Category Archives: love

November 15: Smiling People Make Me Better

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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

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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.

NaBloPoMo 2019:  What Makes Me Better

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My friends, it starts again woohoooooo!

National Blog Posting Month occurs every November, a 30 day daily blogging challenge apparently founded in 2006, inspired by National Novel Writing Month, or NaNoWriMo.  I think this will be my fourth attempt, and it gets easier and more fun every year!

This year’s theme originates from a sense of both gratitude and anticipation.  Increasingly I feel compelled to do more, contribute more, help more.  When I look around I am consistently humbled by those who go before me, on whose broad and strong shoulders I stand.  So I dedicate this month to all of you.

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November 1:  Role Play Makes Me Better.

I was converted to the Church of the Necessity of Role Play in 2003.  I had previously belonged to Tribe of Full-Socket Eye Roll at Role Play.  That year I had the privilege of attending a Stanford Faculty Development Program series.  It was a 7 week clinical teaching program for physicians.  Every week we practiced a specific teaching skill, on camera, then had to watch ourselves and critique our own and one another’s performance.  Even though each ‘encounter’ was only a few minutes, and we were all pretending, it felt real enough to translate into concrete behavior changes in real life—for all of us.

Since then I have always employed role play when teaching motivational interviewing (MI) to medical students.  At first I played the noncompliant or resistant patient, and had students take turns trying MI skils on me.  When I noticed myself feeling defensive and belittled in that role, I realized what the students were missing, and how it could enhance their empathy.  So I started having them take turns playing both patient and physician.  That was an epiphany for us all.  When I attended the Harvard Lifestyle Medicine Conference MI session in 2015, I experienced yet another layer of important experiential learning.  In dyads, we not only took turns playing patient and physician, but we practiced both directive and MI styles of counseling.  The contrast on both sides of each of those interactions solidified in both my cognitive and limbic brains why MI is a superior counseling method for behavior change.

This week at ICCH I innocently volunteered to play the physician in yet another role play.  Little did I know what I was in for.  I should have seen it coming, as the workshop title was “Teaching Medical Students How to Deal with Challenging Patient-Physician Encounters.”  I, unknowingly, stepped into a scenario of recurrent asthma exacerbation brought on by stress, due to domestic violence.  I felt anxious with a circle of international colleagues watching, and also confident that I could enter the play encounter the same as I aspire to enter a real one—present, open, grounded, kind, loving, and smart.  The physician teacher who played my patient stayed solidly in character and immediately drew me in with her slumped posture, dejected facial expression, and barely perceptible voice.  And she, like so many victims of violence, was not giving it up easily.

I had to conduct a medical interview as well as a psychological one, at times alternating between them.  I wanted to get at what I suspected (first generalized stress, and then clearly violence at home), but we had just met, and she really wanted to get out of the hospital.  Her fear was obvious; but she held its cause close to her chest, like the rest of her, until she could trust me.  I approached with general words at first, “Anything else going on lately?”  I kept my questioning as open ended as possible, and tried to leave space for her to answer.  Nothing.  Then I confessed my own inner dissonance:  “I feel like there’s something else…”  When that didn’t work, I continued with the general history.  No other chronic medical problems, no surgeries; allergies that can trigger her asthma, but no recent exposures.  You have 4 young kids, a full time job, a house to take care of.  Are you partnered?  Yes, married, to Bob.  Pause; a breath.  Then, “How does Bob treat you?”  Pause.  Why do you ask me that?  “I’m asking about abuse.”  And then it opened.  How did you know?  “I’ve been doing this a long time…  And someone close to me was abused.”  Do I look like her?  “You remind me of her.”

She was mortified that I would tell anyone.  How could I possibly help, then?  There were longer silences as I, frantic on the inside and slow breathing on the outside, racked my brain for solutions.  The harsh reality eventually settled on us both:  Neither of us could do much about her situation in that moment, her asthma attack was resolved, and the longer I kept her away from her family the worse I might make everything for her in the near term.  We agreed that I would look for ‘stress management’ resources, and I would give her my phone number.  And I would discharge her later that day, back to her violent husband, who had promised he would never hit her again.

It was so real.  I was almost able to forget about the audience.  I was personally invested in the health and well-being of this one person in front of me.  I imagined if she were a real patient.  Would I actually give her my phone number in this moment?  Absolutely I would.  We had to start somewhere, and I was the only person who knew, who could connect her to resources for help.

After it ended, I felt pretty drained.  We had both been tearful at times.  I also felt proud to have gotten through—both the exercise and to my patient.  I connected.  And even though I had no immediate solutions, I had established a relationship that had hope for helping a person who really needed it.

I have not encountered this scenario in real life in a while—that I know of.

I hope I’m not missing something, somewhere, for somebody who needs me.  Yikes.

Role play makes me better.  It reminds me to always beware my blind spots, to keep practicing, and to remember the deep humanity of every person I meet.