The Best Thing That Could Happen

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What do you think is the best thing that could happen out of the COVID-19 pandemic?

I think it’s Connection.

How ironic, as the current best solution to mitigating illness and death is physical (not really social) separation.

Connection won’t come easily, though.  Today I felt all kinds of yuck:  Conflicted.  Unsettled.  Angry, Cynical, Fearful, Guilty, Annoyed, Confined, Enraged.  Not exactly connecting emotions.  The people going about their usual routines, disregarding distancing guidelines, and claiming it as their right to ‘live free’ agitate me the most.  When they get sick, and after they have infected numerous others, some gravely, my colleagues and I will care for them the same as for those who followed the guidelines and acted unselfishly for the greater good.  We will put ourselves in harm’s way, and more of us will pay with our lives for their false freedom.  Because when your ‘right’ to ‘live free’ puts others’ lives at risk, that is not freedom.  That is negligence.

That said, I’ve not lost all hope.  Through Facebook, Zoom, email and snail mail, I am now better connected with some folks than before, and I’m grateful.  They have helped me consider and envision the best possible New Normal on the other side of COVID-19.  I share my wish list below, as well as links to my favorite articles from the past week.

Also, join me this Wednesday, April 8, at 6pm Chicago time for an Instagram live chat.  Owners Tim and Victoria at Ethos Training Systems will host a fireside-style session on COVID-19.  You can join by finding me, chenger91, or Ethos, at the time above.  Please know that I do this public event as a friend of Ethos, and not as a representative of my employer or any medical professional society.  I claim no expertise in infectious disease or epidemiology; I’m just one doctor doing my best to share relevant information and practical advice.

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To Create Our Best Post-COVID Future, Let Us:

Continue to connect earnestly with people near and far.

Advance toward universal healthcare in some form, and shore up our social safety nets.

Reclaim our collective mindset—temper extreme individualism with more altruism and empathy.

Slow down—maintain more flexible work schedules, better childcare options.  Generate less pollution, decrease unnecessary production and consumption.

Live more mindfully and in the present:  Enjoy the good more and dwell less on the bad.  Increase both awareness and appreciation of all that is well in life.

Hold rigorous science and medicine far above opinion and ideology.

Practice Learning, Flexibility, Agility, and Resilience, in all domains, large and small, individually and as a collective.

Recognize our shared humanity, maintain that recognition, and act consistently from that recognition—bake it into our cultural norms henceforth.

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Pieces that helped me the past week:

An excellent review of the evolution of and rationale for universal masking:  https://www.vox.com/2020/3/31/21198132/coronavirus-covid-face-masks-n95-respirator-ppe-shortage?fbclid=IwAR237JXMUy94AcI_4uigdP3ZZUfoNd1c_4tyRDi-A8u2BYm7YZmSJ0f3ii8

A summary of current knowledge of SARS-CoV-2 and COVID-19, written accessibly and with practical recommendations, by my teacher and colleague, Dr. Alex Lickerman:  https://imaginemd.net/blog/coronavirus-april-2020-part-5/?fbclid=IwAR20m7QfOSUlZlAZuTaytKDaw210j_wWuqd6xgGBeTbIHAEfZeASfDnYTac

From Maria Shriver’s Sunday PaperBut today is Palm Sunday, and Easter Sunday is a week away. This week is the beginning of Holy Week, a time of spiritual renewal and rebirth. So, I’m taking that as a sign that we aren’t meant to go back to what was. We are meant to go forward both individually and collectively. Each of us will come out of this time a different person, a changed human being. How could we not?
What a double tragedy it would be if we went back to the way we were. To a time when we didn’t care for our planet. To a time when we were so mean to one another. To a time when we were so divided in every way. To a time when we didn’t know our neighbors. To a time when so many only cared about themselves and saw others as the “other.”

A diagram shared on social media of our human responses to the crisis (I don’t know who created it—if you do, please give credit in the comments and tell them thank you).  I think it’s normal that we should find ourselves doing things in each of the nested circles every day.  We can exercise compassion for ourselves and others at the same time:

covid nested circles

Finally, a poem, also from Maria Shriver’s Sunday Paper, shared by her niece, who died with her 8 year-old son the very same day:

covid after poem maria shriver niece maeve

Things will likely feel worse for at least a few weeks before they feel better, my friends.  Hold tight to those you love and who love you.  Count your blessings.  Take perspective.  Consider deeply our inextricable and undeniable interconnectedness.  Be kind.

Shrink and Separate for the Greater Good

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For every person you contact, you are indirectly contacting every other person they contact.

This is what I’m calling your ‘exposure circle.’ The more people you contact, the more your circle grows–exponentially.

The fundamental goal of social distancing is to
1) shrink each of our exposure circles and
2) minimize overlap of different exposure circles (and unless we only see people who only see us, every circle is different).

At this point we should assume community spread of SARS-CoV-2, the virus that causes COVID-19 illness. Travel to and from ‘hotbed’ areas is likely no longer the main source of new infections.

Each infected person is thought to infect, on average, 2 additional people (the basic reproduction number, or R0=2), so spread is exponential.

If you have a hard time picturing what this looks like, go to the last page of One Grain of Rice A Mathematical Folktake by Demi.  You can see the grid on Amazon by clicking the “Look Inside” icon.  Doubling one grain of rice every day yields over 536 million grains of rice on day 30, and over 1 billion total grains accumulated over all 30 days.

Because we have not been able to test widely in the United States, we cannot know who is infected and who is not. So targeted isolation is not feasible.

It may very well be that young healthy people are infected and don’t show symptoms, so they spread to many others out in community without knowing.

This is why school closures should NOT be seen as vacation, license to go shopping, eating out, seeing movies, partying, etc.

THIS is why we need to keep our distance from one another–all of us.

I know it sucks. I know it’s incredibly disruptive and feels like overkill. If it works, nothing will be that bad and we will think, why did we do all of that?

And that is, of course, the goal.

If we succeed, we may never know how bad it could have been.

If we fail, we will see all too soon and it will be too late to regret.

Sexism and Apologies 2020

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“If you say, ‘Yeah, there was sexism in this race,’ everyone says, ‘Whiner!’ If you say, ‘No, there was no sexism, about a bazillion women think, ‘What planet do you live on?’”

That is how Senator Elizabeth Warren answered a reporter when asked whether she thought gender played a role in her suspending her presidential campaign.  I recommend watching the whole video clip.  In case anyone wonders: if the question even needs to be asked, then yes, gender played a role.  But Senator Warren rightly called out the question for what it is: a trap for any woman running for high elected office.  Her statement summarizes it succinctly; she knows what’s what, and she names it without apology.

I was more upset than I expected when Aunt Eliz Crusader ended her campaign.   Megan Garber expressed the story of my profound disappointment eloquently in her piece for The Atlantic:  “America Punished Elizabeth Warren for her Competence”.  Basically she elaborates the apparently inevitable social equation for women:

Competent  +  Vocal  +  Unapologetic   =   “Strident”  +  “Shrill” +  “Condescending”

The past two weeks I have had a series of encounters wherein I find myself voicing opinions and positions more firmly than I might have in the past.  I feel confident and grounded in my knowledge and expertise.  I am professional and respectful.  I apologized for writing a long email, even though the words were necessary and clear.  My strong woman mentor reminded me to save apologies for when I actually commit a transgression.

What I have learned (perhaps again) in this time, however, is that relationship discord, even just the possibility of it, is what distresses me the most.  How will I be perceived for voicing my concerns, for advocating for my peers and teams?  How will a negative perception undermine my effectiveness?  Will it cost me my seat at this table or others?

Does any man ask himself these questions?

Given that I was already knee deep in vulnerability and self-doubt around these encounters, the Atlantic piece poked my fears and prodded them to the surface.  It shook me.  It also made me angry that here we still are, in 2020, unable to accept, let alone embrace, competent, vocal, and unapologetic women in leadership.  And it’s not just men; countless women also disavow their sisters.

I vented my disappointment on Facebook (of course):

“So it is down to three Old White Men.  Very disappointing.”

A friend tried to make light of the situation, pointing out that Donald Trump is the youngest of the three.  This attempt at levity (from the Right) felt like a nemesis rubbing salt in my fresh wound.  Twice I rebuffed; twice he persisted.  Finally I (voiced):  “I feel ignored and dismissed when I express distress and you make light of it.  Perhaps my distress is not clear to you, because you only know me through social media [we were friendly acquaintances in high school]; you may not know how upset I am.  But after two replies by me rejecting your attempt at humor, to have you schooling me [that humor is a ‘primary’ way] of dealing with [politics] just makes me more angry.”

Turns out he had mistyped; he’d meant to write that humor is one of his primary ways of coping with the absurdity of politics.  He apologized to me.  It felt sincere.  I was consoled, and I thanked him.

Competent and vocal.  Confident and unapologetic.  Respectful and humble.

We need all of these qualities and more to be true leaders.  Women, arguably, must work harder than our male counterparts to prove that we possess all of them.  Then we get punished when the proof proves irrefutable.  How sadly ironic.  The truth is we need many more of our leaders, men and women alike, to own, exude, and model these virtues.  The last two are not weak, though they may feel profoundly vulnerable, which is not the same thing.

I feel urgent impatience at the state of sexism in America.  But I know how to soothe and manage myself; I can reclaim the patient urgency of fierce optimism at my core.

I will persist.

Aunt Eliz has shown me how.

Caring for One Another

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Last Saturday a patient cared about me.

He had severe abdominal pain that had kept him up all night and he needed advice.  By the time we agreed on a plan he had apologized, at least three times, for ‘bugging’ me on the weekend.

I explained that it’s okay to ask for help on weekends. I’m happy to help if I can, and the relationship is the most meaningful part of my work.  I also thanked him for not abusing that relationship—for not taking me for granted, for seeing me not as a transactional service provider, but as a person with a life outside of work.

When we feel seen and appreciated, life is easier to take and we function better.

* * * * *

Recently I’m thinking about organizational values and mission statements.

For the most part I find them superficial and unhelpful, wordy and convoluted.

As I consider the team I have led the past two years, I feel proud that although we have not formally written mission or values statements, we are nonetheless clear on both.  We define them in succinct language, gauge how we manifest them through action, and reconcile behaviors, conflicts, and initiatives against them regularly.

Our values, collectively adopted one year ago:

  1. Fun, joy, creativity
  2. Collaboration and Connection
  3. Accountability
  4. Kindness and Compassion

Reviewing the list, I see that caring for one another serves as the foundation for this house.  This applies both to the team’s inner work, as well as anything facing outward toward patients.

It is of course our responsibility as professional caregivers to manage ourselves and show up our best for our patients.  I expect patients to treat our team with respect, but we should not necessarily feel entitled to their caring about us, per se.  It is our job to care for them; the relationship is inherently imbalanced in that way.  In order to do that well, we the team must also care for and support one another in service of our vocation.

So every once in a while, when a patient expresses genuine caring for me or a member of the team, in addition to appreciation for a job well done, it really brightens our day.  It keeps us going.  It makes all the unappreciative, and even abusive, encounters worth it.

Thus, we march on.  We remember why we do this work and we hold each other up.

* * * * *

Please know how much your expressions of affirmation matter to your medical team.

We’re all here caring for each other in this life.  The more we can remember that and act on it, the better off we will all be, no?

What Makes You a Leader?

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Is it your title?  Your reputation?
Is it your status?  Your paycheck?

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

This quote is attributed to John Quincy Adams, but there is apparently no evidence that he actually said it.  Dolly Parton, on the other hand, said,

“If your actions create a legacy that inspires others to dream more, learn more, do more and become more, then, you are an excellent leader.”

Your actions make you a leader.
Anybody can lead, as long as people are willing to follow.
So what makes people follow?

I think it’s actions grounded in:
Conviction
Authenticity
Openness
Inclusion
Transparency

Accountability
Resonance
Collaboration
Belonging
Integrity
Honesty
Humility
Consistency            …what else?

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So:  How do you lead others?  How aware are you of your leadership, day to day, moment to moment?  How intentional are you about it?
What do you lead others to and for?
What is your purpose in leading?
What is your goal for those you lead?

What is your goal for your cause?

What do you want from your followers?
What do they need from you?
How will you make it so that your cause outlives and continues to flourish without you?

Great leaders do not always know the answers to all of these questions.

But they ask and consider them, regularly, honestly, and humbly.

Attune and Differentiate:  One Week’s Synthesis

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Friends, don’t you just love when an idea you resonate with recurs in your consciousness from disparate sources in short order, further deepening its meaning?  I share three pieces with you this week, which all deepened my commitment to embracing the paradox of attunement and differentiation.

CO fall 2018

First, I listened again to Brené Brown’s Braving the Wilderness.  I highly recommend this book to help us all, conservatives and progressives alike, engage (not avoid) one another this election year with a lot more compassion, civility, and mutual respect.  Throughout the book Sister Brené shares personal stories as well as evidence from her research that define true belonging, which I think of as another expression for self-actualization and self-transcendence.  In her words:

True belonging requires us to believe in and belong to ourselves so fully that we can find sacredness in both being a part of something, and standing alone when necessary. But in a culture that’s rife with perfectionism and pleasing, and with the erosion of civility, it’s easy to stay quiet, hide in our ideological bunkers, or fit in rather than show up as our true selves and brave the wilderness of uncertainty and criticism.

Attune and differentiate:  these two practices are not only not mutually exclusive, they are essential and integral for whole person and societal health and well-being.  Read the book to adopt her four practices to advance true belonging, for yourself and for all of us:

  1. People Are Hard to Hate Close Up. Move In.
  2. Speak Truth to Bullshit. Be Civil.
  3. Hold Hands. With Strangers.
  4. Strong Back. Soft Front.  Wild Heart.

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Second, I met Massimo on Ozan’s last Inner Circle Zoom call.  He is a designer and facilitator from Italy—thank you again, Ozan, for connecting so many of us all around the world!  Massimo has launched a blog, which resonated with me because he also advocates finding your voice (differentiating) as well as finding a community of belonging (attunement) as a reason to write:

…Meet new people and to interact with them

Learning adventures can make you feel on a solitary path, too much unbalanced on the input, reading and digesting side without much interaction. Expand your network, look for more interactive exchanges with whom might provide an alternative, critical point of view compared to yours. Exposing your opinions leads self-selecting people to network and resonate with you. Find your tribe. We need many and none at the same time. You need different communities where to manifest and explore your interests. On the other hand, you need to better focus on creating those which are more fertile ground to nurture your continuously changing interests and aspirations.

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Third, I read David Brooks’s article in The New York Times on the ethos of Scandanavian education.  Eloquent as usual, he synthesizes a complex set of ideas into language we can all understand:

19th-century Nordic elites…realized that they were going to have to make lifelong learning a part of the natural fabric of society.

…(Their system) is devised to help (students) understand complex systems and see the relations between things — between self and society, between a community of relationships in a family and a town. 

…Nordic educators also worked hard to develop the student’s internal awareness. That is to say, they helped students see the forces always roiling inside the self — the emotions, cravings, wounds and desires. If you could see those forces and their interplay, as if from the outside, you could be their master and not their slave. 

…Their intuition was that as people grow, they have the ability to go through developmental phases, to see themselves and the world through ever more complex lenses. A young child may blindly obey authority — Mom, Dad, teacher. Then she internalizes and conforms to the norms of the group. Then she learns to create her own norms based on her own values. Then she learns to see herself as a node in a network of selves and thus learns mutuality and holistic thinking. [See Changing on the Job by Jennifer Garvey Berger for more on this theory of adult development.]

Scandanavians…have a distinctive sense of the relationship between personal freedom and communal responsibility.

(Meanwhile, in the United States…) If you have a thin educational system that does not help students see the webs of significance between people, does not even help students see how they see, you’re going to wind up with a society in which people can’t see through each other’s lenses.

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In 2020 more than ever, we need to cultivate much stronger relationship skills.  We must identify and honor our core values and stand up for them, even when attacked by those closest to us—perhaps even especially then.  How we honor our best selves determines how we honor others.  When we show up at our most honest and authentic, we can call forth the same in others to meet us.  We can relate as fellow humans, inextricably connected, mutually interdependent, and all in it together.  Once we realize this, we can know in our hearts that we truly belong to ourselves and to one another, and we can more easily get on with the world’s most important work—connecting humanity in health, safety, and love.

Be a Connecting Node

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How would you describe American political culture today?

What about the culture at your workplace?

In your family?

Are dissenting voices welcomed?  How do those in authority wield their power?  Do the led have a say in decisions and policies that affect them?  Are their needs and interests taken into account by those who lead?

What role do you play in each of these systems?  How do you contribute to the function, dysfunction, morale, and relationships in these interconnected, overlapping, inextricable and sometimes tenuous systems?

How much of these cultures do you own, do you take personal responsibility for?

I have written before about the interaction between a system and its individuals.  In each of the systems I name above—our nation, your workplace, your family—you are a single individual, a node [a point at which lines or pathways intersect or branch; a central or connecting point].  You are connected, directly and indirectly, to every other node in all of your systems.  Thus, you connect each of your overlapping systems to every other one.  So do I.  This is how we are all connected, every single one of us, and our planet.

Thus, what you do affects me, even if I have never met you, even if we live on different continents, in separate generations, speaking mutually unintelligible languages, and vice versa, for all of us.

Octavia Butler said it best:

All that you touch
You Change.
All that you Change
Changes you.
The only lasting truth
Is Change.
God
Is Change.

So how do you change what you touch?

Do you make it better than it was?  Does the change you make make you better in return?

If the only lasting truth is change, then what do we want tomorrow to look like?  What about next year?  What kind of world do we want our grandchildren and their grandchildren to inherit?

Are you a node that connects, using your power and love to thicken the ties between your adjacent nodes and systems, making them stronger and more resilient?  Who is healthier, stronger, and happier for you having touched them?  How have they then extended that health, strength and joy to others?  How have you resisted destructive forces and stood in the way of systems disintegration?  Whom have you protected?  What did it cost you, and what did you gain?  What have you earned?  How will you persist?  What and who hold you up?  On which nodes do you lean, from which do you draw strength, and how then do you pass that strength on?  How do you influence and co-create the culture around you this way?

Or are you a destructive, severing node?  How do you go around blowing up connections, weakening relationship infrastructures?  Maybe you don’t see it this way. Perhaps you see your work as culling, pruning, removing extraneous nodal debris, clearing the path for a more righteous supersystem to rise.  What does this cost you?  Is the benefit worth the price?  Who are your coconspirators in this effort?  How do they change you for your connections to them?  How do you expect your connections to other destructive nodes to evolve?  What is your impact on your systems cultures, being this way?

I suspect we all possess both poles of nodal potential.  Probably most of us go about our days in relative mindlessness, speaking and acting as our surroundings and culture dictate, by convention and custom.  We suppress the inner dissonance that arises when our personal instincts run counter to prevailing winds of rhetoric.  We fear losing connections if our personal nodal identity reflects a different light or sounds a different note from the collective thrum.  The status quo feels easier to uphold.

I posit to you today that our systems are disintegrating fast, eroded by myriad destructive nodes, spreading like slime mold on a global petri dish.  I argue that our collective political culture suffers much today from these destructive nodes, and connector nodes struggle to nurture ties and maintain relationships.  In such times, we may feel tempted to give in, to allow our inner rage monster to tantrum, to succumb to swelling, destructive, disconnecting culture.  Indeed, it is hard to resist.

And yet, we continue.  We march on.

Culture is created and maintained in each day to day interaction between all members of a system. Any individual may choose, at any time, to maintain the status quo or make a shift. It is the accumulation of multiple small shifts, simultaneously and in series, that moves a system to a new, improved state.  Each day we awaken, we have a choice—an infinite series of choices—to make a shift toward connecting and strengthening our intertwined systems.

Do not wait for someone else to go first.  Make the choice yourself, today, right now.  Be a connecting node.  Speak and act, post online, and show up in person, irrefutably, as a connector.  Make your touch productive and generative, inclusive, empowering, and communal.  See how this changes how others show up to you, and how that changes you for the better still.  Then watch the slime mold recede before your eyes as connector node energy amplifies and restores balance.

Slime molds recur.  Connecting nodes hold the line.  We need you.