Aunt Rachel’s Blessings

My friends, it’s been an intense couple of weeks!  So much so that I have fully neglected the news headlines—this must be why I’m still in a reasonably good mood.  Another is that I have rediscovered Dr. Rachel Naomi Remen, the wise and benevolent matron of medicine whose gentle and gracious example I aspire to follow.

I first read her books, Kitchen Table Wisdom and My Grandfather’s Blessings, at least ten years ago by now.  They felt like my favorite plush blanket, draped over my shoulders with that welcome, comforting weight, and tucked under my feet, warming me with stories of love and belonging.  Life was just as hectic then as today, but in a different way.  The kids were little, and I had few if any responsibilities at work outside of patient care.  Aunt Rachel’s stories calmed me and gave me peace in that young chaos.  I had meant to reread them, but, well, life.

I perused the shelves and stacks of my personal library recently, searching for a book that my friend might like.  Both avid readers, we share and discuss titles on leadership, philosophy, and personal development.  The search this day felt different from browsing Amazon or my local book store.  A deeper part of me knew exactly what I sought for my friend, even as my conscious mind had only a vague idea.  I wanted to share something different with him, something less cerebral.  As soon as I saw it, I settled on My Grandfather’s Blessings, no question.  But after a day or two, as often happens with instantaneous intuitive decisions, I did question.  So I sat down with Aunt Rachel and her grandfather one evening, as if meeting old friends in a cozy, familiar café.  After some years of listening to books rather than reading them, I find quiet sitting with a paper book so comforting now.  I am called to slow down, to be still, more than I have been (have allowed?), for a very long time.

By page two of the introduction, my doubts vaporized.  This is it, I thought.  Stories of humanity, history, culture, medicine, healing, perspective, and how we humans are intertwined with one another and nature in the most beautiful and cosmic, inescapable and daunting ways.  As I reread her grandfather’s wise sayings, his subtle yet unmistakable messages of reassurance and unconditional love, that familiar warmth enveloped me again.  I could almost feel my blood pressure drop, my oxytocin level rise.

So much love and connection—the book is really all about relationships, which my friend and I both hold as the key to a meaningful life.  As I continue to read this week, it occurs to me that perhaps I was not actually looking for a book for my friend, but rather for myself.  For many years I have hunted ravenously for books to teach me, to elevate my performance in parenting, doctoring, leading.  But Aunt Rachel’s books simply soothe me.  They acknowledge and give credence to that still small voice that advocates for and validates the need for deep personal connection, in a world that values it less and less.

I wonder if reading Aunt Rachel’s books so early in my career helped me more than I knew.  Looking back on the past decade, I feel proud to have resisted the pressure of 15 minute clinic visits, to have made the effort to relate as personally as I could with every patient, even if my bids were rejected.  Aunt Rachel’s books honor that heart center in me that holds true to what I value the most, which is connection with people.  Perhaps I have her to thank for watering the strongest, deepest roots of my doctor soul before they could dry up and later require excavation to revive?

I still think my friend will enjoy Aunt Rachel’s book.  Her stories resonate with the humanity in all of us, not just doctors and patients.  I look forward to hearing his feedback, and finding more books to share.  And I must remember to bless our friendship.

May we all acknowledge and share the blessings in our lives, every chance we get.

How Reunions Feed Us

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It was July 1997.

Maria C. and I had just started our third year of medical school, rotating on general surgery.  We stood on evening rounds–it was already dark outside on this balmy summer night.  The hospital hallway was quiet and half the lights were off.  We visited a little old lady who had had surgery in the prior days.  She looked frail, but also like she had been spry once.  Her lips protruded the way my grandmother’s did when she took her dentures out at night.  She wore a round fuchsia sleeping bonnet, a little askew atop her head.  She looked half asleep, barely aware of our presence, and had slid down in the bed such that the pillow and blankets had effectively swallowed her.

We were tired, Maria and I.  It was not a fun rotation for me.  I had witnessed our attending throw a bloody sponge across the OR that month.  He was not particularly interested in us, I don’t recall any direct teaching (but there could have been), and the sleep deprivation was killing me.  But I had Maria.  She always had a smile, always an encouraging word, and she loved surgery.  Her energy held me up.  We stood dutifully, trying our best to pay attention and learn something.

As we listened to the discussion of the nice lady’s plan of care, suddenly I heard a loud, resonant, and prolonged PPPPPPPTHTHTHTHAAAAAARRRRRRRRTTTT.   Our somnolent charge had just passed the longest breath of colon gas I had ever heard, before or since.  And it didn’t phase anybody.  The team continued to discuss her plan of care as if nothing had happened.  I don’t know, maybe they were encouraged, as flatulence is the first step to oral feeds and eventual discharge after abdominal surgery.  They forged on without acknowledgement.  I wondered if I had imagined it.  But when I caught Maria’s eye, within seconds we could both barely contain ourselves.  Maybe we were just slap happy from too little sleep, or we just needed something to break the tension.  But it was too much, we had to step out.  Back out in the dim hallway we laughed out loud as quietly as we could, to the point of gasping for breath, hanging onto the wall and each other to keep from falling down.  Even today, 22 years later, I cannot help but smile at that moment.  Either we went back inside after composing ourselves, or the team emerged eventually, I don’t remember.  Rounds continued and I tucked away this little memory as one of the best bonding experiences of all my years in training.

*****

The Class of 1999 returned to The University of Chicago this past weekend to celebrate 20 years since graduation.  I had only signed up for a couple events, in my usual non-committal way.  I arrived at the breakfast venue, a building that did not exist when we were students.  I glanced over at the tables and saw only people much older than me, and my heart sank a little.  Where were my peeps?  Then at a back table an old friend stood up and waved, and my spirits lifted instantly.  We ate and laughed, and shared photos and anecdotes of surly teenagers at home.  As I had made no other plans that day, I met people again for lunch and we walked through campus, which I had not done in years.  The peonies in the quad burst with color and fullness, welcoming us all back.

I’m so proud of our class.  We are general internists and pediatricians, hospitalists, cardiologists, allergists, emergency medicine doctors, and orthopaedic surgeons.  We do neurologic interventional radiology, microvascular plastic surgery, and private equity.  We are medical directors, section chiefs, and NIH researchers; we teach medical students, residents, fellows and colleagues.  We advocate for immigrant health and lead international research teams to win the war on disease.  We are parents of toddlers and college students, single, married, and divorced.  But mostly we are just older versions of our younger selves, in love with the science of medicine and driven by something deeper within to care for our fellow humans, relieve suffering, and make the world better for our having lived.  This weekend gave us the opportunity to reconnect deeply on that level, to recall and relive those bonding memories tucked away all these years.  I had a chance to catch up with classmates whom I had always wanted to know better in school.  What a blessing.

Our specialties are widely diverse, as are our life experiences, before and since medical school.  But we also share so much in common.  Many of us have had painful experiences as patients or family of patients, and that has impacted our attitudes as physicians.  We collectively recall the stages and transitions of training as both trial and reward.  And everybody has something to say about the current, broken state of American healthcare.  But the overarching feeling of the weekend was camaraderie and love.  Emails poured in from classmates across the country and around the world who could not make it back; I count almost 60/100 of us included in our communications thus far.  We were just waiting for the chance to find one another again.

*****

In our current geopolitical climate of division, competition, and polarization, reunion is the antidote.  In this vital ritual of humanity, we reconnect with those who knew us in a more innocent phase of life, when we bonded through shared struggle, with whom our diversity and shared experience are paradoxically complementary in the best ways.  Our souls are fed by one another, in person, surrounded by food, back at our first professional home.  Relationships long dormant stand revived, and we are lifted.

It occurs to me, in this lovefest of reconnection:  How can we leverage this energy?  What if we could sustain these bonds, reforged and hot in this moment?  If we connected like this more often or regularly, across specialties, geography, and practice structure, how much better could we all be at what we do every day?  How much more empathy could we have for those who don’t do what we do, whom we see as competing for resources or otherwise trying to undermine us?  How would our patients feel in our presence?  Our support staff?  Our hospital leaders?  Gatherings like this prove that we have the capacity to just be together, appreciate one another, and support each other with generosity and grace.  So much potential for positive synergy among this group.

We have big plans for our 25th reunion, but I have a feeling our renewed relationships will find powerful expression long before then.  So stay tuned, my friends.  We are Pritzker Class of 1999, and we’ got work to do.

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Insight While Driving to Work

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Training for Better Angels, it occurs to me:
Confidence in excellent communication skills in order to enter difficult conversations without bailing or lashing out… is akin to the core stability required to get into and out of a deep squat.
It’s the bending down, feet flat, head up, in control and not falling over, that is the challenge—not the forcing up in a quick, mindless burst of brute strength. Bearing the load all the way down and standing back up gracefully, without causing or suffering injury: that is where our real power lies, in the gym and in conversation.

Tombstone Words

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Update, my friends:  My application for moderator training with Better Angels was accepted!  AND, they may let me help with workshops both in Illinois, where I live, and Colorado, my home state!  Woo hoooooooo!  So much good work going on in this organization, please take a look!

* * *

This post is a three-part thought experiment.  Take some time with this one, maybe–sit up straight, take some deep breaths, and see where it takes you!  I invite you to write down your answers to the questions with a pen and paper.  And then please share in the comments how it lands!  Please know that I write purely out of curiosity and a deep desire for exploration and connection, and not out of judgment or an attempt at ‘pimping,’ as we used to call it in med school, when teachers asked us questions just to see us squirm and fail.

I credit my life coach and a new friend and mentor for instigating this post, and the ongoing conversations both in my own head and with others that I absolutely cannot wait to have as a result!  The thread that connects the experiments is this:  How do I show up in my life, and how do I feel about it?

 

Experiment 1

Imagine you’re at an awards ceremony; it’s the end of 2019.

You’re being honored and given an award for something.

You’re at the party, wandering amongst the guests/everyone present, listening to what people are saying about you.

They do not see you; but you will be present to receive the award later–you are not dead.

Who is there?  How have they organized themselves?  What is the vibe in the room?

What are people admiring about you?  What are the words they’re using as they speak about you?

What are their facial expressions, posture, and gestures as they describe you and their relationships with you?

…What else do you notice?

What is the name of this award, and why are you the recipient?

How do you feel doing this exercise?

What emotions/thoughts/memories does it bring up for you?

 

Experiment 2

Now it’s your funeral or memorial service.  Ask yourself the same questions as above, but in this similar and yet very different setting.

How are people dressed? How do they look like they feel?

Do they know how you want to be remembered and/or honored in death?

Who would be there if it happened today?  What about five years ago?  Ten years from now?

Now imagine that the three most frequent words uttered about you at this event will appear on your tombstone.  Which words would you like those to be?  Which do you think your funeral attendees will give you?  How easy or hard is it for you to imagine the latter, and how close to your own wishes are they likely to be, today, five years ago, or ten years from now?

 

Experiment 3

Now, imagine a different set of people attending the events above.

These are your opponents, adversaries, and enemies.  They are your inescapable work colleagues, direct reports, bosses, and your estranged family members.  They are also the people you see regularly on your commute, the homeless people you pass on the street, servers at your favorite restaurants, and people who work at your grocery store.  They are your kids’ former teachers, the customer service representatives at Comcast or United Airlines, your postal carrier, and the workers who collect your trash.  What would all of these people say about you at your awards ceremony and at your funeral?

I did the first exercise with my coach a few weeks ago; it was powerful, enlightening, and grounding.  The second and third experiments occurred to me today, and I will consider them, chew on them, in the coming weeks.

So…  How was it?

A Community of Champions

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Spoiler Alert:  Big Bang Theory Series Finale!

* * * * *

When was the last time you felt totally safe, at work, to address the central relational challenges that hold you and your team back from your best performance?

How often at work can you really assess and evaluate your own interpersonal skills, their impact on those around you, and on the organization as a whole?

How much time and energy do your teams waste being stymied by relational issues, stuck in redundant, dysfunctional power struggles up and down the organizational hierarchy?

How do you feel in your body just reading these questions?  Perhaps tense and frustrated?

* * * * *

We, the eight participants and two faculty members of Leading Organizations to Health Cohort 11, reported palpable heaviness upon convening for our second training retreat last Tuesday.  Despite the Colorado spring bursting with blooms, wildlife, and vast clear blue skies, dark clouds hung over our collective consciousness, each for our own reasons.  Throughout the week we shared stories of successes, challenges, conflicts, power and powerlessness.  We practiced appreciative inquiry and relational coordination, and explored the insidious impact of unearned privilege.  We spent three days in intense skills training, supporting one another through viscerally gnarly role plays and open, honest feedback about how we impact the group.

In the midst of all this deep work, we also shared meals, walks, a horseback ride, and life stories around a fire pit and drippy s’mores.  As we debriefed around the circle on the last day, something had shifted:  overall we now felt refueled and energized.  The air buzzed with the anticipation of learners on the verge of integrating our emerging skills, excited to bring it all home to practice.  The clouds had parted.  We will keep in touch through peer coaching groups—our newly established, intense-support network.  In my heart, I feel we are really becoming a family.

 

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I headed to the mountains straight from the session, for 24 hours of processing and decompression (and more washi tape card-making).  More and more I marveled at what a rare opportunity I have in LOH, to be led and learn to lead in this relationship-centered way.  For these ten months I am immersed in a professional learning lab, experimenting with different ways of speaking, acting, and being, safe among fellow professionals also grappling with this skill set.  It just does not get any better than this!

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On my way down from the mountains, I listened to an interview with Bonnie St. John on Ozan Varol’s podcast, Famous Failures.  She is the first African-American to win medals in Winter Paralympic competition as a ski racer; she is a lower extremity amputee.  She is also an author, an entrepreneur, and a former member of the Clinton administration.  Her story is inspiring, please take a listen!  At the end of the interview she describes asking a former coach about how he built champions.  He said he never built individual champions; rather, he built communities of champions.  You can only push one person so far, he said; but an allied group of people will hold one another up, push each other harder, make each other better, take one another farther.

That is exactly how I experience LOH—my best self is challenged and called forth in the most loving and professional way.  We hold space for all our struggles, allowing the learnings (epiphanies, in my experience!) to emerge.  It is deeply and literally inspiring.  Though I already do so much of this inner work on my own, there is a profound and unparalleled synergy from learning in this group—we serve as one another’s pit crew for the journey toward our better selves at work and in life.

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Nobody succeeds alone.  In the series finale of The Big Bang Theory (my favorite TV show of all time, which I missed while at LOH!), Sheldon (the obliviously self-centered genius) finally realizes this.  During his Nobel Prize acceptance speech, he acknowledges his sudden and profound appreciation for his family and friends, crediting his success to their unconditional love and support, and recognizing them in front of an international audience.  LOH made this finale even more meaningful to me than it already would have been.

It is always through the struggles that we grow.  When struggle together, any and all successes are amplified exponentially.  My nine new friends will make me immeasurably more successful, both professionally and personally, than I would ever be without them.  God bless them all, and may the work we do together ripple out for the benefit of all whose lives we touch.

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Training My Better Angels

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First, Happy Mother’s Day to all!

So friends, what do the Better Angels of your nature feel like?  What do they do, how do they speak and act, especially when encountering those with opposing political views to yours?

A New Tribe

Yesterday I attended a skills workshop run by Better Angels, an organization I have admired for a while.  Their stated mission:

Better Angels is a citizens’ organization uniting red and blue Americans in a working alliance to depolarize America

  • We try to understand the other side’s point of view, even if we don’t agree with it
  • We engage those we disagree with, looking for common ground and ways to work together
  • We support principles that bring us together rather than divide us

On the garden level of a Lutheran church on a drizzly afternoon, we sat quietly in a big circle of folding chairs.  I noticed one black woman, one other Asian woman, and everybody else was white.  Most of us were at least Gen Xers; I estimated maybe one third were Baby Boomers.  It seemed about equal numbers of men and women.  Among the 30 or so participants, 6 of us identified as ‘red-leaning.’  The moderators set a clear and firm expectation that we all respect one another, and especially attended to those in the political minority.  As the facilitator explained the objectives and skills, people listened attentively.  Expressions and postures demonstrated eager engagement.  A sincere and almost sad, desperate longing for bipartisan connection permeated the air.

We were all there to practice listening skills to help one another feel heard.  Speaking skills would also be taught, to facilitate ourselves being heard by our counterparts.  Though I felt confident in these skills already, I looked forward to strengthening them in a new group setting.  When I saw we would do role plays I got super excited!  The method, designed by family therapist Bill Doherty, was brilliant—we paired with a same-color partner, and took turns playing blue and red, challenging ourselves to resist judgment, stay open, tune in to our own and each other’s whole presence, and imagine the minds of ‘the other side,’ inviting all of our whole selves to connect.  The central objective was to create an atmosphere of openness, non-judgment, and balanced, mutual engagement.

The Spark

Even before the activities started I thought, “I want to learn how to lead this.  I want to participate, to contribute in a bigger way.”  So when they invited us to stay afterward if we were interested in moderator training, I practically leapt out of my seat.  Turns out you have to apply—no problem—and good, they have standards, yay!  Once accepted, you complete about 15 hours of online training and a Zoom call with established moderators.  Then you commit to moderating three workshops in the coming year.  Woo hoooooooooo!  There are only 8 moderators in all of Illinois, all from north of I-80.  Better Angels holds firm a 50/50 ratio between red and blue volunteers, and disproportionally more blue folks apply, so I may have ‘competition.’  That’s okay—we’re truly all on the same team here!

Ready, Set, Wait–I’ Got This.

When I got home and opened the application, I hesitated a moment.  They seek, first and foremost, volunteers experienced in group facilitation.  Yikes, I don’t have that, I thought.  And yet I felt intrinsically comfortable in that group setting, imagining myself co-leading with relaxed confidence and grace.  Huh, interesting.  I own this communication skill set, as well as the ability to teach it—I feel eminently qualified for this role.  Where did I get that?

Part of the application required a condensed resume, so I pulled up my CV.  Maybe I’ll find something in here to make the case that despite my lack of group facilitation experience, I’m still qualified, I hoped.  I laughed out loud when I realized, I have been facilitating groups for ten years now—every month with my medical students, discussing topics like professionalism, medical errors, burnout, difficult patients, and interacting with industry, among others.  I’ve also conducted workshops teaching motivational interviewing, the quintessential skill set in open and honest dialogue!  In all of these settings it’s my job to make the environment safe for candid discussion, to model non-judgment and open, honest questions.  I lead role plays in which people take on both patient and provider roles to practice empathy for their counterparts.  I have written on this blog multiple times about how much I learn every time I meet with these groups.  No wonder I felt so at ease in the workshop yesterday, I’ve been doing this—training my and others’ Better Angels—for a decade already, and I did not even realize it.  How cosmic.

So my application is submitted!  I should hear in 15 days.

* * *

Friends, would you consider joining this group?  What are you curious about?  What makes you hesitate?  Who in your circles would be great at this work, and will you share this information with them?

Thank you for reading, and wish me luck!

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.

*****

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.