#AtoZChallenge: Assumptions and Appreciation

Welcome to my first attempt at the Blogging A to Z Challenge!  26 posts in April, one for each letter of the alphabet (I get one day off per week).  I will explore meaningful words to apply to perceptions, attitudes, behaviors, and relationships. It’s a personal journey, part of my mission of self-assessment and development through writing.  Thank you for stopping by, and please feel free to comment! 🙂

 

Yoga instructors. Football players.  ER nurses.  Asian college students.  Old white men.

Hold these likenesses in your mind’s eye for a moment. Who do you see?

Was the yoga instructor a man or woman? The football player?  It’s impossible not to make assumptions, to apply stereotypes.  Such constructions help us make sense of the world.  They allow us to move through countless human encounters quickly and automatically.  And, they can limit us far more than we realize.

One spring day my kids and I sat in the car, waiting to exit the parking lot after church. Three men, Caucasian, in their 60s, crossed in front of us.  They were well-groomed and overweight—grandpas, likely.  Their expressions were neutral, absorbed in conversation.  One of them looked a little winded from walking.  They were perfectly unremarkable, and they did not notice us.

I felt an acute flash of fear.  It was visceral, as if, at any moment, they could decide that my kids and I were not worthy of being at that intersection, and that they somehow had the power to impact my life in ways that I could not control or influence.  Three apparently unassuming white men.   Fascinating.

I remembered this story when a friend and colleague recently shared this blog post on our assumptions about surgeons.  I realized that despite being married to a surgeon, having multiple surgeon friends, and trying every day to live with an open mind, I still ascribe to the stereotype of the mean surgeon.  It comes out when I hang up the phone after a pleasant conversation with an ENT fellow.  “Wow, he was so nice,” I think, surprised.  Or when I feel righteously annoyed after a terse and condescending interaction with his attending.  “What do you expect,” I say to myself, “he’s a(n old, white, male) surgeon.”  Nobody would ever say that about a pediatrician.

I don’t shame myself for harboring the mean surgeon and old white men stereotypes. They were born of a certain reality and make me appropriately cautious in new situations.  I don’t think I behave badly because of them, and I readily acknowledge when the stereotypes are broken.  But the realization that I hold these assumptions so deeply—subconsciously—gives me pause.  What other assumptions do I carry, and how do they limit my relationships?  I think it’s fair to say that we all carry shards of racism, classism, and other forms of blatant prejudice.  Here’s what I also think:  It’s okay.  We can’t help it, that’s just how it is.  Denying it just makes it that much more insidious, subversive, and toxic.  I’m prejudiced, you’re prejudiced, we’re all prejudiced.  The more we say it, the less scary it gets.  The first step is acknowledgement without shame.

But we cannot, and must not, stop there. We can’t only say, “We can’t help it, that’s just how it is.”  We must take the next step, which is to manage it better.

I think an excellent antidote to toxic assumptions is appreciation.

Dictionary.com includes the following definitions of appreciate:

  1. To regard highly; place high estimate on: to appreciate good wine.
  2. To be fully conscious of; be aware of/ detect: to appreciate the dangers of the situation.

Let us first fully appreciate (be aware of/detect) the scope of our prejudices: Their cultural, familial, or experiential origins, their subtle influence on our perceptions, and the covert ways they manipulate our thoughts, words, and actions toward others.  Awareness is key.  It is also hard.  It’s hard because we know we shouldn’t be prejudiced, it’s bad.  Prejudiced people are bad, they do bad things, we don’t want to be like them; if we admit our prejudices then that means we are bad, that we are not worthy.  STOP.  The only way to keep from acting on our negative stereotypes and perpetuating racism and xenophobia is to fully acknowledge their existence and confront them, head on.  They do not define us.  They are not all of who we are and what we stand for.  Their presence does not negate all that is good, generous, and inclusive about us.  AND, they are part of us.  We cannot escape them by way of denial.  If we can call ourselves out honestly, lovingly, and with forgiveness, we can then integrate our prejudices, and put them in their place.  Appreciation does not mean approval of, or abject subjugation by, our biases.  It is simply the first step to living wholly, to knowing and owning all of ourselves, and moving with intention and mindfulness.

Then, let us apply the other definition of appreciation to others. Let us regard more highly those whom we may automatically, however subtly, belittle in our subconscious.  How might we do this?  Look for that which we share.  She is a mom.  She must love her kids as much as I love mine.  What are their circumstances, what lessons is she trying to teach them, and what would I do in her place?  Why did he become a doctor?  He must want to help people like I do.  I could never do what he does, so high risk, so much responsibility.  God bless him, we need people like him.

Let us then solidify the process with words, out loud. “I can tell you really love your son.”  “Thank you for caring so much about our patient.”  It may sound trite, even silly, at first.  But we can never underestimate the impact of a few kind words, not just on others, but on ourselves.  When I acknowledge myself in you, I make a connection.  I see you, I recognize you, I appreciate you, as I do myself.  Prejudice thrives in silence and denial.  It cannot long survive being spoken out loud and it certainly withers in the presence of true connection.

We will always make assumptions.  Tempered with some well-placed appreciation, though, perhaps we can get through life with a little more love and a little less suffering.

Choose Flowers!

Some impromptu thoughts on a Saturday morning… Thanks for the prompt, Jodi! 🙂

“Your mind is a garden.
Your thoughts are seeds.

You can grow flowers,
or you can grow weeds.

– paraphrase from William Wordsworth

Choose flowers!
Cherish the moments.

Cheers & Hugs,
Jodi”

I found myself replying to a comment from Kerfe at https://methodtwomadness.wordpress.com/about/, which said, “Although ‘weeds’ is just our perception…all plants have their place in the ecosystem. As a child, I never understood why people wouldn’t want dandelions covering their yard…”

And since my reply was getting a little long, I decided to make it an actual post…

We will all have unwelcome thoughts from time to time, of course!  And we can learn something from taking some time to examine what the ‘weed’ thoughts look like.  How do they change the landscape?  What, if any, danger do they pose, or, can they be integrated into the natural beauty of the garden?  Sometimes they will just have to go–as attractive as they may seem initially.  Destructive thoughts, like invasive plant species, can overtake the peaceful gardens of our minds, and disrupt an otherwise stable, if dynamic, balance.  In the end I agree with Wordsworth–it’s our choice which flora we nurture in our mind’s garden.

We each must take responsibility for that which we cultivate.  As the saying goes, our thoughts become our words, become our actions, etc.  Pollen and spores from my garden disperse to those around me, carried by forces I may not control.  My neighbor’s soil may be resilient to any weeds I accidentally spread.  Or, it may be fertile breeding ground for an invasive species to take hold and multiply recklessly.  Thus, what I allow to grow in my own garden affects those around me, like it or not.

I suggest that we make some conscious efforts at constructive, rather than destructive, gardening.  I’m thinking of politics here.  I have decided to stop posting things on Facebook that make fun of a certain candidate, or ridicule a certain point of view.  That is simply not helpful; those are definitely weeds in my garden and I categorically reject them.  I will try to resist the temptation to be drawn into circular arguments, incited by others’ attacks on my beliefs.  To those who post crass, below-the-belt insults at certain groups, I will actively guard my plot against the spores of hatred by scrolling over your memes.  I invite you, instead, to use your platform to grow things that sustain us.  What beauty can you bring into the world, what foods can you grow to help feed it?  Can you use your picks and shovels to tend, rather than demolish?

I don’t have to like your garden.  You don’t have to like mine.  But I know we can find ways to exist in each other’s presence without mutually poisoning and undermining the earth we inhabit.  If we try hard enough, we may even grow to appreciate our unique combinations of plant life.  Wouldn’t that be so much better?

Jodi's avatarthe creative life in between

Tulips Pink Spring

Your mind is a garden.
Your thoughts are seeds.

You can grow flowers,
or you can grow weeds.

– paraphrase from William Wordsworth

Choose flowers!
Cherish the moments.

Cheers & Hugs,
Jodi

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What Makes You Think You Can Trust Me?

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My friend, we’ll call her Anna, recently had surgery on her pancreas, and she has generously given me permission to share her story. As soon as I heard she was going, I sat up straighter and paid attention. The pancreas is a sensitive organ, and not a common target for surgery, unlike the appendix or gallbladder. “Eat when you can, sleep when you can, and don’t mess with the pancreas,” they told us in med school.

Doctors discovered a growth on Anna’s pancreas in 2014, when abdominal imaging was done for something else. It was an ‘incidentaloma,’ as we commonly call such findings. She had no symptoms, and further tests showed no abnormalities of pancreas function. Everybody agreed to watch it with periodic CT scans. Fast forward one year, she still felt fine, but the mass was still there and appeared to be growing.

Cancer! What if it’s cancer? This ominous question looms over every unknown growth that we find in clinical practice. Pancreatic cancer is particularly scary, because there is no good screening test, and people usually don’t develop symptoms until the disease is incurable. Anna’s doctors started seriously considering surgery. The pancreas sits in the back of the upper abdomen, behind and outside of the abdominal cavity—not easily accessible. It serves both digestive and endocrine functions, and manipulating it can wreak havoc in multiple systems—hence the ‘don’t mess with it’ admonishment.

What to do? The tumor did not have typical cancerous characteristics on the scan; most likely it was benign. But what if it wasn’t? It was growing, albeit slowly. Would this be the rare chance to catch and cure a cancer, and really save a life? And if it wasn’t cancer, what was it? How long could we safely not know? Which would Anna and her doctors regret more: Operating now, risking complications from the procedure, only to find out it was unnecessary? Or continuing to watch, and realizing when finally forced to take it out, that it had already spread? If only there were accurate and reliable predictive tools—crystal balls and such. In their absence, we are left with incomplete information, and our own (in)tolerance for uncertainty and risk. The key for effective decision making lies in all parties’ self-awareness of the latter, and our ability to communicate it. This can be overwhelming, especially when the situation is complex.

Eventually Anna told her surgeon, “I don’t understand everything you’re telling me, but I trust you and I will do what you recommend.” She said he looked up and sat back abruptly, as if shocked by her declaration of trust and willingness to put the decision in his hands.

How would your doctor respond if you said this to him/her? Why would this surgeon be surprised at my friend’s statement? My patients have told me the same thing. What makes you think you can trust me? I think it’s based mainly on two things: Honesty and commitment.

 

I tell the truth.

I learned a long time ago that bullshitting my way through a patient encounter is completely pointless. If I don’t know the answer to a question I need to admit it, period, right there in real time. But just because I don’t know, doesn’t mean I can’t help. I know a lot. I can estimate. I can make a well-educated guess. I can articulate my rationale, explain that while I don’t know for sure, this is what I recommend based on the information in front of me, my past experience, and my personal biases (that last piece is critical). If I’m missing data, I can look it up. How often does an unknown pancreatic mass turn out to be cancer, in cases like this? If it’s very seldom, why do I recommend surgery? Maybe because I watched one too long once and I have always regretted it. This kind of experience will always influence my decision making; I’m kidding myself if I think it doesn’t. My patients have a right to know. It’s not weakness; it’s honesty. When you know my biases, you can decide for yourself how my judgment is influenced, and whether you’re at peace with it. When I own both my expertise and my limits, with humility and not shame, you are far more likely to trust me.

 

I will stand by you, whatever happens.

In order to trust me, you must also feel that I will not abandon you when things go badly. Because if we know each other long enough, something will always go wrong. You will have side effects from drugs. Treatments will not have the desired results. The worst thing I can say to you is, “Well, there’s nothing more I can do for you, goodbye.” There is always something I can do. I can’t cure your disease or bring your loved one back. I can’t make your depression go away. I cannot change your behaviors for you. But I can ask, “How can I help you suffer a little less?” Whether it’s referring you to a specialist or simply sitting with you for a while, my commitment to you, to our relationship, earns me your trust.

 

And, it’s a two-way street.

Here’s an interesting question: How can I trust you, to trust me? What do I need in order to feel comfortable both driving and navigating on this patient-physician road trip? It’s a huge responsibility, after all. I was honest about how well I know the geography and what I think we can expect on the way. I have made a commitment to be your travel partner, whatever the road and weather conditions. I need to know that you have relinquished the wheel and the GPS in an informed way, and that you will stay in the front of the bus to point out hazards and road signs. I need to know that you will not automatically blame me, or leave me, when we run over a nail and get a flat tire, or hit a deer that suddenly lopes across the road. We each need to take responsibility for our own part in getting to our destination.

Anna’s tumor was benign, and now she’s missing two-thirds of her pancreas. I imagine sometimes she wishes she had asked more questions, or decided to wait a little longer. But I think she does not regret her decision to trust the doctors. Her medical team is still intact and monitoring her appropriately. They may take turns again driving and navigating on her journey.

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.