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.

We Can All Relate

Happy Spring, friends!  How are you doing?  The world is still such an intense and often painful place, but somehow the warmer, lengthening days bring hope and solace.

I find myself still immersed in exploration of tribal experiences… Talking, reading, writing, thinking, connecting, reflecting, learning. What’s on my mind tonight:

Comparative Suffering Is Counterproductive

I have known about abusive and violent acts against Asian Americans since the beginning of the pandemic.  I have felt increasingly self-conscious about my Asian-ness for the past five years—more so than at any time since elementary school.  So it was somewhat gratifying to see anti-Asian hate crimes get more press in recent weeks.  But even as I add my own voice to the call for awareness and action, I hesitate.  All violent acts deserve attention and reckoning.  But part of me feels sheepish ‘complaining’ when anti-Black racism feels like such a more endemic, urgent, and severe crisis.  Even as I read more articles on anti-Asian hate this week, the trial of Derek Chauvin progresses in Minnesota, and so many of us hold our breath, knowing that the outrageous possibility of acquittal is real.  But staying quiet about anti-Asian hate helps no one.  I’m part of an out-group, too, and our needs are not less important than anyone else’s.  It is precisely when we start comparing and ranking the value of one group’s suffering against others that we all lose our collective power and potential to drive positive change for all of us.  When I speak up on behalf of the AAPI community, I remember that we are ‘othered’ in different ways and with different consequences from our Black brothers and sisters, but the shared experience of white supremacy binds us together.  I will do better to point out that the empathy, education, connection, and solidarity that I want people to foster in themselves must be applied to all marginalized people, not just Asians.

Leadership Matters

Looking back at summer 2020, I wonder if I did enough to address the concerns and well-being of everyone on my team, but especially my Black coworkers.  Did I foster a psychologically safe environment where people could express their concerns and emotions?  Did I encourage enough self-awareness in thought, speech, and action?  Do I continue to do so?  As the leader, how much should I bring up anti-Asian hate, does that center myself too much?  How do I maintain a balance of attention and integrate our awareness so as to include the concerns of any and all who feel oppressed?  As I face outward to encourage system leaders to speak out, have I done enough on my own team to connect with my AAPI and Black colleagues in support?  How will I know I’m doing enough?  In the end I submit to the assessment of those I lead.  I can solicit feedback and accept it with humility and honesty.  And if I falter, I can ask that people look not only at my impact, but also at my earnest intentions to cultivate connection between us all, and keep doing my best as I learn from mistakes.  I can also continually work with fellow leaders to develop initiatives to improve diversity, equity, and inclusion—to hold us accountable to tangible results, and not just give lip service.

We Can All Relate

How are you “othered”?  I mean based on the tribes in which you claim membership, or certain personal traits, how can you be identified and ostracized by others?  Consider a scenario:  White woman verbally attacks elderly Black man with racist slur.  He retaliates by fat shaming her.  We all have our vulnerable parts, those things we fear being called out and held against us, that we cannot necessarily control.  Even members of the dominant culture have them, though they may or may not be as readily visible as race, gender, or ethnicity.  The fears and anxieties we carry around these soft spots cause varying degrees of personal and collective suffering and social consequence.  When we dig deep and recognize our own vulnerabilities reflected in others, then we can truly relate to all who suffer, and we are moved to act on their behalf—because advocating for one of us is advocating for us all.

I finished watching the PBS series “Asian Americans” (which PBS has apparently made free for streaming since the Atlanta shootings) this weekend, which I highly recommend.  From it I learned how Asians and other marginalized groups have come together in American history to advocate for one another.  Filipino and Mexican farm workers formed the United Farm Workers in 1965.  Asian, Latinx and Black students at San Francisco State University joined together and succeeded in creating America’s first ever ethnic studies program in 1968.  Jesse Jackson spoke out on behalf of Asian Americans after the murder of Vincent Chin in 1982.  And since last summer, I’m happy to see increasing solidarity again between Asian and Black communities.  From a recent article in TIME magazine:  “’We’re not safe until all people of color are safe. Safety doesn’t come in the form of heavier policing calls or of carceral state oppression of poor communities,’ Dao-Yi Chow tells TIME. Chow, who is Chinese American, was one of the organizers of Running to Protest’s ‘Black & Asian Solidarity’ rally. ‘That’s only continuing to align ourselves with white supremacy. And if we continue to do that, those are anti-Black acts that’s only going to continue to drive divisions in between our communities,’ Chow says.”

Call to Action on the Periphery

I’m currently reading Change by Damon Centola.  Hear him discuss the central tenets with Shankar Vedantam on this episode of “Hidden Brain”.  He asserts, with evidence, that social movements and change originate in the periphery of social networks, through strong and overlapping ties.  This means that we each and all have a role to play in making the world more equal for marginalized people and groups.  It all starts with the conversations we have in our daily encounters, and the cascade effects they have on our friends’ friends, etc.  On my work team, if I’m hearing the same message of solidarity from my manager and my medical director, and then my colleague from another practice, and then my fellow committee member, then I’m more likely to accept and adopt it, and then promote it myself.  Whether or not I had a formal training or participated in some system-wide initiative, I’m influenced by those around me whom I respect and care for—and vice versa.  That is why no matter who I am, what I say and do also matters—we all lead by example. 

The journey is long and arduous.  The path winds through caves of uncertainty and adversity.

The only way out is through.  The best way through is together.

The Value of Comradery

I’m having a party!

Well, not really.  I’m inviting colleagues to convene on video in the name of professional community and connection, so it’s almost a party.  It’s also my homework!

These six weeks I get to take Stanford’s inaugural online Physician Well-Being Director Course, along with over a hundred other physician leaders.  What a privilege and pleasure!  I’ve already learned so much, and we’re only one third of the way through.  I may have made a new friend—we bonded over our shared tendency to stress eat, and that we are both using the Noom app to overcome it.  It happened during a breakout session to sample a Comradery Group.

Turns out there is clear evidence that community building, done intentionally and purposefully, promotes clinicians’ overall well-being.  “Well, duh,” you might say (I have).  Why did this have to be studied formally?  But I get it now.  When there is objective evidence for direct benefit and a positive cascade (well physicians tend to have higher engagement, higher patient satisfaction, happier teams, and systems that thrive—relationally as well as financially), healthcare organizations are more likely to invest resources to execute the well-being programs shown to work. 

In a Comradery Group, the objective is more than just venting.  It’s about finding meaning, fostering growth, and supporting one another through empathy, querying, and sometimes even challenging—all in a psychologically safe environment.  Groups meet to discuss particular topics and are admonished to stay on task.  There is usually a facilitator.

I have always found communing with colleagues nourishing—particularly across specialties.  More and more, we toil in silos.  Advancing technology accelerates complexity of both diagnostics and therapeutics at breakneck speed in almost every field.  Everybody can barely keep up with their own work, let alone understand what’s happening in anyone else’s.  And with in-person conferences and other professional gatherings banned for the past year, our sense of community wanes further and faster.  Our disconnection propagates insidiously, and we will all pay in the end, physicians and patients alike.

So what better moment to tend and strengthen our connections?

I have a few colleagues from internal medicine, OB/gyne, ophthalmology, and orthopaedics ready to gather in meaning on Microsoft Teams.  Can’t wait can’t wait!  The first rule of Comradery Group is that what’s said here stays here; holding confidence is key to connection and trust.  We can set other rules at our (first) session.  The homework assignment is only to experience a group once, but my secret hope is that my colleagues will get enough from this meeting to consider doing it again (and again!). 

I’ve proposed some sample topics below.  I’d love to discuss any of them, and I’m sure my friends will suggest others.  Take a look—how could you adapt these questions to your own profession?  How are you and your colleagues at risk for burnout, and how do you imagine Comradery Groups could help?

Here’s something new for the blog:  If you answer one of the questions in the comments, I’ll share my own answer to the same in reply (or a separate post!).  Please also feel free to offer a different question, one that holds meaning and importance to you.

Times are hard and complicated.  We humans are social creatures.  The better we can maintain and strengthen our ties to one another, the less we will suffer—no—the more we will flourish

Onward, friends.  We are all we have.

  1. How has doctoring the past year through a global pandemic impacted your professional and personal outlooks?
  2. What lasting lessons from the past year do you want to keep front and center?
  3. What do you want most from your colleagues in other specialties?
  4. How would you change medical education?  Why?
  5. How have you seen medical culture evolve over your career, for better and/or worse?  How has this impacted your personal experience of your work?
  6. What concrete changes have you made to the way you do things, over the years and the past year?  What do you miss and not, about the way things used to be?
  7. What makes a hard day at work?  An easy day?  A good day?  A bad day?
  8. What is your preferred leadership style, as both a leader and one who is led?
  9. What is the value of DEI initiatives at work?  What are the barriers?  Pitfalls?
  10. What’s foremost on your mind right now for your own well-being?  How are you upholding it?