Rallying for Reentry

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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.

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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?

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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

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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.

COVID-19 Antibody Testing: What We (Think We) Know and Don’t Know

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Friends, my practice has sent this letter to our patients.  It is a summary of what we think we know about COVID-19 antibody testing, as of today.  This is our collective opinion and expression as a practice.  We do not speak for our employer or colleagues at large.  It is our best interpretation of the available evidence to date, and we present it in good faith.  Information evolves rapidly, and we expect to update our position and practices accordingly.  Please vet your information sources well, and make any and all medical decisions in collaboration with your primary care physician.

Many states are likely to extend shelter in place orders, albeit with some slow loosening of restrictions.  I worry that this will incite further unrest and divisions along ideological lines.

We all must now call forth our highest practices of patience, generosity, and love, so as to pull together better rather than separate further in body, mind, and spirit.  Hang in there, my peeps.  We can do this.

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COVID-19 Antibody Testing

Covid-19 antibody testing is being promoted as a way to tell who has already had COVID-19 and therefore may be immune. We are getting many inquiries about the availability of antibody testing and wanted to let you know about the current state of antibody testing.

If you have had COVID-19, are you immune to it?

We don’t know the answer to this.  What we do know:

  • Most other viral infections stimulate your body to make antibodies against the virus which provide some degree of protection from re-infection for some period of time.
  • Antibodies to the common cold, which is sometimes caused by another type of coronavirus, seem to last only 1-3 years. Antibodies to measles generally last a lifetime.
  • There have been a few reports of seeming re-infections with COVID-19 in China and South Korea, but this is thought to more likely be due to a testing problem rather than true re-infection.
  • It’s very likely that people who have had COVID-19 should have some immunity for some period of time, but nobody knows for sure.

Does the severity of COVID-19 illness or the levels of antibody matter for presumed immunity?

When you are infected with a virus, your body makes many different types of antibodies against many different parts of the virus, in differing quantities. The IgG class of antibodies is the one that tends to provide long term immunity. Scientists are currently looking at all of the different antibodies present in the plasma of people who have had COVID-19, to see which antibodies seem to be the most numerous and react most strongly against the virus.

We currently don’t know which antibodies are most protective, how many of the different antibodies you need to have to be protected, or whether the levels of the antibodies matter for either degree or longevity of protection.

What do we need to know about a test before we call it a good test?

After the onset of the pandemic, the FDA allowed institutions and companies produce their own tests, provided they used an FDA-approved procedure to validate the tests. It’s not at all difficult to make an antibody test . . .but it’s very difficult to make a GOOD antibody test. You have to know:

  • Which antibodies to look for
  • How many antibodies to look for
  • What it means if some antibodies are present but not others (what if 2 of 4 tested antibodies are found -does that mean you are immune?)
  • How good your test is at picking up the people who have a positive test and are truly immune (the positive predictive value of the test)
  • If your test correctly tests negative when people have NOT been infected (the negative predictive value)
  • If your test is specific to COVID-19, or if it shows a positive result by detecting antibodies from infection with a different virus in the last few years (many common colds are caused by other types of coronaviruses).
  • That your test is valid -meaning you have reliably answered the questions above in as many people as possible. Generally this requires hundreds of people known to be positive and negative, as well as some who had other upper respiratory illnesses.

Finally, it is VERY important to remember what we DON’T KNOW:

  • Whether having antibodies and which type of antibodies actually provide immunity
  • If it does, how long the immunity lasts
  • If you have antibodies and have a new virus exposure, whether reinfection can occur
  • If you have antibodies and have a new virus exposure, whether you could still potentially transmit it to non-infected people

If scientists are still studying the antibodies, why are there hundreds of antibody tests already on the market and one being done by a drive-through facility in Chicago?

Many of the tests currently on the market are imported from China or Europe, and some have been made by small US companies who have rushed to produce a test (again, it’s easy to make any test; hard to make a good one).

We have investigated a number of these tests to see how they have been validated and how reliable they are, and the answer is that all of these tests are remarkably poor. (For those who want the scientific details, see below.)

NONE OF THESE TESTS HAVE BEEN VALIDATED OR APPROVED BY ANYONE OTHER THAN THE PEOPLE WHO  MADE THEM, AND THEY CAN DO ANY KIND OF TESTING THEY WANT, WHICH IS LARGELY GROSSLY INADEQUATE.

OK, so if what’s available now is terrible, will there be good antibody tests, and when?

YES! There will be good tests, likely in several weeks. Abbott has a test they are working to validate, as does Roche. When a RELIABLY GOOD, adequately validated antibody test is available to the general public, we will let you know. We anticipate that the first tests will be used to test healthcare and other essential workers, and then as production increases and reliability confirmed, extended to test the public.

Just a reminder . . .

Continue to wash your hands well and frequently, especially if you have been out in public.

Continue to stay 6 feet away from anyone if you leave your house.

We recommend wearing a mask if you are out in public. Remember that the mask protects others from you, and does not necessarily protect you from others . . .so the 6-feet distancing remains very important!

The nitty gritty scientific details, for those who may be interested . . .

Many of these tests look for antibodies to the coronavirus ‘spike protein’, the part that attaches the virus to human cells. The spike protein is very similar across all coronavirus species, so the risk for false positives is high in people who have had the common cold in the last few years (which is all of us).

The test currently being offered by a drive-through in Chicago is made by a German company, Euroimmun.  A recent paper examining its performance found that its sensitivity (meaning the test both accurately found positive and negatives) was only 67%. Put another way, a full third of people had test results that weren’t accurate. The positive predictive value -meaning if you test positive, the likelihood that you actually had the disease -is only 82% (so 18% of people think they are immune to COVID when they are not), and the negative predictive value is 87%.

Another test that is being marked by Vibrant America for $149, was ‘validated’ in a total of only 20-30 patients, which is far too few to claim reliable test performance. It tests several antibodies, each with a sensitivity of only 65-80%. The company doesn’t say how they interpret  a mixed positive/negative result (indeed no one knows how to interpret this right now). Finally, in the small print, the company notes that their test may be positive in people who had common colds in the past.

4/23/2020 11:10pm CDT–  Updated to add:  Please click/tap to find the formal statement on SARS-CoV-2 antibody testing from the Infectious Diseases Society of America (IDSA).  Bottom line:  There are no reliable tests at this time, and none of them should be used to make individual diagnostic or screening decisions.  Also, answers to myriad questions about antibody response are required for vaccine development and testing, so that will likely take many, many months (I expect closer to 18 months or longer, than the 12-18 we have all heard).

 

 

 

 

How Do We Get Better?

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It is Week 5 of sheltering in place for many of us.  How are you feeling?  What emotions occur most often?  To where and on whom are they directed?  How do you see the future, and what does that feel like?

Who do we want to be on the other side if this crisis?

For all our sakes, I hope we can be more patient, kind, empathic, open-minded, thoughtful, intentional, and connected.  The COVID-19 pandemic shows us what ultimate paradox really means—trauma and grief on a scale not seen in generations, as well as an opportunity for unprecedented growth, both as individuals and as a society.

I think about the risks and possibilities as both a clinician and citizen.  The experiences overlap, as do the strategies to mitigate suffering.  I am so grateful that physician burnout and well-being has already been addressed in so many institutions, and at so many levels, before this crisis hit.  Programs like physician peer support and Balint Groups show us that our leadership cares for our well-being, or at least recognizes the need for organizational support of it.  Employee Assistance Programs and the like are much more visible now, and hopefully barriers to access are also down.  Everywhere I see offers for formal organizational support and ‘wellness.’

But what will really make the difference in the end?  How will we really grow into our best selves through this, the greatest global challenge of most of our lives so far?

I think it will be in our small, day to day, apparently mundane interactions.

Too often we underestimate the impact of our milieu on our attitudes, thoughts, words, and actions—how we are impacted by our environment, and how we impact it in return.

A wise friend observed two groups of people responding to COVID-19.  One sees the pandemic in terms of ‘what’s happening to me.’  The other experiences it as ‘what’s happening to all of us.’  This is a falsely dichotomous oversimplification, obviously.  But it may be instructive to notice one day this week, if we were to categorize our own thinking/feeling/speaking/acting with regard to COVID, where would we land more of the time?

I’m reminded of the stages of tribal culture described by David Logan and colleagues in their book, Tribal Leadership, and presented eloquently in his TED talk.  I have discussed this idea in previous posts.

The visual above encapsulates Logan et al’s theory of tribal culture.  Their work aims to advance groups from lower to higher levels of culture and performance.  In this framework, the currency of cultural economy is language.  Each tribe member’s dominant cultural stage mindset emanates in their words, and is represented/encapsulated in each stage’s mantra above.

Those who experience COVID-19 as ‘what’s happening to me’ likely live in the lower three stages most of the time—self-absorbed, competing, uninterested in personal or societal connection and growth.  Those able to see how ‘this is happening to us all’ have made the shift toward an Outward Mindset, seeing their node selves as inextricable members of a larger, interconnected system.  For a system to function well, grow, and sustain itself best through crisis after crisis, it must achieve a collective “We’re great” or “Life is Great” mindset.

Whom do you know on your team, among your friends, or in your family, who lives these words (most of the time)?  How do you feel when you’re around them?  What do you hear them saying right now? What energy do they exude?  When I meet people like this in my life, I feel calm, soothed.  They remind me to be humble, and to remember what I can do to help, both myself and others.  I feel connected in their presence; I recall my strengths and potential for contribution, and I’m motivated to act accordingly.  They give me hope.

So what do I hear them saying, what language do they speak that elevates our communal culture?

First, they avoid ad hominem.  They refrain not just from political rhetoric and attacks; they don’t make generalizations about groups based on race, gender, geography, social class, etc.  They also withhold judgment—they entertain various stories about people’s motivation, circumstances, and values, rather than jumping to oversimplified conclusions based on their own biases.

Second, they empathize.  They strive to relate to each person they’re with, as well ‘the others’.  And if they can’t do that, they validate the others’ feelings.  “That’s so hard,” can be the most soothing words a person can hear when they’re struggling and suffering. And “Well, we don’t know what they’re living,” reminds me to be humble.

Third, they offer hope.  But it’s not false hope or superficial, Pollyannish positivity.  They honestly believe in and see the light at the end of the tunnel, and they point to it for our benefit.  They do this by asking, “What do you need?”  “How can I help?” and saying simply, “I’m here.”

When I come across people like this, I want to be around them more.  I want to emulate them.  I point out their words and actions to others, and show the positive movement they inspire in me and others.  Stage 4 and 5 tribal leaders lead by example.  And make no mistake, they are everywhere.  They often don’t have a title or any designated authority.  But the team/organization/family is always better for their presence.

If you have people like this on your team, consider:  how can you be more like them?  What do they inspire in you?  If you are this person, how can you bring people along in this mindset?  This is how we get better through our current crisis:  We find the leaders who speak the language of We, Together, Growth, and Hope.  We find and follow those who set the example, and we strive to set it ourselves.  We take advantage of the programs and support systems around us.  We get help, get better, and then turn around and help others.

Yes, there is much trauma and grief.  There is also boundless love and connection.  We find the latter easily when we look, and it sustains us.  We can absorb that energy, join that movement, and make a difference in every encounter with our fellow humans.  We can absolutely be better.

 

What Emerges from Crisis:  Connection, Learning, and Contribution

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“What observations/discoveries/learnings have you noticed in these weeks?”

In phone calls, emails, and snail mail to friends, I find myself asking this question repeatedly.  This exercise yields two wins:  1) I’m connecting to my people all across the country; 2) I get to answer for myself, and new insights emerge each time.

How are you connecting with your people in these weeks of physical separation?

What have you had to reframe, create, and experiment with to make life work in our sudden new reality?  How does it feel?  What are you learning?

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 Inconvenient Emotions

Very early in the pandemic, when I realized my clinical volume would drop to practically nothing, I started to feel something akin to survivor’s guilt.  I still feel it—I am not on the front lines; I myself am not in harm’s way, as so many of my colleagues are.  I feel relief for not having to be there (yet).  Then I feel guilty for feeling relieved.  So I try to make myself useful, giving Zoom presentations on wellness to colleagues and firesides on Instagram for the public.  Life has settled into something of a routine.  I do video calls, helping with operations management and team organization from an armchair (standing desk).  Turns out I enjoy working from home!  And I feel guilty for enjoying anything about this time of unprecedented global disruption.  Hello, mental and emotional whiplash, my inescapable human companion.  Thankfully, self-compassion practice keeps me sane.

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Acceptance with Agency

“The first step to changing your circumstances is to accept them.”  Wut?  I have grappled for years to understand this concept; today I think I finally got it (thank you, Donna!).

Today I choose to define acceptance as a state of possibility, rather than of resignation or victimhood.  Sometimes it helps to describe something by pointing to its opposite:  What happens when we refuse to accept what is?  Often we cling to what we think should beWhat should be is a narrow set of unmet expectations that keeps us anchored to the past, or at least to an unreality that simply does not exist.

What happens when we finally accept what is?  We are liberated to ask some important questions:  How do I feel about what is?  What are the best and worst potential outcomes from here?  What do I want to be different?  How can I effect that change?  What is my work here?

Accepting what is brings us over the threshold from the narrowness of what should be to the wide possibility of what could be, where our agency is what we make of it.

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Optimism + Cynicism = Peace

Some days I get so excited, reveling in human ingenuity and resilience!  Look at the transitions we all made, practically on a dime, moving healthcare and education online, organizing COVID testing and creating treatment protocols, constructing hospital wards in convention centers, initiating clinical trials, and sharing experience and data internationally at breakneck speed!  All this learning and application, holy cow, how could we not be smarter, more connected, and better after all of this?

By being human, that’s how.  Despite our great capacity for survival and adaptation, we are creatures of habit and products of our environments and relationships.  We revert more easily than we convert.  On cynical days I think, “Nothing will change.  We will stay the same stupid species we have become, just a couple hundred thousand deaths closer to our own stupid, eventual extinction.  And we will deserve it.”

Here’s the fascinating thing, though:  I vacillate in this false dichotomy lightly, even though the emotions on both sides can get intense.  We humans are such a complex enigma, capable of profound love and selflessness, and also unfathomable hatred and destruction.  That’s simply what is—we are all of these things, intricately complicated in our nature.  Each one of us possesses an infinite set of potential vectors for connection and/or destruction.  But I still get to choose what to do with my time, energy, and resources in this lifetime.  It’s my call.  So I’m okay; I’ got this.

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Co-Creation:  The New Normal

The last two years I have had the privilege to work with colleagues around our vision, mission, and values.  I have studied various work cultures, observed and interviewed associates and teammates.  LOH taught me the language and framework to synthesize my own, evolving style of relational leadership.  During this downtime—this unearned vacation—I have time and space to consider a bigger picture.  What about our culture best manifests our mission and values?  How did this facilitate our successes in reorganization and mobilization?  What held us back?  What needs to happen (change?) in order for us to emerge from this crisis in learning and growth, rather than in fear and trauma?  These questions apply professionally, personally, and societally.

My strengths lie in relationship and connection.   Throughout this long journey to flatten the curve (and it will be months), I can contribute my insight, observations, and talents at synthesis, creativity and vision, to make our new normal as mindful, intentional, collaborative, and functional as possible.  I can paint a vivid picture of where we could go.  I can embrace dissenting voices and find alignment in apparently divergent interests.  I can help us be better.  This is the contribution I can make.

What will your contribution be?

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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

Dr. Lickerman doing a similar review as a guest on a podcast, also excellent: https://www.larryweeks.com/ep-36-coronavirus-qa-with-dr-alex-lickerman-m-d/?fbclid=IwAR077iOtNkCGcyjJdjVWZWKW6RWgtNhVgdN7cYvrnd2bQcbaStrRvTjdqAE

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:

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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:

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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.