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.

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“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.

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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?”

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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.

Why I’m Not Going Home

Friends, I’m sad.  I will not go home to Colorado next month.  The family went already last month; it was a glorious 15 hour road trip each way from Chicago, with 7 amazing days in the mountains, my favorite place on earth.  Because we had planned to be abroad that week, back in January we made plane reservations for a five day trip to my home state in August.  And now I will cancel.

Cancelling a trip home is a big deal for me.  But I cannot ignore the glaring imbalance of risk and benefit here.  It’s a personal, emotional decision, but not without reason. 

Trust

First, I agree that flying during this pandemic can be safe. It depends critically on everybody doing their part, namely masking up and staying on the ground if we feel sick or have a recent known exposure. I do not trust everybody to do their part. I don’t know who will lie on a symptom checklist or suppress a fever with medication in order to fly while ill. I don’t know who will pull their mask off right next to me for the duration of the flight. Sure, the airline can ban them from flying after we land, but I still have to sit next to them for three hours, wondering about their infection status, fuming at their apparent disregard for my safety and that of everybody on the plane.

Shock and Awe

Second, I have never seen a disease like this. The spectrum of illness spans from totally asymptomatic to 100 days in hospital, intubated and proned, on ECMO (heart-lung bypass) and dialysis, limb(s) amputated, before finally dying. Every organ system can be affected, including the brain. COVID patients in the ICU require sedation and paralytics to control agitation, psychosis and flailing. Some suffer catastrophic strokes. Upon discharge, if they survive, months of rehab still don’t guarantee any return to normal. It’s been only six months since the disease emerged; we have no idea what long term consequences or complications lie down the road for these patients, no matter what their illness course.

Statistically, my family and I have a low risk for complications and death if we are infected.  We are young and healthy.  Populationally, the old and infirm have the highest mortality risk.  This is also true for flu.  And, healthy young people die every day from COVID, just like they do during flu season.  And death is not the only horrible thing that happens to COVID patients.  Symptoms can last weeks to months, including cough, shortness of breath, profound fatigue, diarrhea, and mental slowness.  There is no way to predict 1) who will get infected or 2) what their disease course will be.  It could be anything, and there is no good or reliable way to affect the outcome.  You could be totally fine or suffer long and hard before dying.  And the mental and emotional tolls of suffering in isolation, for the patient as well as their loved ones, are the ultimate insult added to injury.

I have profound respect for this virus and this disease.

Regret

Third, it’s a five day vacation.  We were just there a month ago.  This is not essential travel.  My kids are my life.  If one or, God forbid both, of them got sick, or if my husband and/or I got sick and died, or if I infected my patients—if anyone, family or not, ended up suffering because I decided to take this trip—my soul could never rest.

In the end one question always helps me:  Of the worst case scenarios at the end of each path at this fork, which would I regret more?  I will be sad to not go home this time, yes.  But I don’t know how I could take the responsibility of getting someone infected because I wanted to take a five day vacation and made us all get on a plane in the middle of a wildly uncontrolled pandemic.  There is no question here.

The sadness is real, though.  And it’s not just about the trip. It’s about life turned upside down, everything we took for granted—our safety and security—threatened.  It’s about the immense uncertainty, the suffering all around us, the lashing out and fighting from stress and tension, the chaos.  How will we know what do to about school?  When will life be the f*ck normal again?

Clarity

All of that said, there is still a very bright side.

This is temporary.  Life will likely not ever go back to what it was, but it will feel normal again, someday.  It will take some years, all things considered.  In the meantime, we are fully in control of our mindset and response in this moment.

Mindfulness’ has become a trendy buzz word, almost cheapened such that I hate to even write or say it.  But the evidence is all but irrefutable for its benefits, especially in times like these.  The practice is essentially to be with what is, right now, including how you feel about it, with acceptance and nonjudgment.  So much easier said than done!  And yet, in truly mindful moments, peace and clarity ultimately descend (or transcend, I should say).  To look around at the chaos and suffering, and accept it as just the way things are, is the first step to managing it all.  Living fully in the present moment allows us to distinguish clearly what we can control from what we can’t.  We can claim and exercise agency over the former, and let go the latter, thereby suffering less and maximizing energy and resources to effect positive change for ourselves and others. 

To really free ourselves from the anxiety and uncertainty of the present moment, to know what to do today, while we attend to the now, we must paradoxically also cast ourselves into the future.  We must take the long, infinite view.  What really matters today?  What from today will really matter next year, and in five, ten, or fifty years?  Will the disruption of remote learning for my privileged kids this year really make a difference when they are my age?  Likely not.  Will missing essential nutrition and social contacts, and parents’ unemployment this year, for kids in marginalized communities, matter later?  Absolutely.  Many of us will be okay no matter what.  Many more of us will not.  The disparities we see today cast long shadows into the future, and we must attend to them in current policy and guideline decisions. 

We are all in this together, and what we each do affects everybody. This fact is inescapable. There will be more suffering and death, no matter what we do. Somehow we each must make our own peace with the risks, find freedom and joy, and exercise empathy and social responsibility, in the face of it all.

In this crisis we are called to be our best selves for one another.  That ultimately includes individual, short term sacrifices for the greater good.  I can give up my little vacation to help keep everybody healthy.  I wash my hands like I have OCD.  I keep my distance around people I don’t live with.  And I wear. my. mask.  I protect you, you protect me.  Let’s all do our part, shall we? 

Rallying for Reentry

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We’re baaaaaaack…  Sort of.

After ten weeks sheltering and working mostly remotely, the primary care team I lead will phase back into regular office hours this week.  What a long, strange trip it’s been!  And it’s nowhere near over!  But the next chapter begins, and we are ready.  We return with limited staff, all spaced, masked, and sanitized.  We have planned for weeks and done our best to anticipate hiccups and pitfalls.  Now it’s time to dig in and execute.  Exciting!

And maybe a little scary?  We will have minimal face to face appointments in the beginning, but as with businesses and services across the country, we will ramp up over time.  How will this affect and be affected by coronavirus infection and illness rates going forward?  What will flu season look like, while we continue mitigation efforts for COVID-19?  Despite the multitude of models, nobody can say for sure.  And still we must move.

So what’s a leader’s role here?  How can I best serve my team as we step boldly back onto the path, besides planning and execution of operations and logistics?  Now more than ever, I must be both clear and adaptive about my leadership—its meaning, influence, and potential.

This weekend some strong feelings emerged to center, ground, focus, and guide me.  Interesting, isn’t it, for my professional peace to rest so surely on emotions?  The cognitive knowledge that my own leaders have my back gives me confidence and reassurance—I trust them.  I trust us all to flex and adapt as our collective situation evolves.  One could argue that trust itself is, by nature, more limbic than rational.  And such is the human condition—we are emotional beings who think, not the other way around.

So I embrace and anchor to my positive emotions.  I can moderate turbulence with solid intellect and steady spirituality.  I believe good leaders do this visibly and vulnerably—they lead by example.  Right now we all need to manage through a morass of complex feelings—to identify, accept, and allow their passage through us.  This is how we take care of ourselves and each other, and get the work done.

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Pride

I could not be more proud of our team.  Like so many cohesive teams in an emergency, we pulled together, reorganized, and mobilized like champions.  Computers were set up at home, schedules rewritten, tasks redistributed, and personnel reallocated.  Folks overcame fear and anxiety, at times severe, to help other departments, learn new skills, and grow into leaders themselves.  They made connections across the health system and broadened perspectives that will now benefit our whole team.  We supported one another through semiweekly touch points, instant messaging, photos, stories, and some tears.  I have no doubt that we can not only navigate but crush this crisis arc, and emerge a stronger, even more cohesive version of ourselves.

Protectiveness

As clinical director, I appoint myself chief cheerleader and den mother.  Through various channels, it’s my job to keep a finger on the pulse of morale and engagement.  And while I hold the team up to its own standards of integrity and accountability, I also keep a vigilant eye for assailants from outside.  As we prepare to reopen, I consider how I will protect my team from abusive patients.  I think the risk is low, but what if someone refuses to mask or submit to temperature screening?  What if they become aggressive or belligerent?  Our team has cultivated empathy and compassion, especially for patients who feel anxious and sick.  Still, I will not compromise our safety for someone’s angry outburst or agitation.  We have a plan for handling such situations that will never tolerate physical confrontation or humiliation.

Loyalty

We’ve been through a lot together the two years I have been back on this team.  Turnover was high in 2018, and engagement low.  We’ve since built a culture based on connection and accountability, and this complex work continues—culture work never ends.  Technically I hold an interim position; I am a steward.  But I will not leave until the right successor is identified and groomed.  I’m in for as long as this takes, as long as I am able, as long as the team will have me—I will not abandon ship.

Conviction

Our team has a particular, holistic approach to patient care and relationship.  In order to live this approach for ourselves, we defined our core values a year ago:  Kindness and compassion; connection and collaboration; fun, joy, creativity; and accountability.  I see now that we have an opportunity in this moment to further clarify our mission and vision.  Nothing like a global, existential pandemic to make us reorient and reclaim our raison d’être!

Vision and Execution:  It is the leader’s role to manage both—to host the ball and move fluidly between dance floor and balcony, as Ronald Heifetz and colleagues say.

Let’s get this party started.