It Must Be True Because…

Spider web South Shore 8-23-14

NaBloPoMo 2018:  What I’m Learning

Funny how fear crops up sometimes.  It’s especially distressing when you fear your own ‘team.’  But we are here to learn and grow, so we step forward. My point in this post is to practice critical appraisal of research data before accepting or integrating it; especially if I am biased toward it.

BI fox news worse 2012

A fellow progressive Facebook group member posted this photo with a message of glee and encouraging everybody to disseminate.  I admit I also initially felt justified and righteous when I saw it.  But something kept me from sharing on my own page.  I should do this more often, perhaps—let something marinate for 24 hours before sharing, just to make sure it’s really something I want to engage with.  I ended up commenting that I think we should be careful about disseminating this kind of oversimplified graphic, as the data may not justify the claim.  I await the angry backlash.

After reading the article in Business Insider from whence the figure came, I had more questions than answers.  What are  Farleigh Dickinson University and Public Mind, anyway?  “Researchers asked 1,185 random nationwide respondents what news sources they had consumed in the past week and then asked them questions about events in the U.S. and abroad.”  What were the questions?  How were they chosen, and how do we know they represent broader knowledge of current events?  “With all else being equal, people who watched no news were expected to answer 1.28 [out of 5] correctly; those watching only Sunday morning shows figured at 1.52; those watching only ‘The Daily Show figured at 1.60; and those just listening to NPR were expected to correctly answer 1.97 [out of 4—why the ask one less for this?] international questions.”  Are these differences statistically significant?  And regardless, if the best we can do is answer less than 40% of domestic questions correctly, yikes.  How do we know this actually represents the population?  How does this data compare to similar research findings, maybe ones published in higher caliber, peer-reviewed journals?

The Business Insider article did link to the study report it referenced. I consider this to be a sign of responsible journalism—I look for it in the publications I read—access to the primary literature, so I can dissect and interpret ‘data’ for myself.  Turns out the study was a follow up in 2012 of an initial survey done in 2011 that reported similar findings.  The specific questions and statistical methods are included, as well as discussion of the results.  And while it’s not as rigorous as I am used to reading in peer-reviewed scientific journals, with sections for abstract, background, hypothesis, methods, results, discussion, and conclusion, I could follow the language and rationale of the authors, for the most part. I think they could have done a better job making a distinction between correlation and causation.  I also wished for a discussion addressing implications of the data and recommendations for further study.

Interestingly, I found a Forbes article entitled, “A Rigorous Scientific Look Into the ‘Fox News Effect.’”  I thought it was going to answer all of the questions I asked above.  It started out appropriately skeptical:

In 2012, a Fairleigh Dickinson University survey reported that Fox News viewers were less informed about current events than people who didn’t follow the news at all. The survey had asked current events questions like “Which party has the most seats in the House of Representatives?” and also asked what source of news people followed. The Fox viewers’ current events scores were in the basement. This finding was immediately trumpeted by the liberal media—by Fox, not so much—and has since become known as the Fox News effect. It conjures the image of Fox News as a black hole that sucks facts out of viewers’ heads.

I got excited when I read:

I have done similar surveys, both of current events and more general knowledge. In my research too, Fox News viewers scored the lowest of over 30 popular news sources (though Fox viewers did at least score better than those saying they didn’t follow the news). The chart’s horizontal black lines with tick marks indicate the margins of statistical error. Last Week Tonight with John Oliver, a news satire, had the best-informed viewers.

Turns out the rigor of this scientific look at the FDU data amounted to not much more than pointing out that correlation does not prove causation.  The author, William Poundstone, is a prolific non-fiction author and biographer of Carl Sagan, so I imagine he has formidable expertise parsing research data, though I don’t see any published research or surveys of his own.

In the end I’m satisfied, because I have done my homework on this topic.  I feel righteous again because, this time, I extricated myself from ‘liberal lemming’ (is that a thing? If not then I just coined it) mindset…  But it took some time.  And writing about it has cost me some psychic energy for organization and expression.

As I write this it occurs to me that it would be much more time efficient to just not believe anything I see or hear on any media platform—just be skeptical about everything and leave it at that.  Huh…  Nope.  That feels too much like willful blindness, which does not align with my core values.  It’s worth taking several minutes sometimes and disengagement, to verify the quality of what I take in on a daily basis.  I hereby commit to making this a regular practice.  I’ll let you know when I find anything really worthy of integration and dissemination.

 

How Not to Engage

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NaBloPoMo 2018: What I’m Learning

My friend Alex* posted about being a nurse and how she loves it despite having to always hold her pee, skip lunch, and get bled on, puked on, peed on, and yelled at, all while missing her family and taking care of yours.  One of her friends, we will call him Greg, commented that until nurses unionize and demand professional respect ‘just like physicians,’ nothing will change.

My impulsive (GRRR!) response:  “Trust me, physicians are struggling, too. I propose that we stand up for one another. Then we’d really be a strong force. And in the end it benefits us all–doctors, nurses, patients, the whole care team and, most importantly, patients. Also, I don’t know of any unions that physicians can join, but there are ones that nurses can: https://nurse.org/articles/pros-and-cons-nursing-unions/”  Okay, I know, saying, “Trust me,” is not a good way to get someone to trust or listen to you.  And my reply was defensive in its origin.  I sincerely believe what I wrote, though, that allied advocacy is an untapped force for good in medicine.  Physicians, patients, nurses, all healthcare professionals—why should we not actively support one another in all of our efforts to achieve a more cohesive, efficient, fair, and collaborative system, one that works better for all of us?  Why can we not embrace our connections and combine our voices to call for change?

Greg replied that basically he does not believe that physicians are “struggling,” and he does not see how we would stand up for one another.  After Alex described that I’m a physician “who will always help the nurses,” he wrote that doctors “can’t be in the business of supporting nurses.”  That we should “be in the business of supporting” ourselves, and “from all the research I’ve ever seen, they’ve continued to do a pretty good job of it.  Good for them.”  He expressed support for physicians’ right to advocate for ourselves.  In each reply, he continued to make his point that nurses should unionize.

I find this thread fascinating.  There are so many ways Greg and I could interpret each other’s replies.  When he talks about demanding respect ‘like physicians’ through unions, what benefits and outcomes does he imagine will follow?  When I say “struggling,” I wonder what he thinks I mean?  Actually he asks me, “How exactly are physicians struggling?”  He goes on to write, “Nurses are nurses and should be for nurses.”  All of his comments and the tone I inferred from them caused me to beg off of the thread.  Too bad, it might have been an interesting conversation—if we could have it in person.  Maybe we can later.

But it motivated me to look up some information to post here, in case anybody wonders ‘how physicians are struggling.’  The answer is burnout, depression, suicide, and leaving work that we love because it simply costs us too much—and I mean costs other than money.

Physician burnout is well described and referenced.

Doctors suffer from burnout in especially high numbers, according to the study, which was designed to offer a representative snapshot of doctors and the general U.S. working population. Nearly half of U.S. physicians – 49 percent – meet the definition for overall burnout, compared with 28 percent of other U.S. workers. More than 54 percent of doctors have at least one symptom of burnout, a more detailed analysis found.

Doctors also register more than one and a half times the general working public’s rates of emotional exhaustion and depersonalization. Working a median 50 hours per week, their satisfaction with work-life balance is far lower than that of others: 36 percent versus 61 percent.

medscape burnout causes 2018

Medscape Survey 2018

There are myriad causes for physician burnout, and most of them lie in the system, not in our inherent lack of resilience or because of some intrinsic defect in our collective character.  The electronic health record has accelerated our dissatisfaction with work.  It does so by creating innumerable clicks to accomplish menial tasks, burdening us with data entry that detracts from actual medical decision making and patient care, and putting a physical barrier between us and our patients, further separating us in relationship.  Burned out and dissatisfied doctors are distracted, less empathetic, and aloof, and we may even make more mistakes.  And when we aren’t well, our patients aren’t well.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. But they are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity, as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether — an ominous trend as the U.S. experiences a growing doctor shortage.

 

I have not addressed here the challenges that nurses face every day.  My mom is a nurse, and I have worked with nurses my whole career.  I see how they are treated by the system and by patients, and also by us physicians.  And yes, my extracurricular activities focus solely on advocating for physician health and well-being.  Maybe I should learn more about nurse burnout and job satisfaction, and figure out ways to advocate for my nursing friends and colleagues better.

Or maybe it’s too much to ask for groups to stick up for one another.  Maybe Greg is right, and it should be every tribe for itself, let others take care of their own.  Maybe it doesn’t do any good for people to know how and how much doctors “struggle.”  I don’t know.  But I have learned now not to instigate such debates on my friends’ pages on social media.

*Not her real name

 

 

Running Strong In Our Lane

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NaBloPoMo 2018:  What I’m Learning

So the NRA tweets, “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

Hmmm, self-important.  Yes, sometimes.  After four years of college, four years of medical school, up to seven years of residency and then another 3 years of fellowship to earn the privilege of operating on the spines, nerves, organs, and blood vessels of gunshot victims, to maybe give them a chance to stay alive much less walk and talk, I can tolerate a little (just a little) self-importance in my emergency medicine, neurosurgery, trauma surgery, critical care and other colleagues.  They are f*ing rock stars.

Anti-gun.  I have yet to meet any physician, or any person, really, who is wholly anti-gun.  We are pro-gun safety, anti-violence by guns.  We would like for toddlers to not kill their siblings and parents by accident.  We would like for domestic disputes to not escalate to someone shooting their family and then themselves in an impulsive fit of rage.  We would like for depressed and suicidal patients not to actually kill themselves, which is too much easier to do with a firearm than any other method.  We just want to stop being the only country where so many die every year from being shot by guns.

The American College of Physicians (ACP), the internal medicine professional society and my home for professional communion and development, and the largest medical specialty organization, has published an updated position paper on reducing firearm deaths in the US:

In 2015, 9 (the ACP) joined the American College of Surgeons, American College of Obstetricians and Gynecologists, American Public Health Association, American Psychiatric Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, and American Bar Association in a call to action to address gun violence as a public health threat, which was subsequently endorsed by 52 organizations that included clinician organizations, consumer organizations, organizations representing families of gun violence victims, research organizations, public health organizations, and other health advocacy organizations (2). Yet, firearm violence remains a problem—firearm-related mortality rates in the United States are still the highest among high-income countries (3).

Cited in their tweet, the NRA Institute for Legislative Action posted an article (no author identified) picking apart the ACP’s research citations and approach, stating, “This position paper leaves one wondering if the authors reviewed the evidence, or just found works that suited their needs. For all of the bluster about their own important role in the anti-gun movement and all of the misuse of research findings, the ACP makes one thing clear: they respect their own rights and opinions far more than they do those of law-abiding gun owners.”  *sigh*  As I have not read the primary literature on gun mortality and public health myself, I will not comment on that here.  I will just say that I wholeheartedly trust in the integrity of my colleagues and leaders at the ACP.  I’m proud of our advocacy for patients and, more recently, for physicians ourselves and our well-being.

My physician colleagues have posted a multitude of passionate responses on Twitter; you can read them here, here, and here.  And I just now saw this open letter to the NRA from the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) and signed it.  Below are highlights—please take a look.

I admit, I initially responded with profanity at seeing the NRA tweet.  My threshold for swearing is very low these days.  And I wanted to just post screenshots of the anti-NRA tweet storm and let them speak for me.  But that’s not me. I have yet to really decide how I want to design my public platform and conduct on issues like this.  For now, I can just say that tweets and articles like the NRA posted are disappointing.  I don’t want to follow that lead.

* * *

Dear National Rifle Association,

On Wednesday night (11/7/2018), in response to a position paper released by the American College of Physicians (ACP) Reducing Firearm Injuries and Death in the United States, your organization published the statement “Someone should tell self-important anti-gun doctors to stay in their lane.”

On that same day, the CDC published new data indicating that the death toll from gun violence in our nation continues to rise. As we read your demand for us doctors to stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death–gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must ALL come together to find meaningful solutions to this very American problem.

We, the undersigned – physicians, nurses, therapists, medical professionals, and other concerned community members – want to tell you that we are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

Our research efforts have been curtailed by your lobbying efforts to Congress. We ask that you join forces with us to find solutions. Help us in our non-partisan, physician-driven research efforts at AFFIRM Research.

We invite you to be part of the solution.

You dismissed the ACP’s position statement on preventing death and injury from gun violence by stating, “Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

We extend our invitation for you to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence, and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane.

 

I Hurt My Friend Today

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NaBloPoMo 2018:  What I’m Learning

Bummer, it’s no longer November 8.  Well, that’s the humbling kind of week it’s been.

I sat in a meeting with a friend today.  I expressed a perception and opinion about an issue on which she and I have divergent perspectives.  It was early morning (not my best time of day), and I was still emotionally hung over from yesterday.  I spoke up more and louder than usual and may have been a bit aggressive—not toward her or anyone personally, but about my opinion.

Afterward I asked her, “Was I too bitchy?”  I was querying her impressions of how my words and expressions landed on others.  Turns out I had really hurt her personally, and I had no idea.  The fantastic news is this friend shares my values of honesty, empathy, and open communication, so we talked it through in the afternoon.  Even though we had discussed the issue before, today we took more time.  We each listened hard and heard, more clearly than before, details about how decisions were made and how messages were received and perceived.  We dug deeper into underlying snags in relationships between groups, the culture and mindset of team members, and the dynamics that basically hamstrung everybody’s best efforts in the situation.

In the end we agreed that we’re all doing the best we can, and we also have a lot to learn from one another.  We acknowledged that there is room for everybody to own their shit a little more, and that calling a ‘my bad’ and ‘do-over’ of some parts may be the best way to make amends and move forward with more trust and cohesion.  We agreed that we could all benefit from more conversation, acknowledgement, transparency, empathy, attention to people’s feelings and mindset, and mutual understanding.  We brainstormed about what that all might look like; I got kinda excited.

At the end of the conversation we congratulated ourselves on both our courage to give each other some hard feedback, and how we were able to listen with love and generosity of spirit.  Maybe it was easier because we are friends.  But it’s the practice when it’s easy that prepares us for when it’s hard, right?  I’m so proud of us; we really lived into our best relationship potential today.  We walked our talk.  Nobody witnessed it, but we know what we did.  [fist bump, high five emojis]

Here’s to friends holding each other accountable for the consequences of our words and actions, and upholding each other to be our best selves. I wish you all more friends like this.

Rally

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NaBloPoMo 2018:  What I’m Learning

In my first practice it was common for whole families to be my patients.  Grandparents, parents, children, grandchildren, cousins, and other webbed relations.  My fondest memories of those years revolve around witnessing the love, tension, and ultimate cohesion of these complex units of humanity.

One day Grandma came for a routine follow up visit.  We reviewed her blood pressure, glucose, and cholesterol numbers.  She wanted to lose some weight.  Everything was stable, but something seemed off.  I could not put my finger on it, and when I asked if everything was okay she said yes.  This scenario repeated maybe once or twice more over some months, and slowly we agreed she was depressed, though I’m not sure if I ever used that word.  There was no trigger, no event.  She had not had a history of depression.  She was just down, she did not know why, and she could not make it go away.

Grandma came from a culture and a generation that did not feel comfortable doing talk therapy.  She was also reticent to take prescription anti-depressants, even if they might help her feel better.  But she was happy to see me more regularly, just so I could keep track of her medical problems and make sure she was okay.  We reviewed the same list each time: fatigue, low mood, anhedonia.  No suicidality, biometrics stable.

Sometimes I would also see Son, Daughter-in-law, or Granddaughter.  I would ask them how Grandma was doing.  They never used the word ‘depressed,’ but they described how she was ‘kind of down,’ ‘sad,’ ‘going through a hard time.’  And then they would tell me what they were doing about it.  Someone would always be at Grandma’s house, keeping her company.  Sister would invite her out to lunch.  Granddaughter would take her out shopping.  Everybody attended to her just a little more, rallying around her, and nobody ever talked about why.

Grandma herself rallied, and her depression lifted over time.  In Chinese the expression for this is equivalent to having ‘walked out’ of it, like depression is a long tunnel in the mountain.  What a privilege to bear witness to this phenomenon—the family saw Grandma walking in a dark place, and they moved in a little closer, each with their own candle, lamp, or torch.  They helped light her way, and they all walked out with her together.

I had a shit day today, mostly of my own making.  Cramming in too many things, all scheduled too close together, trying to do too much, falling down on multiple levels, and adversely affecting multiple people around me.  I almost bailed on a chance to be with an amazing group of people tonight, out of exhaustion and self-loathing.  But these were my friends and I had not seen many of them in several months.  I felt quite listless at the beginning of dinner, not unlike I imagine Grandma felt.  But as I communed with my tribe, reconnected, and met a new friend, I started to feel better.  The yummy duck helped, too.  They could intuit a shadow on me.  And with gentleness and respect for boundaries, my friends rallied around me.  It was not pity or sympathy.  It was genuine empathy and wishes for my well-being.  So I rallied, too.

Things feel overwhelming more often now than before.  The anger, bickering, blaming, and self-righteousness I see, hear, and feel all around (and within) me really gets under my skin—ha, literally, I guess.  I know this will never be a permanent state; I will feel better tomorrow.  It’s also an interesting opportunity to observe how I’m walking the self-care talk—including the self-compassion part.  Fascinating.

Well friends, that’s what’s on my mind tonight.  My patients save me by teaching me.

I’m going to bed.  So I can rally some more tomorrow, and maybe help someone else do the same.

Diversify Your Network

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NaBloPoMo 2018:  What I’m Learning

Are you friends with a plumber?  My friend Dennis is, or was, as of c.1997.  I forget his friend’s name, let’s call him Frank; they knew each other in high school.  Dennis and I were both medical students when I met Frank.  Looking back he must have thought I was a little strange.  I asked what he did for a living, and when he told me he was a plumber I interrogated him, hard.  “What’s that like?  How do you train, is there a school (I was a straight-through biology pre-med who knew next to nothing about trade schools)?  What are your hours like, are there days when you don’t work?  How do you figure out what the problem is?”  I was just so curious—I had never met anyone who did that kind of work, and it was so different from anything I knew.  He didn’t talk to me for long.  We were at Dennis’s birthday party and Frank quickly found other friends to connect with.

I’m so grateful to work in medicine, where I get to meet people from all walks of life every day.  In the exam room I have met coders, lawyers, teachers, construction workers, professional dog walkers, stylists, food critics, financial columnists, hedge fund managers, engineers, HR directors, leadership coaches, musicians, and myriad others…but I can’t remember any plumbers.  I love when I have time to ask, “What’s that like?” and “What do you spend your days doing?”  I always learn something new, and the best days are when I find some parallel between our work lives.  My husband the orthopaedic surgeon remembers patients by their x-rays.  I remember them by their social histories.

The Harvard Business Review sent an article to my inbox today entitled, “How to Diversity Your Professional Network.”  It cites studies that show “people who are connected across heterogeneous groups and who have more-diverse contacts come up with more creative ideas and original solutions.”  Reading it triggered an avalanche of memories and cognitive dot-connecting, hence my story about Frank.

First, I’m reminded of my first coaching call after accepting my new role at work.  Coach Christine asked about my ‘allies,’ the people whose counsel I value and who will hold me up and accountable through the growth process and pains that are leadership.  She pointed out that allies are not always people who agree with me.  They can be my challengers, my opposition, my rivals.  Through them, I am forced to grapple with my own integrity; they serve as the crucible for my values.  This idea helps me stay open to people whom I might otherwise dismiss.  Diversify.

Second, I remembered of The Big Sort, by Bill Bishop.  It’s thick with data and research, but the part that struck me hardest was the idea that our ideology becomes more extreme when we spend time with like-minded people.  I suppose you might think, well yeah, duh.  But when you consider how this affects decision making on the individual, community, and policy levels, it’s a little scary.  In his description of research by Cass Sunstein and colleagues, Conor Friedersdorf writes:

But for all the benefits of agreement, solidarity, and spending time with like-minded people, there is compelling evidence of a big cost: the likeminded make us more confident that we know everything and more set and extreme in our views. And that makes groups of like-minded people more prone to groupthink, more vulnerable to fallacies, and less circumspect and moderate in irreversible decisions they make.

Groupthink.  That reminded me of Originals by Adam Grant, a book I have listened to at least twice now.  As I have thought incessantly about culture and how to nurture a healthy one where I work, Grant’s advice on hiring for contribution rather than fit holds my feet to the fire:

Emphasizing cultural fit leads you to bring in a bunch of people who think in similar ways to your existing employees. There’s evidence that once a company goes public, those that hire on cultural fit actually grow more slowly because they struggle to innovate and change. It’s wiser to follow the example from the design firm IDEO, and hire on cultural contribution. Instead of looking for people who fit the culture, ask what’s missing from your culture, and select people who can bring that to the table.

So what does all this mean?  I have decided to take it as validation of my curiosity and desire to learn as much as I can from a vast array of different people.  Whether I know them socially or professionally, whether our diversity is race, culture, politics, religion, or music preference, there is always something that connects us.  The search and exploration are what make life colorful and fun.

I wonder whom I’ll get to meet tomorrow?

The Hard Conversations

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NaBloPoMo 2018:  What I’m Learning

Life is about learning.  Learning requires acknowledging lack of skill, knowledge, understanding, or all three and more.  Boundaries, curiosity and non-judgment make it so much easier; too bad we tend to lose these natural traits (or they are trained out of us) early in life.  Then we have to relearn them as skills.  What happens when we reacquire boundaries, curiosity and non-judgment?  We get much better at having the hard conversations.  What makes conversations hard?  Not sure?  Just think of the conversations we avoid.  What are we actually avoiding?

I resist apologizing when I don’t want to admit that I misunderstood, that I made wrong assumptions that led to behaviors that hurt people, that I was not my best self.  I worry that people will think less of me and not trust me, not include me in the future.

I avoid giving negative feedback because I don’t know how the other person will take it.  Will they crumble in a heap of self-flagellating despair?  Will they lash out and attack me, verbally or physically, threatening my safety?  Will they disparage me to others, try to split our colleagues between us, sow discord and undermine our culture?  I worry that I will lose control of the situation.

We resist conversations about politics, religion, and issues like abortion because they can escalate in a nanosecond, filled with emotional tumult.  These are precisely the exchanges during which we blow past all of our boundaries for civility, language, tone of voice, and rhetoric.  We lose all interest in understanding what the other person thinks or, more importantly, how they feel.  We stop relating.  We judge everything out of their mouths as oppositional, ignorant, and unworthy.  We worry that we will lose our status, self-efficacy, agency, or our friends.

* * *

My friend Earnestine * has migraines.  Over the years she has worked out their patterns: timing, location, aura, duration, and triggers.  She hydrates, protects her sleep, and, most importantly, manages her stress with vigilance.  This way she generally avoids medications and keeps her symptoms under good control.  Recently she got caught in an unavoidably stressful situation with family.  A migraine hit her like a Mack truck out of nowhere.  She could barely walk, stumbling around, hanging onto walls and railings.  Her speech may have been slurred.  Thankfully she was able to escape to a friend’s house.  Her childhood friend, also a sufferer of headaches, offered her a handful of pills—her own prescription medications.  Earnestine struggled for the right words, and not just because her head was splitting.  If she refused, would she offend her friend, who has just rescued her from serious family chaos?  Would she trigger indignation, anger, resentment, rejection?  E found her personal values and boundaries tested, unexpectedly.  She felt ambivalent, as the core values of connection with a friend and right use of substances clashed.  She desperately desired relief from her pain, and she also needed to set an example for her boys, who were watching her response—what would she want them to do if one of their friends offered them ‘relief’?  Somehow through the fog, she found a way to acknowledge her friend’s generosity, and also explain that she was not comfortable taking someone else’s prescription medication.  She maintained her boundaries and stayed curious to monitor her friend’s and her boys’ responses.  Since that time, she continues to hold her friend in non-judgment, understanding that although she would not ever do the same, her friend’s intentions were loving.

I tell this story because I see it as a perfect example of boundaries, curiosity, and non-judgment in action:  Holding space for one’s own needs while attending to the needs of others and our relationship with them (both her friend and her sons).  Earnestine practices honoring her boundaries, which can, in some ways, be equated with her core values.  When they are challenged, she can stay in curiosity and explore the feelings that get triggered. She can withhold judgment on the feelings and simply experience them in the present moment, asking what they are trying to tell her.

This combination of boundaries, curiosity, and non-judgment, practiced regularly in small, everyday things, prepares us to face the harder situations and conversations with greater confidence.  We can trust ourselves, even if we don’t walk into any given situation knowing the right answer, to find it when we need it.  On the other side, these skills help us look back with fewer regrets, because we brought our best selves at the time.

I have learned to recognize opportunities to practice these skills, and now I resist apologizing, giving negative feedback, and talking about politics a lot less.  In fact, these are precisely the scenarios in which I can really test and hone my skills—sharpen them and improve my relational dexterity.  I almost look forward to them—sometimes.

It’s all a continuous journey, is it not?  Will we always face our fears with heroic courage and the perfect words and behaviors?  Hell. No.  AND, every day is a new chance to try.  What hard conversation might we come closer to doing better tomorrow?

*Not her real name