Attune and Attend

Posted on January 13, 2019 by Catherine Cheng, MD

My friends, I am offended. I’m insulted and frustrated. Part of me screams, stomps, and rages inside.

I am embarrassed.

My friend went to establish care with a new primary care physician last week. Before the appointment she was told to bring all of her medical records. No instructions, no specification of which parts or in what form. So, being the tech-savvy and eco-friendly woman she is, she downloaded all that was available to her onto a thumb drive, as it was rather copious now in her 7^th decade of life.

Upon arrival, she presented the drive to the woman who initiated the evaluation. She thinks this was a nurse; but she’s not sure. The woman said she could not ‘handle’ the thumb drive, but said, “I can just pull it up here online.” What? Ok whatever, clearly the medical record request was simply a routine request made of all new patients. Thereafter the woman proceeded through routine medical questioning. But as my friend answered the interrogation, she felt distinctly ignored. Her concerns were not addressed and she did not feel any rapport. The woman did an EKG and left the exam room.

Later, while my friend was still sitting on the exam table, the woman returned with an old man in a white coat. He stood there, hands behind his back, and informed my friend they had called for an ambulance to take her to the emergency department. The EKG showed an abnormal heart rhythm. They said she would likely be in the hospital for two days for observation and tests. The nurse and doctor spoke to each other but not to my friend. They did not ask her how she was feeling, or what she knew about the/her condition, and they did not check the online record for evidence of past evaluations or recommendations.

My friend refused, for various reasons, not the least of which was that this condition had already been thoroughly evaluated, multiple times, and was actually well controlled. But the doctor and nurse showed no interest in knowing my friend, nor did they seem to care to include her in any medical decision they made about (for) her.

Granted, this is my friend’s side of the story. But for right now this is where I focus, because her experience is all too common, and I hate it. She experienced everything that makes physicians and our healthcare system look and feel so broken, and that contributes to the widening relationship gap between patients and physicians/providers.

She was asked to bring her records, she put forth the effort to do so, and they were not reviewed.

She felt ignored and dismissed, even though the objective of the visit was to establish care and initiate a long term, collaborative relationship with a new primary care doctor.

She was ordered to submit to an ambulance transfer to a hospital emergency department, with neither discussion nor negotiation of other care options, and without regard to the financial and other costs to her.

She felt harassed by the office in the following days, receiving calls admonishing her for not presenting herself to the emergency department.

The bottom line is that my friend felt completely unseen in this encounter. She felt treated like an object—a set of data, a statistic, a box on a flowchart. Context, history, and individuality be damned. When you’re in a relationship with someone who is supposed to help you, on whom you rely to help you understand the best plan of care for you personally, feeling unseen, dismissed, and belittled is exactly the opposite of helpful.

Maybe we should not judge the nurse and doctor too harshly. We all know the time and volume pressures primary care providers live under these days. Maybe they were distracted by other, sicker patients they had seen that day. Maybe that made them more vigilant and aggressive with care recommendations for her, and put them behind schedule so they felt they could not take the time to explain things in more detail. Maybe the doctor had seen this arrhythmia once before, treated it more casually, and the patient died. We have no idea. And it matters, insofar as it impacted how he presented to my friend. Because his presence was dominating, authoritarian, rigid, and cold.

The patient-physician relationship serves as the foundation for medical care and healing. No matter how much we talk about and try to honor patient autonomy, the power differential in this relationship remains fixed and real. The doctor has the power and the responsibility to make the patient feel safe, to earn the patient’s trust. On this day, in this visit, this doctor blew it, in my opinion. It was their first encounter. He should have taken the time and interest to get to know her, even a little, to agree on how they would work together. If he were truly concerned about her health, knowing she had an arrhythmia (which are often made worse with stress), might he not have noticed the distress he was causing her? Couldn’t he have given her additional care options, like referring her to a specialist within the week? Or perhaps he could have opened the electronic health record and looked at her previous cardiologist’s last note?

He did none of these things—or at least not in any way that my friend perceived.

Further, he not only failed to establish a good relationship with her; he undermined her trust in our whole medical system. How many experiences like this does a person have before she starts to reject the medical community altogether, ignoring symptoms of disease because she would rather deal with pain and disability than try to navigate a hostile system? Fewer than you might think. This is how patients end up in emergency rooms with truly life-threatening illness, where, guess what? They get shamed again for not seeking help sooner.

It’s rather tragic when you think about it.

There is hope, though. But as this post has already a thousand words, my thoughts on solutions will have to wait.

I hope you all had a restful and joyous holiday season. My unplanned holiday writing hiatus lasted longer than I intended, and it’s nice to be back. May we all reconnect with one another in more meaningful, productive, and uplifting ways in 2019.

Grudges and Boundaries

Posted on December 16, 2018 by Catherine Cheng, MD

Has someone wronged you recently? Long ago? (How) Does it still affect you? Are you a grudge holder? Does someone hold a grudge against you?

Last night I gathered with good friends and this topic came up—we go deep, my friends and I. Of course, it started me thinking and wondering: What does it mean to hold a grudge? When I hold a grudge, what do I actually do? What is the motivation? What are the consequences? When/how/why does it resolve, if ever? As we talked, it felt straight forward at first. Everybody knows how it feels to hold a grudge—but how do you describe or define it?

Google dictionary defines it:

Grudge: /ɡrəj/

noun

a persistent feeling of ill will or resentment resulting from a past insult or injury.

“she held a grudge against her former boss”

synonyms:

grievance, resentment, bitterness, rancor, pique, umbrage, dissatisfaction, disgruntlement, bad feelings, hard feelings, ill feelings, ill will, animosity, antipathy, antagonism, enmity, animus;

informala chip on one’s shoulder

“a former employee with a grudge”

verb

be resentfully unwilling to give, grant, or allow (something).

“he grudged the work and time that the meeting involved”

synonyms:

begrudge, resent, feel aggrieved about, be resentful of, mind, object to, take exception to, take umbrage at

“he grudges the time the meetings use up”

The more we thought about it the worse it felt to me. I’m reminded of the saying that hatred hurts the hater more than the hated. Grudges feel like dark clouds hanging over my consciousness, chilling my soul, or at least casting a cold shadow on my joy, freedom of emotion, and possibility for connection. My friends and I contemplated the utility of grudge holding. What good does it do, what need does it meet? I think it’s protective—a defense mechanism, a way of not being vulnerable again—armor, as I believe Brené Brown would call it.

I asked my friends last night, “So is it holding a grudge, or is it setting a boundary?” I wondered if they are the same or different. After all, both make you behave differently toward the other person. But I think it matters whether and how we judge the other person. When I hold a grudge, I judge the whole person based on the bad thing (I perceive) they did to me. I may generalize from my own negative experience and write them off as wholly selfish, ignorant, narcissistic, and unworthy of my compassion and empathy. Perhaps I start to depersonalize them, make them into an abstraction right in front of my eyes—dehumanize them. Does that seem like an extreme description? Even so, doesn’t it still describe the feeling? When I hold a grudge, I do not—cannot—like or even relate to the person. I avoid them, don’t want to be in the same room with them. I don’t trust them.

I listened to The Thin Book of Trust by by Charles Feltman (referenced by Brown in her book Dare to Lead) this past week. He describes four distinctions of trust: Sincerity, Reliability, Competence, and Caring. He suggests that when we find someone else untrustworthy, it’s likely that they have disappointed us in one or more of these elements. I have assumed for a long time that the person I hold a grudge against simply does not care about me or my well-being. Feltman suggests that of the four distinctions, this may be the hardest one to overcome when violated. My story about this person is that they don’t care about me, therefore they are categorically untrustworthy. So I feel justified in denying the validity of their point of view, minimizing their achievements, and casting them as the permanent villain in my story.

Yuck. That perspective does not align with my core values.

So what can I do? Maybe rather than holding a grudge, I can simply reorient myself to our relationship. Instead of harboring bitterness and ill will, can I instead learn, synthesize, and integrate some new information? When I’m wronged, maybe I can say, with curiosity more than resentment, “How fascinating!” Maybe I can take care of my own feelings, connect with people I do trust, and regroup. Then I can decide how I want to present to this person hereafter. I can set some new boundaries.

Rather than dismiss the person as uncaring in general and holding this against them, I can do other things. First, I can withhold judgment on their caring and make a more generous assumption. For example, I feel un-cared for by them, but perhaps their way of expressing caring is different from how I receive it. I can look for alternative signs of caring. Or perhaps they truly don’t care about me, but I need to work with them anyway, so I had better figure out a way to do it—are they at least sincere, reliable, and competent? How must I attend to myself, so I can honor my core values, get the work done, and not get hurt (or at least minimize the risk)? Second, I can set clear boundaries in our relationship. I can point out behaviors that I will not tolerate, and call them out if they happen. I can set realistic expectations about agendas, objectives, methods, and contact. I can give honest and direct feedback with concrete examples of words or actions that require attention and remedy.

Many thanks to my thoughtful and engaging friends who stimulate these explorations. I can feel my grip on the grudge loosening already.

How Do You Stay Healthy While Traveling?

Posted on December 9, 2018 by Catherine Cheng, MD

Once again Nate Green stimulates my thinking and connects my professional and personal dots. Last week he asked newsletter subscribers this question, and I was surprised at the cascade of subsequent questions it triggered for me:

How do we define “healthy?”

What about travel threatens and/or challenges health?

Is it different depending on the person? The trip?

What about the trip—Destination? Duration? Time of year? Companions? Purpose?

How, specifically, is travel different from home?

How do we apply the answers to these questions?

In my practice, the patients I see travel, I estimate, an average of 35% of the time. They endure interstate commutes between work headquarters and home, or fly between company sites and all over to meet customers across the country and around the world. Inevitably these trips include hours sitting in meetings and then the requisite business dinners. Such meals present the quadruple threat for acid reflux, among other problems: They are large volume, fatty, and alcohol-laden, and often occur shortly before people go to bed. Many patients report that they feel badly after business dinners—bloated, sedate, and a little guilty, or at least concerned, about their health. They feel little agency to change the pattern—fascinating. We cannot underestimate the business culture of peer pressure that perpetuates our worst habits of self-sabotage, and I see this as the primary threat to my patients’ health when they travel. Other challenges include jet lag, poor access to healthy food, and disruption of routine, most importantly sleep and exercise.

I have only started to ask my patients Nate’s question. One patient knew his answer without hesitation: Do not eat late. I’m curious to see how others answer, and how their answers may evolve over time. Perhaps I will add this to my standard questions, after my stress/meaning ratio markers.

Nate’s question invites me to consider for myself, as I prepare to travel for the holidays.

How will I define health on this trip? I will be healthy if I stay active, protect my sleep, and connect with my people. I will practice intention and mindfulness. I will read that which enriches my knowledge, awareness, and relationships, and do my best to avoid click bait, sensationalism, and meaninglessness.

What about this travel threatens or challenges my health? OMG the food. It’s not just business dinners that are full of fat, sugar, and portions to satiate hippopotami. Holiday desserts are my crack—one of these days I might just overdose… I also tend to stay up too late, usually watching movies, and then sleep in and feel guilty for wasting half a day already. That kills my motivation to do anything very active, much less a full workout—the day is practically over—what’s the point? Might as well eat, is there any cheesecake left?

Is this different for me compared to others? Oh, yes. My husband seems to have no problem controlling his eating, sleeping, and activity anywhere he goes. Jerk.

Is travel home for the holidays different from, say, conference travel? Yes. I think I am more disciplined at meetings. There isn’t food everywhere whenever I want it, and medical conferences usually offer more healthy options anyway. I still stay up too late, though.

So what’s the answer? How will I keep myself healthy this holiday travel season?

Nate included a video by Matt D’Avella in his newsletter, which made some useful suggestions. Carve out time at the beginning of each day to exercise. Get outside if possible. Make the objective maintenance of fitness and routine, rather than progress—slow and steady prevents injury. I can probably mark time to do some kind of exercise, just not in the mornings—I hate mornings.

Nate suggests making one consistent meal every day of the trip. Matt made chicken, black bean, egg, and rice burritos every morning in Sydney. That fueled his morning workouts, simplified food decision making by one meal a day, and allowed him to explore new foods the rest of each day. I can probably make breakfast my stable meal each day on vacation. My morning meal has been haphazard the past few months at home, too, so this could be a great opportunity to regain a routine even after vacation.

Perhaps my central strategy this time can be labelled “Planning for Real Life.” Whenever I go home I make grand plans to see everybody, cook a ton, hike, shop, relax, read, write, and organize. For some reason I always leave feeling disappointed that I could not fit it all in, go figure. There will be multiple families together this year, lots of little kids. It’s December, and weather can be neither controlled nor fully predicted. We can make plans, but kids get tired and lose interest, and adults can have meltdowns of our own. I can look at the calendar and compare it to my task list for the week. What do I really need to accomplish? What did I just write here? Sleep, move my body every day, read a little, and spend quality time with my peeps. In other words: Rest, Train, Learn, and Connect.

Thanks for the prompt, Nate! And Happy Holidays to you!

Shoots in the Poop

Posted on December 4, 2018 by Catherine Cheng, MD

It’s December 4^th… Time to look back? Honestly, I’d rather just get this year over with and move on, because I have already been looking back all this time. Since January I have counted—weeks and months since the knee injury, months since starting the new job, since surgery, since a spring crisis, since the last this or the first that. What was it all for? I think I was just reminding myself that there’s been a lot going on, reassuring myself that I’m not just whining, not being weak for letting my personal health habits slip.

I’ve felt like a relative slug for the last 6 months, despite my best efforts. I think I must have eaten a pint of ice cream every two days for most of the spring and early summer. Looking back on the calendar, I stopped using smiley stickers to mark workouts around July—their intensity was only worth hand-drawn smileys. By and since August they aren’t worth smileys at all—I just jot down what I did in shorthand. Some weeks it was barely anything. I judge myself every day—perhaps less harshly than I might have a few years ago, and also less compassionately than I might a few more years from now. I still struggle with the fear of self-indulgence if I allow myself too much self-compassion. I am still learning self-compassion. I know it takes time to rewire our limbic brain patterns with knew learnings from our cognitive brains. So I will keep trying, because I know it’s helping. And I’m modeling for the kids. We can do our best and still fail. The key is to keep moving. We can practice admitting we need help, seek it from the appropriate sources, lean on it heavily, and stand back up eventually. And then we remember those who helped us, and prepare to be helpful in return.

I have leaned on so many this year, I feel almost speechless at the outpouring of support and love. The only way I don’t collapse from this weight of gratitude is by storing it like a battery—ready to be discharged, full power, when someone needs to plug into me. This may be my favorite thing about humanity—that we are wired to connect so tightly, to help one another in webs of mutual love and kindness that can extend ad infinitum.

So I’ll look back a little. This week I feel a turning. Did I say this already recently? Oh yes, it was November 12. I was making more room for books, trying to stay off of my phone, off of Facebook. Being on the laptop every night to post to the blog stymied that last part, but it also bought awareness of how I find loopholes in the best plans for self-discipline. And the daily writing practice also contributed loads to this internal revolution. This was my fourth year doing NaBloPoMo. It was by far the most fun, the smoothest, and the most rewarding attempt yet (I think I also said this last year?), and now I miss writing every day (definitely have not said this before). Maybe it was the daily dopamine hit of views and likes. But I think it’s more than that. Through the daily discipline, I had a chance to process and synthesize so many ideas and connections that had been marinating for months, maybe even years. I practiced prioritizing, selecting, and distilling those ideas into about 1000 words each day, more for my own benefit than anyone else’s. That people read and related to them was definitely a happy bonus.

Besides NBPM, I attribute this turnaround to two books that Donna recommended to me earlier this fall: Leadership and Self-Deception and The Anatomy of Peace, both by The Arbinger Institute. I have wanted to write about them for the last several weeks, but I haven’t yet figured out how to prioritize, select, and distill the lessons coherently. The foundational ideas are not necessarily new, but they are profound. The books are written as modern allegories, and there is just something about the metaphors and analogies that has unlocked and integrated everything I have learned about inner work, communication, relationships, and leadership to date. And that is saying a lot. Because of these books, the daily writing, and all the conversations I’m having (with myself and with others) as a result of both, the two most challenging relationships in my life right now have fundamentally improved—mostly because I have been able to shift my own attitude. As with all things, this new ‘way of being’ will take practice. I need to keep the training wheels on for a while yet. But now that I have made this turn, the path looks straight, and I see light.

The manure has piled on all year. So much fertilizer, oh my gosh. It’s done its job, though, because I have definitely grown. I feel strong, healthy shoots of green popping out through the thick, dark carpet of poop.

https://www.pinterest.com/pin/334110866100273370/?lp=true

I Love Mamma Mia!

Posted on December 2, 2018 by Catherine Cheng, MD

Wow, 31^st day! I guess I really love this writing practice…

My kids introduced me to “Mamma Mia!” the movie a couple months ago. Oh my gosh SO FUN! The cast, the scenery, the music!! ABBA!!! And the epilogue scene of them all singing “Waterloo” is one of my favorite musical numbers, ever! I intend to convene a group of friends to reenact the singing/dancing scenes someday, what a great workout that would be, and to such great music!

I just love when the kids and I watch our favorite movies together—Harry Potter, Avengers, and now some musicals. Driving to Target today, after watching the second “Mamma Mia!” movie, I realized why I like these two films so much. It wasn’t just watching how much fun the actors obviously had making it, and oh my gosh CHER (I can still picture on the cover of my dad’s Half Breed album), and the cute story. It was the emotions. In both of these movies, the characters all feel their emotions freely. There is no repressing, numbing (well, maybe some–cake, anyone?), offloading, or prolonged rationalization. The sadness, loneliness, regret, anger, and longing, the fear and the lust, as well as the love, loyalty, devotion, grief, forgiveness, and hope—the characters display them all without shame or self-judgment. And even better, they reach out to each other for support and show up for one another in compassion and solidarity.

We also watched “While You Were Sleeping” today (it’s rainy outside and we are movie people), also a perennial favorite for me. My daughter says she doesn’t like it because of the lying. It’s stressful to keep secrets and maintain false appearances. Even watching it makes some of us uncomfortable—and now that I think about it some more, I recognize the visceral anxiety of seeing it on screen. There are many ways to create tension and conflict in a story. The “Mamma Mia!” movies do it in a lighthearted way that feels more fun than most.

In these days of widespread deception, false pretense, mistrust, evasiveness, and broken relationships, musicals like this uplift my family and me. What a cheer for all that is good about humanity, what a vote of confidence for our silly species! So grateful. We will continue to watch repeatedly, I guarantee it.

Honesty and Integrity

Posted on November 30, 2018 by Catherine Cheng, MD

NaBloPoMo 2018: What I’m Learning

Last day! I’m feeling a little elated. Not sure if it’s Day 30 relief and success, the abnormally large caffeine load I had today, or my awesome breakfast date…

I wish you all to have a friend like Donna. She is one amazing woman. A leadership coach, wife, mom, and fellow cosmic journeyer, I count myself infinitely lucky to know her this time around on earth. I bet we’ve known each other longer than that, though. We met in this life about 9 years ago. I can count on one hand the number of people I remember propositioning for a coffee date on our first meeting, and Donna is one. We meet every two or three months to commune, share, and grow. I consistently experience two or three separate intellectual and spiritual epiphanies each time.

Today was no exception, and possibly even an exponentially positive anomaly. Like I said, I’m caffeine loaded and coming off a 30 day freestyle writing challenge—I was primed! The conversation was so profound I had to type out some notes afterward, as I sense future writings to spring therefrom. Day 30 was the perfect day to meet her! I have synthesized and integrated deeply this month thanks to this daily blogging discipline, and sharing with Donna was the quintessential culmination of it all. I now share with you my favorite segment from our egg-and-toast-laden love-in.

I described a values exercise I did reading Dare to Lead by Brené Brown. From a list of over 100 words including accountability, courage, faith, openness, respect, and truth, I had to choose two core values, or think of two of my own. Brown writes:

The task is to pick the two that you hold most important. …almost everyone…wants to pick somewhere between ten and fifteen. But you can’t stop until you are down to two core values.

Here’s why: The research participants who demonstrated the most willingness to rumble with vulnerability and practice courage tethered their behavior to one or two values, not ten… and when people are willing to stay with the process long enough to whittle their big list down to two, they always come to the same conclusion that I did with my own values process: My two core values are where all of the ‘second tier’ circled values are tested.

Dare to Lead, page 188

I listened to this book twice before I received my hard copy from Amazon. I could. not. Wait! In anticipation of doing the exercise, I thought the whittling process would take a long time—that I would agonize over it. But as I skimmed the pages approaching the list, in a cosmic flash, I realized my two: Honesty and Integrity. It was one of those ‘you just know’ moments, but I had to check in. Really? Was I sure? How did I know? How could I prove it? I turned the page and scrutinized every word, comparing it in importance to these two. Accountability? Yes, but not as much. Equality. Fairness. Gratitude. Learning. Openness, Optimism, Stewardship, and Wholeheartedness: all important, but not nearly so much as Honesty and Integrity. I was done. As surely as I felt self-actualized in seventh grade, I am sure these are my core values. A few days later, I was describing this moment to another thoughtful and astute friend. She mulled for a moment and said, “Yes, I agree, I see these as your core values, too.” Wow, I cannot think of a higher compliment.

Today when I told Donna, her first response was, “Honesty and Integrity… What is the distinction between the two?” What a great question! I had a vague, intuitive idea, but had never taken the time to think it through. As happens so easily when I’m with Donna, and as a person who talks to think, the answer poured forth after only a few seconds. I used a real life example:

Let’s say my friend asks me, “Does this dress make me look fat?”

Honesty compels me to answer truthfully. Yes. Honesty keeps me from lying. That is outside of my core values, no can do.

Integrity helps me choose my words. This dress does not flatter your figure the way a different style would. We are here to choose the dress that makes you look positively stunning and we will not leave until our mission is accomplished! Integrity frames my response in line with all of my other, ‘second tier’ values: kindness, diplomacy, empathy, love, loyalty, and all the rest.

Thus, Honesty tells me what I cannot do. It gives me constraints and standards. Honesty is the guardrail, the floor for my code of conduct. Integrity then tells me what I can and must do. It defines the realm of possibility, meaning, and purpose—the Why, How, and What. How can I be the best friend, mom, doctor, wife, speaker, and leader? It is the accelerator and steering mechanism that keep me in the lane of who I am. Or, Honesty is the launch pad; Integrity creates the universe of potential. I swear I got goosebumps.

Phrases that recur often in my speech and writing are “walk the talk” and “lead by example.” I always ask myself if I exemplify these, and they are the yardsticks by which I measure all those who lead me. One cannot do either without Honesty and Integrity at work all of the time. Brené Brown calls integrity “living into our values rather than just professing them.” Hallelujah. I feel the most at home, confident, and grounded when I know I’m living deeply in my Honesty and Integrity. When I’m outside of these, I feel viscerally uneasy. I cannot tolerate it, or I can only with great suppressive efforts to manage the dissonance. I lose sleep; I get irritable and restless.

Practicing Honesty and Integrity is not always easy, though. Facing the ugly and disappointing truths about myself and my dysfunctional patterns, and then holding myself to a higher standard of conduct—internal benchmarks of behavior and relationship—these aspirations create stress and tension on multiple levels of consciousness.

In the end, though, I know that as long as I hold these two values in front, they will light my right path. I know I will make mistakes. There will be times when my behavior absolutely does not exemplify these values. I wanted to write a blog post right after my A-ha! moment reading the book. But I was afraid someone would recall a time they witnessed the opposite of these values in my actions, and call me out on it. But I’m not afraid anymore. I’m not perfect. And I’m striving every day. That’s good enough, because it is my best. Honest—I swear on my Integrity.

Recentering—Vaccine post #3

Posted on November 30, 2018 by Catherine Cheng, MD

NaBloPoMo 2018: What I’m Learning

When you buy a red car suddenly you notice so many red cars on the road. I write two posts on vaccines, and now I see all these vaccine posts on my Facebook feed. One made me sad for multiple reasons.

Dr. Jennifer Chuang , a pediatrician who ran for the state legislature in New Jersey, posted this:

In 2017, I was moved to run for office in the NJ State legislature because of bills being introduced that were harmful to public health. Among the areas that I stood firm on were the importance and safety of vaccinations, and I was harshly attacked for that, even threatened.
However, NJ should not be proud of introducing the most pieces of legislation that would have made our children at risk for vaccine preventable illnesses. The current measles outbreak in New Jersey has now grown to 18 cases. Legislative decisions have consequences, especially to public health.

“From 2011 to 2017, New Jersey lawmakers introduced the most pieces of legislation that would make it easier for children to skip vaccines, according to a new study by Drexel University researchers.”

She linked to this article, detailing the anti-vaccine legislative history in New Jersey and lawmakers’ rationale, compared to the scientific literature.

I’m sad that there is such a fight against proven public health initiatives, and I’m sad that legislative bodies, who write our health and medical policies, include remarkably few clinicians. But I’m most sad at the meanness in the fights.

A woman immediately commented, “Shut up already” on Dr. Chuang’s page. When challenged benignly by others, she replied telling them to fuck off and calling them assholes. Her page is apparently public, so I visited. The posts that I could see were vehemently opposed to vaccines of all kinds, at least in 2016 and 2017. She apparently lost a son this year, in his 24^th year of life. She has posted about eating healthy, self-care, and seeing intelligence as ‘not because you think you know everything without questioning, but rather because you question everything you think you know.” So while I feel acutely put off and dismissive of her vile reaction to Dr. Chuang’s post, I also imagine that she and I may have things in common and might even be friends, if circumstances facilitated.

Somehow I came across another woman’s page tonight, similarly militantly anti-vaccine. She and the first woman both posted a lot of memes and sayings implying that people who advocate for vaccines are brainwashed and ignorant, and not worthy of engagement. Huh. Sounds to me just like many of the ad hominems hurled by vaccine advocates against women like them. It’s exhausting. Who does it help, this mutual shit-flinging? In Rising Strong, Brené Brown points out the pitfalls of false dichotomies and binary decision trees. If you hear people shouting that you have to choose one side or another, that it’s all or nothing, be suspicious. Look for the beneficiaries of that feud. Often it’s the politicians who leverage our warring tendencies to stay in office. Or maybe it’s physicians who, when they refuse to care for patients who decline vaccines, can feel decisively self-righteous rather than uncomfortably ambivalent. Or maybe it’s the anti-vaccine parent, who feels embarrassed to express fear and uncertainty (because she has been shamed too many times for questioning a sanctimonious medical community), and so finds her voice in combative rage instead. And could it be that anytime one of us shows up in attack mode, we incite our counterpart to take a mirroring stance, even if that was not their original intent (this is a rhetorical question)?

Regardless, I’m tired. Social media and loud, mean, public debate are not venues that yield any meaningful interactions (I see the irony of my writing this on a blog). It feels too slow, but experience teaches me that we win hearts and minds face to face, quietly, intimately. Nothing good ever comes from a collision of two oncoming bullet trains. It’s wildly destructive more than anything else.

Thankfully, my good friend posted Max Ehrmann’s poem “Desiderata” tonight. I first read, transcribed, and posted this poem on my wall in high school, and have not seen it in a couple decades. It really captures the essence of inner peace and right relationship, with self, humanity, and the earth, and it soothes me. It’s a late Thursday night of another long week. I leave you with Mr. Ehrmann’s master work below. Good night.

Desiderata

Go placidly amid the noise and haste,
and remember what peace there may be in silence.
As far as possible without surrender
be on good terms with all persons.
Speak your truth quietly and clearly;
and listen to others,
even the dull and the ignorant;
they too have their story.

Avoid loud and aggressive persons,
they are vexations to the spirit.
If you compare yourself with others,
you may become vain and bitter;
for always there will be greater and lesser persons than yourself.
Enjoy your achievements as well as your plans.

Keep interested in your own career, however humble;
it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs;
for the world is full of trickery.
But let this not blind you to what virtue there is;
many persons strive for high ideals;
and everywhere life is full of heroism.

Be yourself.
Especially, do not feign affection.
Neither be cynical about love;
for in the face of all aridity and disenchantment
it is as perennial as the grass.

Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.
Beyond a wholesome discipline,
be gentle with yourself.

You are a child of the universe,
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.

Therefore be at peace with God,
whatever you conceive Him to be,
and whatever your labors and aspirations,
in the noisy confusion of life keep peace with your soul.

With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful.
Strive to be happy.

Healing Through Connection

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