POCAfest Marin Keynote: Chronic Pain and Endurance, by Jeff Levin of SOAP

Welcome to POCAfest. My name is Jeff and I’m a proud punk and the co-owner of Sacramento Oakland Acupuncture Project, affectionately known as SOAP. We keep it clean.

We’ve all come an impressively long way doing community acupuncture. I’ve heard that we’ve done, like, a million acupuncture treatments. That seems like a lot. Especially when you take into account, not just the act of putting in all those needles and, hopefully, taking most, if not all, of them out, but also all the effort it took to create the container, the clinics and the systems that run them, the rent to be paid, to house all the chairs, maintained in good repair, for people to sit in for their treatment, to even allow fothat to happen. All that is something to be proud of. But not for too long because, looking at the bigger picture, we still have a lot of work to do.

There is a lot of pain in the world. Something all acupuncturists can agree on is that we can help with that. A lot of that pain is chronic, which means that it’s lasted for months already and it isn’t going away. Sometimes it can be treated with NSAIDS and Opioids, but it’s something people have to endure.

About 20% of adults in the United States have chronic pain. The Census Bureau says that there are, as of 2018, 327.2 million people in the United States. 20% is around 65.4 million people. Let’s say that they could that they could all use acupuncture about once a week. That seems like a good general treatment plan for chronic pain. We all know that twice a week would be better, at least for the first month or two, but let’s keep it simple. Community acupuncturists excel with simplicity. 65 million treatments a week is a crazy amount of acupuncture to wrap our heads around so lets narrow our parameters. 19.6 million of adults is the U.S. have high-impact chronic pain which is the really bad kind that substantially restricts your life activities and basically runs and ruins your life. Let’s shoot for giving all of those people acupuncture first and then focus on everyone else.

About 20% of americans have trypanophobia also known as needle phobia. It’s in the top-ten American fears (#1 is public speaking! Yay! Followed by heights, bugs, drowning.). We’re probably NOT going to do much acupuncture on anyone with a needle phobia. So if we limit ourselves to treating high-impact chronic pain, and account  for the 20% of people who are too needle phonic to get acupuncture, that still leaves 6.4 million. And let’s say, conservatively , that only about half of them are going to be a good fit for a community clinic. Rounding down, we’re looking at 3 million treatments a week.

It seems like a lofty goal. But without big goals, all of this starts to feel futile. It sounds like a ridiculous number, and maybe it is. I’ll tell you a secret about SOAP’s operations. We don’t like changing our passwords. Don’t tell anyone. A long time ago, I incorporated into our password, a number that I thought we’d never have to change. It was a goal for all of us to remember and aspire to, of how many treatments we could collectively do in a week. (Should I tell you the number?) 800. Given our total weekly appointment capacity and some chronic understaffing at the time, I thought we could never reach that goal. That it was mathematically impossible. But, this year, we did it. And we were so busy it took over a month before anyone ran the numbers and noticed that we did it. I envision a generation from now, the same thing happening with POCA clinics doing 3 million treatments in a week. This hypothetical future POCA will be so efficient and busy getting the job done, it won’t even notice it’s met this long awaited goal.

If we use a Sacramento Oakland Acupuncture Project clinic as a standard for our model community acupuncture clinic, how many punks and clinics do we need to do 3 million treatments a week? An average SOAP clinic has 3 punks each working four 5 hour shifts seeing 6 patients an hour, for a total of about 360 appointments available each week. The conventional wisdom would say that, long term, on average, only about 80% of those appointments will be full. After a while, people won’t book because the appointments that are left because they aren’t a good match for their schedule. So an average SOAP clinic, will begin to max out at around 288 treatments a week.

To do 3 million treatments a week, we would need about 10,416 clinics to treat all that chronic pain, with 31,249 punks. According to Acupuncture.com, there are about 12,000 actively licensed acupuncturists in the country. If we can remove the barriers to them doing community acupuncture, with the same cleverness and gung-ho attitude we’ve applied to removing barriers to patients receiving acupuncture, we might have a chance of reaching almost halfway to this lofty goal.

However, do we even want to build a profession that treats pain? Is this what POCA can do next? To create a new profession? One that can do 3 million treatments a week and really make a significant dent in all the chronic pain we’ve got around. We’re not going to cure chronic pain. To treat it, our clinics, are not just going to have to grow, but are going to have to exist for a long long time. And, for our clinics to grow and last, each individual community acupuncturist is going to have to do the job for a long time. And the job is intense! The job is doing about 4,000 acupuncture treatments a year, which requires each individual to have a titanic amount of energy, stamina, and focus. Each individual punk is going to need a robust amount of endurance to maintain that level of activity for however many decades it takes to find and train their replacements.

Now. If you are a community acupuncturist (which you probably are), and you want to do that for a long time; decades; (you probably do, maybe not, maybe you have other plans), we need you to take very good care of yourself. Otherwise, this whole plan, this whole goal, of creating a new profession that can be treating chronic pain falls apart. The best and most consistent advice regarding self care in community acupuncture I’ve ever heard, and can give, is: eat well. Eat well. Eat well before you go into the clinic to start working. Eat well while you are seeing patients. If you can manage it, eat well when you are done, so you can do it all again tomorrow.

The most challenging snack to snag is eating while you are seeing patients. For this, I highly recommend hard boiled eggs. Preferably they already have their shell removed and are lightly salted with an artisanal sea salt from New Zealand, and held in a small glass jar, ready to eat quickly in two tasty and nourishing bites. If you are vegan, unsulfured dried apricots are also a quick and tasty treat. Pie is good too, sweet or savory, meat or fruit, in another, slightly larger, wide mouth jar. Bring a fork or large metal spoon. Don’t make it complicated to eat.

Along with eating well, you should drink well. Coffee is good if you like coffee. It goes well with hard boiled eggs. Tea is also acceptable. Most important is water. Get a big pint glass, fill it with cold filtered water and leave it somewhere in the clinic that you are consistently coming back to. Each time you see the glass, drink. You should drink at least a pint of water for every 15 acupuncture treatments that you do which is about 267 pints of water a year. That’s some good work hydration.

Whether or not you are burnt out, you might want to drink a lot of alcohol. Trust me. Try not to. Whatever is the amount of alcohol you are drinking, try to drink a little less. Here’s a drinking game to try: don’t drink more than 14 alcoholic beverages in a week, or more than 4 in a day. [pause] It’s the worst drinking game ever!

There’s a lot of other advice specific to how to sustain punking well over the years and the decades and how to endure. Some of it is practical. Other advice borders on the metaphysical and philosophical. Metaphysical advice like this is great, but not always practical when you are in the trenches of chairs slinging needles like a mad multi-armed Shiva. Reflect on these bits of wisdom at the end of shift when you are drinking coffee, eating pie: Have good boundaries; don’t let your compassion burnout; keep your pace steady; communicate with clarity; listen actively; make sure everyone feels safe; make sure everyone IS safe; make sure YOU are safe; ask for help, especially if you feel burnt out; say prayers keeping goodness and light in the clinic; give thanks for being able to do good work. Celebrate challenges and changes with appropriateness and love. Remind yourself that we are spiritual beings. Don’t let the problems of your shift corrupt your soul.

Other bits of advice are practical, but can be complicated to accomplish. Life in the modern world is crazy . Incorporating enough self care into an already busy life is daunting and sometimes more stressful than its worth. But here it is: take enough vacation time; get plenty of acupuncture; exercise 3 times a week; meditate; don’t drink more than 14 alcoholic beverages a week; cut down on your coffee; don’t get so angry; listen to your local classical music station instead of NPR; practice good sleep hygiene; floss daily; spend time in nature; have fun hobbies like growing spicy peppers.

For 3 million treatments a week, we’ll also need around 10,000 or so of those acupuncturists to be clinic owners or at least facility managers. If you are foolish enough to become a community acupuncture clinic owner, and you want to endure that for a long time, you should still eat well, but you will also need to sleep well, too, which will be hard because you will worry and ruminate about the clinic deep into the night. Sleeping well can often be achieved with the right blend of supplements. What’s more important than supplements, is making sure you are doing the right thing every day. If you know in your heart that you are doing the right thing and creating goodness in the world, you will sleep better. In order to have the endurance to do the right thing on a consistent basis, you will need hope. Ambition is good too because ambition can be transformed into hope if it is guided by your moral compass and tempered by the harsh realities of consistent disappointments. Amidst all the idiots, knuckleheads, and sociopaths of the world making things unpleasant and difficult for the vast majority of people, you have to have hope that facilitating a massive amount of acupuncture can either transform those people, or give the rest of us the strength and fortitude to overcome the obstacles that they create.

Those obstacles can be subtle and insidiously undermine your better nature. It will grind away at you and possibly turn you into something you don’t want to be. Too often the challenges of being a small business owner are like a swirling poop storm that can overwhelm you to the point where you are only sleeping well because you feel broken and ashamed of your failures: greedy landlords who evict you with two months notice; drunk drivers slamming their car into the clinic; acts of god, like rain flooding the entire office; angry ants; angry patients writing lies about you on the yelp or the facebook; people and patients stealing phones, computers, cash, hand towels, acupuncture books, cups, forks, basically, anything not nailed down.

There are so many things that go wrong, it’s amazing that they go right as much as they do. When all the clinic systems are working the way they should be, and the world pauses its onslaught of problems, Whitney, my business partner, calls it, being on cruise control.

When the clinic is on cruise control you should notice that. It’s like a rainbow. It’s only going to last a little while before the storm comes back. Bask in its glory. Cry with joy if you can.

And then, when all else fails, use copious amounts of metaphors and analogies to make sense of the chaos swirling around you.

Running clinics is like growing a garden. It’s often the same plants and the same weeds, year after year, but things do change, evolve, and grow. While there is a lot of repetition, there is also a lot of repetition, and you have to be sensitive and responsive to the subtle changes that are constantly happening. A keystone to any garden is the compost. This is the place where all the crap and flotsam and jetsam, gets recycled into ripe and life filled soil.

To sleep well, put all your clinic problems into a mental compost. When you close your eyes, think, instead, of the flower and fruit filled garden and not the compost. Or, as my grandfather used to say, “As you’re going down life’s highway, whatever be your goal, keep your eye upon the donut, and not upon the hole.” Think of the hope you have given, the sweet jobs you have created, the patients snoozing and the patients smiling, and the pain, both chronic and acute, you helped relieve. Sleep with a full heart and know that whatever happened, you worked hard to make the world better. You nourished and watered the garden of the good.

When you wake up, your mental compost will be there and when compost really gets going, it gets hot. It will steam on a cold day. As you drink your morning coffee or tea, and prepare your glass jars full of eggs and pie, let all the problems, all the obstacles, created by all the idiots and sociopaths, let it ferment into red hot righteous fury. The glory of your indignation will fuel you, like the sparks of nutrients in the soil of your garden, to grow and to accomplish all that you need to do. It will give you the endurance you need to get through the bad and the ugly, and find the good again. To find the hope.

If you are like me, you have found that you are ill suited to any other occupation. Everything else is too corporate, too mindless, without pathos, without honor, without meaning, or just way too hard (like being a teacher). You have a family to support. So, you have to do this job. There is no other job to do, this is your place in the world. You.Must. Endure.

Ralph Waldo Emerson once wrote (more or less), “Trust yourself, accept the place Divine providence has found for you: the connection of events, the society of your contemporaries. The absolutely trustworthy is seated within your heart, working through your hands, predominating your being. As humans, we must accept, in the highest mind, this transcendent destiny, We aren’t invalids hiding in a corner or cowards fleeing before the revolution. We are guides, redeemers, and benefactors, obeying the mysterious oneness of the universe and advancing on the chaos and the darkness.”

But what does that look like? That’s what we are here to talk about. It looks like whatever you want it to look like. This is your co-op and it will move forward in a way that you decide. I see 3 options. Option 1: 3 million treatments a week. Option 2: we keep everything the same as it is now. We don’t grow or shrink. We’re going to have to work a little bit to sustain that, set up some exit plans and other systems to let new people take over for the old people. Continuing on like we are could be a cozy fit. Option 3: We do nothing. Our co-op can slowly wither and die. In 20 years we can all close up our clinics and move into a POCA retirement center where we can, like old fishermen, bemoan the good ol’ days when the seas of health foamed with affordable acupuncture.

Do we want to just be a blip in history, a sociological footnote whose failure seems to prove the superiority of capitalist principles? We already know that when we depend on a free market to guide our morals we end up with a healthcare system that grinds down physicians and profits off of suffering. The garden of Community Acupuncture is happening outside the polluted garden box of the american healthcare system. What we are trying to do is righteous; our aim goes beyond not doing harm, it is to do good, even at the expense of profit. A free market system is void of morals, so in that system, our quest to do good at the expense of acquiring wealth appears foolish and quixotic. In this respect, what we do is more than just a job or a social container, it’s a form of protest. So how do we move forward in a capitalist world that sees our quest to relieve pain, in a practical, cohesive, and affordable way as a joke or a fundamental failure? And, how do we do that as a collective in a way that is sustainable for everyone involved? We can’t just put those of us who are the right combination of capable and foolish into the roles of leadership most prone to the negative aspects of navigating social businesses through the rocky reefs of a for-profit world. To the people in those positions it feels like a long futile grind where capitalism makes us into something we don’t want to be. The work we do is so open hearted that when you’re the person dealing with the many negative elements of running a small business or coop, you have to wear a mask.

I’ll let you in on a little secret about your coop. POCA people are burnt out. The ones wearing the masks are tired of it. We are stalled in succession planning, because the effort to create the infrastructure for succession, like the effort for every extra thing we need to do, has to be scavenged from the actual running of our clinics and people running clinics are burnt out too. You need to step up and get involved. This is your coop. You are the succession. You are the next keynote speaker. You are the next pocafest coordinator. You are the next teacher for an online CEU. And one of you out there is going to step in and help organize a solid governance structure for POCA. Another of you has the solution to our dwindling membership and revenues. This is YOUR coop and if you want it to thrive and not just survive, you ALL need to step up.

If you see a problem, you’re a volunteer. The problem I see is that there is a whole lot of pain in the world and not enough acupuncture happening to address it. I have volunteered to talk about it, because I believe we are a vivacious group of people uniquely placed to greatly increase the amount of acupuncture happening in the world and decrease the amount of pain. As we grow, more good happens.

The alternative is to walk away. We could just let this all languish, let what we are doing succumb to owner burn out, our coop succumb to the entropy of antiquated systems, and let our whole wacky experiment die. But, if that happens, then all of this, these clinics, these pocafests, the intense efforts of punking, and running clinics, it will be meaningless. Or, we could band together, find viable solutions, create lasting good, and be an example for other health care professions to do the same. Let’s do that; let’s work together to unleash all that is good.

But. Before we do that. It’s time for dinner. Let’s go eat well.

Author: lisafer