The Movies That Move Us

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NaBloPoMo 2017: Field Notes from a Life in Medicine

The weekend has gone by too fast, and I have done none of the tasks on The List.  Oh well, it’s all good.  I got up this morning and made the green onion pancakes that my daughter loves so much.  We had a very successful shopping binge at Trader Joe’s and Target, woo hooooo!  And in between, we had something of a Christmas movie marathon:

“Love, Actually” (2003)

“The Holiday” (2006)

“While You Were Sleeping” (1995)

I’ve seen each of these movies so many times that I anticipate my favorite lines with giddiness and delight.  But they often end up serving as background on theTV as I accomplish other things.  Today, though, I was able to relax, sit, and watch.  It was touching and emotional, something of a re-centering.

What I love about each movie is how human all the characters are—there is something to relate to for every aspect of humanity in these films.  No one is perfect but all are lovable, all are flawed.  The relationships between characters—siblings, spouses, neighbors, friends, coworkers, parents, children, boy/girlfriends, and ex-es—are all interconnected, interdependent.  Somehow, watching these three movies in a row today, I’m struck by the portrayals of vulnerability, honesty, humility, judgment, love, and commitment, as well as lapses thereof.  It’s all so real, so human.

The hero’s journey is real.  We are all called to our own adventure, inevitably facing challenges and conflicts against our will.  We search for the easy ways out, alternative paths around our problems.  We avoid the hard feelings, the discomfort, the morass.  And then, somehow, we find a way—we meet someone who can help, we marshal our resources, we find the inner strength to do what’s needed, to carry on.  It’s messy and awkward, meandering and stumbling, often also hilarious and worthy of eye rolls and head shakes.  Looking back we find ourselves thinking, “Well why didn’t I just do that in the first place?”  And we can also appreciate the inevitable, valuable learning from the missteps and wrong turns.

Movies are movies, of course, not real life.  They are an escape.  They are also a mirror, as most art is.  They tell our shared stories, remind us of our relationships and connections through time, across nations, between genders and generations.  They’re called “movies” because they are still pictures shown in series to give the illusion of movement.  But perhaps we can think of them as moving us at our core, drawing us nearer to one another through shared experience and imagination.  The best movie experiences leave us a little cracked, a little exposed, a little sensitive—or a lot.  They remind us of our core humanity, inviting us to bring it forth and live it in authenticity.

Many thanks to all those who create and contribute to this art form.  You make us better.

Seek the Stories

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Do you have time in your doctors’ appointments to tell the story of your problem?  Do you even think of it as a story?  More and more I find myself saying to people, after they have given a list of symptoms in no particular order, “Tell me the story, starting from when you last felt well/normal.”  Then it all comes out in an interesting narrative, often with new insights as to causes, connections, and exacerbating factors along the way.

Do you read more fiction or nonfiction?  I have always been a non-fiction gal.  I appreciated The Grapes of Wrath and devoured the Harry Potter and Percy Jackson series, but usually I avoid novels.  My favorite books this decade are The Art of Possibility, Rising Strong, Big Magic, Start With Why, and Give and Take.  I realize now that these books are also full of stories—just real-life ones.  I have tried to incorporate more stories in my writing, and I find it challenging and awkward.  But I will keep trying, maybe take a creative writing class someday.

I have heard some amazing stories recently, and I will get some details wrong, but I want to share them with you, in case they touch you as they touched me.

A doctor attends a mindfulness workshop because he is interested in mind-body medicine and always looking for new methods to explore his inner world.  Part of the workshop is a professional quality of life survey, on which he scores very high for compassion satisfaction and low for burnout.  He says it’s because this is a second career for him.

He always wanted to be a doctor growing up.  He was accepted to medical school in his home country, but his family could not afford it.  So he stuck with science and went to school the cheapest way possible, and graduated with a biology degree.  Over the years he got married and immigrated to the United States.  He never forgot his dream of being a doctor, but progressed nevertheless in his graduate basic science studies.  When he applied to allopathic medical school here in the 1980s, he was told that since his BS was from abroad and the class was already ‘culturally imbalanced,’ he would not be admitted.

He was offered a spot in an osteopathic school, however, and grabbed it.  Meanwhile his wife was pregnant with their first child.  He had to move away from her and his parents for residency, and while he was away his father died.  Sometime in there his wife also started medical school, and they made it through training and the births of two children (with two weeks maternity leave each for her) intact.  They are now both well-respected primary care physicians in a small outlying community.  He is a physician educator and leader.  They sit side by side at the dining room table on Sunday nights catching up on notes.  They call these their “Epic dates.”  [Epic is the name of a widely used electronic health record.]  Both of their children are doctors.  He never feels burned out; he is living his dream.

Another doctor, a leader in his field and his institution, and a black man, described everyday racism that most of us cannot fathom.  A neighbor approached him on the beach of his own lake house, accusing him of trespassing.  Passing drivers backed up to confront him at his mailbox, suspecting him of stealing some white person’s mail.  A cop pulls him over around the corner from his suburban home in a nice neighborhood, asking, “What are you doing around here?”

A man in his 50s breeds guppies for fun.  It started with his 5th grade teacher, who was his mom’s best friend.  He used to go over to her house with his mom, and got interested in her guppy tanks.  Now he has hundreds of his own tanks, and he knows everything there is to know about inbreeding, crossbreeding, guppy circadian rhythms, and where the world’s experts on guppy breeding live and work.  Now I know this is a thing.

Mr. Rogers is quoted as saying, “There isn’t anyone you couldn’t learn to love once you’ve heard their story.”  I wholeheartedly agree.

 

Hopey, Changey Hero Making

IVY Litt 11-8-17

NaBloPoMo 2017: Field Notes from a Life in Medicine, Day 8

Funny how I just wrote last night about connecting new dots to old dots.  It just happened again tonight!  A couple of weeks ago I responded to an online ad for an IVY Ideas Night with David Litt, author of Thanks Obama: My Hopey, Changey White House Years, entitled, “How to Inspire, Persuade, and Entertain.”  Litt was a senior speechwriter for President Obama, so I thought I could learn new tips for presentations, and feel a little closer to the president whom I miss so much.

I’ve done public speaking since eighth grade, when our speech teacher first taught us abdominal breathing and I discovered the thrill of holding the attention of a room full of people with only my words.  I work at an academic medical center and I hold zero publications, but my CV documents over 10 years of professional presentations to various audiences.  I thought I was pretty good at this speaking thing.

Three years ago I came across this TED talk by Nancy Duarte, whose ‘secret structure’ of great presentations I have used since I subsequently read her book, Resonate.  Essentially, she recommends that we invite audiences on adventure stories, create active tension between what is and what could be, and most importantly, make the audience the hero.  I have done this better and worse since then, but I always recognize the framework when I see it.  Those familiar with this blog know that I am also a fan of Simon Sinek, whose central message is that we perform at our best when we are crystal clear about our Why.  “People don’t buy what you do, they buy Why you do it,” he says.  Barack Obama employs both authors’ principles with eloquence and finesse, which I noticed reading We Are The Change We Seek, a collection of his speeches as president.  The best speeches delivered in this construction create audiences who are inspired, motivated, and empowered to hail a meaningful call to action.

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That’s basically what David Litt conveyed tonight.  When asked what advice he was given that served him best, he said, “Imagine someone in your audience will tell their friend tomorrow about your talk.  What is the one thing you want them to say about it?”  What is the Why of your talk?  Even though he no longer writes speeches for the most powerful person in the world, he expressed a desire to continue inspiring, empowering, and promoting personal agency in all whom his work touches. Make each and every audience member their own hero.

It turns out, however, that this approach applies to much more than public speaking.  On my 50 hour, 500 mile, aspen-pursuing weekend in Colorado last month, I described to my dear friend my favorite moments at work.  At the end of a patient’s day-long physical, after I have spent 90 minutes listening to their stories of weight gain and loss, work transitions and complex family dynamics, and reviewing their biometrics and blood test results, I meet with them for an additional 30 minutes to debrief.  This is when I present an integrated action plan compiled by the nutritionist, exercise physiologist, and myself.  It is a bulleted summary of our conversations throughout the day, centered on the patient’s core values and self-determined short and long term health goals, and crafted with their full participation.  I get to reflect back to my patients all that I see them doing well, and shine light on areas for potential improvement.  It’s an opportunity to explore the possible—to Aim High, Aim Higher, as the United States Air Force exhorts.  I often present the plan with phrases like, “Strong work!” “You’ got this,” and “Can’t wait to see what the coming year brings!”  My friend turned to me as we wound through autumn gold in the Rocky Mountains, a bit tearfully, and said, “You make them the hero of their own story.”  Yeah, I do, I thought, and I got a little teary, too.

Words are powerful.  They are our primary tool for relating to each other, for making another person feel seen, heard, understood, accepted, and loved.  You don’t have to be a public speaker or a presidential speechwriter to make a positive difference with your words.  At work, in your family, with your friends, with people on the street and in the elevator—what is the one thing you want someone to remember from their encounter with you?

To You Who Hold Me Up

 

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October 27, 2017

My Dear Friend,

Thank you so much for hosting me this week!  Your home is a simple and inspiring space—you have clearly arranged and furnished it according to your core values, and its energy is palpable.  OF COURSE you’d orient the sofa squarely facing the big window and rising sun!

I am so grateful to know you, to enjoy welcoming access to your perspective, your experience, your generosity of spirit, and your willingness to explore the unanswered, the uncertain, the mysterious, the daunting.  Because of friends like you, I am a better version of myself.  I hope I can return the favor in your life.

Until next time—love and hugs–

🙂 ❤ Cathy

***

I wrote this to a particular friend today.  Then came the joyous realization that I have many friends to whom I could write the same.  They live their integrity every day, out loud and in person, with clarity, consistency, and discipline.  How lucky am I to be surrounded by such uplifting forces of nature?  Our shared curiosity saves us from cynicism.  Collective love emboldens us to ask the scary questions and stand strong facing the unknown.

None of us can know what’s coming around the corner.  It’s okay to feel afraid sometimes.  Things might suck rocks for a while.  And in the end, because we know we have one another, we also know we’ll be okay.  We walk together, laugh together, wonder together, and learn together.  We are truly stronger and better together.

How can I help but feel hopeful?

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.