Monthly Archives: April 2019

The Optimist and the Cynic

Posted on by
12

DSC_0529

Are you an optimist or a cynic?

I consider myself to be, wholly and without question, an Optimist—with a Big O.

In The Art of Possibility, Ben and Roz Zander describe a cynic as a passionate person who doesn’t want to be disappointed again.

By this definition, cynics are not altogether hopeless and negative; they are simply wary and cautious based on past experience.  Still, I judge cynics and find them tiresome.  I reject their gloom and doom outlook.  Sometimes I really just want to throttle them.  In their presence I turn up my outward optimism to happy headbanger volume.  I can tell this makes them a little crazed—they see me as Pollyannish, idealistic, and naïve—and likely wish to strangle me, too.

And here’s the thing:  I also possess a deep cynical streak; one that can really overtake my consciousness sometimes.

Every day I campaign ardently to empower myself and those around me, pointing to all the ways we can claim our agency and effect positive change.  I advocate for using all of our kindness, empathy, compassion, and connecting communication skills, in every situation—take the high road!  Be our Best Selves!  And yet at the same time, a darker part of me, my shadow side, silently tells a contemptuous story of the forces we fight against.  I paint a sinister picture in my mind of impediments made of ‘the other’ people—the small minded, the pessimistic, the underestimating, unbelieving, rigid, unimaginative, distrustful, conventional, supercilious, and condescending them.  They are not like us.  They are the problem.

Of course this is not true.  It’s just a story I tell—a counterproductive and self-sabotaging story.  How fascinating.

Sometimes I tell this unsympathetic story aloud, out of frustration, impatience, and exasperation.  Sometimes I actually name people and label them all those negative things I listed.  It feels justified and righteous.  But then I feel guilty, as if my worse self kidnapped the better me and held my optimism hostage until I vented against my better judgment.  I wonder when my words will come back and bite me in the butt?  What will I do then?

I suppose I can only claim passion and disappointment.  Sometimes I let the latter get the best of me and allow shadow to overtake the light.  It happens to the best of us; I can own it.  There is no need to disavow the disappointment and disillusionment, the dissatisfaction with what is.  If I didn’t care so much—about patient care, public policy, physician burnout, patient-physician relationship, and relationships in general—I would not suffer such vexations.  And it’s because I care so much that I fight on, to do my part to make it better.  I stay engaged in the important conversations, even if I have to take breaks and change forums at times.

Yes, I, the eternal optimist, harbor an inner, insubordinate cynic.  While most of me exclaims, “Humanity is so full of love and potential!” another part of me mutters subversively, “Also people suck.”  Some days (some weeks) the dark side wins, but it’s always temporary.  The Yin and the Yang, the shadow and the light, the tension of opposite energies—that’s what makes life so interesting, no?  We require both for contrast and context, to orient to what is in order to see what could be. 

The struggle for balance is real and at times exhausting.  And it’s always worth the effort.

On Easter: Separate and Unite

Posted on by
7

Sheil Easter 2019

What does Easter mean to you?

It occurred to me as I sat in the second pew today, coming to church on Easter labels me.  I declare myself Catholic on this occasion, in this place.  I separate myself, in a sense, from all who are not Catholic or Christian, from all who do not celebrate.  You might consider that I do this every Sunday at church, or every time I say I’m Catholic.  But on Easter it feels more intense, because this mass is all about the definition of Christianity—He died for us—we hold this to be true (I still have questions about that, actually) and that is what makes us Christian.  I apply this label to myself by my attendance at this mass.

I generally dislike being labeled, because of the assumptions that inevitably and automatically accompany labels of any kind.  You are Catholic, therefore you must be pro-life and thus anti-woman (I am pro-choice).  Your church is full of pedophiles and those who abet them; your religion, and you as an extension, represent the worst kinds of repression of the reality and diversity of human expression (if you think this please read about Father James Martin).  You are Chinese, you must be so smart and have a Tiger Mom (I am so smart but I don’t attribute it to being Chinese, and my mom is not Amy Chua).  You are a doctor in executive health, you must have done it for the money (this one slapped me recently, and I still seethe a little over it).

I have attended my church for 28 years this fall, starting my freshman year in college.  I was confirmed here, my children were baptized here, and I would have been married by the priest here, had it not been New Student Week that year.  I have so many friends here, from the couple who sponsored me for confirmation to the woman who ran the nursery where both of my kids played, to the director of the prison ministry who has kept the pencil record of my kids’ heights on the wall in his office.  I return to this community not for the ‘body and blood’ mass parts, which I could get at any Catholic church.  It’s how the people here put their faith into action that I admire—seeking connection across diversity, holding space for differing viewpoints and discoursing with respect and compassion.  Next month there will be a dialogue on the Ten Commandments led by our pastoral associate and a Northwestern campus rabbi, entitled, “The Big 10.”

I consider myself not religious at all, rather faithful and spiritual, and this is where I practice.  So while I separate from non-Christians this Easter, I unite with this particular Catholic tribe.  And let me be clear: separating into tribes is a GOOD thing.  Humans are wired for belonging and shared identity.  Support from those we identify with and relate to is essential for survival and thriving, especially in chaotic and uncertain times like now.

But it is in exactly such times when we must be wary of over-identifying with those we perceive as similar to ourselves.  Separating (or sorting, as Bill Bishop calls it) ourselves by religion, ideology, profession, or any other in-group carries risks for us all.  As I looked around the chapel today, I saw a widely diverse group.  Most people were white, many at least a generation older than I.  But there are always college students here, bringing balance, which I love.  I see also families like mine, our children growing up as members of the community, making it a whole of many assorted parts.  No doubt we are not all of one political persuasion, and we each have our own reasons for whatever opinions and positions we take.  We must not assume that just because we attend the same church, in this little building or the Catholic church of the world, that we are all the same, or wholly different from those outside of our church or faith.

As we unite as Christians this Easter, then, separating ourselves from ‘non-believers,’ what is the best object of our spiritual focus?  When we think of ourselves in terms of this religious tribe, how does it impact our identity and relationships in the tribe of humanity?

What are we called to do with this faith of ours, how are we meant to best manifest it here on Earth?

I hear Brennan Manning’s words in my mind all the time, like a warning:

The greatest single cause of atheism in the world today is Christians who acknowledge Jesus with their lips and walk out the door and deny Him by their lifestyle. That is what an unbelieving world simply finds unbelievable.

By the end of mass, I decided that if I choose to accept this ‘religious’ label, oversimplified and overgeneralized as it is, then I must represent it well.  I must not personify the corruption and hypocrisy that so many identify with Christianity—I must demonstrate the opposite.  My faith in action must be driven first and always by love, and never by fear, never by suspicion.  If I can pull this off, then separating myself as Catholic or Christian serves wholly to unite me with all of humanity, because that is what my faith, and what I believe the best of all faiths, calls us all to do.

Reconnecting to Mission, Patients, and Colleagues

Posted on by
2

heart art

What’s the most personally fulfilling aspect of your work?  In times of uncertainty, threat, and transition, what holds you up?

This past week, I had the privilege of standing alongside giants in the fight against physician burnout.  In a series of presentations at the annual meeting of the American College of Physicians (ACP), we did our best to acknowledge and validate the current state of physician burnout (about half of all physicians in all specialties report at least one symptom), and then present as many strategies to reduce it as time would allow.  We showed how changes in workflow, task distribution, and technology, such as pre-visit labs and scribes, have been shown to improve physician satisfaction, team morale, and patient experience.  My role was to attempt to inspire my fellow internists to claim their individual agency, model a culture of wellness, and advocate for systems change in their home institutions.

The content felt dense but manageable, and the audience appeared engaged.  Our colleagues from all around the country approached us afterward to clarify studies of efficacy and ask about local representatives for advocacy in the ACP.  In the end, I think we achieved our primary objective of having most attendees leave with just a little more hope for our profession than they came in with.

Over the four day conference, however, what consistently grounded me in professional mission and meaning, not only in our own presentation but in others, were the personal stories.  That is how we humans relate to one another, after all—through narratives.  And connecting to mission and colleagues is key to maintaining a healthy and productive workforce, physician or otherwise.

Our attendees participated in two practices that I’ll share here.  Both were “Pair and Share” activities, meant to stimulate reflection both internally and externally.

Who In Your Life Really Changed You?

First we asked our colleagues to think of a patient who changed them, how, and to what end.  I know there have been many patients who changed me, but I always think of one particular woman.  She was middle aged, obese, diabetic, depressed, and severely disabled from osteoarthritis.  She lived alone and had a sparse social network, and her life partner had died unexpectedly a few years before I met her.  At every visit we struggled through the same fundamental challenges of weight loss, glucose control, and pain management.  How could she take her diabetes medications more regularly?  How could we control her pain without having to take opioids every day?  How else could we manage her depression, as some of the medications were raising her blood sugar?  She may have cried at almost every visit; wailing was not uncommon, and once she even vomited from cumulative distress.  Our relationship was good overall.  I overcame my impatience with her non-adherence to the treatment plan as I understood her life situation better.  But for four of the five years we knew each other, I saw few if any indicators that her thought, emotional, and behavior patterns would change.

Then things started to turn around.  She started coming consistently to appointments, no more no-shows.  She got online and found a community center that was accessible by bus.  She connected with a knitting group and started going to art fairs to sell her creations.  She started taking her medications more regularly, and lost enough weight to have her knee replaced.  By the time we parted ways, she had transformed from a weeping victim of circumstance to a woman with agency, self-efficacy, and goals, dammit!  And most of this had nothing to do with me.  I simply had the privilege to witness and support her intrinsic revolution.  From her I learned what perseverance looks like; I learned about hope and self-redemption; I learned that I should never make assumptions about anybody’s future.

Who Supported You in a Time of Vulnerability?

They said do the hardest thing that you know you don’t want to do for a living as your first rotation.  So I chose surgery.  In July of my third year of medical school, my days started around 5:30am and could end the next night at 10pm if my team was busy post call.  Most faculty physicians were kind and wise, or at least non-abusive.  Some, however, not so much.  What buoyed me most through that rotation was always the support and protection of the residents on my team.  I would watch them get abused by our attendings, but that sh*t never rolled downhill when the boss left the room.  I did not fully realize until years later what a gift that was and how much it spoke to the character of these men (they were all men).  This was in the 1990s; verbal abuse of medical students and snide comments about one’s appearance, gender, and just about everything else were simply to be expected.  But my favorite residents always pulled me aside and asked how I was.  They always made sure I felt confident about my role on the team, and they taught me basic skills with conviction and encouragement.  As I was about to insert a patient’s bladder catheter in the operating room, my elder brother in training told me firmly, like he really believed I could do it, “Don’t be afraid, hold it (the penis) like a hose.”

As we did this reflection exercise at the meeting last Wednesday along with our audience, I was so moved by these memories that I looked up one of my old residents that night and sent him a thank you card.  I bet he won’t remember at all who I am, but he will hopefully feel validated that he is in exactly the right position now as program director of a surgery residency.

*****

Recalling stories like these, and then sharing them with a person who truly listens, receives them generously, and simply helps you hold them (that was the instruction to the group—when it’s your turn to listen just do that, no interruptions, no jumping in), reconnects us to our calling in medicine.  It’s not just about the patients or the science.  It’s about all of the relationships and how we tend them.

We will not solve the immensely complex problem of physician burnout overnight.  It will take a concerted effort at all levels of healthcare, and physicians cannot and will not do it alone.  And it’s not that we are stoic, arrogant, and somehow intrinsically flawed, and thus dissatisfied with our work and leaving the profession in record numbers.  It is a systems problem, no question.  And, while we call our congressional leaders and professional advocacy groups to change policy, while we lobby our hospital administration to hire more support staff and move the printers closer to where we do our work, we can all take a few minutes each day and reconnect to the core meaning and purpose in that work.  Let us all remember a cool story and share it today.