About Catherine Cheng, MD

I am a general internist in Chicago, Illinois, mother of two, almost native Coloradan, and Northwestern alum. I want to leave the world better for my having lived, by cultivating the best possible relationships between all who know me, and all whom I influence. Join me on this crazy, idealistic, fascinating journey! Look for new posts on the 10th, 20th, and 30th of each month. Opinions posted here are entirely my own, and in no way reflect the opinions or policies of my employer.

Strategies to Get Through

How do you keep going when life gets really hard?

Lately I’m having to pull daily (sometimes hourly) on mantras that hold me up, and I’m also learning from my friends’ examples.

Are We Okay Right Now?

Previously, in life-threatening situations when I was stunned and dumbfounded and also knew I had to hold it together for others, this was the question that got me unstuck.  Obviously we are not totally ‘okay’ if it’s a crisis.  But when I compare current state, right this minute, to worst case scenario (which could happen, hence the crisis) and we are not there yet, then I can take a breath, regain my wits, and take the next necessary step.

One Breath

People say, “One day at a time.”  But so much can happen in one day.  That interval is too long.  Everything can change in a moment—of misunderstanding, of misspoken word, of impulsive action.  We do things in a moment and it’s 来不及后悔—literally ‘cannot regret fast enough’—we can’t take it back, the damage is done.  So one moment at a time is even sometimes too long.  “One breath at a time” seems more helpful.  If I can get one breath’s distance from my impulses, maybe I can make a better choice of words, actions, expression or attitude.  Depending on what’s going on right now, I can be elastic—taking everything One Day, One Moment, or One Breath at a time.  When I can get up to one whole day, it reminds me to be grateful and revel in the good.  When I take one deep breath, in this minute when we are mostly ‘okay,’ I can also find the good, and then a way to keep going.

Show Up Loving

My friend Donna gets it.  When we share our challenges and struggles, we show up loving for each other.  Donna also teaches/reminds me to show up loving to myself.  Because when I show up anywhere or to anyone in self-loathing, nothing good happens.  This doesn’t mean I absolve myself of responsibilities and accountability.  I do not stop striving for learning, excellence, and progress.  It just means I allow myself to be fallible and imperfect—to be human.  When I do that for myself, I’m far more likely to do it for anyone I encounter.  I can take another person’s perspective more easily.  I can show up loving to them, and also hold them accountable, as I do myself.  It’s a win-win, even if it’s hard and painful.

I’m taking a break from the blog for a while, friends.  Hopefully not too long, and not total silence.  Maybe I’ll find a way to post shorter pieces, and/or maybe just not as often?  I’ll figure it out.  Thank you for reading all these years, and for your engagement and support.  Peace to you all.

Cultural Perpetuity

What kind culture do you wish to perpetuate?  What specific actions, policies, behaviors, and outcomes would it manifest?

I learned the term ‘cultural perpetuity’ this past week, from a thought-provoking article on how Maslow’s Hierarchy was influenced by and also misrepresented Blackfeet Nation teachings:

  1. Self-actualization. Where Maslow’s hierarchy ends with self-actualization, the Blackfoot model begins here. In their view, we are each born into the world as a spark of divinity, with a great purpose embedded in us. That means that we arrive on earth self-actualized.
  2. Belonging. After we’re born, imbued with a divine purpose, the tribe is there to love and care for us.
  3. Basic Needs & Safety. While in Maslow’s model, we find love and belonging only after attending to our basic needs and safety, the Blackfoot model describes that our tribe or community is the means through which we are fed, housed, clothed, and protected. The tribe knows how to survive on the land and uses that knowledge and skill to care for us.
  4. Community Actualization. In tending to our basic needs and safety, the tribe equips us to manifest our sacred purpose, designing a model of education that supports us in expressing our gifts. Community actualization describes the Blackfoot goal that each member of the tribe manifest their purpose and have their basic needs met.
  5. Cultural Perpetuity. Each member of the tribe will one day be gone. So passing on their knowledge of how to achieve community actualization and harmony with the land and other peoples gives rise to an endurance of the Blackfoot way of life, or cultural perpetuity.

I also listened this week to the Building an Anti-Racist Workplace episode of Adam Grant’s podcast WorkLife.  It’s an insightful, enlightening, and empowering interview with John Amaechi, whose work I will now explore further.  In their discussion on allyship, Amaechi points out that we upstand against racism and sexism not just to help our individual friends or coworkers, but because we uphold certain core values.  Thus, we speak and stand up to defend and disseminate a certain culture—to perpetuate it:

Adam Grant (21:43):
I wanna talk a little bit about sort of the- the ally perspective here. Just thinking about my own failures in anti-racism and other people who I know, recognize the problems and care about the problems, but haven’t done much about them, I keep coming back to this literature on psychological standing.That sense that, you know, it’s- it’s not my place, it’s not legitimate for me to speak up because I’m white. What are your thoughts on overcoming it and getting those people who are by-standing for those kinds of reasons on board?

John Amaechi (22:13):
There’s a couple of things that I’m trying to do. One of them is to stop the alignment of allyship with black people as individuals and start the alignment of allyship with their own principles or with their organization’s values. So racism is an incivility. Sexism is an incivility. I do not require sisters nor a mother, nor a wife to be against sexism and misogyny because it is an incivility. If I’d intervene on something that’s racist, it’s not on my behalf or another one of my black colleagues. It’s because it’s an incivility against the values that people say they share. Today it’s not about an individual. It’s about standing up for your values and understand that you don’t need to have a black person in your team for that to be important because the presence of a black person has never been required for racism to occur. The presence of a woman has never been required for sexism to occur. As men, we know that the absence of woman reveals sexism and misogyny.

What culture do you lead?

In my role as interim clinical director of a small practice, I see myself as a steward.  My best contribution to most places I inhabit is to highlight and foster relationship and connection.  At work, this manifests as effective teamwork, high engagement, and positive morale.  Last year as we recruited for a new medical assistant (MA), I got to listen on the phone as our current MAs interviewed a candidate.  Through my own questioning, the candidate’s responses were short and sedate.  Then each MA on the team met with her, describing with energy and conviction how they live out our core values of collaboration and accountability, as well as our mission of providing compassionate, holistic patient care.  With each encounter, I heard the candidate’s responses lengthen and deepen.  I heard her own energy and engagement rise to match that of the team.  It was one of my proudest moments as director—I could see (hear) and feel how far our culture of connection has come, and how it could persist after I pass the baton to the next director.

What is the dominant (perpetual) culture in America?

Do not underestimate the complexity of this question, and its profound implications.  The first answer is, of course, it depends whom you ask.

For far too many, the dominant American culture is white male supremacy.  For the past year, I myself find it inescapable.  Increasingly, every time I consider what to post to this blog, or jeez, every day and in almost every domain, the primacy of white men pervades my consciousness like smog on a hot, humid day.  Let me be clear:  White men are not each and all bad; I do not assume every one is a racist sexist, even the actual assholes.  But whenever American systems are examined, we find that they are primarily designed, favored, empowered, and perpetuated by and for white males—it’s baked into our societal structures, hence the terms ‘systemic’ and ‘structural’ racism and sexism.  If you are a white male, it may be hard for you to see the barriers that have not impeded your life journey (Amaechi discusses this in the podcast as well).  You may have answered that dominant American culture is one of success with hard work, of equal opportunity, and of individual freedom.  Of course that is a culture we’d all love to perpetuate.  How could we achieve it for everybody?

What culture do you work to perpetuate?

I think it’s about the values and commitments we hold highest and manifest most in our daily activities.  What do our daily encounters say about our priorities?  What do we want more of, and thus work for every day, for ourselves, our friends, our colleagues, patients, parents, and children?  I want mutual respect and unqualified acceptance.  I want sincere valuation of diversity and real, wholehearted inclusion and integration of that diversity—of thought, experience, wisdom, and perspective—into a coherent, synergistic mosaic of strengths, engaged in service of elevating every individual to their highest potential.  I want to perpetuate a learning culture, one that operates with a growth mindset, founded on kindness, generosity, humility, curiosity, and resilience. 

None of this happens automatically; even well-established gardens of inclusive culture require regular tending.  I have to renew my commitment every day, in every encounter.  I fall down regularly.  And I give thanks every day for loving companions who help me up.  I try also to appreciate the challengers, to see them as allies rather than enemies or hindrances.  That is walking my talk, no?  To value those whose goals and values don’t align with my own, to find a place for them—for everybody—in my world?  I’m strengthening my practice of self-assessment.  How did I walk the talk today?  How can I do even better tomorrow?  The more concrete and specific, the better—words, actions, and attitudes.  It’s my own version of “trudging the road of happy destiny.”

On that note, I leave you with two more resources that hold me up this weekend:

First, Hank Azaria’s conversation with Dax Shepard and Monica Padman on the Armchair Expert podcast.  They discuss addiction, privilege, and racism, among other things.  What an inspiring example of vulnerability, courage, humility, connection, and lifelong learning and growth.

Second, a Forbes profile of Sharon Salzberg, 4 Ways Loving Kindness and Mindfulness Can Change Your Life.  You may read them and think, “Duh, I know that.”  But ask yourself, how does your knowing translate to doing

We have our whole lives to practice.  As Simon Sinek says, the goal is not to be perfect by the end; it is to be better today.

Here’s How We Can All Help

How do we stick with something when it’s hard? 

I queried my Facebook friends this weekend.  My favorite answers:

“Doing it with friends/family.  People you like spending time with.”

“The alternative of not doing it is worse… and how it helps in the long run.  Knowing it helps me feel better about my life.  …Also, hope matters a lot.  Gotta have hope or else it’s hell.  Finally, helps a lot if you love the subject matter or the work, even if it’s hard.  Or you care about the person for whom you’re doing it, if it’s not for you.”

Most people thought about exercise and other personal habits.  But I’m thinking about those hard conversations about racism, bias, and prejudice.  It’s a whole other ball game, and yet similar principles of practice, persistence, and resilience apply.

This week I had a heartfelt and enlightening conversation with fellow physician leaders about addressing racism and bias at work.  It was the first prolonged, frank conversation most of us had had on the topic with colleagues.  I came away feeling connected and also frustrated, with three conclusions:  1) We all see the problem and we all care; 2) Too often we don’t know what to do or how to help; we feel like deer in headlights—because it’s hard—so we stay silent; and 3) What I want most is for us all to keep trying anyway, even though it’s hard and we don’t feel totally competent—yet.

I see parallels to counseling I do for patients about lifestyle habits.  So many people tell me that they don’t bother trying small habit changes because they never stick.  They believe they are ‘all or nothing’ folks—full on angels or devils of habit—no incremental change possible.  Psychology research tells us that this is not an intrinsic or immutable trait; we can overcome it.  But it’s hard.  We forget that learning, competence, and mastery take practice, time, and persistence.  Sounds a lot like communication skills, no?  In lifestyle counseling, we take a very concrete approach to habit change.  After work, I often overeat in a fit of stress and desire for reward/relief.  I always regret it.  I can delay and diminish my mindless vacuum eating, however, by changing small things in my home arrival routine, like bypassing the kitchen and going upstairs, drinking some water, and breathing deeply, to re-center for a mindful dinner.  I can take small steps—not all or nothing, rather all or something

Obviously, addressing bias and racism at work is different from managing eating habits. But we can still take small steps to build confidence and competence. A lot depends on the culture at work—are hard conversations even safe to have? We must also consider relationships and context—sometimes it’s better one on one, other times you can talk about it as a group. There is no substitute for active awareness practice—attunement to self, others, and environment. Moments of potential connection and understanding can be fleeting. How can we develop an effective skillset, one that builds confidence and agility so we may recognize, seize, and capitalize on those moments? Repetition is key for entraining any skill, and it’s our small daily practices that can cumulatively improve the psychological safety of our work cultures, and make the hard conversations easier. Below is a list of small steps we can all take. With regular exercise and training, we can strengthen our upstander and allyship muscles. If we find workout buddies (like my physician leader forum group) and support one another by sharing challenges and iterative victories, just like at the gym, it’s easier and more successful for us all.

How are you already holding up marginalized people in your world?  How do you stick with it when it’s hard?  What and who holds you up?

* * * * *

Learn and Use People’s Correct Names

My first name is spelled with a C, and my last name has an E and ends with a G.  It matters to me.  Allison goes by Ally.  ‘Chien’ could be pronounced with a ‘ch’ sound or a ‘j’ sound at the beginning, depending on where someone is from.  It’s okay to ask someone how to pronounce their name.  It shows that we care to connect and acknowledge their identity and whole personhood.  Hear or read this short article on how this simple practice can make a world of difference in how we include one another in the workplace, and for tips on how to do it effectively and easily. 

Don’t Laugh at Racist (or Sexist, or Any ‘Othering’) Jokes

And for sure don’t make them.  Psychologists call this disparagement humor:  “any attempt to amuse through the denigration of a social group or its representatives… (It is) paradoxical:  It simultaneously communicates two conflicting messages.  One is an explicit hostile or prejudiced message.  But delivered alongside is a second implicit message that ‘it doesn’t count as hostility or prejudice because I didn’t mean it—it’s just a joke.’”  Such expressions perpetuate a social norm that marginalized people and groups should ‘just lighten up’ as others devalue and dehumanize them.  Read how it affected one East Asian woman when she internalized her own white friends’ ridicule, and how she overcame it.  If you see a marginalized person participate in denigration of their own group, ask yourself how that came to be; then recognize and consider the complexities of assimilation and survival.

https://www.diversitybestpractices.com/sites/diversitybestpractices.com/files/attachments/2020/06/upstanding_against_racism_-_a_practical_guide_final.pdf

Upstand When You Witness Aggression of Any Kind

What will you do the next time someone makes a racist, sexist, or otherwise denigrating joke or comment?  Or when someone starts abusing another person on the bus?  How can you help?  You don’t have to be a hero or put yourself in harm’s way.  And you can still respectfully and firmly disrupt aggression, and signal your support to a targeted person.

Learn and Share—Find and Be Peer Support

I’m so grateful for friends and colleagues who have committed to this work.  We validate one another’s experiences, fears, triumphs, and learnings.  We exchange resources like everything linked in this post.  I keep articles in my Pocket app, so I may share them readily and widely.  We acknowledge that the work will not finish in our lifetimes.  And yet we persist, because we believe we can contribute.  We work to leave the world better for our children, and to lead them by example so they may carry the torches after us.  We hold one another up in hope.  Please, join us.

How to Support Your Asian Colleagues at Work Right Now:  1. Reach out in support if it’s appropriate to your relationship.  2. Consider your intent—is it really to help them, or are you just making yourself feel better?  3. Don’t invalidate or diminish their feelings.  4. Listen to understand, not to fix.  5.  Just don’t stay silent.

InclusionLabs Fellowship Program:  For a deep dive of inner work in service of effective action, check out this program to connect to others who have also made the commitment.