The Mark You Make

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Friends, Ozan has written another book!  I know it may seem like it, but he’s not paying me to promote his work, really!  He has offered perks for Inner Circle members, however, like an advance digital copy for preordering, and signed copies when the book is released next April.  In considering what I would ask him to inscribe to my friends in the books I will give them, I realized yet another evocative dimension of my relationships.

If you were to describe your friendships to a third party, or make a meaningful introduction in service of connecting two amazing people, what would you say?  I call it ‘connecting fellow Awesomes,’ and it’s always a pleasure and privilege to serve in this capacity.  I thought to ask Ozan to write to one friend something like, “Cathy thinks the world of you—happy to make such a positive new connection!”  Then I thought, this friend has really made a mark on me.  Then I thought of the mark Ozan has also made, in just 9 months of virtual contact.  And then my mind was blown with the realization of my cosmically marked-up self—the finger, hand, and footprints of all those whom I have contacted.

Years ago I attended the orthopaedic surgery resident graduation dinner with my husband, a happy and fun annual event.  At the end, mingling with faculty and trainees, one of the graduates looked at me and his eyes widened.  “You’re Dr. Cheng!  You were my teaching attending during my third year medicine rotation [7 years prior] at [the hospital where I used to work]!”  I was gratified that his expression was cheerful, rather than distressed or awkward, surprise.  He went on to tell me that I held the team to a high standard of discussion, and that he appreciated my presence and teaching.  I will always remember this encounter with pride and appreciation.

In the past year three patients from my past have resurfaced and told me the positive difference I made it their lives.  I remembered two of them so clearly, both their faces and their names (after 20 years and thousands of patients, I can usually only remember one or other).  Talking to each of them reminded me of all that we had been through together, and I was glad that I had done my job well.

But what about those for whom I have not been a great doctor?  I have had my fair share of patients who left me, for various reasons.  I know I have been seriously disappointing for many.  I wonder how many times I have contributed to patients’ negative overall experience of medicine, and further widened the divide between doctors and patients in our fraught and flawed healthcare system?  Sometimes I look back on my early years of practice and cringe a little—all the writing I do now on empathy, compassion, curiosity, openness, and humility results from years of lessons learned in real time, on real people.  I’m definitely much more adept at it all now than in the beginning.  And I’m still learning—I still get triggered, still fall into old, counterproductive thought and behavior patterns.  Sometimes it feels like I will never be good enough, or enough in general.

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I also think about the people whose marks on me were/are hurtful, dismissive, and otherwise wounding.  It reminds me of carvings I see in the trunks of the beautiful aspens I walked among this weekend.  Did the folks who made them set out to harm the trees?  If they thought the tree might die from their knife marks, would they think twice?  Maybe they were overcome with their profound experience in nature and just wanted to mark it in some way, especially if they shared it with someone they loved (so may initials with plus signs and hearts)?  Sometimes we just want or need to be right, competent, respected, and acknowledged.  So we mark our encounters with stubbornness, aggression, or even violence (in its many forms, overt and cloaked).  Like the strong and flexible aspens, I bear scars from such encounters and still continue to thrive.  Such marks have taught me how to care for myself, and also how not to be toward others.

In the end, how do I reconcile these relationship phenomena?  Sometimes we can see and know the mark we make on others.  Many times we cannot.  Nobody is perfect.  My whole life I will scrape and nick those around me, hopefully never with malicious intent.  I can only hope for their generosity and grace, and forgiveness.

Sister Brené Brown, once again, helps me continue.  In her book Rising Strong, she describes a choice, a mental attitude, that can help us all suffer less.  If you have not read or heard the book, I highly recommend it—it’s my favorite of the 5 of her books I have read.  Assume, she says (with the help of her pediatrician husband), that we are all doing the best we can.  That’s it.  We are all imperfect.  Our circumstances mess with us, our patterns mess with each other, and sometimes it can feel like a strange and inexplicable miracle that we have not all killed one another already.  But choosing to give each other this one, simple, and at times colossally difficult benefit of the doubt, could be what saves us all.

We simply cannot extricate ourselves from each other.  So we can just do your best to take care of one another.  And be prepared to apologize, early and often.

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The Importance of Peer Support

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What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

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When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.

 

All Hail Your Dark Side

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What triggers you?

I don’t mean your pet peeves (please, stop using “there’s” when speaking about anything in the plural).  I mean what gets under your skin and affects you viscerally, really hijacks you?  I’m talking about the thing that escalates you so fast or intensely it’s like an out of body experience—you know you’re overreacting, you know it’s irrational, and yet all you can do is sit by and watch it unfold, powerless to control or direct it.

I had the pleasure of self-witnessing two such episodes recently, and it’s all so fascinating I had to write about them!

Bad Mom

A leader whom I deeply respect has asked me twice, in separate conversations, with slightly different words, how I manage my time.  The second time his words were, “How do you prioritize?”  Interestingly, I immediately altered his question in my mind to What do I prioritize?  I answered easily both times about strategies for handling emails, task lists, time with family, workouts, etc.  But after the second time I started to worry.  What’s behind this questioning?  Is he worried for me about something here?  Does he think I’m neglecting my family for work, and/or my clinical duties for all the extracurricular stuff?  Does he think I can’t handle it?

Over the next several days I had to chuckle with that sly, knowing expression when I realized it didn’t really matter what he was thinking.  The question, repeated, was a stealth trigger for my Bad Mom fear.  It wasn’t that I worried about his concern for my work life balance.  It’s that I was worried for it, and that I secretly question, more than I like to admit, whether my kids really feel loved enough by me.  This despite my previous blog post claiming that I actually don’t question it!  Blaaaaahahaha, how cosmically ironic!  Looking back, the article that incited that post touched pretty much the same trigger, and it has taken me this long to see it (better late than never).  How fascinating!

In my defense, I really do think I’m a good mom—mostly.  But like being a good leader, it’s definitely not always easy, and that I question my competence/proficiency/mastery does not necessarily detract from my real, ever developing, occasionally flourishing skill set.  Thanks to this new awareness of the Bad Mom Trigger, I have adjusted my strategies and tools, and rebalanced, for now, time and energy between work and home.  I look forward to receiving more gracefully the signals for future opportunities to readjust.

Canned and Rote

Last year I was leaving an evening work gathering.  A nice man saw me departing, got out of his seat, and approached me, apparently to introduce himself.  He said he had heard my ‘shtick’ something something something—I did not really hear anything else, as my abhorrence of that word had made me stop listening.  I think I was polite, and I exited with as few words exchanged as possible.

Readers of this blog know how much I admire Brené Brown.  Followers of Brené also know that her work is always evolving, new theories testing, refining, and building on prior ones, always with deeper and more meaningful understanding and application in relationships.  So I was deeply offended when I recently heard someone refer to her presentations as ‘shtick’ and ‘spiel.’  These words feel dismissive, mocking, and pejorative to me.  I have only heard them used in a disrespectful way about a speaker or their speech.  But why should I be so offended on Brené’s behalf?  She knows the value of her work; she does not need me to defend her.

Of course, as usual, it hit me later:  I identify with Sister Brené, so I took these words personally.  To me, shtick and spiel are how we describe presentations, and thus people, who stopped learning and growing long ago.  We utter these words and roll our eyes at having heard it all before—nothing new here, folks.  David Litt has said that when preparing a presentation ask yourself, what is the one thing you want someone in your audience to tell their friend about your speech the next day?  If the words ‘shtick’ or ‘spiel’ appeared within a hundred yards of someone describing my work—if someone thought I had not prepared but just shown up with canned, stagnant drivel—I would be mortified.  I pride myself on constant learning, self-awareness, and self-improvement.  I want every audience to feel that my presentation was uniquely relevant to them, that I worked hard to meet them exactly where they needed me.

I understand that everybody may not see or hear these words the way I do.  I can respect that and monitor/manage my reactions from now on.  But wanna trigger me?  Tell me you heard my spiel.  Go ahead, I dare you.

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Debbie Ford and Your Dark Side

OH it’s all so funny, the things that trigger us.  Because if we don’t laugh we will absolutely cry.  Or pick fights with our spouses that last weeks on end.  That’s what happened to me when I read The Dark Side of the Light Chasers about 10 years ago.  I was young yet in my adult development journey, and I had a few (just a few) more emotional hang ups than I have now.  On page 69 of the paperback edition she lists negative words like greedy, liar, sleazy and freak, and suggests an exercise:

Take a few minutes and identify any words that have an emotional charge for you.  Say out loud, “I am _____.”  If you can say it without any emotional charge, then move to the next word.  Write down the words that you dislike or react to.  If you are not sure that the word has any charge for you, close your eyes for a minute and meditate on the word.  Repeat it to yourself a few times out loud and ask yourself how you’d really feel if someone you respected called you this word.  If you’d be angry or upset, write it down.  Also spend some time thinking about words that are not on this list that run your life or cause you pain.

I didn’t get through the whole book back then, so I don’t know what she wrote about ‘embracing your dark side,’ ‘reinterpreting yourself,’ and ‘letting your own light shine.’  But I think I have figured it out for myself, at least a little bit.  It’s about self-compassion, acceptance, growth mindset, forgiveness, connection, learning, and joy.

Every light casts a shadow, and we need both light and dark for balance in life.  I’m learning to hold it all a little more lightly (ha! Pun!).  Debbie Ford felt too heavy for me ten years ago.  I’m looking for a new book this week.  Maybe I’ll pick hers up again and see how it feels.  …Makes me a little nervous, actually.  I wonder what I’ll find this time?