Episode 374: GAIN without Pain: The Happiness Handbook with Dr. Greg Hammer, M.D.

Throughout our conversation, Dr. Greg shares the story of how he fell in love with critical care medicine and why he went through the pediatric medicine path. We also discuss happiness, how to be consistent in pursuing it, the teamwork between thoughts and feelings needed to achieve it, and the elements that impede happiness.

Steve Shallenberger: Welcome to our Becoming Your Best podcast listeners wherever you may be in the world today. This is your host, Steve Shallenberger. We have a terrific guest with us today. He is a Professor at Stanford University School of Medicine, pediatric intensive care physician, pediatric anesthesiologist, mindfulness expert, and the author of GAIN without Pain: The Happiness Handbook for Health Care Professionals. I have been looking forward to this, Dr. Greg Hammer! 

Dr. Greg Hammer: Thank you, Steve. It’s wonderful to be with you. 

Steve Shallenberger: Yeah, I can’t wait for our visit today. I know it is going to be a blessing to our listeners. We’re so honored and privileged to have them join us, literally from all over. This is going to be worth our time together today. So, before we get started, I’d like to tell you a little bit more about Dr. Hammer. He’s a member of the Stanford WellMD initiative. Dr. Hammer is the former Chair of the Physician Wellness Task Force for the California Society of Anesthesiologists. He has been a visiting professor and lecturer on wellness at institutions worldwide and teaches GAIN to medical students, residents, and fellows at Stanford. His clinical focus is in pediatric cardiac anesthesia and pediatric critical care medicine. What an area to be in. That must be pretty special for you. 

Dr. Greg Hammer: Absolutely, yes. The kids and their families are special indeed, Steve. 

Steve Shallenberger: His research is in developmental pharmacology and immunology, and he has an active laboratory with multiple ongoing studies in these areas. He has published widely on topics related to pharmacology and perioperative care of children. Well, Greg, we’re so happy to have you here. And to begin with, today, can you tell us about your background, including any turning points in your life that’s had a significant impact on you? And how did you end up where you are today? 

Dr. Greg Hammer: That’s a great question, Steve. Well, I had a keen interest in astronomy from a very early age. I remember dragging my telescope out to the end of the driveway in the town where I grew up outside of Chicago. And of course, the clearest nights were those in the middle of winter, which often meant temperatures in the negatives — Fahrenheit — so I remember having my I stick to the eyepiece on occasion. But my interest really was in the relationship between the very micro and the very macro and how planetary bodies, for example, related to their sun, the solar systems relating to their galaxies, galaxies relating to clusters of galaxies, and the universe at large. And then, as I got older, I got interested in human biology in the same vein. I was very taken by the miraculous interaction between the sub-cellular and the macro, the human body. And I think the body, in a way, is like the universe, and the little organelles inside the cell and even down to the molecular and atomic and subatomic level are very much sort of a fractal representation of the universe. And came to a fork in the road, as Yogi Berra advised, I took it. I decided to go into medicine rather than astronomy because I’m a pragmatic guy and I thought the opportunities might be more diverse. In medical school, I just really loved working with people who were involved in taking care of infants and children. It wasn’t so much that I was enamored with kids, per se, although that certainly came and grew later. But I just felt a kinship to the nurses, doctors, and other therapists in pediatric medicine, they seem not to take themselves too seriously, I never have suffered a big ego as well. So those are my peeps. So I did a residency in pediatrics and then fell in love with critical care medicine. And at that time, in particular, there was a natural path in anesthesiology, Critical Care Medicine, and pediatrics, so I did another residency in anesthesiology and then fellowships in pediatric anesthesiology and Intensive Care Medicine. And I have been practicing those specialties ever since. And Steve, it just seems to get more rewarding every year that passes, and I feel absolutely blessed. GAIN is an acronym, by the way, for Gratitude, Acceptance, Intention, and Non-judgement, which I think are the pillars of happiness and that starts with G for gratitude. And I’m just so grateful and appreciative that I’ve had the great privilege of working with these kids and their families. Just absolutely inspiring. And of course, I love medicine as well. 

Steve Shallenberger: Well, what a background. Thanks so much. We’ve got so much to talk about because of that background and I love your attitude. And if you don’t mind, we’ll talk about GAIN later on in our visit today. And how true that is of having gratitude and giving us a wonderful perspective on life and just appreciation, which leads to growing in other areas, and being hungry, and just so much balance comes from that. Well, let’s start out, if you don’t mind, with why you think, from your experience, the number one resolution we should have should be around how to improve mental health and well-being. 

Dr. Greg Hammer: Again, Steve, a good question. I think there is one thing that used to be said that all 7 billion of us want. Somebody told me it’s more like 8 billion now, which is kind of scary. But the one thing that all of us want is happiness. What else can be more important? Peach, happiness, and joy is really all we see. And the fact is that it’s right there within us. It’s our true nature. I really believe strongly that our true nature is happiness, but that gets veiled by the way that our brains are wired. So I think that mental unhealth comes from the wiring of our brains. And the good news is that we have this amazing quality called neuroplasticity so we can change the way we think. We can actually rewire our brains. But a couple of the elements that I think really impede our happiness, at least apparently so, are, one, our brains are wired to impart a negativity bias. So we tend to remember the negative and forget the positive. The other aspect of the way our brains are wired that apparently veils our happiness is that we’re very distracted with the past and the future. So I talked about adaptive ways to think about the past and future and maladaptive ways. For example, it’s adaptive to consider the past to savor the wonderful memories that we’ve had. It’s adaptive to even acknowledge our mistakes that are in the past so that we don’t continue to repeat them. Beyond that, we overthink the past, then this leads to—combined with our negativity bias—shame, regret, self-esteem, and depression — so, mental unhealth. With regard to the future, it’s adaptive to plan for wonderful times with friends and family and loved ones in general. And also, we do have to be pragmatic and plan to put bread on the table. But beyond that, when we overthink the future, again, combined with our negativity bias, we tend to generate fear and anxiety, we catastrophize, and we think of the worst thing that could happen. And I can see how this is a trait that developed over tens of thousands of years.  

Dr. Greg Hammer: So, imagine our forebears, early homosapiens, sitting in a cave, trying to keep the fire going. And outside the mouth of the cave, may have been a saber-toothed tiger that presented a danger. So, the weary caveman or cavewoman, who was always thinking of the worst thing that might happen, and catastrophizing, if you will, was thinking about the danger that lurked just outside the mouth of the cave. And if they really focussed on that, it often allowed them to live longer and have more offspring. So these genes that voted for caution and weariness, and in a way, negativity spread in the population. And here we are, 50,000 years later, those traits are hardwired into our brains. Fortunately, we don’t, for most of us, any longer live in a cave and none of us live with the threat of a saber-toothed tiger. And most of us don’t live with the threat of anything terrible happening in the immediate future. Of course, there are exceptions to that, as we hear about every day in Ukraine. But nevertheless, those dangers are not present for most of us and yet our brains are wired to overthink the future and worry about those hazards. So, I think, again, it’s the negativity bias, it’s the distraction with the past and future. And as we know, happiness lives in the present moment. If we think about all of our happiest times, they’re when we are right there, right then walking through the forest, experiencing that lovely sensation of the pine needles underfoot, looking at the light filtering down from the canopy at the treetops over us. And we’re not thinking about what happened yesterday or what might happen tomorrow, we are right there right then. And our sense of separation, our sense of separate self, which leads to mental unhealth, dissipates. And again, happiness is in the present moment. So the question is, how do we rewire our brains to be happier and more present? And, again, that’s all we really want is happiness. So we can talk about the keys to rewiring our brain from a state of mental unhealth to a state of mental health. 

Steve Shallenberger: Yeah, well, let’s work on that one right now. I’m just going to tell listeners right now, I do pretty good with the past. I’m really grateful for the blessings I’ve had, and I’ve had setbacks, and I love to learn from them. But it’s back there and I’m able to take that forward and I feel pretty happy. I lost my wife a couple of years ago after 46 years, and that put me in a little tailspin, it’s a big adjustment. So, now I’ve been dating a wonderful lady for a couple of years, but she’s not quite ready to get married, and so that is the future and I’m ready. When I’m with her, I’m happy. 

Dr. Greg Hammer: Well, Steve, people like you who are very high functioning, as I said, you are an example of someone who has just achieved so much and is so interested in giving back. So you are living the three principles, I think, of happiness as we age — this is another way of looking at the keys to happiness other than the GAIN elements — and they are: serving other people, being in community with others, and growing personally. So I think you exemplified those things. You are able to put your arms around those elements in the past and future in an adaptive way. So you may not feel shame and regret and low self-esteem related to things you did that you wish you didn’t do; you focus more on the positive. So you take those mistakes that you may have made and you pledge not to repeat them. But let’s face it, we are not all that resilient. So for many of us, it’s the maladaptive ways in which our brains go to the past and future with the negativity bias that makes us feel depression, and frankly, anxiety. 

Steve Shallenberger: I think, Greg, where I struggle a little bit would be that future zone. I love the three things you just suggested, by the way, wonderful. But how do I avoid spinning all the different outcomes trying to make that present extended over a long period of time? I don’t know if you have any thoughts on that. Maybe some of our listeners may have a similar challenge. But I think you’ve talked quite a bit about this.  

Dr. Greg Hammer: I have. And back to the GAIN elements — Gratitude, Acceptance, Intention, and Non-judgment — when we have a GAIN practice, and I can walk you through that briefly if you’d like.  

Steve Shallenberger: Yeah, let’s do it.  

Dr. Greg Hammer: Okay, so let’s do that. We get up in the morning, we open the blinds, the sun is up, and there’s light beaming through, I think that’s an immediate bit of positive energy, literally. We may do our morning hygiene thing and then find a comfortable place to sit, hopefully where it’s quiet, and we close our eyes, and we focus on the breath, we focus on the in-breath, the pause, and the out-breath, which comes with no effort. And we slow these down — so, slow down the in-breath, perhaps, to a count of three, pause to a count of three, and a slow exhalation to a count of four. When we slow down our breath, we lower our heart rate and our blood pressure, we decrease the amount of adrenaline that’s circulating in our body, and we settle into a very clear way of being. And then we begin what can be as little as a three-minute contemplative meditation. I’ll just take a step back for a second and talk about meditation. Many people think that meditation means you have to sit still for 30 minutes at a time, possibly in an uncomfortable position, not scratch an itch and ban all thoughts from your mind. And of course, nobody can do that. I mean, maybe certain gurus can do that, certain Yogis, but I certainly can’t. So, in the GAIN meditation, I’m actually giving you things to think about and making it quite brief so that you don’t feel like you have to get up and do something else. So we start with the breath, we settle into that, and then we begin to contemplate that for which we’re grateful. So, Steve, you might be contemplating the wonderful 46 years you had with your wife, you may be contemplating the gift that the new woman in your life brings to you, you may be thinking of the love with friends and family and how much pleasure you get from giving back doing your podcast, what a privilege it is to be able to help other people, and you’re grateful for all of those things. You’re grateful for your health and your relative wealth. And I put that forward, not because money is the object, but rather that most of us are wealthy enough to have a home, to put food on the table, et cetera, and for that, we’re grateful.  

Dr. Greg Hammer: And then we sit in the shining light of gratitude and transition to acceptance. And this is key, I think that some philosophic and religious traditions overlook this. But pain is as much a part of life as joy, and I think we need to sit with the pain. We actually need to contemplate something painful — for example, I lost my son at the age of 30, and you lost your wife. So contemplate that pain, and actually, bring it closer and closer. And as we sink into our breathing, open our chest, open our heart, bring that pain into our heart and nurture it, envelop it with our heart, join with it until there’s no separation between that pain and in our being. And we can ask ourselves the question, “Can I live with this pain forever?” And the answer becomes yes. And there’s a formula in the book, Steve, ‘suffering = pain x resistance.’ And acceptance might be the inverse or opposite of resistance. So, when we resist, when we try hard not to think about something, when we depersonalized another person who may be bringing us pain, when we rationalize, when we resist and fail to accept, it magnifies our suffering — suffering = pain x resistance. So, in this practice of GAIN, we move to a complete relaxation into the breath where we’re fully accepting of the way the world is, which may not comport with our wants and needs but we’re open-armed about it and we’re open-hearted about it. Then we transition to the I in GAIN, which is Intention. I love the definition that Dr. Jon Kabat-Zinn gave to mindfulness, which is, “Awareness of the present moment on purpose, non-judgmentally.” So, again, happiness is in the present. So awareness of the present moment on purpose, why on purpose? Because if we don’t have purpose or intention, we lapse into our default way of thinking, which is negative and distracted.  

Dr. Greg Hammer: So, if we want to rewire our brains, and fortunately, we have the ability to do that, we need to be intentional about it, we need to have a plan. And I’m sure you recognize the requisite quality of intention and purposefulness in being a successful entrepreneur; you have to have a plan. If we want to be happy as we grow older, we need to have a plan to be in community with others, to be constantly growing, personally, and to give back to others, and we can do that if we have a plan. So, that’s the I in Intention. And the N in GAIN is Non-judgment. And again, we go back to Dr. Jon Kabat-Zinn’s definition of mindfulness, which I think could be the definition of happiness. Happiness is awareness of the present moment, on purpose, non-judgmentally. So, I present to you, as you’re resting into your breath, picturing an image of the earth apparently suspended in space, one of these beautiful NASA images of our beautiful planet. And the earth is neither good nor bad. The earth is just the planet that it is. It’s neither good nor bad. So it’s only rational for us to think, “I am neither good nor bad. I am just the human that I am. I am. I am.” And then we slowly open our eyes and we’re ready to go out in the world. 

Steve Shallenberger: With that framework, and maybe you’ve answered this, maybe you haven’t, you’ve talked, Greg, about the rewiring of our brain. Do you do it through GAIN? In other words, is that a deliberate focus on that? How do you at best do the rewiring?  

Dr. Greg Hammer: Well you do it with the GAIN method is one way. Obviously, there are lots of other ways to rewire our brains toward a more happier way of being. But if we take the GAIN principles, I tried to come up with what I thought was the essence of happiness, and then I wanted to have an algorithm so people could remember it. And I think Deepak Chopra and others have perhaps the seven ways of this or the 10 steps to that, too many for me. So, four, I thought was a good number — so, GAIN. And what happens during the day, Steve, is when we’ve done our GAIN practice, we become much more aware of those moments when we’re being ungrateful, resisting, or lapsing into this negative way of thinking, and we find that our thoughts are just dwelling on the past in a negative way when we’re judging others. A little light bulb will go off. The more we do this practice, again, three minutes in the morning, a light bulb will go off at those moments. You’re driving your car, and a car changes from the right lane to the left lane right in front of you without using its turn signal. And immediately, you start making judgments about that driver. And then a light bulb goes off and you think, with a laugh to yourself, “I don’t need to judge that person. Maybe his wife is in labor in the back seat. It doesn’t matter, though. That person, like me, is neither good nor bad, just drop it.” And you get a little chuckle out of it. So, when you sit with these GAIN principles every morning, it’s wonderful how that recognition just illuminates, that little light bulb goes off when you find that you’re drifting into thoughts of the past, when you’re judging others, when you’re just being ungrateful and focusing on something negative, “Oh, my left knee hurts after my run.” Well, think of how wonderfully tuned the rest of my body is and let’s be grateful for the miracle of the human body and the good health that we have and not dwell on that one little negative thing, which we tend to do. 

Steve Shallenberger: We think about anxiety and depression, and you have thought about this in terms of the winter, and the impact that the winter has on people. And they may be aware of it, especially if they live in Seattle or Alaska, but maybe the rest of the world isn’t so much. What impact can the winter have, and what can people do about it? 

Dr. Greg Hammer: There’s a bonafide condition called the winter blues, or you can assign another name to it. I think what happens, Steve, in the winter, is that a couple of things. One is, many of us, myself very much included, are very affected by the light in our environment. I grew up outside of Chicago, where most of the time there was a bit of a haze in the sky when it was clear, and the colors were a little bit dull. And then I came to California, and one of the first things I noticed was how brilliant the light was, how deep blue the sky was, how green the greens were, and how yellow the yellows were. So, I, like others, am very much affected by light. So, in winter, oftentimes I go to work early, so I get up and it’s dark, I’m inside all day, and when I’m ready to go home, it’s dark. I have no sunlight and no natural light, and so that has a negative effect. I think, as far as taking care of our bodies, we talked about the three elements of happiness as we age, giving back, being in community, and personal growth, and the GAIN elements. But we have to take care of our physical bodies as well. So we need to really focus on our sleep hygiene. Again, with intention. We can’t just lapse into our habitual staying up too late with a laptop our lap in bed. We need to have good sleep hygiene if we’re not sleeping well. We need to have an exercise program, again, very much on purpose. We need to exercise with discipline and move our bodies. The third element of our physical health is our diet or nutrition.  

Dr. Greg Hammer: So I think that a lot of times in the winter, we’re a little blue from the lack of natural light, we don’t get outside and enjoy nature as much. We don’t get enough exercise. This affects our sleep. We’re not sleeping well, and so we lapse into our unintentional mode of eating. And for many of us who work in a hospital, it’s wonderful that grateful patients donate boxes of See’s Candy to the nurses and those are sitting at the nursing station. And I’m tired, I didn’t sleep that well, I haven’t been in the natural light for a couple of days. And that piece of See’s Candy will give me a temporary boost, but these sugary and fatty so-called comfort foods just give us a very temporary burst of energy, then we crash. So, our eating habits go down. So our sleep, exercise, and nutrition, which are very interrelated, may all suffer during the winter. And the good news again is, just like rewiring our brain, if we use our intention and really focus on our sleep hygiene, focus on our exercise, even if it’s just putting on some layers and doing a brisk lap around the block at eight o’clock at night, and if we focus on our diet, we can actually improve our physical health, and therefore, improve our mental health and our desire to be happier and redouble our efforts even more to practice the GAIN elements and those other elements of happiness. 

Steve Shallenberger: For all of our listeners here today, I love the reminder of sleep, exercise, and a healthy diet. Those things will pay dividends forever and ever in our lives in every way. But I have one question, Greg. Dr. Hammer, are you ready? 

Dr. Greg Hammer: I’m ready, Steve. 

Steve Shallenberger: How do we get good sleep consistently? 

Dr. Greg Hammer: Well, I can give you a handful of tips that will help, and they may not totally fix it, that would require a lot more discussion. For example, not eating too late at night, and not having alcohol anywhere near the time we go to bed because alcohol, like our anesthetic drugs and sedative drugs, interacts with the receptor called the GABA receptor, and so drinking alcohol is like taking a valium like drug before you go to sleep. And that GABA stimulation actually may result in unconsciousness or facilitate consciousness, but it interferes with restorative sleep. We can look at the EEG patterns in people who have a GABA-induced state of unconsciousness — general anesthesia, for example, or even alcohol or a sleeping pill. Those GABA-ergic, as we say, agents may facilitate unconsciousness, but it’s not sleep, it’s an unnatural state of unconsciousness and we don’t get the restorative benefits. So, drinking alcohol in the evening is not good. Coffee — caffeine has a very long half-life. So when we drink a strong cup of coffee at three o’clock in the afternoon, it’s like having half a cup of coffee at nine o’clock at night, because the half-life of caffeine is about six hours. And having half a cup of coffee at nine o’clock at night or a quarter of a cup of coffee at three o’clock in the morning would definitely keep me up. So, a light dinner, not eating proximate to the time of going to bed, not drinking alcohol, maybe a glass of wine at dinner if you don’t eat too late, and avoiding caffeine even in the afternoon. And then, of course, we know the blue light from screens, whether it’s a television, computer monitor, or tablet, or phone interferes with our ability to get restful sleep thereafter. So, I would recommend not having screen time, at least, for 45 minutes to an hour before you go to sleep. And then make a list of things that you need to do the next day if your brain goes to that kind of thought pattern when you’re lying in bed. So you can rest easy that you don’t have to think about those things; you’ve already written them down and you can deal with them in the morning. So, those are maybe five tips or so that I think will improve all of our sleep. Going asleep at the same time and waking up at the same time, so our body gets into this rhythmic pattern of sleep. Those are, again, five or six things I think if we really pay attention and put our intention into healthy habits and those areas, that alone will improve our sleep dramatically. 

Steve Shallenberger: This has been a fun interview. I love all the things that you’ve shared with us today and the insights. I’m looking forward to reading your book. Is it on Audible as well? 

Dr. Greg Hammer: No, I haven’t done that. A lot of people have asked me that, so it’s on my list. But the book is on my website, greghammermd.com, gain@greghammermd.com. And also on Amazon, if you just Google GAIN and my name, Greg Hammer, you’ll find it on Amazon. I hope to come out with the next one in the next six to eight months, which is really about mindfulness for teenagers, a group that I think is really at risk these days more than ever. 

Steve Shallenberger: Oh, can’t wait. Well, that sounds great. I’ll order it today. Looking forward to reading it, that’ll be fun. Before we sign off today, any final tips you would like to share with our listeners? 

Dr. Greg Hammer: I think, Steve, that the message is that there’s a simplicity to the truth about our natural way of being, which is happiness, and the roads to become more happy are right in front of us. So, all we have to do is have a plan and we can all rewire our brains, beginning today, to be happier and healthier human beings. 

Steve Shallenberger: Well, thank you so much for joining us. Congratulations on all of the things that you’ve done and continue to do. You’re serving others and working on this community and the relationships and making a difference. So, congratulations, great going. 

Dr. Greg Hammer: Thank you, Steve, very much. And likewise, congratulations to you for all the good work that you’re doing. 

Steve Shallenberger: Well, thanks. And to our listeners, it’s been a privilege having you here. We are grateful for you and honored that you take some time. I know that you’ve gotten some ideas that will be helpful for your happiness, productivity, and becoming your best. So, we’re wishing you a great deal and a great day, and wish you all the best today and always. This is Steve Shallenberger, your host, signing off. Have a great day.