in the world of medicine. I’m super psyched that you’re doing it, because you know I’m on the mindfulness trip as well, so it’s just amazing. I want to ask you a couple of questions.

Neha: Sure.

Terri: The first one is if you could choose one non-negotiable thing that you do daily for self-care, what would you choose? What would you share with us?

Neha: Hmm. I definitely do body check-ins often throughout the day. If I find myself in any kind of a situation that starts to get me a little tense, I actually pause, do some slow, deep breathing, which sounds so simple and silly, but it’s profound, really. Just take three deep breaths.

People say, “Oh, I don’t have time for that.”

I say, “You’ve got to be kidding me. You’re breathing anyway. I’m just asking you to be aware of it. I’m not asking you to do something that you’re not doing. I’m just asking for your awareness.” It’s about pausing.

Also one of the things that I’ve gotten a lot better at is doing take-twos when I didn’t like how a situation or conversation just went. Let’s say you and I had an interaction and you know that moment you walk away that it doesn’t feel quite right in your body. If that happens, I actually now turn around and I say, “You know what, Terri? I didn’t like how I showed up in the interaction we just had. I want to say I am sorry about that. Can we try that again?”

It’s such a simple tool and allows me to be who I am, because if I make a mistake, I do a take-two. Listen, that’s why we have great movies, because they’ve done “Take two” a million times. Why can’t we do a take-two? I give myself permission and grace to be who I am, show up, and then if I make a mistake, I acknowledge it, go back, and do a take-two.

Terri: I love it. All right, what advice would you give your 20-year-old self?

Neha: Probably that I would never reach my true potential until the day I started listening to my own heart rather than the voices of others. That 20-year-old self wanted so hard to be the top of this and that, but it was all in the name of everybody else’s expectations. What I’d tell her is the answer is actually you listening to your own heart even if it disappoints other people sometimes, because in the end, when you look in the mirror, all that matters is that you’re aligned and you feel good about how you showed up here.

Terri: Right on. I like that. I wish someone had told my 20-year-old self that. My last question, because the show is “Hello Freedom,” is always what does freedom mean to you, Neha?

Neha: Hmm, that’s a juicy one. I would say freedom to me has been communication. It’s been learning the language of my body and how it speaks to me and listening to my heart and honoring my brain, but not letting it become a bully where it overrides my heart. Learning how to communicate with myself so I can then show up and communicate better with other people has given me a sense of community, belonging, connection, peace and definitely freedom.

Terri: Right on. That is a perfect place to stop. Thank you so, so, so, so much.

Neha: Thanks, Terri.

Terri: Thanks for being here.

 

To having fun while going deep!

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