Witnessing

So much suffering, friends—everywhere, all the time, every day.  It’s overwhelming. 

Our current circumstances feel like the most distressing case of sensory overload I have ever experienced:  intense, prolonged, and complicated.  Paradoxically, I also often feel like my head and heart could explode from sheer hopefulness—at no other time in my life have I felt so much potential for meaningful, positive collective change.  We stand on the knife edge of a continental divide of sorts, simultaneously overlooking the worst and best extremes of humanity.

People. Are. Losing it. 

Patients with underlying anxiety and depression are increasingly agitated and even combative, at home and in the clinic.  They threaten themselves and/or office staff, sometimes with mortal results.  Lifelong friendships are ending from irreconcilable differences over politics, ideology, and disagreements over social distancing and masking, among other things.  People lash out in rage at the slightest, often innocent provocations.  We doom scroll on social media, amplifying and reverberating (mis)information in our echo chambers, driving ourselves to the cliff’s edge of sanity with fear, fury, and hatred.

I watch it unfold before my eyes, escalating in the past few weeks.  I have joked for a while that the world may end in my lifetime; now it feels less and less like a joke. 

How we do process it all?  How do we get through?

Physicians, therapists, nurses, and many other professionals make a living watching and listening to people through their suffering.  Often we cannot cure people’s problems; sometimes it feels like we can’t even help.  But the truth is we can always help—all of us.

By simply being present to someone in pain, we help.   By not looking or running away, by sitting and facing them full on, we help.  By allowing, even embracing our own discomfort, and holding safe, quiet space for another’s suffering, we help.  We know this because when we suffer, the loving presence of others is what heals us first.

I cannot take away your depression or anxiety.  I cannot create a stronger social support network for you.  I cannot get you a job, bring back your deceased loved one, make the pandemic go away, or stop the next police officer from profiling your son by his skin color.  But I can sit with you in your grief.  I can stand in solidarity with you and advocate for our common cause.  Most importantly, I can take good care of myself so I can keep showing up for you and all those who may need to lean on me from time to time.  I have those who let me lean on them sometimes, too, and I make sure to thank them often.

To witness means to see.  The best witnesses make us feel seen, heard, understood, accepted, and loved, no matter what.  This is what we can do for one another right now.  It is the highest calling of humanity, to take care of each and every other as ourselves.  It is an infinite rather than a finite calculation.  Love shared is multiplied, not divided.  Caring for you feeds me too, whereas disconnecting from you costs me more than I know, and diminishes us all.

“Although the tale of human experience is certainly universal, it contains unique elements for each us and we continue the art of storytelling, both verbally and nonverbally, each and every day. While some stories are sweeter than others, all long for the benefit and necessity of a witness, for a witness assures us that our stories are heard, contained, and transcend time; for it can be said that one is never truly forgotten when one is shared and carried in the hearts of others.” –Kristi Pikiewicz, PhD

Amplify the Important Stories

This weekend we lost another selfless leader, Dr. Joseph Costa of Baltimore.  Chief of his hospital’s intensive care division, he continuously led his team on the front lines of pandemic patient care, despite his own high risk medical condition.  He succumbed to COVID-19, in his husband’s arms, surrounded by colleagues turned caregivers. 

My friends, are you exhausted like I am?  4.2 million American COVID cases (about a quarter of total global cases).  At the current rate we will likely cross 150,000 deaths by the end of this week.  And it won’t stop there.  We will lose many, many more mothers, fathers, sisters, brothers, grandparents, sons and daughters in the coming months.  This, all while PPE shortages still put healthcare workers at risk across the country, caring for those who follow prevention guidelines the same as for those who do not.

Read Dr. Costa’s story.  Remember him.

Then honor his memory and those of the almost 600 healthcare workers who have died of COVID-19 by wearing your mask and protecting the people around you.

***

“Oh, are you from Maryland?”

Her name is Odette Harris, MD. 

She is a neurosurgeon and the director of brain injury care at Stanford Medicine.  She is a Black woman.  “Something as absurd as putting the initials of your state next to your name seems more plausible than the fact that ‘MD’ stands for doctor.  I can’t even tell you how many people ask that.”

Someone handed her their car keys outside of the venue where she gave a keynote address, thinking she was the car valet.  [Michael Welp mentions this in Four Days to Change—it is a common occurrence for our Black sisters and brothers.]

During an all-day meeting, after she stood up from the conference table to stretch her legs, her own colleague asked if she was going to set up for lunch.

Nobody has ever asked me if I’m from Maryland because ‘MD’ comes after my name.  I have never been mistaken for a car valet or wait staff at a professional meeting.  And I am not the chief neurosurgeon who runs traumatic brain injury care at my hospital.  Let us white and white-adjacent folks meditate on Dr. Harris’s experiences for a moment.  Because that’s all we have to do—consider them for a minute or two.  Our Black colleagues and peers live such denigration their whole lives.

***

The Wall of Misogyny

It started with, “Your hair smells incredible.” Followed by, “My hands may touch you. They are hard to control.” It even went as far as, “You were in my dream last night. Did I mention it was wet?” He made my skin crawl. I spent more time focused on trying to be where he wasn’t that I had no space left to focus on why I was there in the first place, and that was to learn. The awkward stares from OR staff looking upon me with pity made me want to vomit. And the number of male physician on-lookers who seemed to watch this behavior for sport did nothing but enable his behavior (when one brought his daughter to work with him, it was all I could do but hope she never had to experience from a man what I was experiencing from him). The lack of shock of such behavior from everyone aware in the system confirmed its normalcy.

Read this stark essay by Dr. Megan Babb, a fellow physician mom.  Inspired by Alexandria Ocasio-Cortez’s incisive speech on the floor of the House of Representatives this week, Dr. Babb published her own story and those of many other physician women.  They recount the everyday misogyny that for too long we have blithely accepted as ‘the way things are’ in medical culture.  Peruse them slowly (a few choice samples below).  Imagine they are your mother, your sister, your daughter, your friend, your colleague.  How would you upstand for them? 

I was asked by a male patient if I needed to practice my prostate exam technique because he was happy to allow me to do so on him. When I asked the administrative team to move him to the service of any one of my many male colleagues I was told, “These are the sort of things that build character. I think we need to thicken your skin. The patient will remain on your service.”

I recently gave a presentation at grand rounds in my hospital. When I walked to the podium, I overheard a male physician say to a group of others, “Isn’t the lecture today supposed to be given by an orthopedic surgeon?” I am the orthopedic surgeon he speaks of.

 As a medical student I was on a surgical rotation with a male urologist. While assisting him with a TURP [trans-urethral resection of the prostate] he asked me, “Would you like to see what a well-endowed penis looks like?”

***

And There Is Still Hope

A specialist physician and woman of color consulted on a patient in the hospital, a white man.  He was frustrated at having to see so many doctors and answer so many questions.  So he demanded that she sit in silence until he was good and ready to talk.  After the 25 minute hospital visit, she rightly documented his behavior in the chart, as she had done for so many episodes of patients’ abusive behavior in the past, especially since these patients often levy complaints against her for treating them badly.  To her surprise, the white male attending hospitalist paged her later to discuss the occurrence.  He had read the chart and apologized for the patient’s behavior.  He also called the patient out, asserting that if our colleague had been a white male herself, the patient would never have treated her like that.

An authentic white male ally, wow. 

…White men are more likely to listen to and follow other white men, I thought.

So I wrote her, “Can his actions be amplified so that he feels empowered and inspired to do this more?  So that other white men can see his example more easily and feel safe to follow?  Can someone mention his actions on rounds, share them in a newsletter, make them as visible as possible?  Examples like this can go such a long way to recruit white men to the cause—so many men sit on the fence, and just need to see one of their own lead the way, and then they get off on the side of doing what’s right.”

She agreed to highlight his actions in an upcoming community spotlight, noting that now he would likely be the target of any patient complaint.  We agreed that he would then need the support he gave her, given back to him, and then some.  We reflected on this great opportunity for colleagues to unite in solidarity for one another, standing up to cultural norms that oppress us all.

***

Stories like these humanize ‘others’ to us.  If we are honest, we may recognize that the ideas of ‘healthcare workers’ and ‘women of color’, among others, too often float on the surface of our consciousness as abstractions.  It does not occur to us to try to relate or empathize, to see them as real, flesh and blood people like ourselves. 

But that is what the world needs the most right at this minute—for us all to relate and empathize with each and every other human who suffers, who lives a different life from our own.  Our connections are the only thing that will heal us.

Love Letters for My Soul

Taking a break from COVID, racism, equity and other heavy things this week, my friends.  It’s too much, what with RBG’s recurrent metastatic cancer and John Lewis’s death.  I’ve been glued to my phone and computers all week, reading, digesting, observing, integrating, posting, connecting and conversing.  I had at least three important ideas for the blog, and they all need to marinate longer.

But I still had to write!  I owe letters to three friends, and they can wait.  What needed doing tonight were five love letters to strangers. 

Sometime this spring, while sheltering at home, I discovered More Love Letters.  Their mission is simple:

Deliver hand written letters to people who could use some extra love via snail mail.

People submit nominations for letter recipients, and every month the MLL team selects five to post.  Each recipient’s nominator writes a heartfelt request, and supplies an address.  Letters are requested to be postmarked by the last day of the month (but I bet they’d take some tardy ones, because they are sent with love?).  Tonight I wrote my second ever set of love letters, on washi tape stationery, of course.  I may have more cards and tape than I will use in my lifetime, so I’m more than happy to share!  Maybe next month I will include a blank card and envelope as a gift for the recipient to pass along—I’ll even put a stamp on it!

In this time of tumult and conflict, of heaviness and stress, reaching out to offer some light to others heals me.  They will not know who I am (well, unless they happen to read this post, I guess), and I will not get a card back in reply.  I get to write some encouraging words that might brighten someone’s day.  But I do it for myself as much as for them.

Maybe you could use a mutual pick-me-up, too?  Each one took less than five minutes.  The words came easily, organically, and happily.  “Holding you in light,” “Sending love and support,” “Wishing you everything you need in this crazy time.” Easy peasy, written sincerely–it feels so good.  You don’t have to write to all five nominees—do what moves you.  Maybe you’ll be inspired to also drop a note to your best friend, your colleague who’s challenged, or someone who recently crossed your mind, who’d probably love to know you were thinking of them.

Now is exactly the time to connect, don’t you think?

Oh and I have no financial or other interests in this organization. I just love that they encourage connection and snail mail, two of my favorite things.