Not Just Words

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Friends, it’s been another week of observing, processing, learning, and integrating.  Holy cow, I really need this vacation.  I need nature, time with family away from work, away from the news.  I need to take a breath.

Things feel different this time.  I think this cautiously; I allow it—hope.  Change will be incremental and slow, but I feel a real acceleration today.  Equality is an infinite game, and we who play to advance it find ourselves in a moment of palpable solidarity and purpose.  But what comes next?  What will the field look and feel like at the end of the summer?  In a year?  In ten years?  When my kids are my age? What progress will we look back and see, initiated in this movement of 2020?  How can we make this a turning point?

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Stories

First, we must seek to understand the scope and nature of the challenge.  For many of us this means listening.  “Facts don’t change our minds.  Friendship does,” James Clear writes.  We humans are not rational, logical beings at our core.  We change our minds when we can relate to someone else’s experience, and the best way to do that is to listen to their stories.

Here are some stories that moved me this week:

Reflections of a Token Black Friend by Ramesh A. Nagarajah:  I think back to when my friends never understood why I wasn’t allowed to play with water guns — or any toy guns, for that matter — when I was a boy. I’d be so excited to visit a friend’s house and use their airsoft gun in the backyard. I used to get so frustrated when my mom told us it was “too dangerous” for black boys to do that and that someone would mistake it for a real gun. When I was 16, 12-year-old Tamir Rice was shot and killed while playing with a replica toy airsoft gun. I realized my mom was right.  …I think of the way the black girls were treated as second rate in high school. Guys rarely tried to talk to them romantically, and if they did, others discussed it with an undertone of comedy. I never felt this way, personally, but didn’t realize until college that my silence was compliance. I was participating in denying dignity to the black women around me.

A passionate and powerful video by Kimberly Jones, author of I’m Not Dying With You Tonight, which is now in my queue.  Listen and watch to the end.  Embrace the discomfort.  Whatever you experience in these few minutes is nothing compared to what Black people have suffered for generations.  Then mull over her last sentence.

A heartfelt and important essay by Dr. Marie Ramas, on her role as a Black woman primary care physician during a pandemic:  Once again, as a healer working in a system seemingly based more on economics than wellness, I felt forced to make an impossible ethical decision. Then, I realized that the underlying question for me to answer was not whether I would treat individuals at the risk of my own self. Rather, I needed to pan out my scope of view and ask, “How can I help rebalance the scales of justice to reflect the inherent worth of the black and brown lives that I both serve and represent?”

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The Sensational Six:  Six Black women graduated from the pediatrics residency at Washington University St. Louis this month.   Follow the link to read the 7 consecutive posts about these remarkable women, and look for their mark on our future.  Their names are

Fehintola Olaiya, MD
Stephanie Diggs, MD
Frances Annan-Fohtung, MD
Mia Henderson, MD/PhD
Olivia Beaubrun, MD
Tobi Olayiwola, MD

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Connection, Action, Accountability, and Togetherness

The goal of all this seeking and listening, of course, is Connection.  The only way to get to shared humanity—true connection—is stories.  And the only way to stay in the infinite game fighting against structural racism is to play together, team members rotating on and off the field.  The metaphor of a choir holding the prolonged single note, strong and clear, by staggering each person’s breaths, applies here.

The team is huge—every one of us has a role to play and a contribution to make.  What Actions can we each take?  Here is a list of 75 to choose from.  Start now.  No action is too small.  Do it sincerely, consistently, and with integrity.

How will we hold each other Accountable?  Company after company declares their opposition and intolerance to racism.  “It’s all words,” as one Black woman told me bluntly.  We need metrics, goals, and transparency.  Medical schools must recruit more students of color.  Companies must promote more people of color to designated leadership roles.  Citizens must demand of our legislators to address systemic and institutionalized discrimination, to give it tangible consequences that motivate change.

Most importantly, we must do the deep work of ferreting out where bias hides in our institutions, understanding clearly how it impacts our practices for the worse, and then reworking our systems to eliminate, or at least moderate, those negative consequences.  The legend of the Boston Symphony Orchestra’s blind auditions can instruct us here.  We can claim success when we see people of color represented proportionally in leadership, policymaking, and all of the most influential and impactful aspects of our culture.

We have so very far to go.  But at least it feels, for the time being, that more of us have opened our eyes to the path ahead.  And rather than turning (running) away, we turn toward—Together.  We find each other’s hands and grab on, holding tight.  We take one tentative step, then another, and another.

If we keep walking, together, we will make progress.

Rallying for Reentry

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We’re baaaaaaack…  Sort of.

After ten weeks sheltering and working mostly remotely, the primary care team I lead will phase back into regular office hours this week.  What a long, strange trip it’s been!  And it’s nowhere near over!  But the next chapter begins, and we are ready.  We return with limited staff, all spaced, masked, and sanitized.  We have planned for weeks and done our best to anticipate hiccups and pitfalls.  Now it’s time to dig in and execute.  Exciting!

And maybe a little scary?  We will have minimal face to face appointments in the beginning, but as with businesses and services across the country, we will ramp up over time.  How will this affect and be affected by coronavirus infection and illness rates going forward?  What will flu season look like, while we continue mitigation efforts for COVID-19?  Despite the multitude of models, nobody can say for sure.  And still we must move.

So what’s a leader’s role here?  How can I best serve my team as we step boldly back onto the path, besides planning and execution of operations and logistics?  Now more than ever, I must be both clear and adaptive about my leadership—its meaning, influence, and potential.

This weekend some strong feelings emerged to center, ground, focus, and guide me.  Interesting, isn’t it, for my professional peace to rest so surely on emotions?  The cognitive knowledge that my own leaders have my back gives me confidence and reassurance—I trust them.  I trust us all to flex and adapt as our collective situation evolves.  One could argue that trust itself is, by nature, more limbic than rational.  And such is the human condition—we are emotional beings who think, not the other way around.

So I embrace and anchor to my positive emotions.  I can moderate turbulence with solid intellect and steady spirituality.  I believe good leaders do this visibly and vulnerably—they lead by example.  Right now we all need to manage through a morass of complex feelings—to identify, accept, and allow their passage through us.  This is how we take care of ourselves and each other, and get the work done.

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Pride

I could not be more proud of our team.  Like so many cohesive teams in an emergency, we pulled together, reorganized, and mobilized like champions.  Computers were set up at home, schedules rewritten, tasks redistributed, and personnel reallocated.  Folks overcame fear and anxiety, at times severe, to help other departments, learn new skills, and grow into leaders themselves.  They made connections across the health system and broadened perspectives that will now benefit our whole team.  We supported one another through semiweekly touch points, instant messaging, photos, stories, and some tears.  I have no doubt that we can not only navigate but crush this crisis arc, and emerge a stronger, even more cohesive version of ourselves.

Protectiveness

As clinical director, I appoint myself chief cheerleader and den mother.  Through various channels, it’s my job to keep a finger on the pulse of morale and engagement.  And while I hold the team up to its own standards of integrity and accountability, I also keep a vigilant eye for assailants from outside.  As we prepare to reopen, I consider how I will protect my team from abusive patients.  I think the risk is low, but what if someone refuses to mask or submit to temperature screening?  What if they become aggressive or belligerent?  Our team has cultivated empathy and compassion, especially for patients who feel anxious and sick.  Still, I will not compromise our safety for someone’s angry outburst or agitation.  We have a plan for handling such situations that will never tolerate physical confrontation or humiliation.

Loyalty

We’ve been through a lot together the two years I have been back on this team.  Turnover was high in 2018, and engagement low.  We’ve since built a culture based on connection and accountability, and this complex work continues—culture work never ends.  Technically I hold an interim position; I am a steward.  But I will not leave until the right successor is identified and groomed.  I’m in for as long as this takes, as long as I am able, as long as the team will have me—I will not abandon ship.

Conviction

Our team has a particular, holistic approach to patient care and relationship.  In order to live this approach for ourselves, we defined our core values a year ago:  Kindness and compassion; connection and collaboration; fun, joy, creativity; and accountability.  I see now that we have an opportunity in this moment to further clarify our mission and vision.  Nothing like a global, existential pandemic to make us reorient and reclaim our raison d’être!

Vision and Execution:  It is the leader’s role to manage both—to host the ball and move fluidly between dance floor and balcony, as Ronald Heifetz and colleagues say.

Let’s get this party started.

Where Is the Light?

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Photo by Tobias Baumgaertner, Fairy penguins near Melbourne, Australia

*deep breath*

I always wonder about you, dear reader.  Where does this post find you, since we last connected?  How are you?

It’s a good practice to check in with ourselves regularly.  These nine weeks of sheltering in place have exercised my patience, awareness, and identity, among other things.  What have they done for you?  How are you?

For a couple weeks now I have felt all but overwhelmed by darkness.  Infection and death rates have slowed, but they will continue to accumulate indefinitely.  I worry that we will become inured, calloused, to the human toll.  PPE is still in short supply at hospitals across the country. Thousands of my colleagues continue to risk both their physical as well as mental and emotional lives to care for gravely ill patients.  They leave their families and support networks to become the sole supports for patients alone in the hospital, whose own loved ones may not visit, even in the hour of death.

Mostly I have felt burdened by the fighting.  The shouting, protesting, mean memes, and ad hominem all around me, directed both by and at my friends and colleagues.  Important reflections and insights arose this week that helped me see clearly the internal origins of my distress.  I re-accepted and re-integrated these parts of myself.  I was able to laugh out loud, exclaiming, “How fascinating!”  I know I will necessarily repeat this discovery exercise ad nauseam, ad infinitum—such is life, karma says, also laughing.  But for now I feel lighter, unburdened, more at peace.

So I thought about role models for peace.  I feel so lucky to have so many.  But one in particular shone in my consciousness this week:  Dr. Vivek Murthy, our 19th Surgeon General.  He has published a book, Together, in which he “makes a case for loneliness as a public health concern: a root cause and contributor to many of the epidemics sweeping the world today from alcohol and drug addiction to violence to depression and anxiety. Loneliness, he argues, is affecting not only our health but also how our children experience school, how we perform in the workplace, and the sense of division and polarization in our society.”

I recently watched a live interview with him conducted by Dr. Lucy Kalanithi, widow of Dr. Paul Kalanithi, who wrote When Breath Becomes Air.  I listened with one earbud, watching in my peripheral vision, while hurrying around my kitchen, preparing chicken and assembling a salad, all before rushing to host a Zoom workout.  It struck me that in stark contrast to my frenetic energy at that moment, Dr. Murthy presented only calm and serenity.  He answered every question with love, joy, conviction, and equanimity.  I noticed and marveled.  Then I rushed around some more and got on with my evening tasks.

Looking back, I have felt this serene and loving presence every time he speaks.  He has a way of making everybody in the room comfortable, welcome, and included.  Even if he’s interacting only with a moderator, it feels like he’s speaking to me personally.  He sees me, he gets me.  He cares about me.  In searching for the Kalanithi interview, I came across this lecture and discussion he gave at Stanford University in 2015.  I hope you will take the time to watch (or at least listen).  Notice how he shares stories of his parents, his patients, and people he met during his national ‘listening tour’ at the beginning of his tenure as Surgeon General.  Hear how he sees and knows every one of these people in their whole humanity.  Abraham Verghese, physician, author of Cutting for Stone, and another hero of the profession, moderated the Q&A, and also named Dr. Murthy’s equanimity—his peacefulness.  Notice how Murthy validates questions asked by students and faculty alike.  Observe his humility, juxtaposed with a resolute, unwavering point of view.  Do you feel it?  Does he not inspire you to be a better person?

Dr. Murthy and his wife, Dr. Alice Chen, have written an open letter to us medical professionals, in the midst of this global pandemic.  Reading it, once again I feel seen, understood, and comforted.  I feel true belonging in a proud and humble tribe of professionals, committed to service.  They shine their light on all of us, so we may see the path before us more clearly and walk more confidently, knowing we’ got our peeps holding us up.  This, in turn, gives us the strength and love to hold up others along the way.

I see the light tonight.  It emanates from my fellow and sister humans, and it saves me.

For a little more light, check out this Jon S. Randal Peace Page post with the picture of the penguins.  In it you will read about gems like John Krazinski’s “Some Good News” YouTube series, and Chris LaCass, founder of Pandemic Kitchen, feeding New York City’s homeless.  You can also share your own stories of inspiration and light in the darkness.

Where is your light today?  How will you keep it in front, as we travel this long road together?