Category Archives: medicine

Love Notes for Bridging Difference

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The PA student wellness talk went great! 42 or so junior colleagues engaged with me and my badly designed PowerPoint for ninety minutes and I had the BEST time! I realized this morning that for the youngest of them (about half the class), the pandemic hit during high school and the beginning of college. It reminds me of The Fourth Turning and how significantly the intersection of phase of life with momentous human events influences our world views. This summer I was challenged to address the impact of generational differences on organizational culture in a corporate wellness talk, and I started to see age and generation as another form of diversity.

“Respect and challenge the hierarchy,” occurred to me for students this year. We elders (some very elder indeed) still run things, and our experience and wisdom matter. We also have much to learn from our juniors, from their fresh and diverse perspectives. If we can all lead, from any chair, by humble and confident example, our professional culture will progress toward stronger inclusiveness and mutual respect.

I continue to seek conversation and connection with both conservative and progressive friends around politics. But I want to go deeper than news headlines and the loudest arguments. I want to know what core goals and values we share, to start walking together to see where our paths diverge. Where are our shared destinations, and why do you choose 90/94 while I choose Lake Shore Drive? What are the dis/advantages of each, what are the trade-offs?

I am really starting to miss more long form posting here, how fascinating! We are 60% through this daily blogging challenge. Many thanks to all who have followed along (Hi Mick and Donna!), and welcome to any new friends! Now let’s see how much love we can find across difference:

  1. Keep your antennae tuned for those who would divide us to serve their own purposes. This is NOT our better nature. Resist them and stay connected!

2. You and I disagree on this today. That may not necessarily be the case in the future. We can keep our minds open to change, without shame or judgement.

3. You don’t believe everything I believe. But let us not let that stop us from staying curious and connecting anyway. May we see light in each other no matter what.

4. The holidays can challenge our patience and resilience to triggers. *deep breath* May we stand firmly in love and ties of respect and shared history to get us through gratefully.

5. Our biases come honestly or not, we inherit many and form others organically. It’s a human thing. But let us hold them loosely and let them go to connect to one another.

6. Today and all days, may our differences feel softer, less threatening, and approachable with openness, light, and optimism for connection.

7. How wonderfully diverse we all are! How boring the world would be if we were all the same! May we appreciate and celebrate every spectrum!

8. To my friends who vote differently and sit with me over a meal or coffee to discuss–thank you. Our persistent and resilient connection gives me hope for our future.

9. I love you because we share important things in common. And the places where we differ teach me, make me better. Because of our love.

10. One deep breath can be the difference between a connecting moment and a destructive one. Let our breath give us the space to make the connecting choice.

11. Humility Curiosity Empathy Kindness Generosity — Is there any theme of love note NOT founded on these?

12. These fun music mash-ups like AC/DC-BeeGees — If we can so easily and artfullly blend divergent melodic creations, why not try with our policy ideas? We are a creative species, no?

Oh, I like this set, friends. Onward to 30!

Uncertainty and Lack of Control

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The more I think about it and talk to thoughtful friends, the more I find uncertainty and lack of control at the foundation of the majority of stress and suffering I observe in our fellow humans.

In terms of health, more and more information from commercial blood tests and imaging can be known, but the utility and predictive value of all that extra information is still too often unclear. And so we spiral, worrying about the uncertain future and looking for more tests and the latest ‘hacks’ to ensure the outcomes we want. Capitalist Medicine, as I think of it, preys on our worries, offering test after test without regard to sensitivity, specificity, or predictive value. Too often there is zero clinical consultation before or after people fork over hundreds or thousands of dollars, with minimal explanations for the meaning of ‘green’ or ‘red’ range results. Overloaded and burned out physicians get inundated with messages from worried patients; precious time, energy, and resources are thus expended for unclear and sparse benefit. In time some of these tests, applied specifically and with strong evidence, may help a lot of people. What do we do in the meantime?

@bradstulberg
Author of Master of Change

Follow Brad Stulberg for evidence-based and practical advice on cutting through hype and sticking to what works. Focus on the basics: Sleep, exercise, nutrition, stress management, and relationships. I emphasize relationships because it’s more complex than we want to admit, especially relationship with self, which is basically self-awareness and self-regulation.

What if we’re already great at sleep, exercise, nutrition, and self-regulation, and we’re still anxious, still ruminating more than is helpful on a future that we ultimately cannot control? How do we get to peace with what is, and stop over-worrying about what could be negative, revel more in what is and could be positive? For more and more of us, life feels VUCA: Volatile, Uncertain, Complex, and Ambiguous. Naturally then, we seek stability, certainty, simplicity, and clarity–we grasp at what comforts–even if it’s false. So how do we get to real, true peace with it all?

That’s the inner work, my friends. It’s different and unique for each of us. Whether it’s family of origin stuff (for so many of us), other trauma, or something else (many somethings!), our patterns of anxiety and compensatory attitude and behavior don’t come from nowhere. And we all learn to carry our anxiety, trauma, etc. in our own dys/functional ways. Look at us, getting through life, getting sh*t done, holding it together the best we can! Good on us, FFS!

My wish for us all is that at the end of our lives, whenever and however it happens, we can each feel vastly more peaceful than regretful. That in those last ten minutes, we can look back and feel satisfied that we lived according to our values, spent our time, energy, and resources on worthy causes and connections, and can leave this mortal life with serenity. I have written before that in order to die at peace, I need to live in peace. That means living as comfortably as possible with uncertainty and lack of control, because that is what life is. I don’t mean that we should never feel anxiety, never acknowledge adversity, lose a little hope sometimes, and rail at what enrages us. I want for us to embrace all of it, allow the intense and difficult feelings, move through them (or let them move through us), with the confidence that we can handle it all, get to the other side of anything, and even gain a little wisdom in the process. I think it’s this confidence and security in ourselves and our connections (because we all need help, whether we admit it or not) that helps us make relative peace with uncertainty and lack of control.

Talk therapy
Somatic psychotherapy
Meditation of any kind
Breathwork
Martial arts
Prayer
Spiritual discernment
Mindfulness practice
Medication
Music
Creativity
Bibliotherapy
Walkabout
What else?

I wrote to a patient recently, “I will continue to look for ways to ease your worry.” This is my work. Every conversation informs and educates me on new possibilities, other ways I can help. We go together, my patients, friends, and I, exploring and co-creating according to our values, goals, and aspirations. I do my best not to judge anyone’s anxiety and worry, even as I observe the suffering it causes.
We all have our own unique burdens to carry in this life. Whatever we can do to lighten one another’s loads, let’s find a way to do it, yes?

For Holly

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https://pritzker.uchicago.edu/news/honoring-legacy-dr-holly-j-humphrey

Our friend, leader, and role model has passed.

What a surreal moment of sadness, reflection, slowing, and conviction.

I always knew you as simply Holly, not “Dr. Humphrey.”  The latter was a given and absolutely respected; it just felt too distant a title for how you showed up as program director to us residents.  Our respect for and deference to you was not commanded, demanded, or condescended by you.  It was a natural consequence of your presence: attuned, caring, earnest, authentic, and integrous.  Your essence emanated teacher, leader, mentor, steward, and patron.

I never knew you closely, but I felt known by you.  And that was enough.  Those three years were grueling and also bonding.  The culture you set of caring and encouragement, of looking after one another and always being on the same team, filtered through the chief residents, senior residents, and interns, so that we (when we had the bandwidth) could show caring and encouragement to the medical students.  Back before work hour restrictions existed, this was significant.  The University of Chicago Internal Medicine Residency Program was known as one of the most collegial and compassionate in the country, as well as one of the most rigorous and accomplished.  The longer I practice, the more I observe corporate and academic cultures from various perspectives, the more I appreciate and marvel at that incredible integration, at the uniquely holistic community of my training.  I knew it at the time; did not take it for granted.  And yet even now, more than twenty years out, the lasting impact on my own ethos and those of my classmates continues to move me.  I am so proud and grateful to have the privilege of calling myself a UofC IM graduate.

Reading the long list of initiatives, accomplishments, and accolades attributed to you after my time at UChicago ended, my psyche swells with pride for you, vicarious gratitude for all whom your programs touched, and inspiration to make my own contribution in kind.  Your mission and impact, as I understand from afar, was always to not only lift others directly, but show us all how to lift one another.  You were a leader of leaders—you helped us all identify and call forth that within each of us that would help make one another better.

What an honor and privilege to have shared even such a brief moment of this lifetime with you, Holly.  Those three years of residency, though short, were transformative.  Looking back, I was definitely not my best self at that time.  I cringe, and then I imagine how you might have counseled me, with honesty, compassion, and conviction to be my better self.  You empowered us through your confidence in us.  You held us accountable to a standard of conduct that made us worthy of our integrity.  Your leadership helped shape our character as clinicians and citizens of the profession.

Your life and memory are blessings on all who knew you. 
May we honor you and the impact you had on us all by carrying on the work you so bravely and generously began in innovative and connecting ways–the work of deepening compassion, inclusion, excellence, and humaneness in medicine.