Beyond the Rant

For the better part of 20 years, I have had the humble privilege of working with medical students.  Whenever I spend time with them, I learn at least as much as I teach, and I come away inspired.

This day was no different, and I will never forget it.  We gathered in the stark conference center for a day-long communication skills workshop—physicians, nurse practitioners, residents, and medical students.  The facilitators came from the Alan Alda Center for Communicating Science; if you ever have a chance to learn from them, I highly recommend it.  I could almost palpate the group’s shy, tense, anticipatory excitement—this was a high-potential learning situation.  After time-travel role playing, imaginary ball-throwing, and Zip-Zap-Zopping with abandon, we relaxed into the liberated format that is improv-based learning.  That’s when I experienced an unqualified quantum leap in consciousness.  It came in the form of a rant.

The instructions:

Partner A: Rant rant rant, HARD, about something that really makes you angry—that truly enrages you, nothing small.  Not allowed to make it up, must be honest, let loose.  Yell, stomp, swear, etc., for two minutes straight.

Partner B: Listen, be present, no talking.  Introduce A to the group afterward.  The catch:  At no time during the introduction should the group be able to tell what A ranted about.

I paired up with Erik, a fourth year medical student.  I did the rage gods proud as I cursed and flailed for two full minutes about the victim mentality.  Your parents ignored you?  Your boss is a jerk? You’re stuck in a dead-end job in a crime-ridden city, hovelled in a grungy apartment with no view, and it’s all someone else’s fault?  Suck it up!  And on it went.  Erik stuck with me through it all, looking me straight in the eye and never flinching.  He introduced me thusly:

“This is my friend Cathy.  Cathy believes strongly, with her whole being, that each and every person has the strength and capacity to overcome any adversity, and lift himself out of whatever situation holds him back.  She believes in people, and wants to see them succeed, no matter what the circumstances.”  Nailed it.  What a powerful thing, to have someone distill and give voice to my core value, and after I had just raved like a lunatic, no less.  I had never met Erik before that exercise, and I felt an instant bond.  He saw me, and showed me a part of myself that I had not seen before. I am proud to know him.

Often when we witness ranting, we pile on and trigger an avalanche of mutual self-righteousness, or we unwittingly invalidate the person by arguing a counterpoint.  The practice of listening beyond the rant, hearing the core value, and then reflecting it, serves a higher calling.  It connects, validates, and settles.  It offers the ranter a mirror, an opportunity for self-reflection and awareness.  If we practice consistently, on each other and ourselves alike, we can hardly help but emerge transformed.

The Best of Both Worlds

I met my husband my second day on campus at Northwestern University, 1991. He started one year ahead of me; I met him in the bookstore. He was an established  molecular biology major, having years of laboratory research experience behind him already. I, too, decided to major in biology, but with a concentration in physiology. The micro and the macro–that may describe us in a nutshell: Both awed by the mysterious and yet completely logical ways of the body—the ultimate integrated system—but from opposite ends of the spectrum. We trained at the University of Chicago, that mecca of hard core basic science. Research and discovery of the fundamental mechanisms of disease—much of it at the molecular level—still thrills him, and leaves me positively lethargic. Show me how people transform health through relationships and beliefs, how the mind and body are connected in ways we cannot measure—that seizes my attention.

Today my husband specializes in orthopaedic tumors and joint replacement, and I do primary care. Much of his professional world consists of binary decision making: operate or not, the experiment proved the hypothesis or not. I like exploring multiple solutions for a particular problem, withholding judgment, and trying one approach at a time. Personally, he likes to be alone; I love people, the more the better! He makes decisions based largely on data and devoid of emotions, whereas I root my decision trees firmly in how I feel about the issue at hand. I seek color, texture, and meaning in everything around me; his needs are pragmatic, functional, and stoic.

And yet, what seems contrasting and opposed turns out to be, in every sense of the word, complementary. For the most part, we both balance objective and empathic information when making decisions. But when my emotions run high and objective data look fuzzy, he points out the practical implications of my choices. When he faces decisions that impact relationships, I help him identify core values that lead him to settle on one side of an issue with confidence. When both people in a relationship are free to be fully themselves, without fear of judgment or ridicule, their differences, and respective strengths, hold each other up.

The most interesting conversations we have about work revolve around teaching.  As a surgeon, his primary charge is to prepare his trainees to be technically excellent in the operating room, to carry out patient care decisions with confidence and resolve. Nobody wants a wishy-washy surgeon. My teaching focuses on fostering empathy, role modeling excellent listening skills, and showing students that no matter what specialty they choose, their patients will always need to feel seen, heard, understood, and cared for. In primary care, the old saying, “They won’t care how much you know until they know how much you care,” has explicit meaning. I like to think that because of me, my husband models more mindful interpersonal skills for his residents and students. And because of him, I try always to incorporate evidence and concrete, goal-oriented rationale in my decision making. We influence each other for the better.

The long-standing tension between surgeons and non-surgeons remains a fact of life in medicine today.  Stereotypes peg internists as ruminating and indecisive, and orthopaedists as dull-witted, mallet-wielding carpenters. This territorial, oppositional culture can be insidious and damaging.  How can we do best by our patients if we cannot get along ourselves?  In our ‘mixed’ marriage, I see us bridging this gap.  I hope it translates to better patient care. For ourselves, at least, it makes for interesting dinner conversation and a shared love for our work. And we would not have it any other way. Footnote: I first published this post on the American Holistic Medical Association blog in 2012.

Pee-Colored Glasses

I had not seen jaundice that bad in years.  He was Caucasian, in his fifties, about five feet, ten inches tall, 150 pounds, maybe less.  He wore straight leg jeans and a thick leather bomber jacket zipped all the way up, and his face was noticeably yellow, even from 100 feet away.  We walked toward each other along a busy sidewalk, on an overcast spring day.  I immediately scanned down to his hands, looking for a hospital patient ID bracelet.  “Why is such a sick man walking around on the street?  Which hospital did he just escape from?” I thought.  I saw no ID band, and his hands were not yellow, though they did look slightly thick—maybe swelling from liver disease?  He walked at a normal pace, no listing or shuffling.  Aside from his yellow face and apparent thinness, he actually did not appear ill.  As I got closer, I noticed that he wore Top Gun, Tom Cruise-style sunglasses, with lenses the shade of a perfect urine specimen.  His skin color was normal.

Would a non-medical person have immediately assumed he was an escaped liver patient, wandering the streets under the influence of hepatotoxic encephalopathy?    “How fascinating,” as Ben Zander would say, that I jumped to these conclusions, having only glimpsed this man from a distance.  What if I had turned an early corner and not gotten a closer look?  In the space of a minute or so, I perceived something shockingly abnormal, and with just a little more observation, reconciled it as only mildly out of the ordinary (I think not a lot of people wear pee-colored glasses).

Weeks later, a headline appeared on my Facebook feed: “Dad’s reply to school on kids’ absence is best response ever.”  The school principal had sent a letter to the family informing them that absences for family vacation were unexcused.  The father replied with a page-long justification of the high educational value of their trip.  Like many, I congratulated the father on his response, feeling righteous and indignant on his behalf.  My sister posted a subsequent article on my page, pointing out that the principal’s letter was merely informational and a formality, not a personal indictment of his choice of vacation timing, and that the father’s public shaming of the principal was both uncalled for and petty.

I feel embarrassed for holding him up like I did.  I don’t condone public shaming, what was I thinking?  I believe now that the headline attracted me for a reason.  Maybe I myself feel defensive around my own children’s school absences for family vacations.  I think I was preconditioned to take the dad’s side, to take the principal’s letter personally, as my medical training led me to see that man’s yellow face as evidence of end-stage liver disease.  Now I am the one wearing pee-colored glasses.

When I first read the father’s response, I wondered about the principal’s purpose in sending her letter.  But I did not take the next step to answer my own question.  Had I read it again, as I did after my sister’s post, I might have realized sooner that it was simply an informational form letter, and did not at all deserve the father’s negative public retort.  How was I able to correct my initial conclusions about the man on the street, and not about the principal?  My observations of the man were objectively inconsistent—apparently jaundiced face but normal colored hands and not otherwise ill-appearing—and I have no personal feelings about people with jaundice.  I do, apparently, have feelings about receiving notices from school about my decisions regarding my children.  My judgment of the principal’s letter came from that emotional place, and impaired my ability to see objectively.

These two very different situations remind me to monitor and manage my biases–inspect the tint of my glasses–early and often.

The Sh*tpile

Everybody has one.  We inherit large parts of it from our parents, whose parents passed theirs down, etc.  Life experiences add mass and odor as we grow up.  It sits squarely in the middle of the house of our existence.  For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off.  The surface gets dry and crusty; we grow accustomed to the smell.  No big deal.

Once in a while, something moves us to start digging, like that sudden urge to clean out the closet.  We quickly learn that sh*tpile insides stay fresh and painful, like unhealed wounds when scabs suddenly get torn off.  Our eyes water, our senses are overwhelmed, and we want to escape, and fast.  Maybe we avoid that room for a while, or we come back driving a tank to flatten the pile, to the destruction of other property.  Maybe we get so disoriented, overtaken by the sheer mass and stench of sh*t, that in fits of rage and confusion, we start flinging. Unknowingly we pelt innocent passersby, or even friends and family, just because they live closest and walked into the line of fire.  Exhausted, we step out, try to clean up some of the mess, shower, and long for the pre-poop-flinging state of things.

To live a truly conscious life, though, we know we need to revisit the sh*tpile regularly.  It’s not good or bad, it just is–everybody has one.  Maybe each time we come better prepared.  We call up our gardener friends, and invite them to the hardware store with us.  They help us choose the right picks, shovels, and wheelbarrows for hauling sh*t out.  They stick with us through the dirty, ugly process, because they know us for more than our smelly piles.  We may pick up some books or otherwise learn about cultivating with manure–what tools we need, what to expect in the process. We start to envision a flourishing garden.  Maybe we enlist professionals–landscapers–to help us bring the vision to life.  Slowly, we may even find a whole community of gardeners, tending their own sh*tpiles, one crumbly corner at a time.

Parts of the pile will always remain.  It’s not good or bad, it just is.  We pass them onto our children, much of them long before we die–multiple sh*tpiles in the same house, imagine that, whew!  And hopefully the kids also benefit from the beautiful gardens that grow from our best selves–play in them, feel safe in them, and see that excrement is just a natural product of living a full life.

One day we may become exactly the gardeners who helped us first. Then we can compassionately help others shovel their own sh*t for the better. Or we can just start now.