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Kidney donation: preoperative preparation & facing challenges generally - values are central

I'm soon due to have an operation on my left kidney.  I'm donating it anonymously to someone else who needs it pretty desperately.  I have already written about this process - see "Kidney donation: why it's well worth consideringand "Kidney donation: what are the risks?".  Primarily these kidney-focused blog posts are to help other donors and their families & friends.  However, some aspects of the posts are likely to be of interest more generally.  For example, these ones on pre-operative preparation have some relevance to many situations where one is facing a potentially daunting challenge.

So how does one "prepare for a challenge"?  How am I preparing for this challenge of a rapidly approaching kidney operation & the planned post-surgical recovery?  Well, as a doctor & psychotherapist, I specialise in helping people with stress.  This is my "business" ...  this is my vocation and it's also how I earn my living.  Here's an opportunity to "walk the talk", and probably to learn a whole lot in the process.  I have hundreds of books, journals & databases of theories & intellectual knowledge about this territory of working through challenging circumstances, but how do I approach it now?  How do I cope effectively? 

Lying in bed this morning I found myself organizing my responses into four general categories ... Values, Goals, Journey, and Self-Compassion.  This four part way of organizing my coping responses tracks well onto the "Bus driver metaphor" (see a downloadable description of this metaphor as a Word doc or as a PDF file) ... it's one of the most usual "maps" I suggest clients try using when responding to challenging experiences.  Values, Goals & Journey are the "Bus driver's" responsibility, while Self-compassion is the territory of the friendly "Bus conductor" & the rather tiresome "Passengers". 

As I've written in the "Bus driver metaphor" handout when highlighting the importance of values - It’s hugely important for our health and wellbeing that we mostly focus on driving the bus in the right direction.  The “right direction” is determined by our values, by what truly matters to us.  Our values are the compass bearing which we need to steer by (the Respected figuresexercise may help here).  Values are things like “I want to live with courage and kindness”, or “I want to look after my health”, or “I want to prioritise those I love”, or “I want to develop my interests and talents as far as I can”.  As the Hasidic rabbi, Susya said “When I get to heaven, God will not ask ‘Why were you not Moses?’.  He will ask ‘Why were you not Susya?  Why did you not become what only you could become?’” 

I go on to write in the "Bus driver" handout: It’s often helpful to distinguish values and goals.  Values are likely to be compass bearings we use to steer by for many decades.  We don’t typically prioritise those we love for a while, or look after our health for a while, and then get to a place where we’ve arrived and can stop doing it.  Our current goals however we may well reach.  So we might want to arrange a surprise birthday party for our partner or train to run a marathon or target other goals that are an expression of our values.  Hopefully we’ll achieve these goals and then we’ll want to make fresh ones (Goals for rolesexercises can help here).  It’s like travelling on a particular compass bearing (values) and seeing that some way ahead in this direction is a landmark (goal) – maybe a tree or a hill – that we can steer towards for a while.  The landmark is the goal we head for as we follow our values compass.  When we reach it, we look ahead on our compass bearing for the next landmark to steer towards.  Values are the way that we walk, the direction.  Goals are checkpoints on the journey.

There's much more about this territory of values & goals in the "Wellbeing, time management, self-control & self-determination" section in this website's "Good knowledge" area.  There is also a relevant sequence of four blog posts beginning "Purpose in life: reduces dementia risk, increases life expectancy, treats depression and builds wellbeing" and "Purpose in life: how do you score on the questionnaire & why does it matter?". 

It can be so helpful to take ownership of our values & goals.  I'm a big fan of "Self-determination theory" with its emphasis on the importance of autonomy for wellbeing - you can click through here to a relevant Wikipedia article and here's a blog post I've written about this approach.  As the theory's originators, Edward Deci & Richard Ryan, have written "Comparisons between people whose motivation is authentic (literally, self-authored or endorsed) and those who are merely externally controlled ... typically reveal that the former ... have more interest, excitement, & confidence which in turn is manifest both as enhanced performance, persistence, & creativity, and as heightened vitality, self-esteem, & general well-being”.  And it's deeply heartening to discover that most of us centrally value self-direction and kindness.  I've written a blog post about this fascinating & very encouraging finding - "Most people agree on the healthy key values that they want to live by and this is real grounds for hope" where I've  commented "It does look that, across the nations, most people probably do agree to a surprisingly large extent on the healthy, self-directing, altruistic values that they want to live by ... "Benevolence, self-direction, and universalism values are consistently most important". This makes me smile & feel at least a little hope in these critical times for our species."  

And despite the caution expressed in the title of this early 2003 study ... "The living anonymous kidney donor: lunatic or saint?" ... it's pretty clear that altruism is a central driver for kidney donors.  Response to risk is probably relevant too, see "Attitudes, psychology, and risk taking of potential live kidney donors: strangers, relatives, and the general public".  The researcher Abigail Marsh has been particularly active in exploring altruism & donation ... see her recent general 2016 paper "Neural, cognitive, and evolutionary foundations of human altruism", her more donor-focused research "Neural and cognitive characteristics of extraordinary altruists" and "Geographical differences in subjective well-being predict extraordinary altruism" and her 12 minute TED talk "Why some people are more altruistic than others".  It's important to underline though that kidney donors are a relatively easy group to identify & study.  There are a multitude of people all around the world, leading lives and performing actions of extraordinary generosity & courage. Going to a gleaming, expertly staffed operating theatre & donating one's kidney under a peaceful general anaesthetic pales into insignificance beside so many other wonderful kindnesses that people perform every day, often with nobody witnessing their great bravery & compassion.  The slightly naughty side of me notes though that the large sum of money offered me by an anonymous doctor for my kidney, suggests that for some suffering people a new kidney is worth an awful lot.

Nearly all of us want to live lives that feel true to us and give to those we love and more broadly to the world.  My decision to give one of my kidneys to a stranger who desperately needs it, is just a personal example of a wish to help that profoundly unites most of us.  Here's the "Dialogue exercise" that triggered my decision to donate this Spring.  Aldous Huxley wrote "There isn't any secret formula or method. You learn to love by loving, by paying attention and doing what one thereby discovers has to be done".  And it spreads - see the blog post "Be the change you want to see in the world".   As the wonderful Louis Armstrong sang in his song "Hello brother" (that moves me & makes me cry) ... "But no matter where you go, you're going to find that people have the same things on their minds."  More broadly, there's Einstein's insight "A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty."

And too there is the precious poem - "Kindness" - by the Arab American writer Naomi Shihab Nye:

Before you know what kindness really is
you must lose things,
feel the future dissolve in a moment
like salt in a weakened broth.
What you held in your hand,
what you counted and carefully saved,
all this must go so you know
how desolate the landscape can be
between the regions of kindness.
How you ride and ride
thinking the bus will never stop,
the passengers eating maize and chicken
will stare out the window forever.

Before you learn the tender gravity of kindness,
you must travel where the Indian in a white poncho
lies dead by the side of the road.
You must see how this could be you,
how he too was someone
who journeyed through the night with plans
and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,
you must know sorrow as the other deepest thing.
You must wake up with sorrow.
You must speak to it till your voice
catches the thread of all sorrows
and you see the size of the cloth.

Then it is only kindness that makes sense anymore,
only kindness that ties your shoes
and sends you out into the day to mail letters and purchase bread,
only kindness that raises its head
from the crowd of the world to say
It is I you have been looking for,
and then goes with you everywhere
like a shadow or a friend.

For the next post in this sequence see "Kidney donation: preoperative preparation & facing challenges generally - goals and journey".


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