Reconnecting to Mission, Patients, and Colleagues

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What’s the most personally fulfilling aspect of your work?  In times of uncertainty, threat, and transition, what holds you up?

This past week, I had the privilege of standing alongside giants in the fight against physician burnout.  In a series of presentations at the annual meeting of the American College of Physicians (ACP), we did our best to acknowledge and validate the current state of physician burnout (about half of all physicians in all specialties report at least one symptom), and then present as many strategies to reduce it as time would allow.  We showed how changes in workflow, task distribution, and technology, such as pre-visit labs and scribes, have been shown to improve physician satisfaction, team morale, and patient experience.  My role was to attempt to inspire my fellow internists to claim their individual agency, model a culture of wellness, and advocate for systems change in their home institutions.

The content felt dense but manageable, and the audience appeared engaged.  Our colleagues from all around the country approached us afterward to clarify studies of efficacy and ask about local representatives for advocacy in the ACP.  In the end, I think we achieved our primary objective of having most attendees leave with just a little more hope for our profession than they came in with.

Over the four day conference, however, what consistently grounded me in professional mission and meaning, not only in our own presentation but in others, were the personal stories.  That is how we humans relate to one another, after all—through narratives.  And connecting to mission and colleagues is key to maintaining a healthy and productive workforce, physician or otherwise.

Our attendees participated in two practices that I’ll share here.  Both were “Pair and Share” activities, meant to stimulate reflection both internally and externally.

Who In Your Life Really Changed You?

First we asked our colleagues to think of a patient who changed them, how, and to what end.  I know there have been many patients who changed me, but I always think of one particular woman.  She was middle aged, obese, diabetic, depressed, and severely disabled from osteoarthritis.  She lived alone and had a sparse social network, and her life partner had died unexpectedly a few years before I met her.  At every visit we struggled through the same fundamental challenges of weight loss, glucose control, and pain management.  How could she take her diabetes medications more regularly?  How could we control her pain without having to take opioids every day?  How else could we manage her depression, as some of the medications were raising her blood sugar?  She may have cried at almost every visit; wailing was not uncommon, and once she even vomited from cumulative distress.  Our relationship was good overall.  I overcame my impatience with her non-adherence to the treatment plan as I understood her life situation better.  But for four of the five years we knew each other, I saw few if any indicators that her thought, emotional, and behavior patterns would change.

Then things started to turn around.  She started coming consistently to appointments, no more no-shows.  She got online and found a community center that was accessible by bus.  She connected with a knitting group and started going to art fairs to sell her creations.  She started taking her medications more regularly, and lost enough weight to have her knee replaced.  By the time we parted ways, she had transformed from a weeping victim of circumstance to a woman with agency, self-efficacy, and goals, dammit!  And most of this had nothing to do with me.  I simply had the privilege to witness and support her intrinsic revolution.  From her I learned what perseverance looks like; I learned about hope and self-redemption; I learned that I should never make assumptions about anybody’s future.

Who Supported You in a Time of Vulnerability?

They said do the hardest thing that you know you don’t want to do for a living as your first rotation.  So I chose surgery.  In July of my third year of medical school, my days started around 5:30am and could end the next night at 10pm if my team was busy post call.  Most faculty physicians were kind and wise, or at least non-abusive.  Some, however, not so much.  What buoyed me most through that rotation was always the support and protection of the residents on my team.  I would watch them get abused by our attendings, but that sh*t never rolled downhill when the boss left the room.  I did not fully realize until years later what a gift that was and how much it spoke to the character of these men (they were all men).  This was in the 1990s; verbal abuse of medical students and snide comments about one’s appearance, gender, and just about everything else were simply to be expected.  But my favorite residents always pulled me aside and asked how I was.  They always made sure I felt confident about my role on the team, and they taught me basic skills with conviction and encouragement.  As I was about to insert a patient’s bladder catheter in the operating room, my elder brother in training told me firmly, like he really believed I could do it, “Don’t be afraid, hold it (the penis) like a hose.”

As we did this reflection exercise at the meeting last Wednesday along with our audience, I was so moved by these memories that I looked up one of my old residents that night and sent him a thank you card.  I bet he won’t remember at all who I am, but he will hopefully feel validated that he is in exactly the right position now as program director of a surgery residency.

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Recalling stories like these, and then sharing them with a person who truly listens, receives them generously, and simply helps you hold them (that was the instruction to the group—when it’s your turn to listen just do that, no interruptions, no jumping in), reconnects us to our calling in medicine.  It’s not just about the patients or the science.  It’s about all of the relationships and how we tend them.

We will not solve the immensely complex problem of physician burnout overnight.  It will take a concerted effort at all levels of healthcare, and physicians cannot and will not do it alone.  And it’s not that we are stoic, arrogant, and somehow intrinsically flawed, and thus dissatisfied with our work and leaving the profession in record numbers.  It is a systems problem, no question.  And, while we call our congressional leaders and professional advocacy groups to change policy, while we lobby our hospital administration to hire more support staff and move the printers closer to where we do our work, we can all take a few minutes each day and reconnect to the core meaning and purpose in that work.  Let us all remember a cool story and share it today.

The Beauty of Repeating Patterns

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Last week I wrote about our stories and how they perpetuate despite their dysfunction.  Tonight I consider patterns and how they also resist change—for better and for worse.

We had a wedding in the family recently.  Aunts, uncles, and cousins flew in from all over the country to attend and celebrate.  I have graduated to the parents’ generation at most weddings now; it feels strange and natural at the same time.  ‘Kids’ these days do things very differently in some ways (everything was online—no paper!), and exactly the same in others (there was a beautiful dress, an aisle, rings, kissing, and I saw her wear something blue).  Sitting with my fellow zhang bei (elder generation), I recalled when each of us got married, all on the order of 15-20+ years ago.  Like the happy couple, we were all young, most of us were thinner, and we had darker hair.  Our Chineseness and its influence on nuptial activities felt a little heavier than for the next generation, and yet that cultural heritage still shines through today—that makes me proud.

How will the new couple choreograph their marriage dance?  When the rest of us started out, could we have predicted our tangoes to look and feel how they do today?  Part of me says yes, absolutely—just look at how our parents boogied—we humans learn by mimicking.  Just imagine your spouse’s father dancing with your own mother, or some other familial counterpart pairing, and you probably see something resembling your own relationship.  Psychology research tells us that our stories and patterns of relating form very early in life, and persist for decades.  We carry the lessons, traditions, and burdens of our families of origin in our neurons and even our DNA—we cannot escape them.

Not that we need to or should.  Each of us is the product of all the atomic, molecular, cellular, interpersonal, and interstellar interfaces that created and continue to recreate us, in an infinite and complex web of moments and contexts.  It’s really quite beautiful, when I stop to think about it.  We can hear echoes of our ancestors in our children.  We pass on core values and family traditions with tribal pride, maintain bonds that hold us up through adversity, and anchor to relationships of identity and belonging.   We can also choose to forge new paths for discovery and growth, diverging from generations of redundant dysfunction and suffering.  Through iterative tribal mergers our children inherit all that came before them—the good and the bad—and the universe both differentiates and unifies with each succeeding generation, with every single individual.

Each dandelion seed is a miniature version of the whole flower itself.  Each human family is a subset of the family of humanity.  We are all uniquely ourselves, and we also belong wholly to one another.

Nothing stays the same for long.  And some things never change.

It’s just a thing of beauty, no?

Wide Open Spaces

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What to write on vacation?  Depends on the schedule, no?  Happily, on my Rocky Mountain escape this week, time lolls wide open.  How rare and precious to have these days with no commitments, no agenda, and a true feeling of detachment!  Wow.  How refreshing, nourishing, relaxing, and challenging.  No patients to see, meetings to attend, immediate work crises to solve.  I feel at once liberated and anxious—as if I enjoy the bright Colorado sun now, but there must be some black cloud looming over the ridge to the west.  *sigh*

The LOH retreat positively saturated me last weekend—mind, body, and soul.  I had Hippie Zealot Conference High, for sure.  And as so often happens, synthesizing learnings and insights proved challenging off the mountain and in real life, especially with only four intense days of re-entry before leaving again for spring break.  But now I have time and space—physical and mental—to process, hallelujah!

It never ceases to amaze me, the cosmic collision of ideas and insights that simultaneously shape my personal and professional development.  It’s like I feel the universe’s Michelangelo, Van Gogh, and Einstein hands sculpting and unifying my consciousness at all levels—it’s awesome!!

Weeks prior to LOH, my own coach Christine and my coach friend Donna each independently introduced me to the work of Jennifer Garvey Berger, expert in adult development and leadership coaching.  She incorporates ideas of complexity and systems, central tenets of LOH training, in her philosophy.  I started listening to her book, Changing on the Job, the week before LOH started.  My friends came to Berger’s work separately (they don’t know each other, which I intend to remedy soon), and the temporal overlap of their new learning with my own makes my heart leap—my friendships are, without question, divinely inspired.  The central learning for me so far is recognition of my current and aspirational states of development as a person in all aspects of life.  I look forward to acquiring and practicing more skills for growth—it is a lifelong process!

Two weeks ago, while searching links for my Thank You post to Ben Zander, I came across Rosamund Stone Zander’s book, Pathways to Possibility, the follow up to their co-authored book, The Art of Possibility, still my favorite book of all time.  I started PtP days before LOH; the synergism of ideas almost overwhelmed me.  I finished it last week and holy cow, this is advanced practice personal development.  The stories we tell, the ones that rule our relationships and lives, can be so deeply entrenched that even when we recognize their dysfunction, revising them feels almost impossible.  In my personal life, I recognize intellectually that I hold onto some seriously destructive stories—ones that cause chronic and palpable suffering not just for me but those closest to me.  I lose circulation in my figurative hands, my emotional grip on these stories is so tight, and I still refuse to let go of them.  It is positively frustrating and fascinating.  I know this stubborn intransigence has untoward effects on my leadership capacity and style at work, however indirectly, because I firmly believe that ‘how we do anything is how we do everything.’  It just kills me—like a padlocked steel door in the long hallway of self-awareness, behind which live insight and psychological freedom—I know I have the key somewhere, I just can’t find it yet.  I will return repeatedly to integrate the practices in this book, like I do to AoP.  And, I get better every year at holding myself with a little more compassion.  We’re all here doing our best; I am no exception.  Nobody is better supported in this work of self-discovery than I.  So I journey on mostly joyfully, surrounded by fellow wayfinders, working on ourselves for the benefit of us all.  Onward!

Spring break writing

I started this post with at least two other ideas to write about, but I’ll hold off.  I have four more days here in the mountains.  More time and space to think on, manipulate, and start to apprehend all of these ideas and learnings of late.  My thank you cards, washi tape, journal, and laptop are spread out over the coffee table.  My favorite movies play on DVD and cable as pleasant and entertaining background ambiance.  What a gift and a blessing are time and space.  May I savor these days with deep and sustaining gratitude.

This Is My Hogwarts

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My friends, I belong.  This weekend marked the beginning of a ten month training program in communication, leadership, connection, and creativity.  9 of us made it to Colorado after the bomb cyclone (Patrick, we missed you—can’t wait to meet you in May!) to launch Cohort 11 of Leading Organizations to Health (LOH).  Our teachers, Tony Suchman and Diane Rawlins, led us through three days of introspection, skills acquisition and practice, and formation in community.  It all happened at the Sylvan Dale Guest Ranch in Loveland, surrounded by mountains, river, wildlife, and a rich history of family and hospitality.

We are training in relationship-centered care and administration, helping one another embody our best relationship tendencies, so we may help our organizations function at higher levels of connection and effectiveness.  It’s too exciting!

I walked into the lodge at Sylvan Dale, saw the vaulted ceiling with the icicle lights, and immediately thought of Hogwarts.  I came to this place, called by something to the Why of my soul, to be with others like me.  We are here to train, to hone our skills for good.  Within the first session I realized I can totally be myself in this crowd.  Here, I’m no longer a lone voice focused on relationships ahead of everything else, no longer the only one who cannot help seeing how the nature of our relationships permeates every interaction, every decision—and how we recreate them in every moment.  No more self-editing and explaining, tip-toeing around what matters most to me.  I can fully inhabit my relationship convictions here, in this space and among these new friends.  I feel an ease of purpose and values in this group that I come to, like a deep well, to fill my bucket and irrigate my garden of personal and professional growth.  Here, I am not a black sheep.

I now have 9 new people-nodes to connect and integrate into my existing relationship webs—a new and emerging system.  We share stories with common themes, new insights, and mutual support.  These ten months we will form and evolve as individuals as well as a community.  It’s a type of love, really…  At least that’s how it feels to me.  Hooray!

 

 

Thank you, Mr. Zander

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Dear Mr. Zander, I met you almost 10 years ago and you transformed my life.

You and Ms. Zander gave the keynote address at the second ever Harvard conference on coaching in healthcare.  I was one of only a handful of physicians in attendance.  You discussed the central tenets of your book, The Art of Possibility.  I could not wait to get my copy signed, and you also graciously agreed to a photo.  I have since read and listened to your book at least a dozen times, and every time I gain something new and relevant.  The names of the practices ring in my consciousness on a regular basis:  Give the A, Rule #6, Be a Contribution, Lead From Any Chair, and Be the Board.  I describe the practices and their benefits, still, to anyone who will listen.

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Back in 2015 I boldly contacted the Boston Philharmonic to see if you could speak at the American College of Physicians Illinois Chapter Meeting.  You actually spoke to me on the phone and considered coming!  I was honored.  Though it did not work out (I knew it was the longest of long shots), it amazed me that someone as sought after as you would personally take a phone call from a random, unknown doctor in Chicago.  Later that year, when I attended the Harvard Writers conference (the birthplace of this blog), I had the honor of observing a master class where I witnessed you love some young musicians into their best selves.  They believed in themselves because you saw them, loved them, and believed in them.  That is the best thing any teacher can do for a student.

Throughout these last ten years, I have continued to seek, study, and attempt to apply learnings from authors, teachers, and mentors like you, people who see the world as broken as it is, and also the hope of humanity’s strengths and connections.  There is no shortage of people trying to help us all be better, for ourselves and one another, and no more urgent time or need for this teaching than now.  I count myself beyond fortunate to have benefited from your influence and inspiration so early in my life and career, to have you as my model.  No doubt I am only one of thousands, if not tens (hundreds?) of thousands, whose lives you have transformed for the better.  I wish you an ever broader and higher platform from which to reach countless more people and organizations.  I wish you peace, health, and joy in all your endeavors and relationships.

Please know how much you have meant to so many.

Sincerely,

Catherine Cheng, MD

 

Washi Tape Gratitude

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My friends, I have a new and serious obsession:  WASHI TAPE!

I have loved paper and stickers since I can remember, and I have hoarded pretty stationery, stickers, rubber stamps, ink pads and all kinds of other writing accessories for at least 30 years.  I left for college with 100 postage stamps and used all of them before returning home for summer.  I plan to single handedly keep the US Postal Service in business if I have to.  I LOVE SNAIL MAIL!!!

So imagine my joy and enthusiasm when the Gottman Institute published this article suggesting that instead of keeping a gratitude list or journal, we instead hand write thank you notes.  Specifically, write one every day for one year—365 hand written notes in 2019.  I read the piece and exclaimed with abandon, “Done!”

I started January 18 and it only gets better! I have connected with friends, just to say thanks for being my friend.  I have acknowledged people at work for going above and beyond.  I have sent cards to Chicago Streets and Sanitation for always being on top of our snow and working on nights and weekends, as well as JBJ Soul Kitchen for providing meals for federal workers during the partial government shutdown.

Best of all, I get to create stationery again.  My favorite hobby is making cards.  Tonight I wrote a card to my friend Audrey, who introduced me to rubber stamping during residency, almost 20 years ago.  Over the years I have used the kids’ art, my own photos, cut-outs from the Paper Source catalog, and of course, stickers.  I have a rolling drawer caddy full of stamps and tools—I could host my own workshop!  But washi tape can be expensive, and my deep-seated hoarder tendencies would never let me use it in large quantities, so I would never let myself buy any…  Until now!  I’m 45 years old, I make a good living, I love making cards, and they bring my friends and me much happiness, so I can afford to invest in my creativity, for all our sakes!

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These last few weeks I have pulled out cardstock and envelopes from the myriad stacks of cardboard boxes in the basement.  I have opened the giant plastic storage containers where I carefully organized and filed all different kinds of paper, labels, stickers, etc.  I have worked out my washi tape art style, and combined it with my favorite rubber stamps and inkpad—Peacock Gold by ColorBox (discontinued, but no worries, I hoarded at least two refill bottles!).  And, cosmically, last week a friend introduced me to another store here in Chicago that sells the most exquisite paper products: Bari Zaki Studio.  It was like heaven on earth.  When I checked out (after joyfully browsing at least 40 minutes in a space smaller than my bedroom) they packaged every piece in its own little envelope or bag, and closed them with—you guessed it—washi tape!  Even the receipt!

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In the month since I started this practice/commitment/challenge/discipline/excuse-to-play-with-paper-and-tape, I think it has actually elevated my mood and helped me feel more generous toward others.  I notice more small things that make me appreciative.  I have a lower threshold for expressing my gratitude, no matter how small, in writing.  I can share it in a tangible, concrete way, with small pieces of art, created with delight and love.  Even if they end up in the trash (cringe—I keep every piece of personal mail I receive), it will have been worth it if my card brightened someone’s day.  And bonus if it also helps them act generously and joyfully toward someone else!

Because that’s how gratitude works, I think—it starts with a positive observation, then an appreciative expression, generating new observations and expressions that connect us in shared humanity, ever pointing us toward what’s good.  I think we need as much of that as we can get these days, and it makes me happy to make even a small contribution.

 

Shoots in the Poop

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It’s December 4th… Time to look back?  Honestly, I’d rather just get this year over with and move on,  because I have already been looking back all this time.  Since January I have counted—weeks and months since the knee injury, months since starting the new job, since surgery, since a spring crisis, since the last this or the first that.  What was it all for?  I think I was just reminding myself that there’s been a lot going on, reassuring myself that I’m not just whining, not being weak for letting my personal health habits slip.

I’ve felt like a relative slug for the last 6 months, despite my best efforts.  I think I must have eaten a pint of ice cream every two days for most of the spring and early summer.  Looking back on the calendar, I stopped using smiley stickers to mark workouts around July—their intensity was only worth hand-drawn smileys.  By and since August they aren’t worth smileys at all—I just jot down what I did in shorthand.  Some weeks it was barely anything.   I judge myself every day—perhaps less harshly than I might have a few years ago, and also less compassionately than I might a few more years from now.  I still struggle with the fear of self-indulgence if I allow myself too much self-compassion.  I am still learning self-compassion.  I know it takes time to rewire our limbic brain patterns with knew learnings from our cognitive brains.  So I will keep trying, because I know it’s helping.  And I’m modeling for the kids.  We can do our best and still fail.  The key is to keep moving.  We can practice admitting we need help, seek it from the appropriate sources, lean on it heavily, and stand back up eventually.  And then we remember those who helped us, and prepare to be helpful in return.

I have leaned on so many this year, I feel almost speechless at the outpouring of support and love.  The only way I don’t collapse from this weight of gratitude is by storing it like a battery—ready to be discharged, full power, when someone needs to plug into me.  This may be my favorite thing about humanity—that we are wired to connect so tightly, to help one another in webs of mutual love and kindness that can extend ad infinitum.

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So I’ll look back a little.  This week I feel a turning.  Did I say this already recently?  Oh yes, it was November 12.  I was making more room for books, trying to stay off of my phone, off of Facebook.  Being on the laptop every night to post to the blog stymied that last part, but it also bought awareness of how I find loopholes in the best plans for self-discipline.  And the daily writing practice also contributed loads to this internal revolution.  This was my fourth year doing NaBloPoMo.  It was by far the most fun, the smoothest, and the most rewarding attempt yet (I think I also said this last year?), and now I miss writing every day (definitely have not said this before).  Maybe it was the daily dopamine hit of views and likes.  But I think it’s more than that.  Through the daily discipline, I had a chance to process and synthesize so many ideas and connections that had been marinating for months, maybe even years.  I practiced prioritizing, selecting, and distilling those ideas into about 1000 words each day, more for my own benefit than anyone else’s.  That people read and related to them was definitely a happy bonus.

Besides NBPM, I attribute this turnaround to two books that Donna recommended to me earlier this fall:  Leadership and Self-Deception and The Anatomy of Peace, both by The Arbinger Institute.  I have wanted to write about them for the last several weeks, but I haven’t yet figured out how to prioritize, select, and distill the lessons coherently.  The foundational ideas are not necessarily new, but they are profound.  The books are written as modern allegories, and there is just something about the metaphors and analogies that has unlocked and integrated everything I have learned about inner work, communication, relationships, and leadership to date.  And that is saying a lot.  Because of these books, the daily writing, and all the conversations I’m having (with myself and with others) as a result of both, the two most challenging relationships in my life right now have fundamentally improved—mostly because I have been able to shift my own attitude.  As with all things, this new ‘way of being’ will take practice.  I need to keep the training wheels on for a while yet.  But now that I have made this turn, the path looks straight, and I see light.

The manure has piled on all year.  So much fertilizer, oh my gosh.  It’s done its job, though, because I have definitely grown.  I feel strong, healthy shoots of green popping out through the thick, dark carpet of poop.