All Good Things Must End

moon path LOH

Setting moon, Sylvan Dale Guest Ranch, Loveland, Colorado.  Photo courtesy of Dr. Karen Cornell

Friends, Leading Organizations to Health has graduated Cohort 11, the Class of 2020.

Ten months ago I started at my Hogwarts, the leadership training program that has definitely made me a better leader.  But more importantly, it made me nine amazing new friends and a much better person.  Today, on the last day of the last retreat, it all came together in the most beautiful way, and I am beyond grateful.

These ten months were the best elective educational experience of my life—they really gave college and med school a run for their money.  We immersed in a curriculum dense with abstract concepts of interpersonal communication and organizational change management.  We then translated the theories into tangible skills in an experiential learning lab, applied to specific challenges brought by my 7 cohort mates and me.  Over four in-person retreats and monthly Zoom calls, we shared, supported, and coached one another in the tenets of relationship-centered leadership.

We bonded in a similar way to residents on call:  Gathered for training, bringing different backgrounds and perspectives, participating in a common curriculum but each with a unique learning path, eventually to disperse and practice in different settings across the country.  We eight now share a connection of stories and struggle that nobody else can know.  We are a tribe.

Thus, I grieved the goodbyes long before we arrived in Loveland this last time.  But I also trusted our master facilitators to help me manage this, by both their loving and authentic presence and the very structure of the program, which is founded on contemplation and self-awareness.  I also felt an abiding faith in the friendships we all grew this past year.  As with my best friends from college and medical school, I knew we would maintain contact and connection, just in a different way.  We can’t stay in the nest forever—now is the time to fly.

In thoughtfully constructed journaling exercises and discussion groups, we reflected, consolidated, and synthesized ten months of learning.  We also examined our personal and professional evolution over this time, growth and movement in fluidity and complexity.  We explored aspirations and imagined the future state of this work in our natural habitats.  Finally, we sat in a closing circle.   Having each shared our own reflections, the group offered each friend observations, affirmations, and well wishes in what I can only describe as the most loving communion.  Each person’s strengths were articulated and amplified.  We acknowledged one another’s challenges.  We celebrated each other’s engagement, perseverance, contributions and triumphs.  Finally, sustained mutual support was extended around the circle, wholeheartedly and without qualification.

In my opinion, we formed the kind of community that we all want to lead.  Tony and Diane led us all by example, deliberately, artfully, and mindfully.  They live the principles they teach; they lovingly and patiently showed us the way.  In the end we discovered our own capacity to each write our own next chapter(s).  By making us feel seen, heard, understood, accepted and loved these ten months, our teachers inspired us to do the same for others.  And that is the strongest foundation for building our houses of positive change agency.

Now we go forth.  We’ got this.

Onward from 2019: Learnings and Intentions

IMG_3635

Friends!  WHAT a year, no?  How are you feeling here at the end?

In this post:  3 key learnings, 3 high intentions, and my 6 recommended life readings.

What resonates with you?

What would you add?

For a thoughtful and inspiring look on the coming year, check out Donna Cameron’s post from yesterday.

IMG_3222

3 Key Learnings of 2019

Complexity

“When we try to pick out anything by itself, we find it hitched to everything else in the Universe.”  –John Muir

“All that you touch, you change.  All that you change, changes you.” –Octavia Butler

We all live in inextricable connection, like it or not, know it or not, want it or not.  Every interaction has potential for benefit and harm, and the scale is exponential.  Some may find this idea daunting, overwhelming, or untenable.  I find it reassuring.  The idea that some cosmic life thread connects us all, that we are made of the same stuff today as that which existed at the dawn of the universe—this gives me peace.  It encourages me that everything I do in good faith could make a difference.  You really never know how far a small gesture or sharing will reach for good.

The 3 Tenets of Relationship-Centered Leadership

Not so much learnings as a synthesis from LOH training, these are the current foundation statements of my personal and aspirational leadership tenets (iterations likely to evolve over time):

  1. Founded on curiosity, connection, and fidelity to a people-centered mission
  2. Attendant to the relational impacts of all decisions, local and global
  3. Respectful of norms and also agile and adaptive to the changing needs of the system

Having defined these ideals for myself, I am now fully accountable to them.  And I hold them as a standard for those who lead me.

Being >> Saying or Doing

Saying and doing compassionate, empathic, and kind things are necessary and noble.  And they are not enough.  These actions ring hollow without honest sincerity behind them.  People feel us before they hear our words.  Our authentic presence, positive or negative, originates from within.  It manifests in posture, facial expression (overt and subtle, intentional and subconscious), movement, and tone and cadence of voice.  Fake it ‘til you make it—saying and doing things because we know we ‘should’—only gets us so far.  We humans possess a keen sense of genuineness—it’s a survival instinct.  If we accept that a meaningful, productive life and effective leadership in particular, require strong, trusting relationships, then we must cultivate true compassion, empathy, and kindness.  That means suspending judgment, managing assumptions, and holding openness to having our perspective changed by all that we encounter (see first key learning above), among other things.  This may be life’s penultimate challenge—our role models include Mother Theresa and the Dalai Lama.

IMG_3446

3 High Intentions for 2020

  1. Continue to ask more and listen better for people’s personal and unique meaning making—not just patients but all people—attend to souls
  2. Let go perfection
    1. All relationships are not great, and it’s not all my fault
    2. Some people/relationships and circumstances challenge my best self and skills more than others
    3. It’s the honest, sincere, good faith effort, and the learning from imperfection and failed attempts that matter
    4. Some relationships are better ended
  3. Guard against judgment, arrogance, and cynicism

IMG_3501

6 Recommended Life Readings—the 6 most personally impactful books I have read in the last decade:

The Art of Possibility by Rosamund Stone Zander and Benjamin Zander.  Scarcity thinking, competition, and looking out for number one hold us all back.  Stepping fully into our central selves, claiming our full collective agency for creativity and collaboration, and manifesting all the good we are capable of—that is the discovery of this book for me.

Start With Why by Simon Sinek.  In my opinion, the most eloquent and resonant writing on the purpose-driven life.  The freedom and creativity that flows forth therefrom—it all just gives me goosebumps.  Sinek’s The Infinite Game may eventually make this list too, once I have integrated its content and learnings more fully.

Rising Strong by Brené Brown.  Strength and vulnerability, confidence and shame, individuality and belonging—these are the essential human paradoxes that Sister Brené reconciles with gritty aplomb through real life stories as well as grounded theory research.

Big Magic by Elizabeth Gilbert.  Be you, all you, all in.  Love thyself—flaws, failures, and falls all included.  Make things.  Because that is what we are put here to do, for ourselves and for one another.

Leadership and Self-Deception by The Arbinger Institute.  Perhaps no book explains the profound importance of being better in order to do better, better than this.  And it took me almost all year to really comprehend, and then begin to apprehend, the concept.

Being Mortal by Atul Gawande, MD.  I started and finished this one on vacation this past week.  Dr. Gawande is my favorite physician writer.  I consider this book required reading for all physicians for sure, but really for all people .  “The death rate from life is 100%,” a wise patient once told me.  In modern western society and culture, multiple intertwined and complex forces hamstring our ability to live and die well and at peace.  This book is a brilliant compilation of heartrending personal and professional stories, neatly folded with history, research, and practical information for improving this sad state of things.  It is also a guide to the hard conversations that we all should really have—now.  It has both validated what I already do in my practice, and profoundly changed how I will do things hereafter.  Thank you, Dr. Gawande.

*****

Best wishes for Peace, Joy, Love, and Connection to all.

IMG_3595

We Must Go Together

Christmas Wish card

How will you celebrate this week, friends?

What do you leave behind, and what do you look forward to?

The sentiments on the front of this Christmas card, created in 2017, align with my core values and my Why:  to cultivate the most meaningful, heart-connected relationships between all people.  The last four years have taught me much on this journey—about American political geography, economic and tribal dynamics, and my personal trigger patterns.  2020 feels daunting and high risk to me; I approach it with caution, and also with Fierce Optimism.

I feel prepared and trained for whatever lies ahead, as I know I have my strong social and emotional ties to lean on.  They may prove tested and strained in the months ahead, and I feel confident they will hold.  Because in the end, however divergent our political or economic leanings, I firmly believe that what unites us infinitely outweighs what divides us.  I keep coming back to our shared humanity—that we all love our children, wish to hand down to them a world in peace; that we all want all of us to live in happiness and security.  This belief is what keeps me going, what makes me continue to reach out and attempt to connect.

We have much work to do my friends, many frayed patches of social fabric to mend.  And I honestly believe we can only do it—we can do anything—if we go together.  Just think of that time when you thought something was impossible—and somehow you pulled it out.  I bet you had help, no?

The road will be long and arduous.  We will stumble and fall, we will argue.  We will fight.  We will also share breathtakingly beautiful vistas, and numerous moments of sublime love and communion.  Let us meditate on the latter—on all that is good—let us seek it and acknowledge it in one another with eyes, hearts, and voices wide open and out loud.  Let us harness that energy and put it in front, guiding our attitudes, words and actions, toward ourselves and all those we encounter.

May this holiday season, this time of reflection and preparation, reconnect us with the whole human family.  Connect on every plain, every mountain, every island; in every school, (church), and statehouse; in every city, village, community, and home of our little blue planet.

May we do better in 2020 and beyond.

November 17:  Elasticity Makes Me Better

IMG_2649

NaBloPoMo 2019

What was school like for you growing up?  Were you bored?  Confused?  Frustrated?  I had a pretty easy time, but many of my classmates did not, even the ‘smart’ ones.

In high school I was on the speech team.  One of my events was persuasive speaking.  I chose one year to advocate for teachers to broaden their teaching styles to match a wider variety of learning styles.  I used the Gregorc Mindstyle Delineator as an example of how styles can vary (mine is Abstract Random, go figure).  It was an interesting thesis and I sincerely believed what I wrote and presented in those 8 minutes each weekend.

Thirty years later, I wonder how much I walk this talk of meeting people where they need me.  Simply asking the question, raising my awareness, makes me better.

Parenting.  It doesn’t matter how many parenting books you read or how well you think your parents raised you.  General principles apply, of course.  But every kid is unique, and we parents do better when we realize that the methods we use for anything on kid #1 won’t necessarily work with kid #2, #3, an onward.  Flexibility is key to a happy and functional household, for getting out the door every morning without yelling.

Marriage:  According to the Dr. John Gottman, about two-thirds of marital problems are perpetual, meaning they will never actually resolve.  So how do couples stay together successfully?  Among other things, they learn to accept one another and work around the hard stuff.  At least partially, we have to soften our rigidities, learn to bend and sway, embrace the supple, intimate dance of commitment.

Teaching:  Not all students learn best by watching.  Not all learn best by doing.  Or by hearing, mimicking, or competing.  Luckily, medical education gives trainees multiple platforms on which to acquire the necessary knowledge and skills to care for patients.  For all its flaws, our profession actually does well here.  I’m happy that I realized this in my own experience.  When I precept students in clinic, they shadow, scribe, see patients alone or lead a joint encounter, so they can experience the work from different perspectives.  I think this mutual versatility and adaptability makes us all better.

Patient Care:  Over the years I have accumulated myriad articles and books to share with patients.  But not everybody’s a reader like me.  Not everybody wants to meditate or journal.  Some people do better with a personal trainer, others in spin class.  It’s my job to assess how each patient is most likely to succeed in health habit optimization, and present the most appropriate resources for consideration.  Primary care definitely does not work with a one size fits all approach.  So now I include audiobooks, podcasts, phone apps, and YouTube videos in my repertoire of medical information sharing.  I am blunt when it’s needed, and also gentle and diplomatic.  I can speak from the head and the heart, often both at the same time.

Speaking Engagements:  Here is where my elasticity has grown the most in recent years.  For the first decade of my career, I still used the expository presentation style I learned in high school.  Thankfully in 2014, I watched Nancy Duarte’s TED talk on transformative oral presentations, and then read her book, Resonate, in 2015.  Make the audience the hero, she says.  Tell a story, contrast what is with what could be, paint the vision of the blissful future clearly.  Engage people’s emotions and aspirations.

This is not easily done with Power Point decks full of words.  But words are my medium!  I had to add color, diagrams, cartoons, photographs.  I started making my presentations more interactive, between myself and the audience, and between audience members themselves.  Now I have people stand up and move their bodies.  I may bring raisins to my next talk and do a mindful eating exercise.  I need to learn how to embed music and videos into my slides.

What is the objective in all of these relationships?  It’s connection.  How do we best connect?  We reach out.  We extend ourselves to others—make ourselves relaxed, flexible, spring-like.  That is how we gather people closer.  It’s not formless or weak.  A strong elastic maintains its integrity even under high tension.  But it must be stretched often, or it becomes stiff, brittle, and ultimately ineffectual.

 

November 16:  Loving Subversion Makes Me Better

IMG_1901

NaBloPoMo 2019

Friends, do you already follow Seth Godin’s blog?  His post from Thursday stirred something a little irreverent in me.  It was about ‘allies and accomplices’:

To be an ally means that you won’t get in the way, and, if you are able to, you’ll try to help.

To become an accomplice, though, means that you’ve risked something, sacrificed something and put yourself on the hook as well.

We need more allies, in all the work we do. Allies can open doors and help us feel a lot less alone.

But finding an accomplice–that’s an extraordinary leap forward.

I thought immediately about my fellow Better Angels volunteers.  We have all committed time, talent, and treasure to the depolarizing of America.  We do it in public, in front of audiences and cameras, to reporters and members of our communities.  We openly challenge the prevailing culture of ad hominem, oversimplification, and overgeneralization.  We all come to it from our own internal optimism and hope.  But in the face of entrenched polarization and a culture of self-protection above all, we could never make any headway as individuals.  It is only together—as mutual accomplices—that we can truly claim and exercise our collective agency.

I feel even more buoyed by Ozan’s latest post.  He describes a series of well-known studies showing that people will organize themselves into in-groups and out-groups with remarkable loyalty, even around random and arbitrary distinctions like taste in abstract art.  This, of course, carries grave and important implications for prejudice and discrimination.  Ozan then points to two exemplars of the opposite, Dr. Martin Luther King, Jr. and Barack Obama.  In their most famous orations (see links), these remarkable leaders speak directly to what unites us as the foundation for solving our problems, rather than what divides us.

MLK:  The marvelous new militancy which has engulfed the Negro community must not lead us to a distrust of all white people, for many of our white brothers, as evidenced by their presence here today, have come to realize that their destiny is tied up with our destiny. They have come to realize that their freedom is inextricably bound to our freedom. We cannot walk alone.

Obama:  The pundits, the pundits like to slice and dice our country into red states and blue States: red states for Republicans, blue States for Democrats. But I’ve got news for them, too. We worship an awesome God in the blue states, and we don’t like federal agents poking around our libraries in the red states.  We coach little league in the blue states and, yes, we’ve got some gay friends in the red states.

I get goosebumps just reading the words.

It really feels like a loving subversion—of cynicism, scarcity, antagonism, and fear.

Who’s not better for that?

 

 

 

November 15: Smiling People Make Me Better

DSC_0521

NaBloPoMo 2019

Winter has set in here in Chicago. Oh well, this too shall pass. The kids were off from school today, so my morning exit was quiet and solitary. I drove along our alley, coming up behind on a slight female figure pushing a stroller. As I passed her, she looked up with a big smile and waved with an open, ungloved hand. She really seemed to look for eye contact with me, the unknown driver passing her. I had wished for the same, but had no expectations. In my pleasant surprise, I smiled back and nodded, one hand on the wheel, the other holding my coffee, which I raised in greeting. I had learned long ago that life in the big city is usually not this friendly.  She pretty much made my morning.

I’ve been thinking about it all day. How many times a day do we contact strangers? How often does a person on the street look at you, make eye contact, and smile? Or say hello? How often do you do this? Does it not just brighten your day, even a little? How does it feel when you pass a dozen people and nobody acknowledges your existence? The most fascinating is when someone looks at me, makes eye contact, expresses nothing whatsoever, then looks away and keeps walking.

I used to be much more judgmental of these behaviors and people. I may have even taken it personally in early adulthood. But now I’ve lightened up a little. I don’t think it’s about me. But it makes me wonder about people—what is it that closes us off from strangers? Based on people’s expressions, I tell stories that they are worried, anxious, angry, distracted, rushing, arrogant, oblivious, or just mean. I make it about them. But this is neither productive nor healthy. It just makes me resentful and less likely to smile at the next person I meet.

Every one of us is one of these things I listed at some point—I think I experience each of those states at least once every day. I apologize in advance if you meet me in one of these moments. So now I try to tell myself that everybody has a unique story of getting through life and the world. This attitude shift has done two things for me. 1) It makes me appreciate smiling people that much more. I notice the twinkle in someone’s eye, the dimples, the cheekbones, the sterling white and/or crooked teeth. I appreciate these joyful strangers and let their joy sink into me. 2) It makes me more, rather than, less, likely to look for eye contact with others. If you’re not having a good day, maybe I can make it better by seeing you and smiling. I do this especially when I see moms with little kids or babies. I remember those days (so hard!) and how reassuring it was when strangers smiled and looked at us lovingly.

That woman really did make my day.

Crossing the street on my way to the parking garage after work today, a car turned left in front of me. The driver had not seen me crossing until the last second. When we made eye contact I could tell he was apologetic. He mouthed, “Sorry,” and raised his left hand in a humble wave. I smiled that I understood, no harm done. Further down the sidewalk a couple walked quickly in the cold, coming toward me. The very tall man marched in front, apparently focused on his destination behind me. His female companion came a couple steps behind. I smiled, and she smiled back—big! She had on a puffy black faux fur coat, a stylishly coordinated black fuzzy hat, nicely coifed hair jutting out from underneath, and neat, metal-framed eyeglasses that complemented her round, friendly face. I think she even said hello. My mood was definitely better for having passed them.

I’ve been in a great mood all day, maybe because of these strangers.

I think we profoundly underestimate the impact we all have on one another, positive and negative, in our smallest interactions. A genuine smile from a stranger on the street can really make your day better. When you smile at me, it makes me smile back at you, and vice versa, obviously—but the best thing about it is that we are both better off for it. That’s how joy works, I think—it doesn’t matter who starts it. It just grows wherever it is, and expands exponentially with each person who shares it.

So here’s to smiling people. You make me better. May I always smile back at you and keep the pageant of joy alive and well.

November 8:  My Students Make Me Better

IMG_1928

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.