Aunt Rachel’s Blessings

Posted on June 23, 2019 by Catherine Cheng, MD

http://www.rachelremen.com/about/

My friends, it’s been an intense couple of weeks! So much so that I have fully neglected the news headlines—this must be why I’m still in a reasonably good mood. Another is that I have rediscovered Dr. Rachel Naomi Remen, the wise and benevolent matron of medicine whose gentle and gracious example I aspire to follow.

I first read her books, Kitchen Table Wisdom and My Grandfather’s Blessings, at least ten years ago by now. They felt like my favorite plush blanket, draped over my shoulders with that welcome, comforting weight, and tucked under my feet, warming me with stories of love and belonging. Life was just as hectic then as today, but in a different way. The kids were little, and I had few if any responsibilities at work outside of patient care. Aunt Rachel’s stories calmed me and gave me peace in that young chaos. I had meant to reread them, but, well, life.

I perused the shelves and stacks of my personal library recently, searching for a book that my friend might like. Both avid readers, we share and discuss titles on leadership, philosophy, and personal development. The search this day felt different from browsing Amazon or my local book store. A deeper part of me knew exactly what I sought for my friend, even as my conscious mind had only a vague idea. I wanted to share something different with him, something less cerebral. As soon as I saw it, I settled on My Grandfather’s Blessings, no question. But after a day or two, as often happens with instantaneous intuitive decisions, I did question. So I sat down with Aunt Rachel and her grandfather one evening, as if meeting old friends in a cozy, familiar café. After some years of listening to books rather than reading them, I find quiet sitting with a paper book so comforting now. I am called to slow down, to be still, more than I have been (have allowed?), for a very long time.

By page two of the introduction, my doubts vaporized. This is it, I thought. Stories of humanity, history, culture, medicine, healing, perspective, and how we humans are intertwined with one another and nature in the most beautiful and cosmic, inescapable and daunting ways. As I reread her grandfather’s wise sayings, his subtle yet unmistakable messages of reassurance and unconditional love, that familiar warmth enveloped me again. I could almost feel my blood pressure drop, my oxytocin level rise.

So much love and connection—the book is really all about relationships, which my friend and I both hold as the key to a meaningful life. As I continue to read this week, it occurs to me that perhaps I was not actually looking for a book for my friend, but rather for myself. For many years I have hunted ravenously for books to teach me, to elevate my performance in parenting, doctoring, leading. But Aunt Rachel’s books simply soothe me. They acknowledge and give credence to that still small voice that advocates for and validates the need for deep personal connection, in a world that values it less and less.

I wonder if reading Aunt Rachel’s books so early in my career helped me more than I knew. Looking back on the past decade, I feel proud to have resisted the pressure of 15 minute clinic visits, to have made the effort to relate as personally as I could with every patient, even if my bids were rejected. Aunt Rachel’s books honor that heart center in me that holds true to what I value the most, which is connection with people. Perhaps I have her to thank for watering the strongest, deepest roots of my doctor soul before they could dry up and later require excavation to revive?

I still think my friend will enjoy Aunt Rachel’s book. Her stories resonate with the humanity in all of us, not just doctors and patients. I look forward to hearing his feedback, and finding more books to share. And I must remember to bless our friendship.

May we all acknowledge and share the blessings in our lives, every chance we get.

Thanks, Ba

Posted on June 16, 2019 by Catherine Cheng, MD

Today I sat stewing a long while over what to write. Too many ideas, all intertwined, tangled, and amorphous. It’s been an intense week of learning and introspection, and I’m happy to have some quiet down time. Hubs and son went to Colorado for a quick weekend getaway, and I got to FaceTime with them briefly while they drove with my dad to the mall before heading to the airport for the flight back. These, the three most important men in my life, all in one place—suddenly I felt moved to say thanks to the dads—Happy Father’s Day, of course!

When we think of dads and their special place in our lives, can we not help but realize the gravity of their job? Let’s not kid ourselves, no dad is perfect. But if we assume each does the best he can, we should really start to appreciate how they shape our lives. At their best, they protect us, model our core values and how to be in the world, and prepare us to launch successfully into that world with conviction. They seem also to possess inherent knowledge on how cars, garage doors, and water heaters work—what is up with that?

Much is written on why boys need strong male role models. But we girls need them, too—dads are key to all kids’ success. My dad immigrated to the US as an engineering graduate student in 1970. He taught me how to be assertive, honest, direct, articulate, and confident–all the things he had to be. Because of him I can stand tall (all 5’2” of me) in a room full of men and know without question that I can hold my own. I can meet my senior corporate executive male patients not just with my MD and expertise, but with the self-assurance that a lifetime of verbal sparring with a powerful mental coach has provided. Because of Ba I am precise, intentional, and sure with my words. [I got my diplomacy from my mom, but that’s another post.] I would not be the person I am today without my dad. It’s not at all that Hallmark commercial mush and goo (we are Chinese, are you kidding?), and we have certainly had our differences. But I do not question his absolute, unconditional, and infinite love, and I know he felt it from my grandfather before him. Hou-Ping Cheng of the Greatest Generation was, by the way, a Renaissance man. He traveled to the United States as a young adult in the early 20th Century, learned English, returned only to flee communist China after World War II, then rose to teach at university and lead infrastructure projects in my parents’ hometown in Taiwan. I think his father was a surgeon (will have to check with Ba on that one). I come from a long line of strong male role models, so voilà, how could I not be a successful, 21^st Century, Chinese-American mama doc?

Healthy relationships evolve and mature with time, and parent-child relationships are no exception. Kids appreciate when parents can admit their flaws and own their mistakes. Parents appreciate when kids acknowledge that we really are here doing our best. Apologies and forgiveness heal wounds great and small. I don’t do everything the way my parents did it, and I expect my kids will do things differently still. But what I really hope never changes through the generations, is that every kid in our family, no matter how old, feels loved through and through.

Ba, you have succeeded. Congratulations and thank you!

How Reunions Feed Us

Posted on June 10, 2019 by Catherine Cheng, MD

It was July 1997.

Maria C. and I had just started our third year of medical school, rotating on general surgery. We stood on evening rounds–it was already dark outside on this balmy summer night. The hospital hallway was quiet and half the lights were off. We visited a little old lady who had had surgery in the prior days. She looked frail, but also like she had been spry once. Her lips protruded the way my grandmother’s did when she took her dentures out at night. She wore a round fuchsia sleeping bonnet, a little askew atop her head. She looked half asleep, barely aware of our presence, and had slid down in the bed such that the pillow and blankets had effectively swallowed her.

We were tired, Maria and I. It was not a fun rotation for me. I had witnessed our attending throw a bloody sponge across the OR that month. He was not particularly interested in us, I don’t recall any direct teaching (but there could have been), and the sleep deprivation was killing me. But I had Maria. She always had a smile, always an encouraging word, and she loved surgery. Her energy held me up. We stood dutifully, trying our best to pay attention and learn something.

As we listened to the discussion of the nice lady’s plan of care, suddenly I heard a loud, resonant, and prolonged PPPPPPPTHTHTHTHAAAAAARRRRRRRRTTTT. Our somnolent charge had just passed the longest breath of colon gas I had ever heard, before or since. And it didn’t phase anybody. The team continued to discuss her plan of care as if nothing had happened. I don’t know, maybe they were encouraged, as flatulence is the first step to oral feeds and eventual discharge after abdominal surgery. They forged on without acknowledgement. I wondered if I had imagined it. But when I caught Maria’s eye, within seconds we could both barely contain ourselves. Maybe we were just slap happy from too little sleep, or we just needed something to break the tension. But it was too much, we had to step out. Back out in the dim hallway we laughed out loud as quietly as we could, to the point of gasping for breath, hanging onto the wall and each other to keep from falling down. Even today, 22 years later, I cannot help but smile at that moment. Either we went back inside after composing ourselves, or the team emerged eventually, I don’t remember. Rounds continued and I tucked away this little memory as one of the best bonding experiences of all my years in training.

*****

The Class of 1999 returned to The University of Chicago this past weekend to celebrate 20 years since graduation. I had only signed up for a couple events, in my usual non-committal way. I arrived at the breakfast venue, a building that did not exist when we were students. I glanced over at the tables and saw only people much older than me, and my heart sank a little. Where were my peeps? Then at a back table an old friend stood up and waved, and my spirits lifted instantly. We ate and laughed, and shared photos and anecdotes of surly teenagers at home. As I had made no other plans that day, I met people again for lunch and we walked through campus, which I had not done in years. The peonies in the quad burst with color and fullness, welcoming us all back.

I’m so proud of our class. We are general internists and pediatricians, hospitalists, cardiologists, allergists, emergency medicine doctors, and orthopaedic surgeons. We do neurologic interventional radiology, microvascular plastic surgery, and private equity. We are medical directors, section chiefs, and NIH researchers; we teach medical students, residents, fellows and colleagues. We advocate for immigrant health and lead international research teams to win the war on disease. We are parents of toddlers and college students, single, married, and divorced. But mostly we are just older versions of our younger selves, in love with the science of medicine and driven by something deeper within to care for our fellow humans, relieve suffering, and make the world better for our having lived. This weekend gave us the opportunity to reconnect deeply on that level, to recall and relive those bonding memories tucked away all these years. I had a chance to catch up with classmates whom I had always wanted to know better in school. What a blessing.

Our specialties are widely diverse, as are our life experiences, before and since medical school. But we also share so much in common. Many of us have had painful experiences as patients or family of patients, and that has impacted our attitudes as physicians. We collectively recall the stages and transitions of training as both trial and reward. And everybody has something to say about the current, broken state of American healthcare. But the overarching feeling of the weekend was camaraderie and love. Emails poured in from classmates across the country and around the world who could not make it back; I count almost 60/100 of us included in our communications thus far. We were just waiting for the chance to find one another again.

*****

In our current geopolitical climate of division, competition, and polarization, reunion is the antidote. In this vital ritual of humanity, we reconnect with those who knew us in a more innocent phase of life, when we bonded through shared struggle, with whom our diversity and shared experience are paradoxically complementary in the best ways. Our souls are fed by one another, in person, surrounded by food, back at our first professional home. Relationships long dormant stand revived, and we are lifted.

It occurs to me, in this lovefest of reconnection: How can we leverage this energy? What if we could sustain these bonds, reforged and hot in this moment? If we connected like this more often or regularly, across specialties, geography, and practice structure, how much better could we all be at what we do every day? How much more empathy could we have for those who don’t do what we do, whom we see as competing for resources or otherwise trying to undermine us? How would our patients feel in our presence? Our support staff? Our hospital leaders? Gatherings like this prove that we have the capacity to just be together, appreciate one another, and support each other with generosity and grace. So much potential for positive synergy among this group.

We have big plans for our 25^th reunion, but I have a feeling our renewed relationships will find powerful expression long before then. So stay tuned, my friends. We are Pritzker Class of 1999, and we’ got work to do.

There Is a Good “I” in TEAM

Posted on June 3, 2019 by Catherine Cheng, MD

The joke goes like this: “There’s no ‘I’ in team… Yes there is; it’s hidden in the A-hole.” The point of the joke is valid: Self-absorbed and self-serving individuals make bad teammates.

https://www.memecenter.com/fun/859499/theres-no-i-in-team-false

Yes, AND: There must be certain kinds of I’s on any good team: Each of us must have a uniquely contributory identity and role in order for our team to function well. Diversity—of experience, ideas, and perspective—is always the strength of a good team. Homogeneity leads to extinction in nature.

Also, we all have to get in the same boat and row in the same direction—each of us I’s must join wholly in the We in order for Us to accomplish anything meaningful. It is the balance of the Good I and TEAM that determines an organization’s success.

The Good I: Self-differentiation

We all recognize the kind of “I” who makes team life miserable—that person who’s always competing, always one up-ing us, constantly reminding us how great they are, wondering why we don’t notice. But then there are the I’s whom we respect. They exude a quiet confidence, speak their truth with grace. We seek their opinion even, or especially, when we know it will differ from our own. Anyone on the team could be either of these people: captain, quarterback, goalie, setter, relay anchor, department chair, CEO, professor, senior resident, intern, president. Standing out for the sake of lording power over others, or advancing one’s own interests at others’ expense, is the “hidden I” in the A-hole. This is the bad I.

The ability to stand up and out for our core values and integrity, even in the face of anxiety and external pressure to conform, however, is the Good I; it is an expression of self-differentiation. To do this well, and to contribute to the team as a creative individual, requires self-awareness, emotional and social intelligence, and self-regulation. In order to self-differentiate effectively, we must work on ourselves, not just promote ourselves. It’s not about getting what’s ours in a world of scarcity; it’s about owning our talents and claiming our agency to make a unique and meaningful contribution to the whole.

TEAM: Attunement

If all we ever do is work on ourselves, however, without looking up and around, we may disregard important relationships. I may have an important contribution to make. But if I cannot communicate my ideas in a way that you understand, or if I come off as condescending, arrogant, dismissive, aggressive, or otherwise unpleasant, I undermine my own effectiveness, and thus the forward progress of the team.

The ability to withhold judgment, seek understanding of and from others, and recognize their unique and important contributions, is the art of attunement. Simply, it is the practice of awareness and constructive responsiveness to others. When I am attuned, I know when I need to set context before pitching my idea. I observe my colleagues’ posture, body language, tone of voice, and facial expressions. I query for (mis)understanding. I hold space for open dialogue, debate, and idea exchange. This kind of resonance, when successful, facilitates the wave propagation of teamwork, and advances objectives faster and more efficiently with the synergy of morale.

Some might see self-differentiation and attunement as opposed or dichotomous—you can or should be one or the other. Rather, we should consider them as complementary and counterbalancing. We should each pursue proficiency and mastery of both skill sets, and practice them as both individuals and as whole teams. I can be both a self-differentiated and attuned leader of my department. My department can be both a self-differentiated and attuned member of my organization. My organization can be both a self-differentiated and attuned member of our profession or industry. And we can all, individuals and organizations alike, be both self-differentiated and attuned members of society at large.

TEAMS get things done when we well-self-differentiated I’s attune to one another and march together on our shared mission—regardless of the size, mission, or make-up of our teams. Every successful team is made up of individuals who claim their unique strengths, and then direct those strengths in service of the greater good, the overarching intention of the We.

Such harmonious and resonant balance is the quintessential win-win.

Insight While Driving to Work

Posted on May 30, 2019 by Catherine Cheng, MD

Training for Better Angels, it occurs to me:
Confidence in excellent communication skills in order to enter difficult conversations without bailing or lashing out… is akin to the core stability required to get into and out of a deep squat.
It’s the bending down, feet flat, head up, in control and not falling over, that is the challenge—not the forcing up in a quick, mindless burst of brute strength. Bearing the load all the way down and standing back up gracefully, without causing or suffering injury: that is where our real power lies, in the gym and in conversation.

Tombstone Words

Posted on May 26, 2019 by Catherine Cheng, MD

Update, my friends: My application for moderator training with Better Angels was accepted! AND, they may let me help with workshops both in Illinois, where I live, and Colorado, my home state! Woo hoooooooo! So much good work going on in this organization, please take a look!

* * *

This post is a three-part thought experiment. Take some time with this one, maybe–sit up straight, take some deep breaths, and see where it takes you! I invite you to write down your answers to the questions with a pen and paper. And then please share in the comments how it lands! Please know that I write purely out of curiosity and a deep desire for exploration and connection, and not out of judgment or an attempt at ‘pimping,’ as we used to call it in med school, when teachers asked us questions just to see us squirm and fail.

I credit my life coach and a new friend and mentor for instigating this post, and the ongoing conversations both in my own head and with others that I absolutely cannot wait to have as a result! The thread that connects the experiments is this: How do I show up in my life, and how do I feel about it?

Experiment 1

Imagine you’re at an awards ceremony; it’s the end of 2019.

You’re being honored and given an award for something.

You’re at the party, wandering amongst the guests/everyone present, listening to what people are saying about you.

They do not see you; but you will be present to receive the award later–you are not dead.

Who is there? How have they organized themselves? What is the vibe in the room?

What are people admiring about you? What are the words they’re using as they speak about you?

What are their facial expressions, posture, and gestures as they describe you and their relationships with you?

…What else do you notice?

What is the name of this award, and why are you the recipient?

How do you feel doing this exercise?

What emotions/thoughts/memories does it bring up for you?

Experiment 2

Now it’s your funeral or memorial service. Ask yourself the same questions as above, but in this similar and yet very different setting.

How are people dressed? How do they look like they feel?

Do they know how you want to be remembered and/or honored in death?

Who would be there if it happened today? What about five years ago? Ten years from now?

Now imagine that the three most frequent words uttered about you at this event will appear on your tombstone. Which words would you like those to be? Which do you think your funeral attendees will give you? How easy or hard is it for you to imagine the latter, and how close to your own wishes are they likely to be, today, five years ago, or ten years from now?

Experiment 3

Now, imagine a different set of people attending the events above.

These are your opponents, adversaries, and enemies. They are your inescapable work colleagues, direct reports, bosses, and your estranged family members. They are also the people you see regularly on your commute, the homeless people you pass on the street, servers at your favorite restaurants, and people who work at your grocery store. They are your kids’ former teachers, the customer service representatives at Comcast or United Airlines, your postal carrier, and the workers who collect your trash. What would all of these people say about you at your awards ceremony and at your funeral?

I did the first exercise with my coach a few weeks ago; it was powerful, enlightening, and grounding. The second and third experiments occurred to me today, and I will consider them, chew on them, in the coming weeks.

So… How was it?

A Community of Champions

Posted on May 19, 2019 by Catherine Cheng, MD

Spoiler Alert: Big Bang Theory Series Finale!

* * * * *

When was the last time you felt totally safe, at work, to address the central relational challenges that hold you and your team back from your best performance?

How often at work can you really assess and evaluate your own interpersonal skills, their impact on those around you, and on the organization as a whole?

How much time and energy do your teams waste being stymied by relational issues, stuck in redundant, dysfunctional power struggles up and down the organizational hierarchy?

How do you feel in your body just reading these questions? Perhaps tense and frustrated?

* * * * *

We, the eight participants and two faculty members of Leading Organizations to Health Cohort 11, reported palpable heaviness upon convening for our second training retreat last Tuesday. Despite the Colorado spring bursting with blooms, wildlife, and vast clear blue skies, dark clouds hung over our collective consciousness, each for our own reasons. Throughout the week we shared stories of successes, challenges, conflicts, power and powerlessness. We practiced appreciative inquiry and relational coordination, and explored the insidious impact of unearned privilege. We spent three days in intense skills training, supporting one another through viscerally gnarly role plays and open, honest feedback about how we impact the group.

In the midst of all this deep work, we also shared meals, walks, a horseback ride, and life stories around a fire pit and drippy s’mores. As we debriefed around the circle on the last day, something had shifted: overall we now felt refueled and energized. The air buzzed with the anticipation of learners on the verge of integrating our emerging skills, excited to bring it all home to practice. The clouds had parted. We will keep in touch through peer coaching groups—our newly established, intense-support network. In my heart, I feel we are really becoming a family.

I headed to the mountains straight from the session, for 24 hours of processing and decompression (and more washi tape card-making). More and more I marveled at what a rare opportunity I have in LOH, to be led and learn to lead in this relationship-centered way. For these ten months I am immersed in a professional learning lab, experimenting with different ways of speaking, acting, and being, safe among fellow professionals also grappling with this skill set. It just does not get any better than this!

On my way down from the mountains, I listened to an interview with Bonnie St. John on Ozan Varol’s podcast, Famous Failures. She is the first African-American to win medals in Winter Paralympic competition as a ski racer; she is a lower extremity amputee. She is also an author, an entrepreneur, and a former member of the Clinton administration. Her story is inspiring, please take a listen! At the end of the interview she describes asking a former coach about how he built champions. He said he never built individual champions; rather, he built communities of champions. You can only push one person so far, he said; but an allied group of people will hold one another up, push each other harder, make each other better, take one another farther.

That is exactly how I experience LOH—my best self is challenged and called forth in the most loving and professional way. We hold space for all our struggles, allowing the learnings (epiphanies, in my experience!) to emerge. It is deeply and literally inspiring. Though I already do so much of this inner work on my own, there is a profound and unparalleled synergy from learning in this group—we serve as one another’s pit crew for the journey toward our better selves at work and in life.

Nobody succeeds alone. In the series finale of The Big Bang Theory (my favorite TV show of all time, which I missed while at LOH!), Sheldon (the obliviously self-centered genius) finally realizes this. During his Nobel Prize acceptance speech, he acknowledges his sudden and profound appreciation for his family and friends, crediting his success to their unconditional love and support, and recognizing them in front of an international audience. LOH made this finale even more meaningful to me than it already would have been.

It is always through the struggles that we grow. When struggle together, any and all successes are amplified exponentially. My nine new friends will make me immeasurably more successful, both professionally and personally, than I would ever be without them. God bless them all, and may the work we do together ripple out for the benefit of all whose lives we touch.

Healing Through Connection

The Inner Work of Physician-Patient Relationship…And Other Things