Category Archives: personal growth

What Makes You Think You Can Trust Me?

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My friend, we’ll call her Anna, recently had surgery on her pancreas, and she has generously given me permission to share her story. As soon as I heard she was going, I sat up straighter and paid attention. The pancreas is a sensitive organ, and not a common target for surgery, unlike the appendix or gallbladder. “Eat when you can, sleep when you can, and don’t mess with the pancreas,” they told us in med school.

Doctors discovered a growth on Anna’s pancreas in 2014, when abdominal imaging was done for something else. It was an ‘incidentaloma,’ as we commonly call such findings. She had no symptoms, and further tests showed no abnormalities of pancreas function. Everybody agreed to watch it with periodic CT scans. Fast forward one year, she still felt fine, but the mass was still there and appeared to be growing.

Cancer! What if it’s cancer? This ominous question looms over every unknown growth that we find in clinical practice. Pancreatic cancer is particularly scary, because there is no good screening test, and people usually don’t develop symptoms until the disease is incurable. Anna’s doctors started seriously considering surgery. The pancreas sits in the back of the upper abdomen, behind and outside of the abdominal cavity—not easily accessible. It serves both digestive and endocrine functions, and manipulating it can wreak havoc in multiple systems—hence the ‘don’t mess with it’ admonishment.

What to do? The tumor did not have typical cancerous characteristics on the scan; most likely it was benign. But what if it wasn’t? It was growing, albeit slowly. Would this be the rare chance to catch and cure a cancer, and really save a life? And if it wasn’t cancer, what was it? How long could we safely not know? Which would Anna and her doctors regret more: Operating now, risking complications from the procedure, only to find out it was unnecessary? Or continuing to watch, and realizing when finally forced to take it out, that it had already spread? If only there were accurate and reliable predictive tools—crystal balls and such. In their absence, we are left with incomplete information, and our own (in)tolerance for uncertainty and risk. The key for effective decision making lies in all parties’ self-awareness of the latter, and our ability to communicate it. This can be overwhelming, especially when the situation is complex.

Eventually Anna told her surgeon, “I don’t understand everything you’re telling me, but I trust you and I will do what you recommend.” She said he looked up and sat back abruptly, as if shocked by her declaration of trust and willingness to put the decision in his hands.

How would your doctor respond if you said this to him/her? Why would this surgeon be surprised at my friend’s statement? My patients have told me the same thing. What makes you think you can trust me? I think it’s based mainly on two things: Honesty and commitment.

 

I tell the truth.

I learned a long time ago that bullshitting my way through a patient encounter is completely pointless. If I don’t know the answer to a question I need to admit it, period, right there in real time. But just because I don’t know, doesn’t mean I can’t help. I know a lot. I can estimate. I can make a well-educated guess. I can articulate my rationale, explain that while I don’t know for sure, this is what I recommend based on the information in front of me, my past experience, and my personal biases (that last piece is critical). If I’m missing data, I can look it up. How often does an unknown pancreatic mass turn out to be cancer, in cases like this? If it’s very seldom, why do I recommend surgery? Maybe because I watched one too long once and I have always regretted it. This kind of experience will always influence my decision making; I’m kidding myself if I think it doesn’t. My patients have a right to know. It’s not weakness; it’s honesty. When you know my biases, you can decide for yourself how my judgment is influenced, and whether you’re at peace with it. When I own both my expertise and my limits, with humility and not shame, you are far more likely to trust me.

 

I will stand by you, whatever happens.

In order to trust me, you must also feel that I will not abandon you when things go badly. Because if we know each other long enough, something will always go wrong. You will have side effects from drugs. Treatments will not have the desired results. The worst thing I can say to you is, “Well, there’s nothing more I can do for you, goodbye.” There is always something I can do. I can’t cure your disease or bring your loved one back. I can’t make your depression go away. I cannot change your behaviors for you. But I can ask, “How can I help you suffer a little less?” Whether it’s referring you to a specialist or simply sitting with you for a while, my commitment to you, to our relationship, earns me your trust.

 

And, it’s a two-way street.

Here’s an interesting question: How can I trust you, to trust me? What do I need in order to feel comfortable both driving and navigating on this patient-physician road trip? It’s a huge responsibility, after all. I was honest about how well I know the geography and what I think we can expect on the way. I have made a commitment to be your travel partner, whatever the road and weather conditions. I need to know that you have relinquished the wheel and the GPS in an informed way, and that you will stay in the front of the bus to point out hazards and road signs. I need to know that you will not automatically blame me, or leave me, when we run over a nail and get a flat tire, or hit a deer that suddenly lopes across the road. We each need to take responsibility for our own part in getting to our destination.

Anna’s tumor was benign, and now she’s missing two-thirds of her pancreas. I imagine sometimes she wishes she had asked more questions, or decided to wait a little longer. But I think she does not regret her decision to trust the doctors. Her medical team is still intact and monitoring her appropriately. They may take turns again driving and navigating on her journey.

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.

 

 

Setting Intentions For 2016

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Happy New Year, Friends! Was 2015 not a wild ride?  However you experienced it, we can safely call the past year eventful, if nothing else.  The violence and the tenderness, the destruction and the connections—how can we hold it all at once?  I used to think myself an optimist, but now I often wonder if the world will actually end in my lifetime—whether we humans will obliterate one another in a rapid succession of escalating violence, or somehow see the light and work harder toward mutual understanding.  Nature will go on, though, with or without us.  I’m still an optimist, then—for the Earth, not necessarily for people…

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare.   After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

First, they accept it. They have made peace with this phase of life, letting go their reproductive years and embracing their elder position in our human tribal order.  They see menopause as a rite of experience and advancement, rather than a loss.  They move with confidence through this segment of life, and make the best of whatever happens.

Second, these women almost always have well-established habits of good health long before their hormone levels start dropping. Nutrition and physical activity come to mind first, but the practice of  ‘being at peace’ must also be included among the ‘habits.’  They have, whether innate or learned, effective mechanisms for overcoming adversity and maintaining balance—physical, mental, emotional, and relational—they are resilient.  I aspire to be like them.

So, until such time as humanity actually annihilates itself, I pledge to persist on the journey toward my best self. The more I read and share with contemplative friends, teachers, students, patients and others, the more I see how we make our lives out of small, daily choices.  As such, I propose below my intentions for the coming year.  I will fail, over and again, I know.  But as Ben Zander would say, these are not expectations to live up to.  They are possibilities to live into.

 

Choose to Train

I started working with Melissa, my trainer, in January of 2014. It was slow going that first year, with only a vague goal of exercising for its own sake, because I knew I ‘should.’  Now, my pursuit of fitness has much more meaning.  I have a finite amount of time to get in the best possible shape before ‘The Change.’  It’s an exhilarating challenge now.  How fit could this body get?  Every week since July, except for one, I have managed to exercise at least three times.  I set this goal on January 1, 2014, and it’s only since my Menopause Epiphany that I have truly owned it.  I think of myself as an athlete again, training for the ultimate marathon of living well in old age, by getting off my butt and moving, each and every day.

 

Choose to Fuel

*sigh*

I need to manage better what I put in my mouth. Eating is one of the hardest things for me to control.  I know exactly how much my patients struggle to include more vegetables, avoid sugar and starches, and eat less overall, because I fight the same battle every day.  After my daughter was born, at age 35, I successfully lost 25 pounds in nine months by simply cutting my portions in half, getting down to my wedding weight.  I had neither the time nor the interest to exercise, nor the energy to police my food choices.  Though I have kept the weight off for the most part, 7 years later I find myself wondering if I’m pre-diabetic.  I see every day how insidiously a persons’ glucose metabolism changes, and it’s ever clearer to me that ‘trying to eat healthy’ is not enough.  I need to set goals for eating, just like for exercise.  Is it food, or is it junk?  If it’s junk, is it at least junk that I really, really enjoy?  Will it be worth the cost to my body after eating it?  Does it align with my highest goals for health and a sustainable ecosystem?  Will it help me age well?  A body in training needs appropriate fuel.  The training piece feels established by now.  In 2016 I will strive to discern and allocate my energy resources better.

 

Choose Curiosity

It always amazes me, and scares me a little, how easily I slip into assumptions and negative storytelling about the people around me. I play old scripts in my head about other people’s intentions, based on my own fears and insecurities.  These thought patterns reinforce themselves over time, creating perceptive realities that are hard to distinguish from objective truths.  This phenomenon is well-described in psychology research, and contributes to misunderstanding at least, disconnection and isolation at worst.  My heroes Rosamund Stone Zander, Brené Brown, and Elizabeth Gilbert, all propose curiosity as the core antidote to assumptions, judgment, and alienation.  First, I can get curious about my emotions, whenever I feel triggered or agitated. What am I feeling? Where did it come from?  Then I can ask myself, “What story am I telling about this person, and what assumptions do I make about their thinking or perspective?”  If I can get this far, I’m already doing pretty well, and on a good day, I can take the next step, asking, “What other story can I tell, one that could cause me to suffer less?”  Last, I can always engage the other person from a place of vulnerability.  I can ask questions, confess my inner stories, and clarify what’s happening between us.  I’ve been practicing this for the past year, too, and it is hard.  But I’m getting better at it, and the results are well worth the effort.  Mutual understanding and deeper connections are only the beginning.  Curiosity may well be the best approach to world peace.

 

Choose My Family, My Tribe

We are each born into a family, for better or worse. And throughout a lifetime, we can also choose our connections, both inside and outside of our genetics.  I wrote recently about my friend Yakini.  My son had been to her daycare for months, and morning drop-offs were happy and smooth.  Then we went on vacation for a week, and when we came back, he was suddenly distraught every time I left him.  Immediately, Yakini knew what to do.  “We need to come to your home for a meal,” she said, as if it were the most obvious thing in the world.  “He needs to know that we are part of your family, that we will take care of him the same as you,” she continued.  Of course, it was a no-brainer.  We had to validate the sacred contract, as she called it.  Her whole family came over with their guitar.  We ate, we sang, we bonded.  After that the boy was happier than ever to see them every morning.  We had officially claimed Yakini’s family as our own.

My family of origin has its complexities. Culture, generation, and sibling rivalry have all contributed to my repeating scripts and stories.  I have learned with age that these patterns can and do change, and it serves all of us to hold space for the evolution.  I can practice curiosity, allow myself to be vulnerable, and choose deeper connections to the people I might otherwise take for granted or let drift away.  My siblings and I have also chosen our spouses.  We need also, then, to acknowledge each of their families of origin, their patterns, scripts, and stories.  I feel very lucky that my husband and my brothers-in-law all seem to accept our family’s quirks and dysfunctions—I can certainly learn from their example.

Lastly, in 2016, I intend to continue nurturing my ties to my tribe. These are the other family members I have chosen over the years, my friends.  They come from all stages and places of my life, and all offer unique perspective.  They accept my imbalances and love me anyway, and always challenge me to live in my integrity.  They hold me up on my quest for self-actualization.  They invite me to do the same for them, and together I honestly believe we make the world better.

2015 comes to a jumbled end for me, full of intensity, volume, texture, and possibility. I’m grateful for this blogging platform to explore and share ideas.  Thank you for reading to the end of this, I think my longest post yet.  I look forward to more growth and exploration in the coming year.  Nothing matters more than our relationships, first with ourselves and then with one another.  Let us cultivate connections that promote peace, love, and harmony, this year and beyond.

 

Warrior Pride, and a Plea for Preserving Our Connections

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My heart feels unusually heavy this weekend. Two years ago today a beautiful young girl named Claire Davis lost her life to gun violence and her schoolmate’s rage.  It happened at my alma mater, Arapahoe High School, in Centennial, Colorado.  It had been almost two years to the day after the tragedy at Sandy Hook, and not 18 months since the horrible theater shooting just across town, in Aurora.  I remember thinking then, what is happening to us?  How does this kind of thing happen so often, and what kind of pain moves people to commit such violence, against others and then themselves?

I remember high school with great love and (Warrior) pride. Classes were challenging but not overwhelming.  Our volleyball team never had a winning season, but we had fun and learned teamwork.  Our speech team, on the other hand, won consistently, and competed at State every year. The excellence of our choir concerts and musicals rivaled professional companies I have seen (no help from me).  Some of my best friends are teachers I met at Arapahoe.  Their dedication to education, of others and themselves, even now in retirement, inspires me.  I had my core peer group (fellow nerds), but I was friendly with people in almost every social cluster.  I was one of maybe seven non-white students in my class of 462, but I never felt singled out or threatened.  Looking back, it was the relationships, as usual, that made my time at AHS special.

Today, I see so much more vitriol and violence in our world than even just 2013. Our relationships deteriorate faster than ever.  We oversimplify our political views to post on social media, looking for the most searing and aggressive words to make a terse point.  It’s as if we think 140 belligerent characters will make someone with an opposing view say, “Oh, of course, you’re right, I change my mind.”  We reply to others’ combative posts impulsively, defensively, and with hostility.  What good does this do anyone?  It certainly does not lead to any meaningful discourse or mutual understanding.  We write things on social media that we might never say in person, or at least not without thinking twice.  As a result, we feel indignant, offended, and angry.  We ‘unfriend’ one another on Facebook, narrowing our relations to the echo chamber of those who share our exact views, collectively deriding those who don’t.

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy.  We must choose carefully with whom we are willing to undertake such a venture.  And perhaps most importantly, we must be clear about our objective(s).  Do we really expect to change someone’s fundamentally held political or religious beliefs?  How realistic is that?  What other purpose, what other good, could possibly come from such conversations?

I propose that we seek these personal interactions to deepen and strengthen our relationships—our connections.  Social media, and probably media in general, constantly work to divide us.  We need to sit down with one another to reunite, find our common ground, and rediscover our shared humanity.  I believe this can only be done in person. It gives us a chance to practice our best skills in patience, curiosity, and withholding judgment. We must listen to understand, and not merely to reply or refute.   In the best of these conversations, we ask more questions and make fewer sweeping, generalized statements.  We avoid accusatory language, and say more, “Help me understand,” and, “What makes you think that?”  The key is to really mean it, though—we need to honestly seek to understand our counterpart’s point of view.

In the best cases, we each walk away feeling seen, heard, understood, and accepted—even loved—despite our differences. We pledge to continue the conversation, seeking always mutual understanding, bringing always mutual respect.  Let us start with our real friends.  Let us make it safe for those closest to us to express their views without fear of ridicule and contempt. Let us request the same of them, and practice openness and reflective listening in the harbor of established connection.  Emboldened with the courage to stand firm in our own beliefs while generously allowing others theirs, then maybe we can venture out into social media again, and serve to bring openness, generosity, and respect to our virtual relationships.

Maybe you feel confused—how did a post starting with the shooting at my high school end up as a plea for kindness on social media? I suppose blogging is, at times, an exercise in stream of consciousness.  Thank you for sticking with it to the end.  Your willingness to do so gives me hope that we can all move toward patience, generosity, and compassion.