November 8:  My Students Make Me Better

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NaBloPoMo 2019

Oh how I love my medical students!

Every other year I meet a new group of about 10 third year students, at the dawn of their clinical careers.  What a privilege!  I lead a monthly small group for a class called Personal Transition to the Profession.  I have written about this honor before, describing how

  1. My only job in this class is to love these students into the amazing doctors they are meant to be
  2. They help me see physician burnout from different perspectives
  3. Their experience of medical culture resonates with my own

Monthly group meetings are just enough to start to know any one person after two years, and then they disperse and I grieve the loss, just until my new group starts.  After ten years of stimulating conversations on professionalism and the humanity of medicine, I still feel anxious about my impact on these bright, insightful learners.  Did I do a good job?  Did I make a difference?  Did their time with me matter at all, or was it a monthly waste of time?

This June, I finally faced these questions head-on during a coaching call with Christine.  What are my strengths, what value do I bring?  How can I distill the central learning objective each month?  How can I connect more effectively?  We settled on some ideas for setting expectations and being more direct about goals and touchstones.  I instituted check-ins at the beginning of each meeting, something I should have started years ago.

This month’s topic was open; students were invited to write and discuss whatever was on their minds.  Blog posts and check-in comments resonated around words like exhaustion, sleep, and longing for connection.  So rather than delve into the content of their writing, I simply asked how I could help.  One student, ever honest and forthright, said, “let us go home and get to bed.”  The air felt heavy, almost forlorn… but not hopeless.  I found myself monologuing a few minutes about appreciative inquiry, and finally asked them, a little desperately, “What is the most loving thing someone has said to you this week?” and then, “or how have you felt loved this week?”

Slowly, small vignettes of connection, meaning, and hope emerged.  The student who wanted to get home to bed had received an email from a former preceptor, whose patient finally started and stayed on much needed antidepressant medication, which the doctor attributed to our student’s contact with the patient during his primary care rotation.  Another’s parents had driven into the city early in the morning to lend her their laptop after she had spilled water on hers.  Other students had connected with family members and friends, who expressed pride and encouragement.  Once again I was overcome with love for these young colleagues, and I could not help but tell them:  I have one job here, and that is to make sure you know you’re loved in your training.  I am not here to evaluate you.  You will all finish, you will all succeed.  In the time I have with you, my only objective is to hold you up in the process.  I made sure they all have my cell phone number.  I encouraged them to call me if they ever need anything.

Two students (and one’s wife) came to my house for dinner tonight.  It was supposed to be everybody, but I neglected to send a confirmation email so people weren’t quite sure if I meant my invitation last month (probably because I had planned for them to come over last month and then cancelled on them that week).  We ordered pizza and salad, I fried some potstickers, and we sat around the kitchen island with my kids, just talking.  We are all nerds.  We love to read, to learn.  S’s wife is a resident at my former hospital, and knows my friends there.  They have a book club there now, and this year’s theme is wellness.  She asked for suggestions, so I lent her my copy of My Grandfather’s Blessings.  She and S also borrowed our season one DVDs of The Big Bang Theory.

Our group will meet at a local restaurant after next month’s class.  We will plan (better) another evening meal at my house in the spring.  In the meantime, I will extend an invitation to each of them to come down if they ever need a break from school, a change of scenery, or just to feel a little extra love.  I have been where they are, and I remember how much I appreciated the empathy and compassion of my elders in the profession.  I still do.

How does this all make me better?  In medicine we talk all the time about the calling to care for patients.  But caring for one another, our colleagues and trainees, is equally important.  It keeps us and our souls whole, feeds us so we can keep doing the work.  My students recharge me, inspire me, and keep me young.  What an absolute honor to know them.

November 5:  Peer Coaches Make Me Better

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NaBloPoMo 2019

When you’re working through a challenge, who helps you?  What is it about them, how are they most helpful?  How not?

Through the years I have learned what I can get from certain people.  I know to call this person when I need validation, that person when I need a devil’s advocate.  I also know which people to avoid altogether—those who cannot be trusted with my vulnerability or confidence.

But when I need to hold space and tension with an issue, to patiently look at it from different angles and process the perspectives, I look to my peer coaches.  I feel gratitude and gladness for these friends today, after my LOH group had our monthly peer coaching call.  As we progress through our 10 month leadership training, we take tenets and skills home from each retreat to practice.  Monthly Zoom calls have no agenda, other than to reconvene, share, and mutually support.  Every time I come away appreciating just a little more how nothing in life—work, personal things, social context—can really be separated from anything else.

These friends are not my first or only coaches, however.  In 2005 I started working with Christine, my life coach.  Every session, 14 years later, is still transformative.  How is this possible?  Curiosity.  Christine coaches every call squarely and unwaveringly from this perspective.  It was not long before I realized how powerfully this method could alter my own encounters with patients.

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The best coaches have no preformed or decisive answers.  They have the uncanny ability to ask the best questions–Open, Honest Questions (OHQs)–which then lead clients to their own best answers.  They help frame and reframe problems.  They point us to alternate perspectives and help us open our minds to narratives other than the ones we too often grip so desperately.  It was my second year in practice when I started asking coaching questions to patients, and I have never since feared any symptom, syndrome, or answer.  When there is no clear diagnosis or answer for someone’s distress, I can just keep asking until something helpful emerges.  Most often it’s not a single piece of information that gives clarity; rather, it’s the story that materializes.  Coaching skills help me help my patients find and tell their stories of health and wellness, illness and pain, agency and action.

Here are the tenets of true Open, Honest Questions, from the LOH syllabus:

  • The best single mark of an honest, open question is that the questioner does not know the answer and is not leading toward a particular answer.
  • Ask questions aimed at helping the other person come to a deeper understanding (help them access their own inner teacher).
  • Ask questions that are brief and to the point without adding background considerations and rationale—which make a question into a speech.
  • Ask questions that go to the person as well as the problem or story—for example, questions about feelings as well as about facts.
  • Trust your intuition in asking questions. Inviting metaphors or images can open feelings, new lines of thinking, and unexpected possibilities.
  • Try to avoid questions with yes-no, right-wrong answers.
  • Avoid advice disguised as questions.

My best friends are my peer coaches.  And now I have my LOH cohort-mates.  We make no judgments about one another’s circumstances, feelings, or experiences.  We make the most generous assumptions about our motives.  Our role in each other’s lives is almost never to give advice; rather it is to hold space, listen reflectively, offer moral support, hold up core values, and help one another query thoughtfully and honestly.

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Questions asked and reflective statements made on the call today:

  • If you left work tomorrow with enough money to be unemployed for 6 months, what would you do?
  • How does it feel to speak (your issue) out loud?
  • When you think about current state compared to past, how does it feel physically in your body?
  • Sounds like you’re working on a core tension.
  • What do I/you want now?
  • What’s roiling around in you?
  • Who around you can get creative with you?

We each bring diverse questions and challenges to each call.  But somehow we always relate deeply, and listening/querying helps us each learn from every other.  Today I saw central themes emerge around identity, contribution, voice, and meaning.

In the end, I think there are few things more important in life than meaning and connection.  These are the gifts from my peer coaches, and they always make me better, no question.

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The Mark You Make

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Friends, Ozan has written another book!  I know it may seem like it, but he’s not paying me to promote his work, really!  He has offered perks for Inner Circle members, however, like an advance digital copy for preordering, and signed copies when the book is released next April.  In considering what I would ask him to inscribe to my friends in the books I will give them, I realized yet another evocative dimension of my relationships.

If you were to describe your friendships to a third party, or make a meaningful introduction in service of connecting two amazing people, what would you say?  I call it ‘connecting fellow Awesomes,’ and it’s always a pleasure and privilege to serve in this capacity.  I thought to ask Ozan to write to one friend something like, “Cathy thinks the world of you—happy to make such a positive new connection!”  Then I thought, this friend has really made a mark on me.  Then I thought of the mark Ozan has also made, in just 9 months of virtual contact.  And then my mind was blown with the realization of my cosmically marked-up self—the finger, hand, and footprints of all those whom I have contacted.

Years ago I attended the orthopaedic surgery resident graduation dinner with my husband, a happy and fun annual event.  At the end, mingling with faculty and trainees, one of the graduates looked at me and his eyes widened.  “You’re Dr. Cheng!  You were my teaching attending during my third year medicine rotation [7 years prior] at [the hospital where I used to work]!”  I was gratified that his expression was cheerful, rather than distressed or awkward, surprise.  He went on to tell me that I held the team to a high standard of discussion, and that he appreciated my presence and teaching.  I will always remember this encounter with pride and appreciation.

In the past year three patients from my past have resurfaced and told me the positive difference I made it their lives.  I remembered two of them so clearly, both their faces and their names (after 20 years and thousands of patients, I can usually only remember one or other).  Talking to each of them reminded me of all that we had been through together, and I was glad that I had done my job well.

But what about those for whom I have not been a great doctor?  I have had my fair share of patients who left me, for various reasons.  I know I have been seriously disappointing for many.  I wonder how many times I have contributed to patients’ negative overall experience of medicine, and further widened the divide between doctors and patients in our fraught and flawed healthcare system?  Sometimes I look back on my early years of practice and cringe a little—all the writing I do now on empathy, compassion, curiosity, openness, and humility results from years of lessons learned in real time, on real people.  I’m definitely much more adept at it all now than in the beginning.  And I’m still learning—I still get triggered, still fall into old, counterproductive thought and behavior patterns.  Sometimes it feels like I will never be good enough, or enough in general.

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I also think about the people whose marks on me were/are hurtful, dismissive, and otherwise wounding.  It reminds me of carvings I see in the trunks of the beautiful aspens I walked among this weekend.  Did the folks who made them set out to harm the trees?  If they thought the tree might die from their knife marks, would they think twice?  Maybe they were overcome with their profound experience in nature and just wanted to mark it in some way, especially if they shared it with someone they loved (so may initials with plus signs and hearts)?  Sometimes we just want or need to be right, competent, respected, and acknowledged.  So we mark our encounters with stubbornness, aggression, or even violence (in its many forms, overt and cloaked).  Like the strong and flexible aspens, I bear scars from such encounters and still continue to thrive.  Such marks have taught me how to care for myself, and also how not to be toward others.

In the end, how do I reconcile these relationship phenomena?  Sometimes we can see and know the mark we make on others.  Many times we cannot.  Nobody is perfect.  My whole life I will scrape and nick those around me, hopefully never with malicious intent.  I can only hope for their generosity and grace, and forgiveness.

Sister Brené Brown, once again, helps me continue.  In her book Rising Strong, she describes a choice, a mental attitude, that can help us all suffer less.  If you have not read or heard the book, I highly recommend it—it’s my favorite of the 5 of her books I have read.  Assume, she says (with the help of her pediatrician husband), that we are all doing the best we can.  That’s it.  We are all imperfect.  Our circumstances mess with us, our patterns mess with each other, and sometimes it can feel like a strange and inexplicable miracle that we have not all killed one another already.  But choosing to give each other this one, simple, and at times colossally difficult benefit of the doubt, could be what saves us all.

We simply cannot extricate ourselves from each other.  So we can just do your best to take care of one another.  And be prepared to apologize, early and often.

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