Category Archives: physician

Why I’m Not Going Home

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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.

Where Is the Light?

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Photo by Tobias Baumgaertner, Fairy penguins near Melbourne, Australia

*deep breath*

I always wonder about you, dear reader.  Where does this post find you, since we last connected?  How are you?

It’s a good practice to check in with ourselves regularly.  These nine weeks of sheltering in place have exercised my patience, awareness, and identity, among other things.  What have they done for you?  How are you?

For a couple weeks now I have felt all but overwhelmed by darkness.  Infection and death rates have slowed, but they will continue to accumulate indefinitely.  I worry that we will become inured, calloused, to the human toll.  PPE is still in short supply at hospitals across the country. Thousands of my colleagues continue to risk both their physical as well as mental and emotional lives to care for gravely ill patients.  They leave their families and support networks to become the sole supports for patients alone in the hospital, whose own loved ones may not visit, even in the hour of death.

Mostly I have felt burdened by the fighting.  The shouting, protesting, mean memes, and ad hominem all around me, directed both by and at my friends and colleagues.  Important reflections and insights arose this week that helped me see clearly the internal origins of my distress.  I re-accepted and re-integrated these parts of myself.  I was able to laugh out loud, exclaiming, “How fascinating!”  I know I will necessarily repeat this discovery exercise ad nauseam, ad infinitum—such is life, karma says, also laughing.  But for now I feel lighter, unburdened, more at peace.

So I thought about role models for peace.  I feel so lucky to have so many.  But one in particular shone in my consciousness this week:  Dr. Vivek Murthy, our 19th Surgeon General.  He has published a book, Together, in which he “makes a case for loneliness as a public health concern: a root cause and contributor to many of the epidemics sweeping the world today from alcohol and drug addiction to violence to depression and anxiety. Loneliness, he argues, is affecting not only our health but also how our children experience school, how we perform in the workplace, and the sense of division and polarization in our society.”

I recently watched a live interview with him conducted by Dr. Lucy Kalanithi, widow of Dr. Paul Kalanithi, who wrote When Breath Becomes Air.  I listened with one earbud, watching in my peripheral vision, while hurrying around my kitchen, preparing chicken and assembling a salad, all before rushing to host a Zoom workout.  It struck me that in stark contrast to my frenetic energy at that moment, Dr. Murthy presented only calm and serenity.  He answered every question with love, joy, conviction, and equanimity.  I noticed and marveled.  Then I rushed around some more and got on with my evening tasks.

Looking back, I have felt this serene and loving presence every time he speaks.  He has a way of making everybody in the room comfortable, welcome, and included.  Even if he’s interacting only with a moderator, it feels like he’s speaking to me personally.  He sees me, he gets me.  He cares about me.  In searching for the Kalanithi interview, I came across this lecture and discussion he gave at Stanford University in 2015.  I hope you will take the time to watch (or at least listen).  Notice how he shares stories of his parents, his patients, and people he met during his national ‘listening tour’ at the beginning of his tenure as Surgeon General.  Hear how he sees and knows every one of these people in their whole humanity.  Abraham Verghese, physician, author of Cutting for Stone, and another hero of the profession, moderated the Q&A, and also named Dr. Murthy’s equanimity—his peacefulness.  Notice how Murthy validates questions asked by students and faculty alike.  Observe his humility, juxtaposed with a resolute, unwavering point of view.  Do you feel it?  Does he not inspire you to be a better person?

Dr. Murthy and his wife, Dr. Alice Chen, have written an open letter to us medical professionals, in the midst of this global pandemic.  Reading it, once again I feel seen, understood, and comforted.  I feel true belonging in a proud and humble tribe of professionals, committed to service.  They shine their light on all of us, so we may see the path before us more clearly and walk more confidently, knowing we’ got our peeps holding us up.  This, in turn, gives us the strength and love to hold up others along the way.

I see the light tonight.  It emanates from my fellow and sister humans, and it saves me.

For a little more light, check out this Jon S. Randal Peace Page post with the picture of the penguins.  In it you will read about gems like John Krazinski’s “Some Good News” YouTube series, and Chris LaCass, founder of Pandemic Kitchen, feeding New York City’s homeless.  You can also share your own stories of inspiration and light in the darkness.

Where is your light today?  How will you keep it in front, as we travel this long road together?