The Primal Fear of Overachievers

Not. Good. Enough.
The driver of overachievers to overachieve.
At some point the overachiever realizes how much they have accomplished.
I’m kinda awesome.
But it’s always overshadowed by
I’m Not Enough.
More overachieving.
I’m pretty awesome.
Still not enough.
More achieving.
Fuck, I am the shit.
And Still. Not. Enough.
Hopefully the realization of this dichotomy sets in–two sides of the same coin–so awesome and not enough.
So how to reconcile?
Reach out.
Connect with other Awesomes.
We are all enough.
Let something else drive the awesomeness, something other than running from not enough.
Be a contribution.
Collaborate, synergize with fellow Awesomes.
Then it doesn’t matter how awesome you are alone because all of your awesomeness just goes into the pot to make the whole greater than the sum of its parts.
Awesomes hold each other up, expecting only that we will each bring our authentic selves to the table to share–nothing more, nothing less.
The only objectives are to participate, exchange, connect, explore, grow, and radiate awesomeness to make the world better for having communed.
We are enough.
Even if we don’t believe it all the time.
Put that fear in its place. It’s not allowed to drive anymore.

Applying the Wisdom of Atticus Finch

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“You never really understand a person until you consider things from his point of view—until you climb into his skin and walk around in it.”

–Atticus Finch

To Kill a Mockingbird, by Harper Lee

 

How do you practice and achieve empathy?  How do you notice others doing it?

It’s been on my mind a lot these last two weeks.  Current American politics resembles an interminable abscess, oozing ever more copious and putrid gobs of pus, from ever more unforeseen tracts of deep, diseased tissue.  How can we find any Healing Connection in the midst of all this?

Here’s my answer:  Role play and storytelling.

Role Playing Game Males Lego Duplo Play Build

 

Role Play for the Good

I used to hate role play, and now I jump at any chance to try it!  It all changed through a 7 week teaching workshop I did during my chief resident year, and I am forever grateful for the experience.  Now I regularly use role play to teach motivational interviewing, or MI, to medical students and residents.  Put simply, MI is a counseling technique that focuses on patient autonomy, and aims to reinforce intrinsic motivation for change.  My teaching method has evolved over time, due to my own unexpected experience of ‘climbing into the skin’ of others.

In the beginning I used to play the patient, letting students take turns practicing their MI skills on me.  After a couple of sessions I realized that even though I was pretending, I really felt like the students were earnestly trying to help me change my health habits, or making me feel bad about myself, depending on their proficiency.  So to give them the benefit of this perspective, I had them take turns playing both patient and physician.  The feedback revealed a richer, more insightful experience for all.

In 2015 I attended the Active Lives conference, where my technique was further enlightened.  I got to role play four times with a partner: first as patient, then physician, doing it the ‘wrong’ way (directive, authoritative, confrontational), and again in both roles doing it the ‘right’ way (collaborative, empathetic, nonjudgmental).  I felt the immediate contrast of the four roles emotionally and viscerally.  When all I heard from the doctor was, “Yes, I know you’re busy, but you have to find time to exercise,” and “Why don’t you do this…” and, “You should… You need to… If you don’t, then…” I felt absolutely no impetus to take any of this advice.  But questions like, “How important is it to you to…  How confident are you to… What would it take…what would need to happen in order for you to…” and, “What would life be like if…” invited me to explore possibilities, helped me to imagine and create my own future.  As an authoritative physician, I felt frustrated at my patient’s resistance to my evidence-based and well-intentioned advice.  By contrast, as a collaborative doctor, I feel freed to embark on an improvisational Yes, And adventure to reveal each patient’s personal path to healthier habits.  Now I offer my students the opportunity to experience all four roles.

I remembered this insight evolution last week when I came across a 1970 video of Jane Elliott’s classroom racism experiment.  She divides the class by eye color, asserts that blue-eyed children are better than brown-eyed children on one day, then reverses the premise the next.  While she makes privilege assignments that likely would not fly today, she also debriefs with the kids, helping them identify their assumptions, feelings, actions and reactions—much more authentically and directly than I think we are willing to do today.  She does it all without judging or shaming, pointing out biases and encouraging her students to examine them for themselves.  I admire her for pioneering this exercise, and I bet it affected her students in profound and lasting ways.

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The Importance of Story

Clearly, we cannot possibly depend on such academic practices to develop everyday empathy.  Luckily we now have infinitely easier access to one another’s stories than ever before, which is the next best thing.   Lately I feel a keen new appreciation of the importance of storytelling for conveying experience and stimulating mutual understanding.  Obligingly, the universe (read Facebook) has provided me with numerous testimonies of my fellow humans’ experiences and conditions, and this week they touch me even more acutely.  Here are some of them:

  • Former white supremacists talk about the importance of upholding others’ humanity, even as we denounce their beliefs.
  • A black writer recounts multiple instances of racism over her lifetime, inviting her white high school classmate to imagine and consider how they exemplify his white male privilege.
  • The head of neurosurgery at the Mayo Clinic in Florida tells his story of illegal, then legal immigration, and a subsequent life dream realized.
  • Neil DeGrasse Tyson shares stories of genitals on fire, educators’ responsibility to the electorate, pressure from his black classmate to contribute to ‘the black cause,’ realizing that he is doing just that, and why he wants to be buried instead of cremated (he has changed my mind, by the way).
  • David Duke’s godson credits the college friends who welcomed him despite his pedigree, with helping him defy and shed it.

 

What’s the Point?

The overarching goal here is to intentionally thwart the abstraction and dehumanization of people who are different from ourselves.  Stepping into another person’s shoes, ‘climbing into (their) skin,’ imagining how they feel, and actually feeling it—this is the best protection against bias, prejudice, and discrimination.  Empathy forms the sticky webs of connection that stymie the hymenoptera of hatred mid-flight, or catch us in the face and remind us to look where we’re going.  Where do we want our thoughts, words, actions, and relationships to take us?

I imagine a world of colorfully flawed humans, who acknowledge our biases openly and honestly; who recognize the risks that those biases carry; who accept ourselves, warts on soles and souls and all; who commit to a lifetime of extending that acceptance to one another; and who understand that it is our relationships, all of them, that kill us or save us.

So let’s play and tell—and feel and listen.  Really,  it’ll be good for all of us.

 

Love You Into Being

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A couple of weeks ago I met my new medical students.  These 10-12 trainees will be my small group for the next two years.  We will meet monthly to discuss the soft stuff of medical training—hierarchy, tribalism, death and dying, medical errors, difficult patients, etc.  Some call it “third year medical student support group.”  This is my 6th year of the pleasure and privilege (I inherited my first group halfway through, when their previous preceptor moved out of state).

With each successive group I am ever more amazed at the students’ level of insight.  They articulate compassion, humility, and maturity that I don’t think I had at their level of training. Or maybe it’s because we did not have classes like this to explore such things when I came up (or maybe I don’t remember?).  More and I more I see my role as facilitator more than teacher.  I am not here to impart medical knowledge.  Rather, it is my job to stimulate exploration, conversation, and meaning.  It’s so freeing, really—there is no standardized test to teach to.  And yet I see it as my responsibility to help prepare these gifted young people to face the greatest challenge and reward of the profession: human relationships.

I feel no fear or trepidation.  We cannot ‘fail’ at this class, any of us.  Because the point of it is simply for everybody to participate, contribute, consider, and learn—myself included.  Each month the students are given questions to answer in the form of a blog post.  For example, “Recall an example of inspiring or regrettable behavior that you witnessed by a physician.  Describe the situation, and its impact on you, the team, and/or the patient.”  I read them all and facilitate discussion, tying together common themes and asking probing questions.  My primary objective is to help them maintain the thoughtfulness and humanity that led them to medicine in the first place.  Medical training has evolved in the past 20 years, for the better in some ways, not so much in others.  One way we do much better nowadays is recognizing the hidden curriculum, and shining light on its effects, both positive and negative, through classes like this.

We all have those teachers who made a difference in our lives—or at least I hope we all do.  I have multiple: Mrs. Cobb, 4th grade; Mr. Alt, 7th grade math; Ms. Townsend (now Ms. Anna), 7th grade English; Ms. Sanborn, 7th grade social studies; Mrs. Stahlhut, 9th grade geometry; Mrs. Summers, 10th grade English; Coach Knafelc, varsity volleyball; Dr. Woodruff, primary care preceptor; Dr. Roach, intern clinic preceptor; Dr. Tynus, chief resident program director.  My mom is one of these teachers, also.  She leads nursing students in their clinical rotations.  I have seen her student feedback forms—they love her.  And it wasn’t until I heard her talk about her students that I realized why they love her and what makes her so effective—she loves them first.  Teaching is often compared to parenting.  Our parents, at their best, see our potential and love us into our best selves.  They cheer us, support us, redirect us, and admonish us.  They show us the potential rewards of our highest aspirations.  If we’re lucky, they role model their best selves for us to emulate.

All of my best teachers did (do) this for me.  I’m friends with many of them to this day, and I still learn from them in almost every encounter.  I love them because I feel loved by them.  They held space for my ignorance and imperfections.  I always knew that they knew that my best self was more than the last paper I wrote, the last test I aced, or the last patient encounter I botched.  To them, my peers and I were not simply students.  We were fellow humans on a journey of mutual discovery, and they were simply a little farther along on the path.

This is my aspiration as a teacher, to live up to the example of all those who loved me into the best version of myself today.  This kind of love allows for growth and evolution, from student to colleague, to friend, and fellow educator.  This is not something attending physicians typically express to medical students, positive evolution of medical education notwithstanding.  But when I met this new group, I was overcome by love for them.  So I told them.  “If you take away nothing else from our two years together, I want you to have felt loved by me.  I wish to love you into the best doctors you can be.  That is my only job here.”  Or something like that.  It was impulsive and possibly high risk.  But it was the most honest thing I could say in that moment, my most authentic expression of my highest goal for my time with them.  I only get to see them once a month, and I want them to be crystal clear about what I am here to do.  We have lots to cover these two years, so much to learn and apply.  And love is the best thing I can offer to hold us all up through it.

Support for the Inner Work

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Things were a little crazy this week.  I have an idea for a post and still have not sat down to write it out.  But I want to share something that came out on my Facebook page (of course) tonight.  One of the reasons I love writing is that insights pop out when you least expect them.  Writing exchanged with others is even better, because those insights are then shared, and their meaning amplifies.

I posted this article from the Washington Post yesterday: “Nearly half of liberals don’t even like to be around Trump supporters.”  It’s a summary of a recent Pew Research Center survey, which finds that 47% of liberal Democrats “say that if a friend supported Trump, it would actually put a strain on their friendship.”  It posits, among other things, that liberals are less tolerant of dissenting ideas because they are clustered in urban areas, lending to louder echo chambers.  By contrast, only 13% of Republicans answered that “a friend’s support of Hillary Clinton would strain their friendship.”

From the survey report:…Nearly nine months after the election, most people (59%) say it is ‘stressful and frustrating’ to talk about politics with people who have a different opinion of Trump than they do; just 35% find such conversations ‘interesting and informative.'”

I consider myself a socially heavily left-leaning, fiscally centrist Independent, but I identify more with liberals than conservatives, by a large margin.  This article made me sad, that my ‘tribe’ shows itself to be much more intolerant and judgmental than I would like.

I posted this comment along with the article:

Ooohh, so much data here, so much potential for blame, and also for self-exploration. Humbling, no question.
“Be extra kind with your comments on this one please, friends. No need to reopen barely scabbed wounds. I mean for my page to be a safe place for all of us to engage. We are all in it together, and the sooner we *all* figure out how to deal with 45 and one another, the better we will all be.
“Also, I’m bummed that Asians are always left out of the data set.”

I got some comments from my liberal friends about how hard it is to talk to Trump supporters, so much so that they avoid talking politics with those friends altogether.  But one friend exemplified my aspiration for all of us.  She wrote:

“… I recently had dinner with a very close friend who voted for Trump. Typically I think I’m a really good listener, listening with curiosity and a desire to raise the conversation and all involved to a higher level. However, when our conversation turned to politics I found myself cutting her off, getting defensive and bordering on being critical of her. I was horrified by my own behavior. I think this article hits on it – the support or opposition of Trump feels like less of a political stance and more of a statement of a person’s values and morals. I don’t think that’s necessarily true- I think a large population of Trump voters (my friend included) were actually voting against Washington more than for Trump. While I can’t get behind Trump I can get behind a vote to change the system. I wonder what might happen if more of us looked for what we can stand behind together?! Thank you for continuing to be a voice for this movement!”

Exactly!  Immediately I felt connected to my friend in a higher calling, and a shared struggle.  I replied:

“(My dear friend), I derive so much of my strength and curiosity from you. How many of us can own up publicly about our own flaws and failures, like you did here? And I know you know I use the word failure in the most empathetic and loving, mutually understanding way. I think that is the first step–complete humility and openness to our own imperfection. It’s so fucking hard. And I’m so lucky to have friends like you, (these four other dear friends), and others… I know now, better late than never, that we cannot do this work without unwaveringly reliable support, no matter how motivated we are.  And for those of us who are already well-supported, I think it’s our responsibility to look outward and support others. You never know when or where someone may be standing on the edge of openness, and when your small gesture of encouragement may nudge them on. Thank you for your loving support, my soul sister!”

It really is true, we cannot dig deep and bring out our best selves by ourselves.  We are meant to hold one another up and accountable, to bring out the best in each other.  It breaks my heart when I interview patients, and learn how sparse and frail their emotional support networks are.  There is no stereotype for this scenario, it can happen to the best of us.  Past experiences, circumstances, timing, life events—they can all combine to undermine our relationships, thereby weakening our capacity for self-awareness and exploration.  So we fall back on default modes of defensiveness, righteousness, denial, and blame.  Whether it’s quitting smoking, sticking to a healthy eating plan, or elevating our political discourse, we are truly stronger together.

I share this tonight because I so admire my friend for owning her whole self.  I am so grateful to her for sharing her imperfections and vulnerability with humility and hopefulness.  She gives me strength to keep going, despite how fucking hard it is.  And I hope I can do the same for many, many others.

Innocence, Indignation, and Idealism:  An Optimist’s Reconciliation

I took my daughter to see “Wonder Woman” last weekend.  I highly recommend it—such a strong, complex, and inspiring portrayal of humanity at its best and worst, with a hopeful ending.

Today I’m (somewhat) inspired in parallel by (some) politicians, three Republican senators in particular, calling for transparency in drafting healthcare reform.  I hereby present my attempt to integrate that exquisite Wonder Woman Experience with my current political outlook.

***WARNING*** THIS POST MAY CONTAIN SPOILERS FOR THOSE WHO HAVE NOT SEEN THE MOVIE.

Innocence

Diana of Themyscira grows up believing in the innate goodness of humans.  The Amazons are educated, independent, strong, and proud, and also collaborative, compassionate, kind, and sensitive.  When Diana learns of the horrific war waged by mankind outside of her paradise home, she relates it to the story of Ares, the God of War, who corrupts the hearts of men to commit acts of hatred upon one another.  So, naturally, she sets out to kill Ares and fix it.

We journey with Diana through challenge and triumph, as she learns that, of course, it’s not that simple.  She kills the man she thought was Ares, and nothing changes, the war rages on.  She must reconcile the possibility that the heart of mankind is not actually pure goodness.  Even without an insidiously corrupting God of War, humans are prone to their own malignant beliefs and actions.  Her innocence is pierced.

In the summer of 2009 or 2010, my best friend from college and his wife came to visit.  He, a molecular biology and political science double major and emergency medicine physician, and she, a worldly intellectual and future legal counsel for a major media outlet, were the first to burst my innocent political bubble.  For some reason, likely due to the tremendous inspiration of Barack Obama, I had gone from thinking all politicians were liars and performance artists, to seeing them as genuine public servants, working to advance their authentic ideas of how society functions better for all citizens.  I know, La-La Land!  My friends described an alternative, more realistic path to politics: Person succeeds at business, rubs elbows with regulators and influences them (with money or otherwise) to facilitate his/her business success.  Said person then realizes s/he could actually become one of those regulators and make a more permanent positive impact on these business interests, and so runs for office.  I still remember how deflated I felt, shoulders slumped, spine rounded, at this sudden and stark realization.

Indignation

As with everything, I’m sure political reality lies somewhere in the messy middle between pure altruism and blatant, self-serving avarice.  But these days, for someone who loved Obama and almost everything he stood for, it’s hard not to see the whole of our current political landscape as the latter.  I think, Really, WTF?  Can those in power really see nothing valid whatsoever in anything accomplished the past 8 years?  Do they really think that see-saw policy-making, each administration reversing everything from the previous one, replacing wise, experienced public servants with ignorant neophytes (my opinion), is the best way to govern?  OMFG, you have got to be kidding me.  I seethe.  But what can I do?

Ares reveals himself, and taunts Diana in her most vulnerable moment with his arrogant disdain for man’s weakness and corruptibility.  He also reveals that she is, in fact, the only one who can vanquish him—only a god can kill another god.  Diana, daughter of Zeus himself, possesses the power to Kick. His. Ass.  Yet he dismisses her out of hand, oblivious to her inner strength of conviction and compassion (I know, so much to expound on here, maybe in another post!).  Nope.  Righteous indignation rises.  She digs deep, finds that core courage, and obliterates him.  Fist pump.  He never saw it coming.

Idealism

In the end, Diana realizes that humans are a paradox: a big jumble of contradictions, perpetrators of horrific rage and destruction, and also fully worthy of love, forgiveness, and compassion.  She somehow finds peace in this enigma, loving the best of humanity and vowing to protect us against our worst selves, helping us to become better.

This resonates with the idealist in me.  This is how she helps us, and how we can help ourselves.

How Can We Help?

We can choose to fight against one another, and thereby focus on what we hate (about ourselves).

Or, we can choose to seek the good in one another, and focus on what we love— even better, focus on love itself.  We all want access to healthcare, and to be free from bankrupting medical expenses.  Everybody wants to be safe from gun violence.  We all want an efficient government that sets reasonable regulations, protects citizens’ constitutional rights, and spends money wisely and with accountability.  We all want to feel protected and free, loved and free to love.

The messy middle is the how.  That is where we negotiate.  That is also where the magic happens, as Brené Brown says, and that is where we must go, where we must persist.  We can bring our best selves to meet others’ best, in mutual respect.  It can be high risk, so we can enter slowly, strategically, with realistic expectations and a few trusted friends.

To this end, I will continue to seek out and hold up elected officials who call for more thoughtful political processes.  My friend Triffany and I have made a habit of writing thank you notes to Members of Congress to validate their cooperative acts.  We harbor no illusions about purity of intent, but we also know that positive reinforcement works.  We can be Diana to anybody’s Ares.

Focus on and fight for what we love: common goals and interests, shared humanity, connection, and one another.  It’s a lifetime’s worth of work, and well worth the fruits, if we can stick with it.

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Exploring the Rules of Engagement: A New Blog Series

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The Descent and the Rising

The past two weeks have assailed, masticated, consumed, digested, and expelled important parts of my psyche.  A week after basking in peaceful solidarity at the Women’s March, I found myself losing sleep and breaking out—both signs of acute distress.  My mind swam with questions of identity, purpose, and action.  I wrestled with fears around policy, violence, and integrity.  All of a sudden I wasn’t enough, I wasn’t doing enough.  Resist!  Call your representatives now!  Support this march and that protest!  And on the internet, rage escalated everywhere.

I read this article, which I highly recommend, on how to stay engaged and not lose your mind.  The author recommends that we focus our actions on one or two issues, and gives useful self-care tips.  After a few days, I was surprised to find that no particular issue moved me enough to passionate advocacy.  I began questioning my dedication.  But thank God for therapy (which the author also recommends), hallelujah!  I had a breakthrough in session last week, wherein I realized that I am, actually, enough.  And I do actually affirm one key interest: Relationship.

Duh.

For me, it’s less about specific issues than it is about how they’re addressed.  While generally I favor a progressive social agenda, I abhor the entrenched, partisan, winner-takes-all attitude that infects our government operations and civic discourse.  I also deplore the rhetorical, broad brush generalizations that people make about one another, based only on how we voted or an oversimplified position on one issue.  I wrote about this recently, though I buried the thesis in what should have been a separate discussion of healthcare reform.

Looking back, of course, relationship and communication have always been my core concerns—I launched this blog specifically to discuss them, for crying out loud!  Over and again I find myself in the role of mediator—between family members, Chinese and American culture, conventional versus alternative medicine, and between patients, physicians, and the healthcare system.  My whole life I have practiced, sometimes under duress, the art of mutual understanding and negotiation.  Maybe I’ve just been training for this moment in history.

How Talking Politics Is Like Eating Healthy

We could all learn and apply better practices.  We know the theories—more vegetables, less judgment, whole grains instead of processed, less name-calling and more calm, reasoned debate.  But so often the opposite happens:  junk food, sugary sodas,  pointless shouting and blaming—especially on social media.  We feel ashamed and frustrated at the futility of it all.  We figure screw it, I’ll never change (and neither will they), so why bother, it’s too much work, and anyway, it’s not the end of the world.

Never mind that your rising blood pressure and glucose accelerate the formation of atherosclerotic plaque each passing year, and that your risk of dying from a heart attack or stroke escalates exponentially as a result.  Never mind that the less we engage one another in meaningful ways, the farther apart we drift and the more we allow the most extreme factions of our parties to run the show.

The Challenge

In the coming weeks, I will share my own key learnings on healthier engagement practices.  I make no claims to have all the solutions, and I do not mean to be preachy.  These posts will serve mainly as reminders to myself, aspirational pieces to hold my own feet to the fire, marshaling my highest ideals of thought and behavior.  I will try to minimize promoting my own political views, though I suspect they will surface one way or another.  I hope you will follow with an open mind, and a heart that yearns to connect with the best of humanity, especially in those with whom you may disagree.

I’ve said it before and I’ll say it again:  It’s our relationships that save us.  Right now they desperately need repairs.  So let’s get to work.

Inspired

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…by a friend of a friend.

It’s okay to lament the darkness. Grief is normal and healthy.

But then go get a candle and light it.  Then go about lighting other people’s candles with yours.

The best part is, the light just multiplies. Your light shines no less brightly for giving some away.

And pretty soon darkness gives way to all of our light.

Peace and hope, friends.