70 Years Married

 

 

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Dear Mr. and Mrs. Wonderful,

Hello and hugs to you both!  How are you feeling?

I received a message from Wonderful Son this weekend, and it made my day!  He said you have settled in a place where you are both happy and getting the care you need.  You live near Wonderful Daughter, whom you see often, and everybody is happy and doing well.  I’m so glad!

More importantly, Son said the family will celebrate your 70th wedding anniversary soon!  He invited me to contribute a short video selfie to the well wishes.  Wow, what an honor.  I only got to serve as your primary care doctor a couple of years before you moved.  In that time I had the privilege of witnessing not just each of you as my patients, but you both as a couple, and your Wonderful family.  Please allow me to share my observations?  Here is my experience of you:

Ease.  Whenever I saw you two together, there was a peace and ease about your dynamic.  Patterns of relation were established long ago, and it worked.  I witnessed friction at times, but it was transient.  The vibe of our encounters was never agitated; it always felt to me that I had stepped respectfully into your well-oiled routine, and I tried my best to not disrupt it.

Patience.  Nobody rushed anybody when we were together.  Questions were answered, sometimes right away, sometimes after a while.  But you always gave each other the time and space to get where we were all going.

True Acceptance.  The Gottmans tell us that about 2/3 of marital problems are unsolvable.  This fall I will have been married half my life, 23 years.  This summer I think I may finally understand in my limbic brain, possibly, how to be in a marriage—something to do with really accepting the other person for who he is, like really, honestly, and wholeheartedly.  It was clear soon after meeting you both that you had figured this out long ago.  If I can get to 70 years, maybe I don’t have to feel bad that it took me 23+.

Devotion.  Medically, it has not been all lollipops and rainbows these few years, for either of you.  But whatever was happening for one of you, the other was right there, attending, caring, waiting, loving.  What more could any of us ask for?  And the Wonderful Children learned from your example; knowing them and seeing their devotion to you, their loving parents, inspires me deeply.

Learning, Growth, Adaptation.  Even at your age, there were things you did not know or understand.  Your bodies betrayed you in some ways we could not have predicted, and in others that you may have anticipated but were still a challenge to accept.  With the help of the medical team and your Wonderful Children, you have both managed to adapt to successive new normals with grace.

Loyalty and Commitment.  In it together.  That’s how you two roll.  I know it’s not easy, and we have discussed the challenges.  But you stick with each other through thick and thin, I’ve seen it.  You set the bar for the rest of us.

Love.  I think you, Mr. and Mrs. Wonderful, show us what true love lives like.  After 70 years I imagine you have some colorful stories to tell, some that belie all of the idealistic descriptions I write here.  But that is the point, no?  If we stick with it and do The Work, all of us hope to be rewarded with that deep, peaceful, reliable, and resonant love that transcends even what we innocently and earnestly vowed to each other at the altar.

Science, technology, and social convention have evolved beyond anyone’s imagination, and the pace only accelerates.  But the lifelong human need for love and belonging will never change.  Thank you for showing us how it’s done in a marriage.  Congratulations!

Sincerely, Cathy

Our 5 Fundamental Needs

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To Feel:

 

Seen

Look what I can do

This is how I can contribute

See me achieve

 

Heard

Hear my concerns

Take me into account

 

Understood

Validate me

Normalize my feelings

Say you can relate

 

Accepted

Tell me I belong

 

Loved

Participate in the Messy with me

Commit to sticking with me through the hard shit

Let me be my whole self with you

Be your whole self with me

 

Children by parents

Patients by doctors

Students by teachers

Workers by managers

The led by their leaders

Spouses

Friends

 

What if?

 

 

Good Doctor and Good Mom

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What do you sacrifice in pursuit of your dreams?

What does your calling cost you?

What are the returns on your investments?

* * * * *

Last week I mentioned Dierks Bentley’s, “Woman, Amen”, a song I love.  After listening to it for many days on repeat this past week, I decided to tour his nine albums this weekend.  His songs vary in topic and form, and at the same time he has a consistent style and vibe.  I like it.  Yesterday I heard his song, “Damn These Dreams”:

Now honey I know you miss me, I feel it when you kiss me

Trust me when I say every goodbye hurts

Well damn these dreams

Playin’ my heart just like a guitar string

Pullin’ me away from you and everything I really need

Well damn these dreams

Chasing that same old whiskey melody

All up and down these Nashville streets

It’s hard to look true love in the eye and leave

Damn these dreams

 

Instantly I remembered two other songs with similar themes:

 

Goodbye Again”, by John Denver:

Other voices beckon me, and for a little while

It’s goodbye again, I’m sorry to be leaving you

Goodbye again, as if you didn’t know

It’s goodbye again

Have to go and see some friends of mine

Some that I don’t know

Some who aren’t familiar with my name

It’s something that’s inside of me

Not hard to understand

It’s anyone who’ll listen to me sing

…Lying by your side’s the greatest peace I’ve ever known

But it’s goodbye again…

 

And “I Play the Road”, by Zach Brown Band:

…She says daddy where to you go

When you leave me all these nights

With a suitcase and guitar in your hand

Kissing me and mom goodbye with a tear and a smile

Where do you go? 

Daddy where do you go?

I play the road

And the highway is our song

And every city’s like the same three chords

Been helping us along when the story’s told

And the crowd is done and gone

Shaking off the miles and trying to make it home

…Mile after mile… 

Baby, I’m comin’ home

Years ago, I think it was either Dana Carvey or Martin Short who said something like one can only tolerate the life of a comedian because s/he simply cannot do anything else—they must do comedy.  If anyone can find the reference, please share!

* * * * *

As it is in music and comedy, so it is in medicine.  For many of us, we simply must do it; we have no existential choice.  These songs describe well our pain and conflict when we take call or have to work on weekends, or miss the kids’ school and sports events, and spend hours at home on the medical record or answering pages.

I recently read an article, “A Good Doctor or a Good Mom, Never Both”.  Early in this physician mom writer’s career, an elder colleague told her, “’You can be a good doctor, and you can be a good mother, but you can never be both at the same time.’”  The author disagrees, saying it’s either/or, never both, ever.  At once hearing Bentley’s song, I felt a moment of panic, mortified that I’m destroying my family for my job.  Am I totally selfish for choosing this career, and are my priorities so distorted that I so often put work before my family?  Have I chosen to be a good doctor and a horrible mom?

Thank goodness for Simon Sinek who, in his 2014 book, Leaders Eat Last, referenced a 2011 study that showed “a child’s sense of well-being is affected less by the long hours their parents put in at work and more by the mood their parents are in when they come home.  Children are better off having a parent who works into the night in a job they love than a parent who works shorter hours but comes home unhappy.”  This idea has saved me from countless episodes of self-flagellation and guilt.  It was so instantly redeeming that I recall the exact moment I heard it—I was at the airport, traveling solo, likely for a work related conference.  I can’t say I’m ecstatic every evening coming home, but I generally feel satisfied by a fulfilling day doing something I love.  I can confidently report that my husband feels the same.

I’ve attended one swim meet in two years.  I miss any school event that occurs during the workday.  I still get lost walking the maze that is the kids’ school, though we (they) have been there over a decade.  But I get to choir and orchestra concerts, and dinner potlucks.  I know my kids’ friends and am friends with their parents.  The kids’ teachers think they feel loved by us.  I think I do okay.

My kids hear me on the phone with patients and colleagues.  They know it takes time and understanding to take good care of people.  I’m confident they see and feel how meaningful this work and these relationships are to me.  And the science is pretty cool, too.  I would never pressure my kids to go into medicine, but I would not be surprised if they did.  I would absolutely encourage it, if it gives them the joy it gives me.

“You can be a good doctor, and you can be a good mother, but you can never be both at the same time.”  I respectfully agree and disagree.  You can absolutely be both, often at the same time.

 

Aunt Rachel’s Blessings

My friends, it’s been an intense couple of weeks!  So much so that I have fully neglected the news headlines—this must be why I’m still in a reasonably good mood.  Another is that I have rediscovered Dr. Rachel Naomi Remen, the wise and benevolent matron of medicine whose gentle and gracious example I aspire to follow.

I first read her books, Kitchen Table Wisdom and My Grandfather’s Blessings, at least ten years ago by now.  They felt like my favorite plush blanket, draped over my shoulders with that welcome, comforting weight, and tucked under my feet, warming me with stories of love and belonging.  Life was just as hectic then as today, but in a different way.  The kids were little, and I had few if any responsibilities at work outside of patient care.  Aunt Rachel’s stories calmed me and gave me peace in that young chaos.  I had meant to reread them, but, well, life.

I perused the shelves and stacks of my personal library recently, searching for a book that my friend might like.  Both avid readers, we share and discuss titles on leadership, philosophy, and personal development.  The search this day felt different from browsing Amazon or my local book store.  A deeper part of me knew exactly what I sought for my friend, even as my conscious mind had only a vague idea.  I wanted to share something different with him, something less cerebral.  As soon as I saw it, I settled on My Grandfather’s Blessings, no question.  But after a day or two, as often happens with instantaneous intuitive decisions, I did question.  So I sat down with Aunt Rachel and her grandfather one evening, as if meeting old friends in the squishy armchairs of a cozy, familiar café.  After some years of listening to books rather than reading them, I find quiet sitting with a paper book so comforting now.  I am called to slow down, to be still, more than I have been (have allowed?), for a very long time.

By page two of the introduction, my doubts vaporized.  This is it, I thought.  Stories of humanity, history, culture, medicine, healing, perspective, and how we humans are intertwined with one another and nature in the most beautiful and cosmic, inescapable and daunting ways.  As I reread her grandfather’s wise sayings, his subtle yet unmistakable messages of reassurance and unconditional love, that familiar warmth enveloped me again.  I could almost feel my blood pressure drop and my oxytocin level rise.

So much love and connection—the book is really all about relationships, which my friend and I both hold as the key to a meaningful life.  As I continue to read this week, it occurs to me that perhaps I was not actually looking for a book for my friend, but rather for myself.  For many years I have hunted ravenously for books to teach me, to elevate my performance in parenting, doctoring, leading.  But Aunt Rachel’s books simply soothe me.  They acknowledge and give credence to that still small voice that advocates and validates the need for deep personal connection, in a world that values it less and less.

I wonder if reading Aunt Rachel’s books so early in my career helped me more than I knew.  Looking back on the past decade, I feel proud to have resisted the pressure of 15 minute clinic visits, to have made the effort to relate as personally as I could with every patient, even if my bids were rejected.  Aunt Rachel’s books honor that heart center in me that holds true to what I value the most, which is connection with people.  Perhaps I have her to thank for watering the strongest, deepest roots of my doctor soul before they could dry up and later require excavation to revive?

I still think my friend will enjoy Aunt Rachel’s book.  Her stories resonate with the humanity in all of us, not just doctors and patients.  I look forward to hearing his feedback, and finding more books to share.  And I must remember to bless our friendship.

May we all acknowledge and share the blessings in our lives, every chance we get.

How Reunions Feed Us

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It was July 1997.

Maria C. and I had just started our third year of medical school, rotating on general surgery.  We stood on evening rounds–it was already dark outside on this balmy summer night.  The hospital hallway was quiet and half the lights were off.  We visited a little old lady who had had surgery in the prior days.  She looked frail, but also like she had been spry once.  Her lips protruded the way my grandmother’s did when she took her dentures out at night.  She wore a round fuchsia sleeping bonnet, a little askew atop her head.  She looked half asleep, barely aware of our presence, and had slid down in the bed such that the pillow and blankets had effectively swallowed her.

We were tired, Maria and I.  It was not a fun rotation for me.  I had witnessed our attending throw a bloody sponge across the OR that month.  He was not particularly interested in us, I don’t recall any direct teaching (but there could have been), and the sleep deprivation was killing me.  But I had Maria.  She always had a smile, always an encouraging word, and she loved surgery.  Her energy held me up.  We stood dutifully, trying our best to pay attention and learn something.

As we listened to the discussion of the nice lady’s plan of care, suddenly I heard a loud, resonant, and prolonged PPPPPPPTHTHTHTHAAAAAARRRRRRRRTTTT.   Our somnolent charge had just passed the longest breath of colon gas I had ever heard, before or since.  And it didn’t phase anybody.  The team continued to discuss her plan of care as if nothing had happened.  I don’t know, maybe they were encouraged, as flatulence is the first step to oral feeds and eventual discharge after abdominal surgery.  They forged on without acknowledgement.  I wondered if I had imagined it.  But when I caught Maria’s eye, within seconds we could both barely contain ourselves.  Maybe we were just slap happy from too little sleep, or we just needed something to break the tension.  But it was too much, we had to step out.  Back out in the dim hallway we laughed out loud as quietly as we could, to the point of gasping for breath, hanging onto the wall and each other to keep from falling down.  Even today, 22 years later, I cannot help but smile at that moment.  Either we went back inside after composing ourselves, or the team emerged eventually, I don’t remember.  Rounds continued and I tucked away this little memory as one of the best bonding experiences of all my years in training.

*****

The Class of 1999 returned to The University of Chicago this past weekend to celebrate 20 years since graduation.  I had only signed up for a couple events, in my usual non-committal way.  I arrived at the breakfast venue, a building that did not exist when we were students.  I glanced over at the tables and saw only people much older than me, and my heart sank a little.  Where were my peeps?  Then at a back table an old friend stood up and waved, and my spirits lifted instantly.  We ate and laughed, and shared photos and anecdotes of surly teenagers at home.  As I had made no other plans that day, I met people again for lunch and we walked through campus, which I had not done in years.  The peonies in the quad burst with color and fullness, welcoming us all back.

I’m so proud of our class.  We are general internists and pediatricians, hospitalists, cardiologists, allergists, emergency medicine doctors, and orthopaedic surgeons.  We do neurologic interventional radiology, microvascular plastic surgery, and private equity.  We are medical directors, section chiefs, and NIH researchers; we teach medical students, residents, fellows and colleagues.  We advocate for immigrant health and lead international research teams to win the war on disease.  We are parents of toddlers and college students, single, married, and divorced.  But mostly we are just older versions of our younger selves, in love with the science of medicine and driven by something deeper within to care for our fellow humans, relieve suffering, and make the world better for our having lived.  This weekend gave us the opportunity to reconnect deeply on that level, to recall and relive those bonding memories tucked away all these years.  I had a chance to catch up with classmates whom I had always wanted to know better in school.  What a blessing.

Our specialties are widely diverse, as are our life experiences, before and since medical school.  But we also share so much in common.  Many of us have had painful experiences as patients or family of patients, and that has impacted our attitudes as physicians.  We collectively recall the stages and transitions of training as both trial and reward.  And everybody has something to say about the current, broken state of American healthcare.  But the overarching feeling of the weekend was camaraderie and love.  Emails poured in from classmates across the country and around the world who could not make it back; I count almost 60/100 of us included in our communications thus far.  We were just waiting for the chance to find one another again.

*****

In our current geopolitical climate of division, competition, and polarization, reunion is the antidote.  In this vital ritual of humanity, we reconnect with those who knew us in a more innocent phase of life, when we bonded through shared struggle, with whom our diversity and shared experience are paradoxically complementary in the best ways.  Our souls are fed by one another, in person, surrounded by food, back at our first professional home.  Relationships long dormant stand revived, and we are lifted.

It occurs to me, in this lovefest of reconnection:  How can we leverage this energy?  What if we could sustain these bonds, reforged and hot in this moment?  If we connected like this more often or regularly, across specialties, geography, and practice structure, how much better could we all be at what we do every day?  How much more empathy could we have for those who don’t do what we do, whom we see as competing for resources or otherwise trying to undermine us?  How would our patients feel in our presence?  Our support staff?  Our hospital leaders?  Gatherings like this prove that we have the capacity to just be together, appreciate one another, and support each other with generosity and grace.  So much potential for positive synergy among this group.

We have big plans for our 25th reunion, but I have a feeling our renewed relationships will find powerful expression long before then.  So stay tuned, my friends.  We are Pritzker Class of 1999, and we’ got work to do.

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A Community of Champions

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Spoiler Alert:  Big Bang Theory Series Finale!

* * * * *

When was the last time you felt totally safe, at work, to address the central relational challenges that hold you and your team back from your best performance?

How often at work can you really assess and evaluate your own interpersonal skills, their impact on those around you, and on the organization as a whole?

How much time and energy do your teams waste being stymied by relational issues, stuck in redundant, dysfunctional power struggles up and down the organizational hierarchy?

How do you feel in your body just reading these questions?  Perhaps tense and frustrated?

* * * * *

We, the eight participants and two faculty members of Leading Organizations to Health Cohort 11, reported palpable heaviness upon convening for our second training retreat last Tuesday.  Despite the Colorado spring bursting with blooms, wildlife, and vast clear blue skies, dark clouds hung over our collective consciousness, each for our own reasons.  Throughout the week we shared stories of successes, challenges, conflicts, power and powerlessness.  We practiced appreciative inquiry and relational coordination, and explored the insidious impact of unearned privilege.  We spent three days in intense skills training, supporting one another through viscerally gnarly role plays and open, honest feedback about how we impact the group.

In the midst of all this deep work, we also shared meals, walks, a horseback ride, and life stories around a fire pit and drippy s’mores.  As we debriefed around the circle on the last day, something had shifted:  overall we now felt refueled and energized.  The air buzzed with the anticipation of learners on the verge of integrating our emerging skills, excited to bring it all home to practice.  The clouds had parted.  We will keep in touch through peer coaching groups—our newly established, intense-support network.  In my heart, I feel we are really becoming a family.

 

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I headed to the mountains straight from the session, for 24 hours of processing and decompression (and more washi tape card-making).  More and more I marveled at what a rare opportunity I have in LOH, to be led and learn to lead in this relationship-centered way.  For these ten months I am immersed in a professional learning lab, experimenting with different ways of speaking, acting, and being, safe among fellow professionals also grappling with this skill set.  It just does not get any better than this!

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On my way down from the mountains, I listened to an interview with Bonnie St. John on Ozan Varol’s podcast, Famous Failures.  She is the first African-American to win medals in Winter Paralympic competition as a ski racer; she is a lower extremity amputee.  She is also an author, an entrepreneur, and a former member of the Clinton administration.  Her story is inspiring, please take a listen!  At the end of the interview she describes asking a former coach about how he built champions.  He said he never built individual champions; rather, he built communities of champions.  You can only push one person so far, he said; but an allied group of people will hold one another up, push each other harder, make each other better, take one another farther.

That is exactly how I experience LOH—my best self is challenged and called forth in the most loving and professional way.  We hold space for all our struggles, allowing the learnings (epiphanies, in my experience!) to emerge.  It is deeply and literally inspiring.  Though I already do so much of this inner work on my own, there is a profound and unparalleled synergy from learning in this group—we serve as one another’s pit crew for the journey toward our better selves at work and in life.

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Nobody succeeds alone.  In the series finale of The Big Bang Theory (my favorite TV show of all time, which I missed while at LOH!), Sheldon (the obliviously self-centered genius) finally realizes this.  During his Nobel Prize acceptance speech, he acknowledges his sudden and profound appreciation for his family and friends, crediting his success to their unconditional love and support, and recognizing them in front of an international audience.  LOH made this finale even more meaningful to me than it already would have been.

It is always through the struggles that we grow.  When struggle together, any and all successes are amplified exponentially.  My nine new friends will make me immeasurably more successful, both professionally and personally, than I would ever be without them.  God bless them all, and may the work we do together ripple out for the benefit of all whose lives we touch.

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Elephant to Elephant:  How to Change People’s Minds

 

Friends!!  If you read only one thing today, stop here and click on this link to James Clear’s essay on why facts do not change minds.  It’s very similar to Ozan Varol’s post of a similar title from last year.  That piece prompted a prolonged conversation on my Facebook page two months ago, which I described and shared here.

The Trigger

I’m thinking hard again about facts and changing minds now, as the number of new measles cases skyrockets not just in the US but around the world.  I’m so angry that we have to fight his war again—a war we had won as of 2000.  I’m so frustrated that because of the actions of a relative few, the health and safety of the very many and vulnerable are once again at risk.  I know my colleagues and many in the general public share my sentiments, and we often end up shaming and deriding our ‘anti-vaxxer’ peers.  We hurl facts and statistics at them, incredulous at their intransigence to the truth of science.

In the end everybody digs in, feelings get hurt, relationships suffer, and the outbreaks progress.

There is a better way.

James and Ozan (I imagine them as friends and so refer to them by first name) explain it eloquently in the posts I share here, and I really encourage you to click on those links.

The Metaphor

Personally, I return often to Jonathan Haidt’s analogy of our mind as an elephant (the emotional, limbic brain) and its rider (cognitive, rational brain).  We think, as rational beings, that our riders steer our elephants.  But psychology research and evidence tells us that the elephant goes where it wants; the rider rationalizes the path.  That is why facts do not change people’s minds—they are the rider’s domain.

Chip and Dan Heath, in their book Switch, take Haidt’s idea further in their formula for behavior change:

  1. Direct the rider (provide the facts, rationale, and method),
  2. Motivate the elephant (make the message meaningful on a personal, emotional level), and
  3. Shape the path (shorten the distance, remove obstacles).

It occurred to me recently that when I flood you with facts about measles and vaccines, I speak only through my rider.  You listen (or not) as both rider and elephant.  But as Simon Sinek describes eloquently in Start With Why, the elephant limbic brain has no capacity for language.  And facts, conveyed in words, have no emotional meaning or context.  So unless your rider is somehow really driving in this moment, my rider’s appeal will not move you.  Your elephant does not understand my rider, thus I cannot steer you where I want you to go.

The Approach

So how can I motivate your elephant?  If I’m using words, I can tell a story.  But the words of any story matter far less than the emotions the story evokes.  If I can relate with your own past experience, point you to a loss, a gratitude, or some shared connecting experience between us, then your elephant may hear me.  If I tell my story with honesty, authenticity, and humility, then my rider serves as translator for my elephant, communicating directly with your elephant.

But the most important connection between our elephants, if I really want to change your mind, is my presence.  Researchers agree that a vast majority of communication, up to 90%, occurs non-verbally.  Even if my rider interpreter tells a great story, my attitude carries the real message.  This manifests in my tone of voice, facial expressions, posture, stance, and all kinds of other subtle, nonverbal, subconscious cues—all seen and understood by your elephant, because they emanate from mine.  Even if my story tugs at your heart strings, you will defend your position if you feel me to be righteous, shaming, condescending, etc.  Elephants are smart; they know not to come out if it’s not safe.  And if my elephant is at all on the attack (see anger and frustration above), your elephant knows full well not to show itself.

It’s not the words we say or the things we do—it’s not the method that counts.  It’s how we are, how we make people feel—the approach—that gains us access to people’s consciousness and allows us to influence their thinking (which is really their feeling).

So I calm my rider and elephant first.  Deep breaths.  Then instead of my rider jumping off my elephant and charging at you with a wad of sharp verbal sticks, she sits back in her seat.  My elephant humbly ambles alongside yours on the savannah of community and (humanity), shares some sweet grass, points to the water hole where we both want to go.  I invite your inner pachyderm lovingly on a shared adventure toward optimal health for us all.  Rather than rush, berate, or agitate you, I wait.  I encourage.  I welcome.

James Clear writes, “Facts don’t change minds.  Friendship does,” and “Be kind first, be right later.”

My elephant fully concurs.

 

Some Facts, because I’m a doctor after all:

  • As of last Friday, May 3, 2019, there were 764 known cases of measles in the United States. According to the CDC, “This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.”
  • About 2/3 of patients are unvaccinated; 1/10 have been vaccinated, and the vaccination status of the rest is unknown.
  • 44% of patients are children under 4 years of age.

See this article in the Washington Post from today for more statistics.

For answers to frequently asked questions about Measles, please refer to the CDC measles FAQ webpage.

Please talk to your doctor if you are unsure about your risk.