The Sh*t Sandwich

“I have realized that I really enjoy learning about ***, but I don’t necessarily like studying it and being tested on it.”

And there it is. My mama pride swells at this concise, distilled insight of self-awareness that Son shared with me, about 6 weeks into college. So you really like ***. How much might you be willing to work/tolerate/sacrifice to stick with it? Will you keep *** as a hobby/interest, or can you see yourself making a career out of it? No rush to figure it out! And how cool to know there is a distinction to make?

How much are we willing to give for something we really want? Are we willing to eat the particular flavor of shit sandwich (a la Mark Manson–check out his blog and books!) that’s inevitably served on the path to our goal?

Sometimes we don’t even have to know what we want; clarity about what we don’t want–shit sandwiches we will not eat–is enough to set us on the right path for each of us. Some shit sandwiches I have rejected:

Three Dimentional Calculus and Vector Analysis: Freshman year in college, one problem on the final exam of this class took up 8 pages in the exam book. And why did I have to know it? How did the reasoning help me in life? No more math for me, thank you. I left engineering the following quarter.

Physical Chemistry: Having already gotten a C in physics (which happens when you fail the second midterm because you start dating your husband), empowered with an aversion to math, and knowing already that life is too short for this kind of suffering, I rejected chemistry and embraced biology as a major.

5:30am Rounds: General surgery, my first ever clinical rotation. My intern, the wonderful Gopal Kowdley whom I love to this day, looked at me and said, “You’re tempted, I can tell.” But OMG surgery–the egos, the bombast, the misogyny–AND getting up in the dark every day, forever? Nope.

Lifelong call: I love reading echocardiograms–ultrasounds of the heart, beating in real time. Second year of residency is when internists apply for subspecialty fellowships. That year my cardiology fellow stood right next to me at 10pm, monitoring a dying patient in the cardiac ICU. He had a little girl at home who missed her dad. Later that year, the attending cardiologist, my amazing teacher, sat across from me at the nurses station, in the middle of the night, reviewing the EKG of a lady with a likely heart attack. He had grandchildren already. He had to get up in the dark–in the middle of the night. No cardiology fellowship for me!

I live in Chicago when my home is Colorado. Wut? But Husband is from here, we trained here, and we both found jobs here that fulfill us and allow us to make a difference in people’s lives. WINNER! Love makes us do crazy things, like eat this. huge. shit sandwich. Without hesitation, no matter how it tastes. Every day. For 20+ years.

Through the long hallways of my career, at each door has stood a waiter offering some shit sandwich for me to taste in order to get through. I closed some doors, and walked through others. I wrote last month that I regret none of the work thresholds I’ve crossed to date. Since the beginning, nothing has been be-all, end-all. If I hadn’t gotten into med school the first time I’d have decided to try again or try something else. I committed to finish an internal medicine residency and pay back my student loans; those doors swung heavily one way. Other than that, I have always had the privilege of myriad opportunities to use my skills and credentials in new and interesting ways if I wanted to–generalists are needed everywhere. But the older I get, the more selective I am about what shit sandwiches I’m willing to eat. I think that’s normal.

As Liz Gilbert interprets Manson in her book, Big Magic: “So the question is not so much ‘What are you passionate about?’ The question is ‘What are you passionate enough about that you can endure the most disagreeable aspects of the work?’”

So ONWARD, I say to Son. Keep learning about yourself and the world. Try out different things, taste a little of everything as long as you’re sure it’s not toxic. Carve out your space. I am confident you will find your favorite flavor of shit sandwich.

Being An Officer

Chief Executive. Operations. Financial. Information. Wellness.

Officers.

What’s it like to be one, I wonder? How do you see yourself? What is your purpose? Whom do you serve?

I recently heard some business executives refer to themselves as ‘officers’ of their company, and it struck me, as if I were hearing the word for the first time in this context. The vibe was not arrogant or self-aggrandizing. It came off not as corporate speak, as some label used to separate (elevate) themselves from others in the organization. The feeling really reminded me of how Simon Sinek describes marine officers in his books–the ones who lead from the front, who put themselves in harm’s way first to accomplish a mission. The leaders I heard spoke with an air of respect for the role ahead of themselves personally. It was almost reverent, in a way, like being an ‘officer’ of the company meant, as Sinek puts it, not just caring about being ‘in charge,’ but caring for the people ‘in your charge.’

Officers sit at the top of organizational hierarchy. They enjoy rank, default status, and the highest pay and benefits. They also shoulder the greatest responsibility (and ideally, accountability). In the military this includes for people’s very lives. In business this includes people’s livelihoods, and thus also their lives and those of their families. Setting aside for now the premise that boards, and thus the execs who report to them, function to advance the interests of shareholders above all, I’m thinking about how hierarchical corporate structure and its attendant attitudes serve us, each and all of us, relationally.

I perceive three primary, intersecting answers to “Whom do you serve?”: 1. Shareholders 2. Mission 3. People of the organization. The first two can be abstract; the last is very concrete. I strongly believe that leaders who prioritize the health and well-being of their people above all else are the most successful. I don’t necessarily mean success in the conventional business sense–profits, stock price, US News & World Report ranking. I mean relational success–manifest in organizational loyalty/pride, team cohesion, mission focus, low turnover, and high moral and community standing.

I think organizations with relationship-centered leaders cultivate and elevate officers who respect, acknowledge, and attend to workers at all levels in their perspective and decision making. They ask, “How does this affect our people?” before, “How does this affect our bottom line or brand?” When the latter come under threat, they will look for every available solution before sacrificing the health and well-being of their people, even when doing so is the easy and obvious path to balancing books and looking good. Led by this example, lower level leaders can feel safe to behave similarly, and the culture of safety cascades down to the lowest level worker. Cultures like this foster creativity, collaboration, innovation, and then multi-dimensional success.

I write all of this so easily as a non-officer. I understand that leading large, complex organizations is a practice in agile and dynamic balance of disparate interests in the midst of shifting markets and diverse stakeholders. I try to assess leaders fairly, and always with the heavy burden of their work in mind.

Still, I hold our highest designated leaders wholly accountable for their relational output. They set the cultural tone and attitudes for the organizations they lead. As a worker, I want to follow my officers wholeheartedly and without reservation. They have a hand in cultivating that loyalty in me. I want to show up every day proud to be part of an organization that does good–more good than just making money for the folks who own company stock, more good than meeting some external benchmark of ‘excellence’. In order to do that, I need to feel that my leaders establish and uphold a culture that cares about me as a person, as a member of the organization who matters and contributes. I want to be seen as, to feel like a unique and valued individual, not just a money making cog.

The officers I heard speaking of their roles with self-awareness and benevolence inspire me. They palliate my cynicism that corporate power and status bloat ego and ecclipse selflessness. They make me consider my own role as physician. Though I no longer hold any designated leadership title, I still lead–like it, want it, know it or not–just by virtue of my MD and role on the patient care team. I argue, too, that any team member also leads to some degree. We all take our cues from one another; we self-organize around collective priorities and norms of behavior, reinforced implicitly more than explicitly, every day. Even so, we may often think of ourselves as mere minions, that we just come to work and ‘do a job.’

What if we all thought of ourselves more as Officers like the ones I heard? What if we all took some personal responsibility to uphold a culture of valuing one another as important contributors to a mission of caring and meaning? Could we, as a groundswell from the bottom up, elevate and inspire our own officers’ attention to and value of the whole of us, from the top down? Can we all support and uphold one another from all corners, more visibly, audibly, and audaciously? Wouldn’t that be amazing?

Taking Up More Space

Dillon Reservoir, Dillon, Colorado

Here in the last week of 30 daily posts, some themes have emerged. Liberated was initially intended as a description of growing more irreverent with age, and ‘the value of your opinion to me…’ was all I had to say about that. As I thought (and wrote) about what I really feel liberated to do and say at this age, it really did circle back to bolder bids for connection, especially at work, with patients.

Smooth With Edges also started out with more of a defiant, rebellious feeling. The meme about Hecate came across my FB feed and vibrated immediately with deep resonance–of holding divergent, soft and hard, smooth and edgy parts of myself together in harmony. I like that I’m playful, curious, lighthearted, and nerdy. I also see myself as strong, taller in personality than physical height, and a force to be reckoned with when needed. It was too much yet to try to express in prose, so I chose stanzas instead. It spilled out in seconds, and by the end was no longer about me, but about Daughter and every girl or woman who holds back any part of herself in any way, about my urgent desire for us all to shed our constraints and own our power in full.

One kid has cleared the launchpad; the other now readies in the hangar. For almost twenty years they have been the two foci of my elliptical life orbit. I have done nothing in all this time without considering and accommodating them first–waking hours, meal plans, social activities, vacation dates/locations, professional meetings and engagements. Mom liberation occurs in stages: from nursing, from carseats, from dependent cook, obligatory chauffeur. While both kids lived at home, simultaneous attunement and attachment to both was 24/7, the default. The center of my logistical world was always our house. I felt most secure when my two life hubs were home, my universe a tight sphere. Now one nucleus is flung 1700 miles away, and my heart space has expanded exponentially, in a familial big bang of sorts–and I celebrate it.

As the kids’ independence grows, I find myself with bandwidth reserves now available for other pursuits–my own. It’s not that I subsumed all of my own needs and priorities to the family, and some constraints were still very real. Sometimes now I feel like my lung capacity is bigger, my breaths deeper, my armspan longer. How fascinating.

Last year my 30 November posts were a consolidation, a legacy capsule series to reference when the primary source is deceased. This year, like Sven the sourdough starter, I rise. I expand, multiply, propagate–ideas, connections, reach. I get to play, noodle, experiment, riff–make more. How exciting!

Liberated, indeed.