Rallying for Reentry

IMG_3205

We’re baaaaaaack…  Sort of.

After ten weeks sheltering and working mostly remotely, the primary care team I lead will phase back into regular office hours this week.  What a long, strange trip it’s been!  And it’s nowhere near over!  But the next chapter begins, and we are ready.  We return with limited staff, all spaced, masked, and sanitized.  We have planned for weeks and done our best to anticipate hiccups and pitfalls.  Now it’s time to dig in and execute.  Exciting!

And maybe a little scary?  We will have minimal face to face appointments in the beginning, but as with businesses and services across the country, we will ramp up over time.  How will this affect and be affected by coronavirus infection and illness rates going forward?  What will flu season look like, while we continue mitigation efforts for COVID-19?  Despite the multitude of models, nobody can say for sure.  And still we must move.

So what’s a leader’s role here?  How can I best serve my team as we step boldly back onto the path, besides planning and execution of operations and logistics?  Now more than ever, I must be both clear and adaptive about my leadership—its meaning, influence, and potential.

This weekend some strong feelings emerged to center, ground, focus, and guide me.  Interesting, isn’t it, for my professional peace to rest so surely on emotions?  The cognitive knowledge that my own leaders have my back gives me confidence and reassurance—I trust them.  I trust us all to flex and adapt as our collective situation evolves.  One could argue that trust itself is, by nature, more limbic than rational.  And such is the human condition—we are emotional beings who think, not the other way around.

So I embrace and anchor to my positive emotions.  I can moderate turbulence with solid intellect and steady spirituality.  I believe good leaders do this visibly and vulnerably—they lead by example.  Right now we all need to manage through a morass of complex feelings—to identify, accept, and allow their passage through us.  This is how we take care of ourselves and each other, and get the work done.

IMG_3442

Pride

I could not be more proud of our team.  Like so many cohesive teams in an emergency, we pulled together, reorganized, and mobilized like champions.  Computers were set up at home, schedules rewritten, tasks redistributed, and personnel reallocated.  Folks overcame fear and anxiety, at times severe, to help other departments, learn new skills, and grow into leaders themselves.  They made connections across the health system and broadened perspectives that will now benefit our whole team.  We supported one another through semiweekly touch points, instant messaging, photos, stories, and some tears.  I have no doubt that we can not only navigate but crush this crisis arc, and emerge a stronger, even more cohesive version of ourselves.

Protectiveness

As clinical director, I appoint myself chief cheerleader and den mother.  Through various channels, it’s my job to keep a finger on the pulse of morale and engagement.  And while I hold the team up to its own standards of integrity and accountability, I also keep a vigilant eye for assailants from outside.  As we prepare to reopen, I consider how I will protect my team from abusive patients.  I think the risk is low, but what if someone refuses to mask or submit to temperature screening?  What if they become aggressive or belligerent?  Our team has cultivated empathy and compassion, especially for patients who feel anxious and sick.  Still, I will not compromise our safety for someone’s angry outburst or agitation.  We have a plan for handling such situations that will never tolerate physical confrontation or humiliation.

Loyalty

We’ve been through a lot together the two years I have been back on this team.  Turnover was high in 2018, and engagement low.  We’ve since built a culture based on connection and accountability, and this complex work continues—culture work never ends.  Technically I hold an interim position; I am a steward.  But I will not leave until the right successor is identified and groomed.  I’m in for as long as this takes, as long as I am able, as long as the team will have me—I will not abandon ship.

Conviction

Our team has a particular, holistic approach to patient care and relationship.  In order to live this approach for ourselves, we defined our core values a year ago:  Kindness and compassion; connection and collaboration; fun, joy, creativity; and accountability.  I see now that we have an opportunity in this moment to further clarify our mission and vision.  Nothing like a global, existential pandemic to make us reorient and reclaim our raison d’être!

Vision and Execution:  It is the leader’s role to manage both—to host the ball and move fluidly between dance floor and balcony, as Ronald Heifetz and colleagues say.

Let’s get this party started.

Where Is the Light?

covid fairy penguins melbourne

Photo by Tobias Baumgaertner, Fairy penguins near Melbourne, Australia

*deep breath*

I always wonder about you, dear reader.  Where does this post find you, since we last connected?  How are you?

It’s a good practice to check in with ourselves regularly.  These nine weeks of sheltering in place have exercised my patience, awareness, and identity, among other things.  What have they done for you?  How are you?

For a couple weeks now I have felt all but overwhelmed by darkness.  Infection and death rates have slowed, but they will continue to accumulate indefinitely.  I worry that we will become inured, calloused, to the human toll.  PPE is still in short supply at hospitals across the country. Thousands of my colleagues continue to risk both their physical as well as mental and emotional lives to care for gravely ill patients.  They leave their families and support networks to become the sole supports for patients alone in the hospital, whose own loved ones may not visit, even in the hour of death.

Mostly I have felt burdened by the fighting.  The shouting, protesting, mean memes, and ad hominem all around me, directed both by and at my friends and colleagues.  Important reflections and insights arose this week that helped me see clearly the internal origins of my distress.  I re-accepted and re-integrated these parts of myself.  I was able to laugh out loud, exclaiming, “How fascinating!”  I know I will necessarily repeat this discovery exercise ad nauseam, ad infinitum—such is life, karma says, also laughing.  But for now I feel lighter, unburdened, more at peace.

So I thought about role models for peace.  I feel so lucky to have so many.  But one in particular shone in my consciousness this week:  Dr. Vivek Murthy, our 19th Surgeon General.  He has published a book, Together, in which he “makes a case for loneliness as a public health concern: a root cause and contributor to many of the epidemics sweeping the world today from alcohol and drug addiction to violence to depression and anxiety. Loneliness, he argues, is affecting not only our health but also how our children experience school, how we perform in the workplace, and the sense of division and polarization in our society.”

I recently watched a live interview with him conducted by Dr. Lucy Kalanithi, widow of Dr. Paul Kalanithi, who wrote When Breath Becomes Air.  I listened with one earbud, watching in my peripheral vision, while hurrying around my kitchen, preparing chicken and assembling a salad, all before rushing to host a Zoom workout.  It struck me that in stark contrast to my frenetic energy at that moment, Dr. Murthy presented only calm and serenity.  He answered every question with love, joy, conviction, and equanimity.  I noticed and marveled.  Then I rushed around some more and got on with my evening tasks.

Looking back, I have felt this serene and loving presence every time he speaks.  He has a way of making everybody in the room comfortable, welcome, and included.  Even if he’s interacting only with a moderator, it feels like he’s speaking to me personally.  He sees me, he gets me.  He cares about me.  In searching for the Kalanithi interview, I came across this lecture and discussion he gave at Stanford University in 2015.  I hope you will take the time to watch (or at least listen).  Notice how he shares stories of his parents, his patients, and people he met during his national ‘listening tour’ at the beginning of his tenure as Surgeon General.  Hear how he sees and knows every one of these people in their whole humanity.  Abraham Verghese, physician, author of Cutting for Stone, and another hero of the profession, moderated the Q&A, and also named Dr. Murthy’s equanimity—his peacefulness.  Notice how Murthy validates questions asked by students and faculty alike.  Observe his humility, juxtaposed with a resolute, unwavering point of view.  Do you feel it?  Does he not inspire you to be a better person?

Dr. Murthy and his wife, Dr. Alice Chen, have written an open letter to us medical professionals, in the midst of this global pandemic.  Reading it, once again I feel seen, understood, and comforted.  I feel true belonging in a proud and humble tribe of professionals, committed to service.  They shine their light on all of us, so we may see the path before us more clearly and walk more confidently, knowing we’ got our peeps holding us up.  This, in turn, gives us the strength and love to hold up others along the way.

I see the light tonight.  It emanates from my fellow and sister humans, and it saves me.

For a little more light, check out this Jon S. Randal Peace Page post with the picture of the penguins.  In it you will read about gems like John Krazinski’s “Some Good News” YouTube series, and Chris LaCass, founder of Pandemic Kitchen, feeding New York City’s homeless.  You can also share your own stories of inspiration and light in the darkness.

Where is your light today?  How will you keep it in front, as we travel this long road together?

 

 

Trust and Safety in an Uncertain World

IMG_2022

Suddenly I felt my heart pounding.  My palms got sweaty.  My jaw felt tense.  I’m anxious, I realized.  It felt like sometimes when I speak up in big meetings.  Wow, I don’t even have to be in front of people for this to happen, how fascinating.

It was the second or third comment I had written on another Facebook page, belonging to a high school classmate.  I think we became ‘friends’ through his wife, a friendly acquaintance of mine in high school, with whom I’ve been connected on Facebook for several years.  I don’t really know her husband at all, and yet here I was, writing long replies on his page about universal masking, why recommendations changed between March and now, and why I trust Dr. Fauci despite his apparent flip-flop on this issue.

I had entered someone else’s house, offering my unsolicited opinions.  Though we have a handful of mutual friends, I had no idea who else would attend this party, and whether I would be welcome.  I wasn’t sure it was safe.

And yet I felt compelled to enter, why?  Perhaps I felt defensive of my professional standard bearer, Dr. Fauci, the father of modern infectious disease and icon of science, medicine, and public health.  He has basically led the research to define and defeat HIV/AIDS since the 1980s.  Through six administrations, he has directed the National Institute of Allergy and Infectious Diseases (NIAID) to successfully manage H1N1, Ebola, and Zika, at home and abroad.  He is one of my heroes.  Likely, I also wanted to absolve myself a little, as I had also recommended against masking in public early on.  I wanted to help some strangers see us, the ‘experts’, as human and fallible, and also earnest and caring, worthy of heeding.

So I obsessed over my comments.  I read and reread before posting.  I edited after posting.  I included the links embedded above, inviting anyone on the thread to hear Dr. Fauci in his own words, in full.  I offered my own mea culpa twice, explaining how academics sometimes fall victim to ivory tower thinking, as we did in this case.  Perhaps this was my attempt at earning back whatever trust people may have lost because we experts contradicted ourselves in such an important and pivotal moment.  I regret this, and I wanted people to know, and then maybe not hold it against me (us).  Would I be crucified?  Or would I crack a door open to hearing what I had to say?  I feel anxious now, just thinking about it again.

My own friends discussed this on my page a few weeks ago, after my post on antibody testing (our recommendations have not changed yet).  Paul, MD PhD and rheumatologist, pointed out, “US experts really blew it initially when it came to masks… All they had to do was consider the possibility that Asian countries might be right and then consider that the risk associated with (masking) was virtually zero.  The first thing experts need to do, when confronted with circumstances that are truly new to them, is admit uncertainty and base recommendations accordingly.”  I’m so lucky to have such honest and direct friends.  I replied that I felt badly for following the ‘expert’ advice like a sheep (which is exactly how others on my acquaintance’s page described followers of universal masking, yikes).  “Lesson learned,” I wrote—but have I really learned it?  David, Paul’s and my classmate who now leads quality and hospitalist programs at his institution, replied, “It’s weird to be here with you (two) bashing experts, since the three of us are by any definition, experts.  But the value of experts is not that they’re always right, but that they have a) a better track record and b) the ability to self-correct.”  Yes, humility is key.

It all makes me wonder, how do we trust someone?  I have conversations every day with patients and non-medical friends and family, educating and advising, and they are appreciative; they trust me.  But we have already established mutually respectful, personal relationships.  What made me think I could go on this unfamiliar man’s social media page, interact with perfect strangers, and have them trust or accept anything I said, when they had already expressed reservations about, if not hostility toward, my ‘tribe’?  Was it my place?

The original post commented on universal masking and referenced Dr. Fauci not in a snarky, pejorative, or aggressive way.  If it had I would have scrolled right by.  Because it was a neutral presentation, I felt it could be safe to enter this house and offer my perspective.  Out of respect for the page owner and his friends, I did my best to present both humbly and objectively, to be informative but not condescending.  I really wanted to put my best online foot forward, to represent my tribe and my profession as well and as trustworthily (it’s a word!), as possible—to connect.  So far I have not been attacked, and a few readers have liked my comments.

In the end, as I have written before, I think it’s about how we show up to one another.  I wrote recently about tribal culture, and how through this crisis, individuals can help our own tribes thrive by modeling a more collaborative rather than competitive mindset, by amplifying our togetherness.  “Who do we want to be on the other side of this crisis?” I asked.  David Logan and colleagues go on in their work to discuss how tribes can effectively interact with other tribes, forming alliances and advancing even greater good together.  They posit that tribes draw closer when their respective members, especially designated leaders (representatives), connect.

We find ourselves now in an existential battle for our lives, literally.  Now is exactly the time to find common ground, step onto it, set up camp, and make decisions from there—to merge tribes.  A friend asked me today, “Who do you want to be now?”

I want to be a connector, I answered.  I will do my best not to contribute to division, polarization, alienation, disconnection, and suffering, through my words or actions.  I will not be perfect.  I will make mistakes.  I will continue to learn and apply.  I will strive to earn and maintain people’s trust.  And I will help make it safe for people to question and challenge, discuss and explore any point of view.  In the face of uncertainty, this is what I can offer.

Please Stop With the Fighting

IMG_1596

What a difference a week makes.  How are you feeling?  I can only describe my own experience as ‘off.’  Things feel heavy, fraught, tense, uncertain, and anxious.  All the talking and writing I do about tolerating uncertainty and holding space for tension feels almost comically hypocritical right now, as I grapple with my own practices.  But more than that, I feel accelerated degradation of relationships all around me.  Armed men march and yell at the Michigan capitol building (where a woman governor serves).  More armed men gather in front of state public health director Dr. Amy Acton’s house in Ohio (not the capitol, where a man governor serves), saying there will be no violence, “for now.”

People on the ‘side’ of public health deride decisions to reopen state economies as willfully ignorant, even malicious.  People on the ‘side’ of reopening economies derail stay at home orders as fascist.  Perhaps these are the minority voices of each ‘side’, but they are loud, and they dominate public discourse and social media (I know, I know, moderate my intake, yada yada).  Yet another false dichotomy escalates with increasing vehemence on both sides.  I have mulled it for weeks and not found a good way to write about it.

Late yesterday, I found two pieces that help, written by conservatives I respect.

In the first, “What Republicans’ Kool Aid Moment Means for the Rest of Us”, Chris Ladd outlines our fatal flaw as humans, and then asks some profoundly important questions about how to resist the ultimate pitfalls of that flaw:

“Confronted with displays of cult loyalty we commonly resort to some mistaken conclusions, dismissing these people as crazy or stupid. These assumptions are born of the same logic that leads people to blame the sick for their illness, a desire to manufacture some difference between them and us, something that would leave us immune to their condition. We want to believe that there’s something uniquely broken, inferior, or even subhuman about the people in those pathetically sad images of self-destruction. Those dismissive characterizations of cultists aren’t just false, they are dangerous.

“We are not inherently rational creatures. By nature, our model of reality is not a product of careful individual inquiry, formed through a critical review of all available data, but a social construct heavily influenced by our preferences, hopes, and the collective will of our tribe. Human beings are capable of independent, rational thought premised on a body of constantly moving data, just like we are capable of juggling or riding a bike. Absent special training, critical, data-centered reasoning is so effortful, difficult and unnatural that any political order premised on the rationality of the average man will be consistently unstable.

“Even with careful training over years, a life of critical thought remains a challenging endeavor, costly to maintain and not suited to every circumstance. Riding a bike sounds easy once you’ve learned to do it but try dialing your phone or eating a sandwich while peddling and you’ll see the challenge. Careful, critical reasoning is resource-expensive. None of us engage in it as much as we think we do.

* * * * *

In the second essay, “What If We Loved Them Both?”  David French invites us to exercise that resource-expensive skill of critical, rational, nuanced and complex analysis:

“Once again, our nation is faced with the painful process of sorting through grave sexual assault allegations against a powerful man. Once again, the public assessment of the veracity of those claims is lining up all-too-neatly with the partisan needs of the moment. Those who object to the rush to judgment against the accused will often ask if how we’d respond if, say, Joe Biden or Brett Kavanaugh was someone you loved. What if he was your father or grandfather. Would you feel like they’d been treated fairly?

“The counter is quick. What if Tara Reade or Christine Blasey Ford was someone you loved? Can you imagine how you’d feel as they mustered up the courage to tell a dreadful story and then you watched them endure the inevitable slings and arrows of scorn, hatred, and mockery?

“But there’s a different, better construct. What would the world look like if an imperfect population that possessed imperfect knowledge loved them both?  

“Due process is just, and it’s indispensable to the pursuit of justice. It is the answer to the question at the start of this newsletter—in the most fraught of claims and the most vicious of crimes—What if we loved them both? What if both accused and accuser were of equal worth? When we consider the right to bring a claim, the requirements of evidence, and even the time limits imposed on cases (given the difficulty of both defending against and proving very old allegations), we not only humbly acknowledge our inability to peer into a person’s soul to discern truth, we also acknowledge that even the mightiest man can and should be brought low when the evidence dictates. 

“But protecting due process (like protecting free speech) is hard. Just as permitting bad speech is a necessity for maintaining the larger, just legal structure of free speech—individual injustices can also protect the larger, necessary structure of due process.

“Each person involved in the controversy is of equal worth, a human being created in God’s image. That means the accusers have a right to bring their claim and be heard, respectfully and fully. That means the accused have their own rights to defend themselves, and a presumption of innocence is wise. Our own extreme fallibility and inability to peer into a human soul means that we should diligently seek external evidence that corroborates or rebuts any allegation or defense. 

“It is true that our culture has frequently failed women. It has failed in the obligation to treat them with respect or to fully hear or fairly consider their claims of terrible crimes. It is also true that our culture has also failed men, especially black men. There are simply too many terribly tragic tales of men dying at the hands of a mob in the face of an unsubstantiated claim of sexual misconduct. Even today, there are echoes of that awful injustice in the way in which black men are treated in campus courts. 

“But the answer to historical injustice isn’t another, equal and opposite injustice. That’s the score-settling that leads to endless ideological and partisan conflict. Instead, the answer is to discern the correct standard, and hew to it as closely as we can. Conservatives should not seek ‘revenge’ for Brett Kavanaugh. Progressives should not give in to the temptation of believing a Democrat through highly-subjective judgments of ‘demeanor’ or ‘temperament.’ That’s the God’s-eye view. And human beings are terrible at playing God.” 

* * * * *

The essays above, while encouraging, also ring abstract and esoteric.  How do we take these lofty ideals and apply them today, in our daily lives, so as not to feel so disconnected, so disparate?  Because what good are ideals if we cannot live them out?  We really are all in this together.  What’s helping you remember that, really feel it, right now?

In our lifetime, there may be no more important moment than right now to recognize and truly honor, in our minds, hearts, and bodies, our shared humanity.  I took a stab at an action plan with the list below.  What would you add?

  1. Stop thinking ‘we’ are better than ‘them’; really try hard to see everybody as equally worthy to engage.
  2. Marshal our best skills at patience and generosity when ‘they’ say they’re better than ‘us.’
  3. Focus on shared goals and humanity— how are we all ‘us’?
  4. Lead by example resisting the urge to oversimplify and over generalize; look for and point out complexity and nuance.  See this as a strength rather than a weakness.
  5. Do not fall for baiting and inciting statements meant to trigger defensiveness.
  6. Acknowledge and concede the flaws and faults of ‘our side’; encourage others to do the same.
  7. Disengage, for the moment, when ‘opponents’ as well as ‘allies’ show themselves, or we find ourselves, to be uninterested in following or unable to follow these rules of engagement. Even when our intentions are earnest, this stuff is hard. And it takes grit and perseverance to train. And almost all of us are total novices at it. So we have a LONG way to go. Try again later. And again, and again, and again.