The Mark You Make

IMG_2633

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.

IMG_1852

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.

IMG_2498

The Importance of Peer Support

IMG_2151

What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

IMG_1939

When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.

 

On Labor Day

IMG_1530

For a New Position

May your new work excite your heart,

Kindle in your mind a creativity

To journey beyond the old limits

Of all that has become wearisome.

 

May this work challenge you toward

New frontiers that will emerge

As you begin to approach them,

Calling forth from you the full force

And depth of your undiscovered gifts.

 

May the work fit the rhythms of your soul,

Enabling you to draw from the invisible

New ideas and a vision that will inspire.

 

Remember to be kind

To those who work for you,

Endeavor to remain aware

Of the quiet world

That lives behind each face.

 

Be fair in your expectations,

Compassionate in your criticism.

May you have the grace of encouragement

To awaken the gift in the other’s heart,

Building in them the confidence

To follow the call of the gift.

 

May you come to know that work

Which emerges from the mind of love

Will have beauty and form.

 

May this new work be worthy

Of the energy of your heart

And the light of your thought.

 

May your work assume

A proper space in your life;

Instead of owning or using you,

May it challenge and refine you,

Bringing you every day further

Into the wonder of your heart.

 

–John O’Donohue, from To Bless the Space Between Us

 

I know Labor Day is not about doctors, but I’m thinking about all workers and how we each relate to our work.  I discovered the poem above earlier this summer and loved it.  Rereading it this weekend, it resonated even more deeply and I shared it with some friends.  Since taking on a new leadership role about 20 months ago, it feels like I have really lived into these aspirations, as if the cosmos has held this blessing for me a while already.  I was primed for the call; I summoned every skill and insight I already possessed; still the learning curve has proven steep.   And no success is achieved alone!  The steady, honest, and loving support I enjoy from so many humbles me beyond expression.

Our practice recently welcomed new physicians and staff, and I will soon share this piece with the whole team.  Even for us veterans, it never hurts to look at our everyday work with new eyes, as if approaching it for the first time.

I hope O’Donohue’s words above speak to you in your chosen vocation, even if your occupation does not fulfill all of these lofty ideals (it’s kind of a lot of pressure to put on a job).  I wish you work that is much more meaningful than stressful.  If that’s not the case, I hope for you an effective and peace-giving way to reconcile this and find great meaning elsewhere in life.

And I thank you for the work you do, whatever it is.

 

 

Our 5 Fundamental Needs

561512_4331884049855_1855935252_n

 

To Feel:

 

Seen

Look what I can do

This is how I can contribute

See me achieve

 

Heard

Hear my concerns

Take me into account

 

Understood

Validate me

Normalize my feelings

Say you can relate

 

Accepted

Tell me I belong

 

Loved

Participate in the Messy with me

Commit to sticking with me through the hard shit

Let me be my whole self with you

Be your whole self with me

 

Children by parents

Patients by doctors

Students by teachers

Workers by managers

The led by their leaders

Spouses

Friends

 

What if?

 

 

Inclusion and Belonging

IMG_0927

What do diversity and inclusion mean to you these days?

Honestly for me, they mean different things depending on the context in which I think about them.  Cathy the Cynic thinks diversity initiatives too often feel trendy and superficial, like a knee-jerk response to the social pressure to check a box.  Cathy the Optimist believes that those who direct such initiatives honestly see the communal value in a truly diverse and inclusive work environment.

A wise friend recently pointed out to me that inclusion can be a challenge even in a homogeneous group.  “You could have 25 white men in a room and everybody may not feel included.”  So, he said, perhaps we should work on inclusion first, and diversity will come more naturally as a result.  Brilliant!  If we make it safe for everybody to be themselves, no matter who they are, then they feel free to bring their best, authentic selves—it’s a win-win for each individual and the organization.  An inclusive work culture supports and values each person for their unique contributions.  In such an environment, diversity is achieved because people value their differences as much as their similarities.  They live in curiosity and awe, always in a learning stance.  Inclusive cultures seek more perspectives, experiences, expertise, and backgrounds—they cultivate depth and breadth in the humanity of their workforce.  People from divergent walks of life seek to join such cultures, drawn to vibrant cohesion, synergy, and creativity.

This idea marinated in my mind for some weeks until an article from the Wharton School of Business crossed one of my online feeds last Thursday.  It says diversity and inclusion are not enough; we need to cultivate a sense of belonging in our workplaces.  The article quotes Sam Lalanne, a senior vice president of Global Diversity and Talent Management at Citigroup:  “…whereas diversity often gets linked to numbers and percentages, belonging ‘is about how you feel’ when you’re at work. ‘Do you feel valued? Do you feel like you should be there? Do you feel that your insights, commentary and perspectives matter?’”

“Rebekah Bastian, a vice president of culture and community at Zillow Group, said that the superior business outcomes often associated with having diverse teams can’t be achieved without a sense of belonging. It’s not enough to simply include people at the table, she said, but to ‘amplify everyone’s voices, clear barriers … and appreciate each other for our unique backgrounds.’ Both she and Lalanne said that a sense of belonging means that people can bring their full selves to work, and not feel like they’re a different person there than at home.”

A different person.  So what I described above as inclusion is really what these leaders define as belonging.  We want each person to feel they belong in the work tribe, that their presence and contributions are valuable and worthy, as themselves.  When we include, from our hearts, each person in their wholeness, only then will they truly belong.  And that is the sweet spot where teams thrive.

So what do we do?  How do we create such loving cultures of true belonging?  According to panelists quoted in the Wharton article (and we all know this), it comes from the top:  “Lalanne also commented on the importance of ‘tone at the top’ toward fostering a sense of belonging. ‘Our CEO, Mike Corbat, has really pushed us on our diversity, inclusion and belonging agendas. And it really comes from, what does he preach, what comes out of his mouth, how does he execute against the things that we see around us.’”  Simon Sinek calls us to live our values with clarity, consistency, and discipline.  So if you’re a leader who talks about diversity and inclusion, about belonging, then we workers have to see you, to feel you, living these values out loud and in front of us.

Belonging is more about how we are toward each other than how we act or what we do, which is inclusion.  This is the key to successful ‘diversity and inclusion’ initiatives—they must be sincere.  Humans are intuitively social animals.  We smell insincerity and reject it, because it is unsafe.  We cannot trust it.

A garden of belonging must be grown organically.  There are no shortcuts.  It takes time, and the gardener must tend it regularly.  Young seedlings require protection from weather and predators.  She must bring in pollinators and other helpers—one person cannot do it all.  So we can all pick up a trowel and participate.  We look to our leaders to set the path, and when we see the shining hope of our collective destination we follow willingly, eagerly, and together.

There Is a Good “I” in TEAM

IMG_1167

The joke goes like this:  “There’s no ‘I’ in team… Yes there is; it’s hidden in the A-hole.”  The point of the joke is valid:  Self-absorbed and self-serving individuals make bad teammates.

Yes, AND:  There must be certain kinds of I’s on any good team:  Each of us must have a uniquely contributory identity and role in order for our team to function well.  Diversity—of experience, ideas, and perspective—is always the strength of a good team.  Homogeneity leads to extinction in nature.

Also, we all have to get in the same boat and row in the same direction—each of us I’s must join wholly in the We in order for Us to accomplish anything meaningful.  It is the balance of the Good I and TEAM that determines an organization’s success.

The Good I:  Self-differentiation

We all recognize the kind ofI” who makes team life miserable—that person who’s always competing, always one up-ing us, constantly reminding us how great they are, wondering why we don’t notice.  But then there are the I’s whom we respect.  They exude a quiet confidence, speak their truth with grace.  We seek their opinion even, or especially, when we know it will differ from our own.  Anyone on the team could be either of these people: captain, quarterback, goalie, setter, relay anchor, department chair, CEO, professor, senior resident, intern, president.  Standing out for the sake of lording power over others, or advancing one’s own interests at others’ expense, is the “hidden I” in the A-hole.  This is the bad I.

The ability to stand up and out for our core values and integrity, even in the face of anxiety and external pressure to conform, however, is the Good I; it is an expression of self-differentiation.  To do this well, and to contribute to the team as a creative individual, requires self-awareness, emotional and social intelligence, and self-regulation.  In order to self-differentiate effectively, we must work on ourselves, not just promote ourselves.  It’s not about getting what’s ours in a world of scarcity; it’s about owning our talents and claiming our agency to make a unique and meaningful contribution to the whole.

TEAM: Attunement

If all we ever do is work on ourselves, however, without looking up and around, we may disregard important relationships.  I may have an important contribution to make.  But if I cannot communicate my ideas in a way that you understand, or if I come off as condescending, arrogant, dismissive, aggressive, or otherwise unpleasant, I undermine my own effectiveness, and stymie forward progress of the team.

The ability to withhold judgment, seek understanding of and from others, and recognize their unique and important contributions, is the art of attunement.  Simply, it is the practice of awareness and constructive responsiveness to others.  When I am attuned, I know when I need to set context before pitching my idea.  I observe my colleagues’ posture, body language, tone of voice, and facial expressions.  I query for (mis)understanding.  I hold space for open dialogue, debate, and idea exchange.  This kind of resonance, when successful, facilitates the wave propagation of teamwork, and advances objectives faster and more efficiently with the synergy of morale.

Some might see self-differentiation and attunement as opposed or dichotomous—you can or should be one or the other.  Rather, we should consider them as complementary and counterbalancing.  We should each pursue proficiency and mastery of both skill sets, and practice them as both individuals and as whole teams.  I can be both a self-differentiated and attuned leader of my department.  My department can be both a self-differentiated and attuned member of my organization.  My organization can be both a self-differentiated and attuned member of our profession or industry.  And we can all, individuals and organizations alike, be both self-differentiated and attuned members of society at large.

TEAMS get things done when we well-self-differentiated I’s attune to one another and march together on our shared mission—regardless of the size, mission, or make-up of our teams.  Every successful team is made up of individuals who claim their unique strengths, and then direct those strengths in service of the greater good, the overarching intention of the We.

Such harmonious and resonant balance is the quintessential win-win.

Tombstone Words

IMG_1131

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?