See, Do, Teach

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NaBloPoMo 2018:  What I’m Learning

When did you first notice you were led well?  Who was it, what was the circumstance?

See

I was in 7th grade math class.  The teacher was Joe Alt.  I met him 33 years ago, when I was 12, and I still consider him one of my greatest and most important mentors.  He could teach anything and make it interesting, and we learned not only math and science, but how to be good people.  In a class that included both uber-nerd me and ultra-headbanger dude, he helped us both to see each other as people and get along so we could all learn.

Later I would find leadership role models in my athletic coaches, professors, program directors, committee colleagues, and hospital administrators.  At their best, these people were/are:

  • Attuned
  • Empathic
  • Reflective
  • Articulate
  • Intrinsically Motivated
  • Actively Engaged
  • Personal
  • Approachable
  • Genuine

I have also studied on my own, seeking guidance from sources like Benjamin and Rosamund Stone Zander, Simon Sinek, Brené Brown, Daniel Goleman, Chip and Dan Heath,  Rachel Naomi Remen, The Harvard Business Review, most recently Anthony Suchman, and, soon again, Marcus Aurelius.  I’m always looking for the next new or old related idea, the next dot to connect in order to draw my leadership map with more depth and detail.

Do

Recently I asked a new mentor what books he likes to read about leadership, organizations, etc.  He said he reads some, but prefers to simply do, always learning, adapting, applying, and evolving along the way.  I have had small leadership roles at school and work, in my professional society, as well as in my community, over the years.  They have all given me tremendous opportunities to practice what I read.  More and more, I see the value in getting my nose out of the books, looking up, and stepping forward.

Teach?

I spoke with a high school freshman athlete recently.  She plays two sports, both teams comprised of both upper and lower class(wo)men.  She contrasted the coaches’ personalities and styles, and how she learns about the respective sports as well as teamwork, integrity, etc.  We noted how much better it feels when the coach knows you personally, and pays attention to your state of mind as well as your performance.  The team with the less attuned coach will soon choose a captain for next year.  It’s usually a senior, perhaps regardless of leadership skill or potential.  She described the various candidates to me, and why she thought they would be good captains (or not).

I asked her whether the team feels like a true team, or more like just a group of individuals.  She said right now, it’s the latter.  I asked how she would show up if one of the less desirable candidates were named captain.  She had not really thought about it other than to continue working on her own sports skills.  I then found myself offering copious unsolicited advice:

You have a few choices, I told her.  First, you could remain an individual, holding your own goals as primary.  You may or may not improve, your team may or may not do well, and your personal contribution to the success of the whole will be proportional to your own individual performance.  Second, as you progress in your skills and newer kids join the team, you can help teach and mentor them.  You could observe the new captain, identify her weaknesses. If possible, and if you’re so inclined, you can fill in the gaps for the team—lead from within the pack.  You could help build morale, create a true team from its inside, cultivate relationships that will make the whole greater than the sum of its parts.  You could set your sights higher than your own personal achievement and really help the team succeed.  Third, you could take it to the next level by cultivating an advisory relationship with the captain herself.  If you have her trust, and exercise tact, you could help her see and maximize her strengths, navigate around her weaknesses—you can ‘coach up.’

The latter choices are, obviously, harder and more labor intensive.  I would also argue that they would make membership on the team exponentially more meaningful for everybody.  By serving as a connector among teammates (with boundaries, realistic expectations, and self-care, of course), this young athlete could make connectors of her teammates, too.  And a few years from now, if she herself is tapped to lead, she will have already earned her peers’ respect.  They’ll follow out of course; it will feel only natural.  And, they may then already be the cohesive team that she really wants to serve as leader.

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These ideas poured forth in a torrent of consciousness, forming sentences before I could actually think them.  As happens so often, I found myself saying words, advising someone else, that I myself needed to hear at exactly that moment.  Most of the time it’s about eating, sleep, or exercise.  This was an A-ha! moment on my personal leadership journey.

Now I see the true meaning behind the phrase, “See one, do one, teach one.”  It’s not about becoming a teacher.  It’s about always remaining a student, because the best way to truly understand anything is to try teaching it.

See, do, teach.  It’s not linear.  It is, no question, completely cyclic.

Culture of Medicine, Part II

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NaBloPoMo 2018:  What I’m Learning

So, what did you think of how trainees described the Culture of Medicine?  If you’re in medicine, how much did you resonate?  If you’re not in medicine, how much were you surprised, or not?  How do you think this affects our relationships with you, our patients?

Do you wonder how we get through any given day?

I asked the group:  What are characteristics or traits of Culture of Wellness (COW) Leaders?  Once again, I present their responses here, in order of discussion.

  1. “They ask how people are doing.” They are proactive about it, opening the door, making it safe to talk honestly about how we really are doing.  They exhibit the ‘body language of listening.’  It’s still hard to talk about it, one student pointed out.  The best leaders explicitly carve out time to talk, to invite feedback.  It also matters what they do with the information once they get it—empathizing and acting on it if needed, rather than dismissing.
  2. Mentor. This is someone who knows you and whose role it is to help you ‘unconditionally,’ different from any of your evaluators—maybe an advisor.  It can be an informal relationship, maybe just someone you want to emulate.  Trainees agreed that it often happens organically, and they seek it actively.  One resident identified her program director as ‘absolutely a COW leader.’
  3. Walk the Talk. Examples: work/life balance/integration, acceptance of mistakes, admitting when you don’t know something.  NO DEFLECTING; OWN YOUR SHIT.  This one hit home with me—this is Integrity.  As Brené Brown says, integrity is “choosing what’s right instead of what’s fun, fast, or easy.  It is living your values rather than simply professing them.”

The next several descriptors emerged in a flurry.  The atmosphere in the room swelled with positive energy as one label after another of what we admire about our teachers and colleagues overtook the downtrodden mood just moments before:

  • Consistency
  • Proactivity
  • Openness
  • Empathy
  • Personally engaged
  • Curiosity
  • Caring
  • Kindness
  • Vulnerability—willing to share
  • Positivity—seeing mistakes as learning opportunities. Encouraging—“We’ got this!”
  • (Understand the importance of) Food: attending to physical needs
  • Humor—acknowledging the challenge and weight of the work and also holding it loosely
  • Validating
  • Appreciative
  • Grateful

The last one triggered a story.  One student rotated on an inpatient service.  Critically ill patients poured into the hospital; all work hour restrictions were necessarily violated.  Nerves were more than frayed, and people were at their worst.  He witnessed open hostility by senior residents toward interns, backstabbing, undermining.  The attending, present only minimally, was oblivious.  And, “They never said thank you.”  The student, who had planned to enter this field, considered switching.  It was that bad.  But somehow, he was able to get perspective and remind himself that this one bad experience did not represent the whole of this specialty.  It had been an unusually busy month at the end of a long, hard year.  Maybe the cumulative exposure to some of his COWL role model traits had rubbed off, and buoyed him when he stepped onto a leaky boat.

A senior student admitted that when she started medical school she had heard of burnout.  “I initially didn’t believe it could happen to me…  Then later I realized it can happen to anybody—it could absolutely be me, if I don’t take care of myself.”  I asked what that means, taking care of yourself?  They answered:

  • Sleep
  • Nutrition: “Any food your intern year; choices matter more when you’re PGY (post graduate year) 3!”
  • Outside interests
  • Finding a practice situation that fits: eg caring for the underserved, women’s health, hospital medicine, etc.
  • Find Your Tribe. The trainees did not use these words, but this is what I wrote in my notes—they expressed a need for belonging.
  • People at work: truly collegial relationships, especially across specialties
  • Confidants: safe people to share with, your emotional support network
  • Physician-Patient relationships: mutually vulnerable and open

I asked them what they needed to take care of themselves.

  1. Purpose
  2. Time—to be given by the system, and also to be responsible and efficient with themselves.
  3. Habits—established and also adaptible

Overall the discussion felt productive and successful in the end.  We had just mapped out the way(s) to Be The Change we seek in our profession.  Some of them took pictures of my notes (so Millennial), which made me feel gratifyingly connected.  I had tried to question more than lecture, to explore and facilitate more than ‘teach.’  I wanted each of them to own their own path to leading from any chair, now and forever.  I proposed that they could start the moment they walked out of the conference room door—no elevated status or title necessary.

This is why the calling still resounds compellingly, why our enthusiasm for the work persists resolutely, despite the hardships.  It’s Hope.  And at its foundation lies the bedrock of our best relationships—with ourselves, with one another, and with our patients.  On the march toward a true Culture of Wellness, real leaders go in front and set the example.  The rest of us learn by mimicking.  Thus we all have leadership potential and, dare I say, responsibility.  We are the system; we make the culture—each and every one of us makes a unique contribution.  Nothing we do is too small to matter.

Onward.

What The Best Teachers Do

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NaBloPoMo 2018:  What I’m Learning

The post last night was a long time coming, maybe.  It took longer than I thought it would to actually write, edit, and publish, but it poured out in a flurry of energy that has built up over several months.  I received immediate feedback from members of my Counsel of Wisdom, supportive and encouraging, gratifying.

As I thought more, I realized that my best teachers growing up practiced emergent design and strategy.  Imagine you teach the same subject, the same skill, the same content, year after year.  Your approach is to do it the same way, expecting the same result.  Would you not get bored?  And if you’re bored, no question your students may want to gore their eyeballs out with their writing implements.  In medical school my classmate and I met a physician in his office for a lecture on his area of expertise.  We sat across from him in his big armchair behind a mahogany desk piled high with papers in disarray, the sun shining through the window at his back.  He spoke in a slow, bass monotone.  The words that dribbled forth practically fused together, such that I strained to distinguish and make sense of them.  And I kid you not, he literally put his elbow on the desk and rested his face in his palm while he spoke, as if he may have a near death experience from the sheer dullness of it all. That was not his best teaching moment, I’m sure he would agree.

My best instructors, on the other hand, engaged us learners in real time, with rapt energy.  They asked us what we knew about the topic, encouraged us to consider and describe how core principles applied in real life situations.  In classrooms, my best teachers were both goal-oriented and open-minded.  They had a clear learning objective but held the map only loosely. They allowed space for the learning journey and path to unfold before the class, always with an eye on the destination. We learners all got to choose the way, and we still ended up where we needed to be.  And every time I bet it was a little different for the teachers, so it was fun for them and they always learned, too.  I know that’s how it feels for me.  That’s what keeps any of us engaged and improving, I think—the confidence of knowing we hold the reigns coupled with the excitement of not knowing which new trail our class will blaze to apprehend the learning.

My Counselor friend described it as, “The map becomes a new and storied journey with each iteration of participant-cartographers.”  Is she not eloquent?  I have invited her to write a post with me soon.

Coach Christine reminded me, “What you describe is coaching at its best – the fundamental philosophy of the coaching I’m trained in is, the client is naturally creative, resourceful and whole. Not broken, doesn’t need fixing.  Capable of digging deep to find the answers within themselves, and /or where to find the help they need.”  Creative, resourceful, and whole.  I had not heard or seen those words in this context in a long time.  So grateful for the reminder—Thanks, Christine!

What are you teaching these days?  How might you hold your leadership map more loosely and allow those you lead to point to a new or different way?  What might you all gain in the process?

I Hurt My Friend Today

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NaBloPoMo 2018:  What I’m Learning

Bummer, it’s no longer November 8.  Well, that’s the humbling kind of week it’s been.

I sat in a meeting with a friend today.  I expressed a perception and opinion about an issue on which she and I have divergent perspectives.  It was early morning (not my best time of day), and I was still emotionally hung over from yesterday.  I spoke up more and louder than usual and may have been a bit aggressive—not toward her or anyone personally, but about my opinion.

Afterward I asked her, “Was I too bitchy?”  I was querying her impressions of how my words and expressions landed on others.  Turns out I had really hurt her personally, and I had no idea.  The fantastic news is this friend shares my values of honesty, empathy, and open communication, so we talked it through in the afternoon.  Even though we had discussed the issue before, today we took more time.  We each listened hard and heard, more clearly than before, details about how decisions were made and how messages were received and perceived.  We dug deeper into underlying snags in relationships between groups, the culture and mindset of team members, and the dynamics that basically hamstrung everybody’s best efforts in the situation.

In the end we agreed that we’re all doing the best we can, and we also have a lot to learn from one another.  We acknowledged that there is room for everybody to own their shit a little more, and that calling a ‘my bad’ and ‘do-over’ of some parts may be the best way to make amends and move forward with more trust and cohesion.  We agreed that we could all benefit from more conversation, acknowledgement, transparency, empathy, attention to people’s feelings and mindset, and mutual understanding.  We brainstormed about what that all might look like; I got kinda excited.

At the end of the conversation we congratulated ourselves on both our courage to give each other some hard feedback, and how we were able to listen with love and generosity of spirit.  Maybe it was easier because we are friends.  But it’s the practice when it’s easy that prepares us for when it’s hard, right?  I’m so proud of us; we really lived into our best relationship potential today.  We walked our talk.  Nobody witnessed it, but we know what we did.  [fist bump, high five emojis]

Here’s to friends holding each other accountable for the consequences of our words and actions, and upholding each other to be our best selves. I wish you all more friends like this.

Diversify Your Network

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NaBloPoMo 2018:  What I’m Learning

Are you friends with a plumber?  My friend Dennis is, or was, as of c.1997.  I forget his friend’s name, let’s call him Frank; they knew each other in high school.  Dennis and I were both medical students when I met Frank.  Looking back he must have thought I was a little strange.  I asked what he did for a living, and when he told me he was a plumber I interrogated him, hard.  “What’s that like?  How do you train, is there a school (I was a straight-through biology pre-med who knew next to nothing about trade schools)?  What are your hours like, are there days when you don’t work?  How do you figure out what the problem is?”  I was just so curious—I had never met anyone who did that kind of work, and it was so different from anything I knew.  He didn’t talk to me for long.  We were at Dennis’s birthday party and Frank quickly found other friends to connect with.

I’m so grateful to work in medicine, where I get to meet people from all walks of life every day.  In the exam room I have met coders, lawyers, teachers, construction workers, professional dog walkers, stylists, food critics, financial columnists, hedge fund managers, engineers, HR directors, leadership coaches, musicians, and myriad others…but I can’t remember any plumbers.  I love when I have time to ask, “What’s that like?” and “What do you spend your days doing?”  I always learn something new, and the best days are when I find some parallel between our work lives.  My husband the orthopaedic surgeon remembers patients by their x-rays.  I remember them by their social histories.

The Harvard Business Review sent an article to my inbox today entitled, “How to Diversity Your Professional Network.”  It cites studies that show “people who are connected across heterogeneous groups and who have more-diverse contacts come up with more creative ideas and original solutions.”  Reading it triggered an avalanche of memories and cognitive dot-connecting, hence my story about Frank.

First, I’m reminded of my first coaching call after accepting my new role at work.  Coach Christine asked about my ‘allies,’ the people whose counsel I value and who will hold me up and accountable through the growth process and pains that are leadership.  She pointed out that allies are not always people who agree with me.  They can be my challengers, my opposition, my rivals.  Through them, I am forced to grapple with my own integrity; they serve as the crucible for my values.  This idea helps me stay open to people whom I might otherwise dismiss.  Diversify.

Second, I remembered of The Big Sort, by Bill Bishop.  It’s thick with data and research, but the part that struck me hardest was the idea that our ideology becomes more extreme when we spend time with like-minded people.  I suppose you might think, well yeah, duh.  But when you consider how this affects decision making on the individual, community, and policy levels, it’s a little scary.  In his description of research by Cass Sunstein and colleagues, Conor Friedersdorf writes:

But for all the benefits of agreement, solidarity, and spending time with like-minded people, there is compelling evidence of a big cost: the likeminded make us more confident that we know everything and more set and extreme in our views. And that makes groups of like-minded people more prone to groupthink, more vulnerable to fallacies, and less circumspect and moderate in irreversible decisions they make.

Groupthink.  That reminded me of Originals by Adam Grant, a book I have listened to at least twice now.  As I have thought incessantly about culture and how to nurture a healthy one where I work, Grant’s advice on hiring for contribution rather than fit holds my feet to the fire:

Emphasizing cultural fit leads you to bring in a bunch of people who think in similar ways to your existing employees. There’s evidence that once a company goes public, those that hire on cultural fit actually grow more slowly because they struggle to innovate and change. It’s wiser to follow the example from the design firm IDEO, and hire on cultural contribution. Instead of looking for people who fit the culture, ask what’s missing from your culture, and select people who can bring that to the table.

So what does all this mean?  I have decided to take it as validation of my curiosity and desire to learn as much as I can from a vast array of different people.  Whether I know them socially or professionally, whether our diversity is race, culture, politics, religion, or music preference, there is always something that connects us.  The search and exploration are what make life colorful and fun.

I wonder whom I’ll get to meet tomorrow?

The Hard Conversations

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NaBloPoMo 2018:  What I’m Learning

Life is about learning.  Learning requires acknowledging lack of skill, knowledge, understanding, or all three and more.  Boundaries, curiosity and non-judgment make it so much easier; too bad we tend to lose these natural traits (or they are trained out of us) early in life.  Then we have to relearn them as skills.  What happens when we reacquire boundaries, curiosity and non-judgment?  We get much better at having the hard conversations.  What makes conversations hard?  Not sure?  Just think of the conversations we avoid.  What are we actually avoiding?

I resist apologizing when I don’t want to admit that I misunderstood, that I made wrong assumptions that led to behaviors that hurt people, that I was not my best self.  I worry that people will think less of me and not trust me, not include me in the future.

I avoid giving negative feedback because I don’t know how the other person will take it.  Will they crumble in a heap of self-flagellating despair?  Will they lash out and attack me, verbally or physically, threatening my safety?  Will they disparage me to others, try to split our colleagues between us, sow discord and undermine our culture?  I worry that I will lose control of the situation.

We resist conversations about politics, religion, and issues like abortion because they can escalate in a nanosecond, filled with emotional tumult.  These are precisely the exchanges during which we blow past all of our boundaries for civility, language, tone of voice, and rhetoric.  We lose all interest in understanding what the other person thinks or, more importantly, how they feel.  We stop relating.  We judge everything out of their mouths as oppositional, ignorant, and unworthy.  We worry that we will lose our status, self-efficacy, agency, or our friends.

* * *

My friend Earnestine * has migraines.  Over the years she has worked out their patterns: timing, location, aura, duration, and triggers.  She hydrates, protects her sleep, and, most importantly, manages her stress with vigilance.  This way she generally avoids medications and keeps her symptoms under good control.  Recently she got caught in an unavoidably stressful situation with family.  A migraine hit her like a Mack truck out of nowhere.  She could barely walk, stumbling around, hanging onto walls and railings.  Her speech may have been slurred.  Thankfully she was able to escape to a friend’s house.  Her childhood friend, also a sufferer of headaches, offered her a handful of pills—her own prescription medications.  Earnestine struggled for the right words, and not just because her head was splitting.  If she refused, would she offend her friend, who has just rescued her from serious family chaos?  Would she trigger indignation, anger, resentment, rejection?  E found her personal values and boundaries tested, unexpectedly.  She felt ambivalent, as the core values of connection with a friend and right use of substances clashed.  She desperately desired relief from her pain, and she also needed to set an example for her boys, who were watching her response—what would she want them to do if one of their friends offered them ‘relief’?  Somehow through the fog, she found a way to acknowledge her friend’s generosity, and also explain that she was not comfortable taking someone else’s prescription medication.  She maintained her boundaries and stayed curious to monitor her friend’s and her boys’ responses.  Since that time, she continues to hold her friend in non-judgment, understanding that although she would not ever do the same, her friend’s intentions were loving.

I tell this story because I see it as a perfect example of boundaries, curiosity, and non-judgment in action:  Holding space for one’s own needs while attending to the needs of others and our relationship with them (both her friend and her sons).  Earnestine practices honoring her boundaries, which can, in some ways, be equated with her core values.  When they are challenged, she can stay in curiosity and explore the feelings that get triggered. She can withhold judgment on the feelings and simply experience them in the present moment, asking what they are trying to tell her.

This combination of boundaries, curiosity, and non-judgment, practiced regularly in small, everyday things, prepares us to face the harder situations and conversations with greater confidence.  We can trust ourselves, even if we don’t walk into any given situation knowing the right answer, to find it when we need it.  On the other side, these skills help us look back with fewer regrets, because we brought our best selves at the time.

I have learned to recognize opportunities to practice these skills, and now I resist apologizing, giving negative feedback, and talking about politics a lot less.  In fact, these are precisely the scenarios in which I can really test and hone my skills—sharpen them and improve my relational dexterity.  I almost look forward to them—sometimes.

It’s all a continuous journey, is it not?  Will we always face our fears with heroic courage and the perfect words and behaviors?  Hell. No.  AND, every day is a new chance to try.  What hard conversation might we come closer to doing better tomorrow?

*Not her real name

Walk a Mile

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NaBloPoMo 2018:  What I’m Learning

These last 5 years, I have had the privilege of caring for designated leaders of all kinds—business leaders who also lead their families, their faith communities, their professional societies, and myriad other entities. I have studied and presented on the intersection of health and leadership, the reciprocal relationships between self-care and care of others.  Each day I ask probing questions of my patients’ habits of thought and action, and they answer with honesty and candor.  It’s particularly fulfilling when I hear, “Huh, that’s a good question, I’ve never thought of that before.”  In those moments, I feel I bring value beyond interpreting blood pressure and cholesterol results.

I’ve been interested in leadership for a long time, and had opportunities to lead in various small ways through the years.  In January 2018, I was given a more visible title and designation than I had ever had—YIKES.  I was surprised and unsuspecting, though not totally unprepared.  And, like parenting, nothing can quite prepare you fully for the experience.  I spoke to a leader in my organization about a year ago, who expressed loneliness in his position.  I admit that I half dismissed the idea, thinking there should just be a way to balance collegial, friendly, and leader-led relationships.  I think I was about a week into my new role when I fully, viscerally, understood his perspective and humbly admitted my own loneliness.  I felt guilty and a little ashamed for my reflexive disregard for his confession of vulnerability—because even if I did not fully dismiss his experience, I did judge it.  And that speaks more to my own fear of loneliness and isolation than it says anything about him.

Thankfully, I did not wallow in guilt or shame for long.  “How fascinating,” I thought.  Being judgmental like that is not consistent with my core values.  These ten months have been a practice in navigating and managing that loneliness—cultivating relationships in new ways to maintain connection while simultaneously practicing the required discretion in information sharing.  Often I have felt profound humility (and now more embarrassment than shame) at how I thought I knew so much about effective leadership, mostly from the point of view of being led, and only sometimes as a leader myself.

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This fall Brené Brown saved me from further self-flagellation over my lack of skills and understanding of what it takes to be a good leader.  The thing I admire most about her is how she walks the talk of vulnerability and courage.  She shares her mistakes, missteps, and learnings so openly, and anyone who reads her books or sees her presentations gets to profit from it all.  I will always remember where I was, because I laughed out loud in sheer relief, when I heard her read from her latest book, Dare to Lead:

Over the past five years, I’ve transitioned from research professor to research professor and founder and CEO.  The first hard and humbling lesson?  Regardless of the complexity of the concepts, studying leadership is way easier than leading.

When I think about my personal experiences with leading over the past few years, the only endeavors that have required the same level of self-awareness and equally high-level ‘comms plans’ are being married for twenty-four years and parenting.  And that’s saying something.  I completely underestimated the pull on my emotional bandwidth, the sheer determination it takes to stay calm under pressure, and the weight of continuous problem solving and decision making.  Oh, yeah—and the sleepless nights.

I thought, well, if Brené Brown still had stuff to learn after assuming a new leadership role, then I’m doing okay!  I am both freed from self-imposed, unrealistic expectations of perfection, and also still responsible for continuing to practice self-awareness, humility, and honesty.

I have learned to look harder at the cynical stories I tell about my leaders, and seek to understand better the divergent and competing interests they must balance every day.  I can withhold judgment of their motivations until I have more information, and if I’m not entitled to all the information, I can decide how much I trust my leaders to act in my best interests, or at least in the best interests of the organization.  I can hold myself accountable to my own standards of honesty, candor, and integrity.  I can ask and challenge, inquire and resist (or accommodate), all with curiosity and respect, and making the most generous possible assumptions of others.

How lucky am I to have this remarkable learning opportunity?  To practice the skills I have observed, admired, and studied in others for so long, to own them.  I have walked a mile in these new shoes.  I have a few shallow blisters for the journey so far.  But the shoes are the right size, and the leather is softening.  I’m still feeling fit.  The path will wind and climb, and that’s okay.  I don’t walk alone; I have mentors and role models walking ahead and by my side.  So bring it!  We’ got this.