Insight While Driving to Work

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Training for Better Angels, it occurs to me:
Confidence in excellent communication skills in order to enter difficult conversations without bailing or lashing out… is akin to the core stability required to get into and out of a deep squat.
It’s the bending down, feet flat, head up, in control and not falling over, that is the challenge—not the forcing up in a quick, mindless burst of brute strength. Bearing the load all the way down and standing back up gracefully, without causing or suffering injury: that is where our real power lies, in the gym and in conversation.

Tombstone Words

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Update, my friends:  My application for moderator training with Better Angels was accepted!  AND, they may let me help with workshops both in Illinois, where I live, and Colorado, my home state!  Woo hoooooooo!  So much good work going on in this organization, please take a look!

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This post is a three-part thought experiment.  Take some time with this one, maybe–sit up straight, take some deep breaths, and see where it takes you!  I invite you to write down your answers to the questions with a pen and paper.  And then please share in the comments how it lands!  Please know that I write purely out of curiosity and a deep desire for exploration and connection, and not out of judgment or an attempt at ‘pimping,’ as we used to call it in med school, when teachers asked us questions just to see us squirm and fail.

I credit my life coach and a new friend and mentor for instigating this post, and the ongoing conversations both in my own head and with others that I absolutely cannot wait to have as a result!  The thread that connects the experiments is this:  How do I show up in my life, and how do I feel about it?

 

Experiment 1

Imagine you’re at an awards ceremony; it’s the end of 2019.

You’re being honored and given an award for something.

You’re at the party, wandering amongst the guests/everyone present, listening to what people are saying about you.

They do not see you; but you will be present to receive the award later–you are not dead.

Who is there?  How have they organized themselves?  What is the vibe in the room?

What are people admiring about you?  What are the words they’re using as they speak about you?

What are their facial expressions, posture, and gestures as they describe you and their relationships with you?

…What else do you notice?

What is the name of this award, and why are you the recipient?

How do you feel doing this exercise?

What emotions/thoughts/memories does it bring up for you?

 

Experiment 2

Now it’s your funeral or memorial service.  Ask yourself the same questions as above, but in this similar and yet very different setting.

How are people dressed? How do they look like they feel?

Do they know how you want to be remembered and/or honored in death?

Who would be there if it happened today?  What about five years ago?  Ten years from now?

Now imagine that the three most frequent words uttered about you at this event will appear on your tombstone.  Which words would you like those to be?  Which do you think your funeral attendees will give you?  How easy or hard is it for you to imagine the latter, and how close to your own wishes are they likely to be, today, five years ago, or ten years from now?

 

Experiment 3

Now, imagine a different set of people attending the events above.

These are your opponents, adversaries, and enemies.  They are your inescapable work colleagues, direct reports, bosses, and your estranged family members.  They are also the people you see regularly on your commute, the homeless people you pass on the street, servers at your favorite restaurants, and people who work at your grocery store.  They are your kids’ former teachers, the customer service representatives at Comcast or United Airlines, your postal carrier, and the workers who collect your trash.  What would all of these people say about you at your awards ceremony and at your funeral?

I did the first exercise with my coach a few weeks ago; it was powerful, enlightening, and grounding.  The second and third experiments occurred to me today, and I will consider them, chew on them, in the coming weeks.

So…  How was it?

The Optimist and the Cynic

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Are you an optimist or a cynic?

I consider myself to be, wholly and without question, an Optimist—with a Big O.

In The Art of Possibility, Ben and Roz Zander describe a cynic as a passionate person who doesn’t want to be disappointed again.

By this definition, cynics are not altogether hopeless and negative; they are simply wary and cautious based on past experience.  Still, I judge cynics and find them tiresome.  I reject their gloom and doom outlook.  Sometimes I really just want to throttle them.  In their presence I turn up my outward optimism to happy headbanger volume.  I can tell this makes them a little crazed—they see me as Pollyannish, idealistic, and naïve—and likely wish to strangle me, too.

And here’s the thing:  I also possess a deep cynical streak; one that can really overtake my consciousness sometimes.

Every day I campaign ardently to empower myself and those around me, pointing to all the ways we can claim our agency and effect positive change.  I advocate for using all of our kindness, empathy, compassion, and connecting communication skills, in every situation—take the high road!  Be our Best Selves!  And yet at the same time, a darker part of me, my shadow side, silently tells a contemptuous story of the forces we fight against.  I paint a sinister picture in my mind of impediments made of ‘the other’ people—the small minded, the pessimistic, the underestimating, unbelieving, rigid, unimaginative, distrustful, conventional, supercilious, and condescending themThey are not like usThey are the problem.

Of course this is not true.  It’s just a story I tell—a counterproductive and self-sabotaging story.  How fascinating.

Sometimes I tell this unsympathetic story aloud, out of frustration, impatience, and exasperation.  Sometimes I actually name people and label them all those negative things I listed.  It feels justified and righteous.  But then I feel guilty, as if my worse self kidnapped the better me and held my optimism hostage until I vented against my better judgment.  I wonder when my words will come back and bite me in the butt?  What will I do then?

I suppose I can only claim passion and disappointment.  Sometimes I let the latter get the best of me and allow shadow to overtake the light.  It happens to the best of us; I can own it.  There is no need to disavow the disappointment and disillusionment, the dissatisfaction with what is.  If I didn’t care so much—about patient care, public policy, physician burnout, patient-physician relationship, and relationships in general—I would not suffer such vexations.  And it’s because I care so much that I fight on, to do my part to make it better.  I stay engaged in the important conversations, even if I have to take breaks and change forums at times.

Yes, I, the eternal optimist, harbor an inner, insubordinate cynic.  While most of me exclaims, “Humanity is so full of love and potential!” another part of me mutters subversively, “Also people suck.”  Some days (some weeks) the dark side wins, but it’s always temporary.  The Yin and the Yang, the shadow and the light, the tension of opposite energies—that’s what makes life so interesting, no?  We require both for contrast and context, to orient to what is in order to see what could be. 

The struggle for balance is real and at times exhausting.  And it’s always worth the effort.

Synthesis and Integration: Self and Other Focus

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Hey friends, how was your week?  Learn anything new and interesting?  Anneal any new ideas to existing frameworks in your already complex world view?  I did!  And it came in another big wave after my presentation on Friday.

I wrote last week about how I put together a new presentation.  For the first time, I added the idea of medicine as a complex adaptive system to a talk I gave to physicians at various levels of training and practice.  The objective of the presentation was for people to understand the scope of physician burnout, and leave with some ideas of how they could not only cope better themselves today, but also influence the system and move it toward a healthier, more compassionate state in the future.

As usual for my talks, I focused first on personal resilience.  Many physicians push back at this idea, and rightly so, as many medical organizations have instituted physician wellness programs aimed mainly at ‘fixing’ the doctors with yoga and meditation classes, while allowing the system that burns them out to continue its toxic trends toward over-regulation, loss of physician autonomy, and driving metrics that lie outside of, or even counter to, our core values.  I worried that my talk would be taken as just another attempt to tell physicians we aren’t good enough at self-care.

Thankfully, the feedback so far has been positive and I have not heard anyone say they felt berated or shamed.  I hope it’s because in addition to tips for self-care (eg 7 minute workout, picnic plate method of eating), I talked about how each of us can actually help change the system.  In a complex system, each individual (a ‘node’) is connected to each other individual, directly or indirectly.  So, difficult as it may be to see in medicine, everything I do affects all others, and everything each other does affects me.  This means I can be a victim and an agent at the same time, and the more I choose one or the other (when I am able to choose), I actively, if unintentionally, contribute to the self-organizing system moving in one direction or another [URL credit for image below pending].

Nodes in Complex System

My primary objective in every presentation is to inspire each member of my audience to claim their agency.  Before that can happen we must recognize that we have any agency to begin with, then shore up our resources to exercise it (self-care and relationships), and then decide where, when, and how that agency is best directed.

 

In 5 years of PowerPoint iterations, including and excluding certain concepts, I have always incorporated David Logan’s framework of stages of tribal culture.  Basically there are 5 stages, 1-3 being low functioning, and 4-5 high functioning.  The tribal mantras for the first three stages are, respectively, “Live sucks,” “My life sucks,” and “I’m great”.  Stage four tribes say, “We’re great” and in stage 5 we say, “Life’s great.”  The gap between stages 3 and 4 is wide, as evidenced by the traffic jam of people and tribes at the third stage.  In my view, the difference is mindset.  In the first three stages, most individuals’ implicit focus is on self, and subconscious mindset centers around scarcity and competition.  Victims abound in these cultures, as we focus on recognition, advancement, and getting ours.  We cross the chasm when we are able to step back and recognize how our mutual connections and how we cultivate them make us better—together—we see the network surrounding and tied to our lone-node-selves.

This week I realized that crossing the stage 3-to-4 chasm relates to two frameworks I learned recently:

The way I see it, in Logan’s tribal culture structure, one initially works toward self-actualization, essentially achieving it when fully inhabiting stage 3, “I’m great.”  But crossing to stage 4 requires self-transcendence, as described by Abraham Maslow, by recognizing a greater purpose for one’s existence than simply advancing self-interest.  In the same way, through stage 3 we live in what the Arbinger Institute describes as an ‘inward mindset,’ and we cross to stage 4 when we acquire an ‘outward mindset’, which is pretty much what it sounds like.  Essentially in stage 3 we mostly say, “I’m great, and I’m surrounded by idiots,” and in stages 4 and 5 the prevailing sentiment resembles, “We’re great, life’s great, and I’m so happy to be here, grateful for the opportunity to contribute.”

An astute colleague pointed out during my talk on Friday that we do not live strictly in one stage or mindset in serial fashion.  Depending on circumstances, context, and yes, state of mind and body (hence the importance of self-care!), we move freely and maybe often between stages, sometimes in the very same conversation!  The goals are to 1) look for role models to lead us to higher functioning stages more of the time, and 2) model for others around us to climb the tribal culture mountain with us, spending more and more mindset and energy at higher and higher stages.

The problem is the system, and we are the system.  So, onward.  Progress moves slowly and inevitably.  It will take time, energy, and collective effort.

We’ got this.

Grudges and Boundaries

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Has someone wronged you recently?  Long ago?  (How) Does it still affect you?  Are you a grudge holder?  Does someone hold a grudge against you?

Last night I gathered with good friends and this topic came up—we go deep, my friends and I.  Of course, it started me thinking and wondering:  What does it mean to hold a grudge?  When I hold a grudge, what do I actually do?  What is the motivation?  What are the consequences?  When/how/why does it resolve, if ever?  As we talked, it felt straight forward at first.  Everybody knows how it feels to hold a grudge—but how do you describe or define it?

Google dictionary defines it:

Grudge: /ɡrəj/

noun

a persistent feeling of ill will or resentment resulting from a past insult or injury.

“she held a grudge against her former boss”

synonyms: grievance, resentment, bitterness, rancor, pique, umbrage, dissatisfaction, disgruntlement, bad feelings, hard feelings, ill feelings, ill will, animosity, antipathy, antagonism, enmity, animus;

informala chip on one’s shoulder

“a former employee with a grudge”

verb

be resentfully unwilling to give, grant, or allow (something).

“he grudged the work and time that the meeting involved”

synonyms: begrudge, resent, feel aggrieved about, be resentful of, mind, object to, take exception to, take umbrage at

“he grudges the time the meetings use up”

 

The more we thought about it the worse it felt to me.  I’m reminded of the saying that hatred hurts the hater more than the hated.  Grudges feel like dark clouds hanging over my consciousness, chilling my soul, or at least casting a cold shadow on my joy, freedom of emotion, and possibility for connection.  My friends and I contemplated the utility of grudge holding.   What good does it do, what need does it meet?  I think it’s protective—a defense mechanism, a way of not being vulnerable again—armor, as I believe Brené Brown would call it.

I asked my friends last night, “So is it holding a grudge, or is it setting a boundary?”  I wondered if they are the same or different.  After all, both make you behave differently toward the other person.  But I think it matters whether and how we judge the other person.  When I hold a grudge, I judge the whole person based on the bad thing (I perceive) they did to me.  I may generalize from my own negative experience and write them off as wholly selfish, ignorant, narcissistic, and unworthy of my compassion and empathy.  Perhaps I start to depersonalize them, make them into an abstraction right in front of my eyes—dehumanize them.  Does that seem like an extreme description?  Even so, doesn’t it still describe the feeling?   When I hold a grudge, I do not—cannot—like or even relate to the person.  I avoid them, don’t want to be in the same room with them.  I don’t trust them.

I listened to The Thin Book of Trust by by Charles Feltman (referenced by Brown in her book Dare to Lead) this past week.  He describes four distinctions of trust:  Sincerity, Reliability, Competence, and Caring.  He suggests that when we find someone else untrustworthy, it’s likely that they have disappointed us in one or more of these elements.  I have assumed for a long time that the person I hold a grudge against simply does not care about me or my well-being.  Feltman suggests that of the four distinctions, this may be the hardest one to overcome when violated.  My story about this person is that they don’t care about me, therefore they are categorically untrustworthy.  So I feel justified in denying the validity of their point of view, minimizing their achievements, and casting them as the permanent villain in my story.

Yuck.  That perspective does not align with my core values.

So what can I do?  Maybe rather than holding a grudge, I can simply reorient myself to our relationship.  Instead of harboring bitterness and ill will, can I instead learn, synthesize, and integrate some new information?  When I’m wronged, maybe I can say, with curiosity more than resentment, “How fascinating!”  Maybe I can take care of my own feelings, connect with people I do trust, and regroup.  Then I can decide how I want to present to this person hereafter.  I can set some new boundaries.

Rather than dismiss the person as uncaring in general and holding this against them, I can do other things.  First, I can withhold judgment on their caring and make a more generous assumption.  For example, I feel un-cared for by them, but perhaps their way of expressing caring is different from how I receive it.  I can look for alternative signs of caring.  Or perhaps they truly don’t care about me, but I need to work with them anyway, so I had better figure out a way to do it—are they at least sincere, reliable, and competent?  How must I attend to myself, so I can honor my core values, get the work done, and not get hurt (or at least minimize the risk)?  Second, I can set clear boundaries in our relationship.  I can point out behaviors that I will not tolerate, and call them out if they happen.  I can set realistic expectations about agendas, objectives, methods, and contact.  I can give honest and direct feedback with concrete examples of words or actions that require attention and remedy.

Many thanks to my thoughtful and engaging friends who stimulate these explorations.  I can feel my grip on the grudge loosening already.

How Do You Stay Healthy While Traveling?

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Once again Nate Green stimulates my thinking and connects my professional and personal dots.  Last week he asked newsletter subscribers this question, and I was surprised at the cascade of subsequent questions it triggered for me:

How do we define “healthy?”

What about travel threatens and/or challenges health?

Is it different depending on the person?  The trip?

What about the trip—Destination?  Duration?  Time of year?  Companions?  Purpose?

How, specifically, is travel different from home?

How do we apply the answers to these questions?

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In my practice, the patients I see travel, I estimate, an average of 35% of the time.  They endure interstate commutes between work headquarters and home, or fly between company sites and all over to meet customers across the country and around the world.  Inevitably these trips include hours sitting in meetings and then the requisite business dinners.  Such meals present the quadruple threat for acid reflux, among other problems:  They are large volume, fatty, and alcohol-laden, and often occur shortly before people go to bed.  Many patients report that they feel badly after business dinners—bloated, sedate, and a little guilty, or at least concerned, about their health.  They feel little agency to change the pattern—fascinating.  We cannot underestimate the business culture of peer pressure that perpetuates our worst habits of self-sabotage, and I see this as the primary threat to my patients’ health when they travel.  Other challenges include jet lag, poor access to healthy food, and disruption of routine, most importantly sleep and exercise.

I have only started to ask my patients Nate’s question.  One patient knew his answer without hesitation: Do not eat late.  I’m curious to see how others answer, and how their answers may evolve over time.  Perhaps I will add this to my standard questions, after my stress/meaning ratio markers.

Nate’s question invites me to consider for myself, as I prepare to travel for the holidays.

How will I define health on this trip?  I will be healthy if I stay active, protect my sleep, and connect with my people.  I will practice intention and mindfulness.  I will read that which enriches my knowledge, awareness, and relationships, and do my best to avoid click bait, sensationalism, and meaninglessness.

What about this travel threatens or challenges my health?  OMG the food.  It’s not just business dinners that are full of fat, sugar, and portions to satiate hippopotami.  Holiday desserts are my crack—one of these days I might just overdose…  I also tend to stay up too late, usually watching movies, and then sleep in and feel guilty for wasting half a day already.  That kills my motivation to do anything very active, much less a full workout—the day is practically over—what’s the point?  Might as well eat, is there any cheesecake left?

Is this different for me compared to others?  Oh, yes.  My husband seems to have no problem controlling his eating, sleeping, and activity anywhere he goes.  Jerk.

Is travel home for the holidays different from, say, conference travel?  Yes.  I think I am more disciplined at meetings.  There isn’t food everywhere whenever I want it, and medical conferences usually offer more healthy options anyway.  I still stay up too late, though.

So what’s the answer?  How will I keep myself healthy this holiday travel season?

Nate included a video by Matt D’Avella in his newsletter, which made some useful suggestions.  Carve out time at the beginning of each day to exercise.  Get outside if possible.  Make the objective maintenance of fitness and routine, rather than progress—slow and steady prevents injury.   I can probably mark time to do some kind of exercise, just not in the mornings—I hate mornings.

Nate suggests making one consistent meal every day of the trip.  Matt made chicken, black bean, egg, and rice burritos every morning in Sydney.  That fueled his morning workouts, simplified food decision making by one meal a day, and allowed him to explore new foods the rest of each day.  I can probably make breakfast my stable meal each day on vacation.  My morning meal has been haphazard the past few months at home, too, so this could be a great opportunity to regain a routine even after vacation.

JAX gym view

Perhaps my central strategy this time can be labelled “Planning for Real Life.”  Whenever I go home I make grand plans to see everybody, cook a ton, hike, shop, relax, read, write, and organize.  For some reason I always leave feeling disappointed that I could not fit it all in, go figure.  There will be multiple families together this year, lots of little kids.  It’s December, and weather can be neither controlled nor fully predicted.  We can make plans, but kids get tired and lose interest, and adults can have meltdowns of our own.  I can look at the calendar and compare it to my task list for the week.  What do I really need to accomplish?  What did I just write here?  Sleep, move my body every day, read a little, and spend quality time with my peeps.  In other words:  Rest, Train, Learn, and Connect.

Thanks for the prompt, Nate!  And Happy Holidays to you!

Shoots in the Poop

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It’s December 4th… Time to look back?  Honestly, I’d rather just get this year over with and move on,  because I have already been looking back all this time.  Since January I have counted—weeks and months since the knee injury, months since starting the new job, since surgery, since a spring crisis, since the last this or the first that.  What was it all for?  I think I was just reminding myself that there’s been a lot going on, reassuring myself that I’m not just whining, not being weak for letting my personal health habits slip.

I’ve felt like a relative slug for the last 6 months, despite my best efforts.  I think I must have eaten a pint of ice cream every two days for most of the spring and early summer.  Looking back on the calendar, I stopped using smiley stickers to mark workouts around July—their intensity was only worth hand-drawn smileys.  By and since August they aren’t worth smileys at all—I just jot down what I did in shorthand.  Some weeks it was barely anything.   I judge myself every day—perhaps less harshly than I might have a few years ago, and also less compassionately than I might a few more years from now.  I still struggle with the fear of self-indulgence if I allow myself too much self-compassion.  I am still learning self-compassion.  I know it takes time to rewire our limbic brain patterns with knew learnings from our cognitive brains.  So I will keep trying, because I know it’s helping.  And I’m modeling for the kids.  We can do our best and still fail.  The key is to keep moving.  We can practice admitting we need help, seek it from the appropriate sources, lean on it heavily, and stand back up eventually.  And then we remember those who helped us, and prepare to be helpful in return.

I have leaned on so many this year, I feel almost speechless at the outpouring of support and love.  The only way I don’t collapse from this weight of gratitude is by storing it like a battery—ready to be discharged, full power, when someone needs to plug into me.  This may be my favorite thing about humanity—that we are wired to connect so tightly, to help one another in webs of mutual love and kindness that can extend ad infinitum.

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So I’ll look back a little.  This week I feel a turning.  Did I say this already recently?  Oh yes, it was November 12.  I was making more room for books, trying to stay off of my phone, off of Facebook.  Being on the laptop every night to post to the blog stymied that last part, but it also bought awareness of how I find loopholes in the best plans for self-discipline.  And the daily writing practice also contributed loads to this internal revolution.  This was my fourth year doing NaBloPoMo.  It was by far the most fun, the smoothest, and the most rewarding attempt yet (I think I also said this last year?), and now I miss writing every day (definitely have not said this before).  Maybe it was the daily dopamine hit of views and likes.  But I think it’s more than that.  Through the daily discipline, I had a chance to process and synthesize so many ideas and connections that had been marinating for months, maybe even years.  I practiced prioritizing, selecting, and distilling those ideas into about 1000 words each day, more for my own benefit than anyone else’s.  That people read and related to them was definitely a happy bonus.

Besides NBPM, I attribute this turnaround to two books that Donna recommended to me earlier this fall:  Leadership and Self-Deception and The Anatomy of Peace, both by The Arbinger Institute.  I have wanted to write about them for the last several weeks, but I haven’t yet figured out how to prioritize, select, and distill the lessons coherently.  The foundational ideas are not necessarily new, but they are profound.  The books are written as modern allegories, and there is just something about the metaphors and analogies that has unlocked and integrated everything I have learned about inner work, communication, relationships, and leadership to date.  And that is saying a lot.  Because of these books, the daily writing, and all the conversations I’m having (with myself and with others) as a result of both, the two most challenging relationships in my life right now have fundamentally improved—mostly because I have been able to shift my own attitude.  As with all things, this new ‘way of being’ will take practice.  I need to keep the training wheels on for a while yet.  But now that I have made this turn, the path looks straight, and I see light.

The manure has piled on all year.  So much fertilizer, oh my gosh.  It’s done its job, though, because I have definitely grown.  I feel strong, healthy shoots of green popping out through the thick, dark carpet of poop.