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Summit Shah: My Journey With Smile Cards

Aug. 22, 2015

Theme: My Journey With Smile Cards
Speaker: Summit Shah
Host: Deven Shah
Moderator: Birju Pandya

Birju: Our guests today are no strangers to access kindness as a practice. Summit Shah and his partner Julie are quite accomplished folks in the world and do things professionally that are quite beautiful, but for the purposes of this call, the best way to introduce them may simply be that they are kind folks. After coming across smile cards many years ago, they have walked an inspiring path towards generosity. Summit and Julie thank you so much joining us.

So first off, how are you both feeling today?

Summit: Feeling wonderful. We are in Virginia right now. Woke up, had a little bit of exercise in the morning, and we are happy to join this call now.

B: The topic for today is kindness at a high level and very specifically smile cards. Can you tell us about the first time you came across the concept of smile cards and what that felt like?

S: Sure. The first time I heard about smile cards was in 2007 or 2008. I was at a conference in Los Angeles and I heard Nipun Mehta speak at the conference on his journey with kindness and the development of smile cards. He talked about how kindness had impacted his life, and I was completely inspired by the talk.

Everyone in the audience received smile cards to take home with them. I kept those smile cards around. I took them back to Columbus Ohio where I live. But I never actually used them, until about 4-5 years later when Julie sent me a link on a blog about a mother who went around and decided to celebrate her birthday by doing random acts of kindness. It immediately triggered memories in my mind of hearing the talk and the smile cards that I had. I told Julie that we have to pick a day and do a random act of kindness together.

We had known each other for a few months back then. We were friends. So one random Tuesday evening, I picked her up after work and we decided that we were going to do random acts of kindness that evening. So we went to a famous ice cream shop in Columbus called Jenny's Ice Cream. We sampled a few flavors and picked out our favorites, and told the person at the register that we wanted to pay for the next individuals that selected our favorite ice cream flavors.

We wrote a little message for them on a card mimicking smile cards. So we wrote, "Happy Tuesday! You've been touched by a random act of kindness. Tag you are it. Now go ahead and spread kindness to someone else."

We had never done it before so I was a little nervous. The person at the ice cream shop was absolutely ecstatic. They had a huge smile on their face. They wanted to help us in any way that they could. They were even happier than we were. (laughs) So we left some money; left some handwritten notes there; and we had so much fun that we decided to go to another ice cream shop the same night.

We ended up going to three different places. I remember laughing the entire time. Until this day, Julie says it is one of the happiest moments that she has ever seen me be in. We had a great time. That was the start of our journey, and we decided that we were going to try to do that more regularly. Now we try to get together every Tuesday night. It is kind of our special night together. We try to block it off for other commitments and activities. We try to do something new, and do a random act of kindness.

Julie: My most vivid memory is I remember after stopping at the last place just sitting in the parking lot and laughing and reflecting on how we didn't expect everyone to be as excited as they were, but everyone was just thrilled to be able to do something like this. That is the trend that we've seen essentially every Tuesday night since then is that people just get really excited about even the smallest act that they get to be involved with.

B: What is it that made it stick as a practice?

S: Speaking for myself, for me it was overcoming that initial uncertainty of how someone will respond. Now it seems quite obvious that it just a joyous interaction, but the first time before I had someone else to do it with, I really wasn't sure how to do it and what to do and how someone would respond. Having done it once and seeing that positive feedback motivates us to do it over and over again.

The second piece is having someone or finding someone in life that share that same joy with you. I have always believed in life that when you have other people to do things with, you are much more likely to do them. It's like having a partner in crime or partners. If one person is feeling a little off one day, the other person might suggest, "Oh, let's do a random act of kindness or let's leave a smile card here." You keep each other motivated and moving forward.

J: For me, it is just how easy it is. It is one of the most simple things to incorporate into your day to day or your weekly life. Oftentimes volunteering commitments can be significant. Organizations can be significant, but smile cards are something you can use with no notice, no resources, just a moment's thought. It is so easy to incorporate into daily life, which is what has really made it stick for me.

B: There is something about the value of practice with a community that seems to add up to making it easier. Tell us about the idea of the practice. What happens week to week?

S: We started that Tuesday night. Then the following Tuesday night I would reach out to Julie and we do something else. We would always have good deep conversations when we would see each other often related to serving others, kindness, giving back, and greater purposes in life.

One night we decided that we were going to make a list--a google document. We started making a list of things we wanted to do in life--little things--like going to a drive-in theater. Doing things around Columbus that we wanted to do. We would work and meet up on Tuesday nights whenever we could and start doing those things. And one of those things was distributing smile cards and doing random acts of kindness.

As we started making the list and seeing each other on Tuesday nights, we realized that we had so much fun from distributing smile cards and doing random acts of kindness (RAK) that we should incorporate random acts of kindness and smile cards into every Tuesday night, whatever we were doing. Whether that was going to an art gallery or going ice skating. Whatever activity we had planned we would try to incorporate RAK. On the list, we also started keeping track of our memories of our RAK, so we could look back on them and smile if we were having a bad day.

So we have this ongoing shared Google Doc called "Tuesday Nights."

B: The part of the practice that is really inspiring to me is the consistency of it. It seems like it is every single Tuesday. I'm wondering if there are times when you don't feel like holding to the "kindness schedule." What do you do when your energy is not there?

J: There are definitely times when things come up and you can't adhere to the specific Tuesday night schedule. I taught Summit how to set calendar appointments because my day to day life was by my calendar, so if for some reason we couldn't be together on a Tuesday because of work, etc. we usually have a substitute day for that.

From the perspective of being tired of kindness, I don't remember a time when we didn't feel like doing a simple RAK. It is almost the opposite. If one of us is having a bad day, one of the ways that we help each other get through bad days is reminding each other that it is not all about us. It is about what we can do for others and how we can make a positive impact. And how blessed each of us really are in our day to day lives. We use kindness as a way to get through bad days as opposed to looking at kindness as a task that we have to get through.

S: I can remember days when it was late and we don't get together until about 9:30 or 10 P.M. on a Tuesday night sometimes and we'll run out real quick and distribute a smile card. We are both a little tired. It may have been a long day, but immediately after we do a RAK, often interact with someone, always puts us in a better mood.

B: How long has this been going on?

S: It was in February of 2013 that we had that Tuesday night at the ice cream shops.

B: So how do you both feel like you have changed from having this as a practice with such consistency?

J: For me it has been more in my day to day actions. Activities that I do that bring about positive impact to others has been something that has been consistently emphasized since I was growing up. My parents were instrumental in my commitment to service over the years, but it was always activity based or hours base or organization based. Where as I feel like the transformation for me has been in recognizing that those small acts can make a difference.

You don't have to be doing something that is completely significant in everyone else's eyes. It is really about bringing a smile to someone else's face even if it is just for a moment.

S: I would echo those exact same sentiments. I've always grown up knowing that I've wanted to help the world and do good things. But in my mind, my ultimate goal was always to do something on the larger scale, knowing that I wouldn't be satisfied until I did something on a larger scale, like lead an organization or start a non-profit.

All those things are wonderful, but I think that as we started distributing smile cards and doing small RAK, we realized that the world truly can be transformed by these small day to day tasks that don't take certain years of training or certain amount of resources. Something that everyone can do in their everyday life and cause potentially a ripple effect of kindness which can truly change the world. It has been a growing journey towards that mentality ever since we met and started doing these RAK.

B: I'd like to delve deeper into that, Summit. I think for a lot of people out there in the world at least who are classically trained by the system, there is this idea that it is nice to put a smile on somebody else's face, but the world is burning. What are we really doing here if all we do is call it a day after making sure people have ice cream? Are we actually making the big changes in the world that we need to? How do you combat those types of thoughts in yourself, much less in other people, as in when you guys share in what you are up to?

S: It can be difficult. I had that same mentality before. When we address big problems that are more tangible and do things that have more tangible results, it is easier to say, "Hey, I did this, and this is the product of it. This many more people have food or resources." When you are doing a RAK, what you are providing and measuring that is something that is much more intangible. It's a positive emotion; it's a smile; it's an inspiration to go out and be kinder to other people and to continue this chain.

It is difficult to combat those perceptions, but you have to have trust that when you do something kind or something good, other people see that and want to mimic that behavior, and trusting that that doesn't die with you or the next person you inspire, because they may spread that to 10 more people and those people may spread it to 10 more people. So really believing in this idea of the ripple effect. We notice that every time we through RAK or do any volunteer activity together because we are inspired by other people and other people are inspired by watching us do good things and hearing our stories.

J: I think the easiest way I combat those views is by recognizing that having an impact on one person doesn't mean that you might be having an impact on the world. All too often we think that we need numbers or measurements. You can see the tangible results on one individual when you give someone a smile card and you wait in the background and see they joy that they experience with distributing that smile card and putting a smile on someone else's face. I do believe that seeing the impact is the best way. For any doubters, I just encourage them to try it and see how it affects them.

B: You are both professionals. What do you do in the world that intersects and is informed by your practice of kindness? How as a medical doctor do you think about inviting practice into the seemingly big stuff that you need to do on a daily basis?

S: I'm in medicine. I think in medicine, there are a lot of hours that you spend at the hospital or at your office, it is easy to feel jaded. And to feel burnt out. And to feel that you are not making a grand difference in the world, especially when you see patients that are not getting better or when you see patients that continue to have the same problems. One way that I implement this is by thinking about little things that I can do to make other people's lives a little bit better.

And it doesn't have to be providing them with a diagnosis or a medication, but it can be just listening to their story, to holding their hand, to looking in their eyes and giving them a few extra moments, going out of my way to do something that may help them. Taking time to explain something to them a little bit better, knowing that that kindness that you can show to other people at work or in your day to day life can have a large impact on their mood and health as several studies have shown.

J: I'm a pharmacist by training. Summit and I actually met for the first time at a free clinic when I was a resident. I finished residency and now have an administrative position, so I don;t take care of patients on a day to day basis. I take care of employees and now residents. For me, smile cards and the mindset of kindness in general has helped me to be a better manager. It has helped me to be more patient with employees. It has helped me give me perspective in that there is more to a person than what is going between the four walls of the hospital. So I remind myself that, remind them of that, reminding them that there is purpose outside of their work, and emphasizing the importance of other things that provide one with fulfillment.

I actually have a stack of smile cards that are pinned to my bulletin board in my office. Oftentimes I get questions about them, and I love sharing with people the joy that I have received from those and giving them suggestions on how they can incorporate kindness in their day to day lives.

B: Given that both of you are connected to the world of medicine, how do you think about this movement of empathy in medicine? How does that fit with your ideas of kindness?

S: I think the two are intricately connected. Part of the purpose of practicing kindness is to develop empathy and to practice empathy with other individuals. Connecting with other individuals is something that we both strive for and derive joy from.

In medicine, I know that empathetic providers are some of the best providers, so cultivating empathy is very important to me. Kindness directly helps cultivate empathy, at least within myself. Kindness helps you relate to other individuals a little bit better, helps you see life from their shoes, which directly helps you build up empathy within yourself for another individual, no matter how different they may be from you, which helps me become a better physician.

J: I agree. One of the benefits that both of us have seen through distributing smile cards is that variety of people that we have gotten to interact with and hearing different people's stories at times, and giving us a broader view of the world and situations that people come in with. Oftentimes as health care providers it is fairly easy to make assumptions about your patients. The more you are out in the world interacting with people outside of your health professional bubble, it is much easier to place yourself in that person's shoes and to demonstrate empathy and ultimately to be a kinder person.

B: I'm curious about taking it up a level from practicing kindness to practicing systems awareness, for lack of a better term. How do you think about your relationship to the system of medicine as a result of wanting to be kinder and kinder in life?

S: I do think that kindness does cultivate empathy. By cultivating empathy, we are able to take steps back and see the broader picture of other individual's lives. It allows us to take a step back from the moment of making a more objective decisions on diagnoses and treatments and management decisions, but, instead, look at more of the factors that influence a person's well-being, which are not directly related to medicine. By doing so, hopefully, we can provide better care for patients by looking at the whole system which is driven by more empathetic care.

B: Can I ask about the phrase "well-being"? How do you define what it means for a patient to be well?

S: There are several components of well-being. There is physical well-being which is what traditionally we measure the most in medicine. There is mental and emotional well-being which is also measured in medicine, but maybe less frequently. Then there are the things that are largely important to a patient's overall health which is a combination of their physical and emotional well-being. It is not measured as much. It is something that is harder to measure. Something that takes more time to talk about and think about. It is more difficult to treat from a scientific standpoint, but it is equally as important as their physical well-being and they both connect with each other by focusing on the entire individual, by being kinder, being more empathetic, hopefully we can combine these two things and look at the whole picture and look individual to serve them in the best way possible.

J: It is easy as a pharmacist to lean towards where does the evidence point to? How can you tell me that this is better than another thing? In the oncology setting, so often patients come in and they have ideas about treatments they would like to pursue that are really not evidence based and not necessarily what you as a practitioner would necessarily recommend. So often I have to coach our pharmacist on "yes, I agree if you look directly at the literature that might not be what is best for the patient, but you can't just look to academic literature when you are making decisions related to people's lives."

Oftentimes, people make decisions for reasons based on their background, based on their culture, based on their spiritual beliefs and it is our jobs as health care practitioners to listen to patients and to make the decision that is best for that specific individual based on multiple components of their life not just the disease state that they have and the medications that are available for them.

B: I'm hearing you describe something that is almost invisible. Just not getting in the way of a person's subtlest desires. I appreciate the chance to hear about it.

Summit you travel the world to serve others. How did that intention come about for you?

S: I'm of Indian descent, so I grew up going to India. The culture and socio-economic diversity is very different than the United States. At an early age, I always felt a lot of compassion for individuals who had much less than I did. There was a distinct moment when I was in high school, before I realized I was going to pursue medicine, that I heard about an organization called Operation Smile which went to other countries and performed surgeries on children with facial defects to help them smile.

I was completely moved by that. I knew that whatever I did in life, I would want to go to other countries where people were less advantaged to serve them, connect with them, and to learn from them. That inspired me to pursue my first medical mission trip to Honduras about four and a half years ago, when I was doing my residency training. It has completely broadened my perspective on the world and practicing kindness in another country with different patient population.

Julie and I were able to go on our first mission trip together to Mexico this past January. It was wonderful to put our thoughts of kindness into another system and another country.

B: Can you share a bit about your own relationship and how kindness plays a part in that?

J: The beginning of the relationship the important part is that we were friends. We enjoyed doing similar activities with kindness. We enjoyed having philosophical conversations about the world and our desires to make things better for other people. That lead to spending enough time together which developed into a more romantic relationship. Keeping kindness and spirituality and faith as the center of our relationship helps keep us both grounded. It helps us be more patient with one another. It helps us be kinder to one another. And definitely makes us better as a couple.

S: I completely agree. The concept of focusing on others instead of ourselves is something that helps us with our relationship as well helping us with ourselves which helps us with our relationship. Whenever we have a bad day or we may be upset with each other about something small, but as soon as we go out into the world and focus instead on other people and how we can serve other people whether through volunteering or RAK. Instead of focusing on our own emotions or things that we may not like about the other individual, we focus on other individuals.

It makes everything better. We are smiling. We forget about all of our problems, because we are completely absorbed in service of other people. Sometimes we even forget about what we were upset about before or why we were having a bad day. It is a wonderful transformation that happens when you focus on others instead of yourself. It has been a blessing to our relationship.

B: I would love to invite some stories. Are there a few stories that stand out to you?

J: One of our favorite stories happened on a day when we needed to quickly do a smile card distribution, so we walked to a library. We had every intention of giving the librarian some money to pay for a client's overdue fees. We spent some time talking to the librarian, who was very passionate about reading and books. We gave her our smile card. She looked at us and said, "I can't do that. How am I going to pick my favorite client to pay off their past due fees? That would be completely inappropriate. I could never pick a favorite."

We were like, "could you just give us a couple and we can pick one?" She refused. She could not play favoritism. After having a fun conversation for her, we put a smile card and some money in one of the books for someone to find. Just inspirational to see someone who is so passionate about this job and the people that come into the library and the service that she is doing for the community.

S: We both like service and volunteering, but we realized that it would be a fun idea to explore different non-profits in our community. So we decided to find one new non-profit every month and try to spend some time with them and volunteering with them. So one month, we went to a local park and helped with a park clean-up.

It was a beautiful day. We were wrapping up and they organizers mentioned that they needed a specific garden tool that someone had taken. As soon as the event was over, Julie and I had the exact same thought in our head that we would go and purchase the set of clippers and drop it off to them anonymously with a smile card.

What was wonderful is when other people present to you a need that you can fill. That brings us joy to fill that need. And it something that they actually need. So we went to the hardware store and bought the clippers and drove back by. And we dropped it off on their door, knocked, and ran. It always adds a little excitement in our lives.

Q & A

Deven: We have a question from a volunteer over email: A lot of research has been done about how medical students start off with compassion, but med school wrings the compassion out of them. How did you two survive the cut throat programs with your compassion and kindness intact?

S: I will say that I went through the same exact roller coaster of compassion going through medical training. I admit that there were times particularly early on in my career where I had lost a lot of my compassion and the initial energy that I went into medicine with. It is easy to lose compassion when you are under such large time constraints. You don't have a chance to take care of yourself--your sleep and healthy habits. It is easy to get caught up in a culture where physicians often become jaded, especially older physicians that are your mentors. They become jaded by either long hours or not receiving the results from their patients that they want or receiving negative feedback.

But one way that I have found to combat this and maintain compassion has been to practice RAK in my life and realizing that it is not about the big grand things that we do in life. We don't have to cure a patient's disease to practice compassion, to practice kindness, and to help another individual. We can do small things for them.

Distributing smile cards and doing RAK in my daily life has translated into deriving more satisfaction from small things that I do for patients. Engaging myself in volunteer activities outside of medicine has helped maintain that level of compassion, optimism, and goodness in the world.

Finally, I would say that doing work internationally has been a blessing. Seeing the little resources that others have in other countries and how grateful patients are to receive the smallest form of medical care from you. It also applies to local clinics that we volunteer at. The appreciation you receive when you provide something without a charge in your own free time is much higher. All those things has helped me to continue to build compassion even while it can be difficult in the day to day work-life.

D: We have one more question via email from Oceanside California. Thank you for this great call. There're two of us listening to it and are loving it. Questions: 1. Where can you buy Smile Cards? 2. How do you suggest someone can take this into another country? Are there copy rights to translate the smile cards?

J: No charge for smile cards. You can order them from They will be delivered directly to your home. There is an opportunity to make a donation. As far as in other countries, we are very fortunate that in many countries people speak at least limited English. I did have the pleasure of traveling to Europe and distributing one at a Gelato shop. It was really interesting trying to communicate something that is a foreign concept even in the U.S. So I used a few hand motions and finally got the point across. Luckily the person who was receiving the gelato spoke English, so as I was walking away I could hear her excitement.

B: We have a creative commons license, so as long as the intention behind the work is non-commercial and to spread goodness in the world, you are welcome to take the ideas and use them as you will whether that means you have usage of the smile card itself or something that is translated over and turned into cards in your country is all welcome.

D: We have another question over email: How do you think we can make kindness the "in" thing? I look at people like Trump and the rise of narcissism and sometimes lose hope, but I have heard that kindness can spread like a viral contagion.

S: It is something that is a ripple effect. Everyone that has seen us practicing an act of kindness, whether as a recipient, an observer, or a co-creator, has been inspired and wanted to do the same thing. Several people have asked us for smile cards or where to get them. We've sent little anonymous packages in the mail to friends or family members and maybe one or two gift cards and a few suggestions on how they could practice RAK and use the smile cards.

Just by practicing kindness to yourself and sharing what you are doing and how it inspires your life can transform those around you, your communities, your friends, your family members. Hopefully, they can spread that to other individuals. It may be far fetched to think that the whole world can see this. This is the concept behind smile cards, being a card that you can pass on from person to person. We always underestimate the number of people that we influence in our lives by our actions and our words.

It is one of those naturally, intrinsic good things that very few people cannot be moved by.

D: Another question: "Have you either tagged each other anonymously?"

S: About a year and half ago at Christmas time, we were co-hosting a get together with friends to collect donations for underprivileged children in our area. So people were dropping off things at my house before-hand. I came home one day and I saw a few kid's bikes in my garage. There was a little note that said, "Bikes for kids." I had no idea who did it.

I'm not 100% sure, but I'm fairly certain it was Julie based on the handwriting that I have now seen a number of times and the purple pen which she loves using. (laughs). It's exciting. One thing we love doing is dropping things off to other people and saying it someone else.

D: If I may ask one question. I've heard about fight and flight response in our brain that is so much more developed then the logical thinking brain. Over the years as we evolved as a species, we are hardwired to react to fear, but now that hardwire response is creating anxiety and high blood pressure in our day to day life. In your experience and opinion, do the acts of kindness help with that?

S: I'm sure there is actual studies demonstrates how kindness calms people down, lowers anxiety, lowers stress, and reduces blood pressure. Those would be my anecdotal experiences as well. That is what it has done for my life. It calms me down, reduces my anxiety and stress, helps me become a more compassionate, loving individual to everyone else in life, and especially my relationship with Julie.

I read a study once that looked at people who wrote a letter of gratitude or called up someone who they were grateful for, and they measured their levels of stress before and after. All the individuals demonstrated much more calmness, much less anxiety and stress after practicing gratitude, which is a form of kindness.

B: What directions would you like to grow as it relates to this value of kindness?

J: Focusing on remembering kindness in my day to day life when I have frustrations. It is easy to be in a good mood when you are intentionally doing a RAK for someone else. I think it is different when you are experiencing some anxiety in life. Remembering to be kind in those moments is a personal focus for me moving forward. The other focus would be spreading the joy to more people.

S: Grow this community and spread RAK to more individuals and share our stories. Certain things we have an easy time talking about with others like I got a new job or I have this new car. But one thing we don't talk about enough are things like acts of kindness, and sometimes they are private acts like volunteering or serving others. I think that is something I would like to be more vocal about. Almost be like a child about it, announcing how much joy it brings into my life and my relationship. So that everyone around me knows that it is a focal point around my life and relationship and how it has greatly influenced my life for the better. I would hope that it would influence their life and relationships.

D: One more comment from California: Having moderated a Kindspring Challenge and participated in a few others, I and others find it difficult to post about our acts. To some, it feels like bragging. How do you respond to that? Also, I always find it most rewarding doing acts that go unnoticed by all except the recipient, and they don't know who did what. Is that the same with you?

S: I think this is an excellent question, and it something that Julie and I often struggle with. Something that we sometimes disagree on. She tends to be more private than me. Or sometimes I want to do something anonymously, and she says, "No, we should just write our names down."

I think it is a balance that you have to find within yourself. You never want to brag, but as long as your intentions are right, the outcome will always be right. As long as your intentions are pure purely focused on other individuals and spreading kindness and serving others, whatever you do, the result will be good.

So focus on your intentions, keep your intentions, focus on others and not on yourself, and you will be changing the world.

D: One last question: On behalf of us at ServiceSpace, what can we do for you in your initiative? How can we help you?

J: Order some smile cards and start distributing them.

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