Trust and Safety in an Uncertain World

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Suddenly I felt my heart pounding.  My palms got sweaty.  My jaw felt tense.  I’m anxious, I realized.  It felt like sometimes when I speak up in big meetings.  Wow, I don’t even have to be in front of people for this to happen, how fascinating.

It was the second or third comment I had written on another Facebook page, belonging to a high school classmate.  I think we became ‘friends’ through his wife, a friendly acquaintance of mine in high school, with whom I’ve been connected on Facebook for several years.  I don’t really know her husband at all, and yet here I was, writing long replies on his page about universal masking, why recommendations changed between March and now, and why I trust Dr. Fauci despite his apparent flip-flop on this issue.

I had entered someone else’s house, offering my unsolicited opinions.  Though we have a handful of mutual friends, I had no idea who else would attend this party, and whether I would be welcome.  I wasn’t sure it was safe.

And yet I felt compelled to enter, why?  Perhaps I felt defensive of my professional standard bearer, Dr. Fauci, the father of modern infectious disease and icon of science, medicine, and public health.  He has basically led the research to define and defeat HIV/AIDS since the 1980s.  Through six administrations, he has directed the National Institute of Allergy and Infectious Diseases (NIAID) to successfully manage H1N1, Ebola, and Zika, at home and abroad.  He is one of my heroes.  Likely, I also wanted to absolve myself a little, as I had also recommended against masking in public early on.  I wanted to help some strangers see us, the ‘experts’, as human and fallible, and also earnest and caring, worthy of heeding.

So I obsessed over my comments.  I read and reread before posting.  I edited after posting.  I included the links embedded above, inviting anyone on the thread to hear Dr. Fauci in his own words, in full.  I offered my own mea culpa twice, explaining how academics sometimes fall victim to ivory tower thinking, as we did in this case.  Perhaps this was my attempt at earning back whatever trust people may have lost because we experts contradicted ourselves in such an important and pivotal moment.  I regret this, and I wanted people to know, and then maybe not hold it against me (us).  Would I be crucified?  Or would I crack a door open to hearing what I had to say?  I feel anxious now, just thinking about it again.

My own friends discussed this on my page a few weeks ago, after my post on antibody testing (our recommendations have not changed yet).  Paul, MD PhD and rheumatologist, pointed out, “US experts really blew it initially when it came to masks… All they had to do was consider the possibility that Asian countries might be right and then consider that the risk associated with (masking) was virtually zero.  The first thing experts need to do, when confronted with circumstances that are truly new to them, is admit uncertainty and base recommendations accordingly.”  I’m so lucky to have such honest and direct friends.  I replied that I felt badly for following the ‘expert’ advice like a sheep (which is exactly how others on my acquaintance’s page described followers of universal masking, yikes).  “Lesson learned,” I wrote—but have I really learned it?  David, Paul’s and my classmate who now leads quality and hospitalist programs at his institution, replied, “It’s weird to be here with you (two) bashing experts, since the three of us are by any definition, experts.  But the value of experts is not that they’re always right, but that they have a) a better track record and b) the ability to self-correct.”  Yes, humility is key.

It all makes me wonder, how do we trust someone?  I have conversations every day with patients and non-medical friends and family, educating and advising, and they are appreciative; they trust me.  But we have already established mutually respectful, personal relationships.  What made me think I could go on this unfamiliar man’s social media page, interact with perfect strangers, and have them trust or accept anything I said, when they had already expressed reservations about, if not hostility toward, my ‘tribe’?  Was it my place?

The original post commented on universal masking and referenced Dr. Fauci not in a snarky, pejorative, or aggressive way.  If it had I would have scrolled right by.  Because it was a neutral presentation, I felt it could be safe to enter this house and offer my perspective.  Out of respect for the page owner and his friends, I did my best to present both humbly and objectively, to be informative but not condescending.  I really wanted to put my best online foot forward, to represent my tribe and my profession as well and as trustworthily (it’s a word!), as possible—to connect.  So far I have not been attacked, and a few readers have liked my comments.

In the end, as I have written before, I think it’s about how we show up to one another.  I wrote recently about tribal culture, and how through this crisis, individuals can help our own tribes thrive by modeling a more collaborative rather than competitive mindset, by amplifying our togetherness.  “Who do we want to be on the other side of this crisis?” I asked.  David Logan and colleagues go on in their work to discuss how tribes can effectively interact with other tribes, forming alliances and advancing even greater good together.  They posit that tribes draw closer when their respective members, especially designated leaders (representatives), connect.

We find ourselves now in an existential battle for our lives, literally.  Now is exactly the time to find common ground, step onto it, set up camp, and make decisions from there—to merge tribes.  A friend asked me today, “Who do you want to be now?”

I want to be a connector, I answered.  I will do my best not to contribute to division, polarization, alienation, disconnection, and suffering, through my words or actions.  I will not be perfect.  I will make mistakes.  I will continue to learn and apply.  I will strive to earn and maintain people’s trust.  And I will help make it safe for people to question and challenge, discuss and explore any point of view.  In the face of uncertainty, this is what I can offer.

Please Stop With the Fighting

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What a difference a week makes.  How are you feeling?  I can only describe my own experience as ‘off.’  Things feel heavy, fraught, tense, uncertain, and anxious.  All the talking and writing I do about tolerating uncertainty and holding space for tension feels almost comically hypocritical right now, as I grapple with my own practices.  But more than that, I feel accelerated degradation of relationships all around me.  Armed men march and yell at the Michigan capitol building (where a woman governor serves).  More armed men gather in front of state public health director Dr. Amy Acton’s house in Ohio (not the capitol, where a man governor serves), saying there will be no violence, “for now.”

People on the ‘side’ of public health deride decisions to reopen state economies as willfully ignorant, even malicious.  People on the ‘side’ of reopening economies derail stay at home orders as fascist.  Perhaps these are the minority voices of each ‘side’, but they are loud, and they dominate public discourse and social media (I know, I know, moderate my intake, yada yada).  Yet another false dichotomy escalates with increasing vehemence on both sides.  I have mulled it for weeks and not found a good way to write about it.

Late yesterday, I found two pieces that help, written by conservatives I respect.

In the first, “What Republicans’ Kool Aid Moment Means for the Rest of Us”, Chris Ladd outlines our fatal flaw as humans, and then asks some profoundly important questions about how to resist the ultimate pitfalls of that flaw:

“Confronted with displays of cult loyalty we commonly resort to some mistaken conclusions, dismissing these people as crazy or stupid. These assumptions are born of the same logic that leads people to blame the sick for their illness, a desire to manufacture some difference between them and us, something that would leave us immune to their condition. We want to believe that there’s something uniquely broken, inferior, or even subhuman about the people in those pathetically sad images of self-destruction. Those dismissive characterizations of cultists aren’t just false, they are dangerous.

“We are not inherently rational creatures. By nature, our model of reality is not a product of careful individual inquiry, formed through a critical review of all available data, but a social construct heavily influenced by our preferences, hopes, and the collective will of our tribe. Human beings are capable of independent, rational thought premised on a body of constantly moving data, just like we are capable of juggling or riding a bike. Absent special training, critical, data-centered reasoning is so effortful, difficult and unnatural that any political order premised on the rationality of the average man will be consistently unstable.

“Even with careful training over years, a life of critical thought remains a challenging endeavor, costly to maintain and not suited to every circumstance. Riding a bike sounds easy once you’ve learned to do it but try dialing your phone or eating a sandwich while peddling and you’ll see the challenge. Careful, critical reasoning is resource-expensive. None of us engage in it as much as we think we do.

* * * * *

In the second essay, “What If We Loved Them Both?”  David French invites us to exercise that resource-expensive skill of critical, rational, nuanced and complex analysis:

“Once again, our nation is faced with the painful process of sorting through grave sexual assault allegations against a powerful man. Once again, the public assessment of the veracity of those claims is lining up all-too-neatly with the partisan needs of the moment. Those who object to the rush to judgment against the accused will often ask if how we’d respond if, say, Joe Biden or Brett Kavanaugh was someone you loved. What if he was your father or grandfather. Would you feel like they’d been treated fairly?

“The counter is quick. What if Tara Reade or Christine Blasey Ford was someone you loved? Can you imagine how you’d feel as they mustered up the courage to tell a dreadful story and then you watched them endure the inevitable slings and arrows of scorn, hatred, and mockery?

“But there’s a different, better construct. What would the world look like if an imperfect population that possessed imperfect knowledge loved them both?  

“Due process is just, and it’s indispensable to the pursuit of justice. It is the answer to the question at the start of this newsletter—in the most fraught of claims and the most vicious of crimes—What if we loved them both? What if both accused and accuser were of equal worth? When we consider the right to bring a claim, the requirements of evidence, and even the time limits imposed on cases (given the difficulty of both defending against and proving very old allegations), we not only humbly acknowledge our inability to peer into a person’s soul to discern truth, we also acknowledge that even the mightiest man can and should be brought low when the evidence dictates. 

“But protecting due process (like protecting free speech) is hard. Just as permitting bad speech is a necessity for maintaining the larger, just legal structure of free speech—individual injustices can also protect the larger, necessary structure of due process.

“Each person involved in the controversy is of equal worth, a human being created in God’s image. That means the accusers have a right to bring their claim and be heard, respectfully and fully. That means the accused have their own rights to defend themselves, and a presumption of innocence is wise. Our own extreme fallibility and inability to peer into a human soul means that we should diligently seek external evidence that corroborates or rebuts any allegation or defense. 

“It is true that our culture has frequently failed women. It has failed in the obligation to treat them with respect or to fully hear or fairly consider their claims of terrible crimes. It is also true that our culture has also failed men, especially black men. There are simply too many terribly tragic tales of men dying at the hands of a mob in the face of an unsubstantiated claim of sexual misconduct. Even today, there are echoes of that awful injustice in the way in which black men are treated in campus courts. 

“But the answer to historical injustice isn’t another, equal and opposite injustice. That’s the score-settling that leads to endless ideological and partisan conflict. Instead, the answer is to discern the correct standard, and hew to it as closely as we can. Conservatives should not seek ‘revenge’ for Brett Kavanaugh. Progressives should not give in to the temptation of believing a Democrat through highly-subjective judgments of ‘demeanor’ or ‘temperament.’ That’s the God’s-eye view. And human beings are terrible at playing God.” 

* * * * *

The essays above, while encouraging, also ring abstract and esoteric.  How do we take these lofty ideals and apply them today, in our daily lives, so as not to feel so disconnected, so disparate?  Because what good are ideals if we cannot live them out?  We really are all in this together.  What’s helping you remember that, really feel it, right now?

In our lifetime, there may be no more important moment than right now to recognize and truly honor, in our minds, hearts, and bodies, our shared humanity.  I took a stab at an action plan with the list below.  What would you add?

  1. Stop thinking ‘we’ are better than ‘them’; really try hard to see everybody as equally worthy to engage.
  2. Marshal our best skills at patience and generosity when ‘they’ say they’re better than ‘us.’
  3. Focus on shared goals and humanity— how are we all ‘us’?
  4. Lead by example resisting the urge to oversimplify and over generalize; look for and point out complexity and nuance.  See this as a strength rather than a weakness.
  5. Do not fall for baiting and inciting statements meant to trigger defensiveness.
  6. Acknowledge and concede the flaws and faults of ‘our side’; encourage others to do the same.
  7. Disengage, for the moment, when ‘opponents’ as well as ‘allies’ show themselves, or we find ourselves, to be uninterested in following or unable to follow these rules of engagement. Even when our intentions are earnest, this stuff is hard. And it takes grit and perseverance to train. And almost all of us are total novices at it. So we have a LONG way to go. Try again later. And again, and again, and again.

 

Sexism and Apologies 2020

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“If you say, ‘Yeah, there was sexism in this race,’ everyone says, ‘Whiner!’ If you say, ‘No, there was no sexism,’ about a bazillion women think, ‘What planet do you live on?’”

That is how Senator Elizabeth Warren answered a reporter when asked whether she thought gender played a role in her suspending her presidential campaign.  I recommend watching the whole video clip.  In case anyone wonders: if the question even needs to be asked, then yes, gender played a role.  But Senator Warren rightly called out the question for what it is: a trap for any woman running for high elected office.  Her statement summarizes it succinctly; she knows what’s what, and she names it without apology.

I was more upset than I expected when Aunt Eliz Crusader ended her campaign.   Megan Garber expressed the story of my profound disappointment eloquently in her piece for The Atlantic:  “America Punished Elizabeth Warren for her Competence”.  Basically she elaborates the apparently inevitable social equation for women:

Competent  +  Vocal  +  Unapologetic   =   “Strident”  +  “Shrill” +  “Condescending”

The past two weeks I have had a series of encounters wherein I find myself voicing opinions and positions more firmly than I might have in the past.  I feel confident and grounded in my knowledge and expertise.  I am professional and respectful.  I apologized for writing a long email, even though the words were necessary and clear.  My strong woman mentor reminded me to save apologies for when I actually commit a transgression.

What I have learned (perhaps again) in this time, however, is that relationship discord, even just the possibility of it, is what distresses me the most.  How will I be perceived for voicing my concerns, for advocating for my peers and teams?  How will a negative perception undermine my effectiveness?  Will it cost me my seat at this table or others?

Does any man ask himself these questions?

Given that I was already knee deep in vulnerability and self-doubt around these encounters, the Atlantic piece poked my fears and prodded them to the surface.  It shook me.  It also made me angry that here we still are, in 2020, unable to accept, let alone embrace, competent, vocal, and unapologetic women in leadership.  And it’s not just men; countless women also disavow their sisters.

I vented my disappointment on Facebook (of course):

“So it is down to three Old White Men.  Very disappointing.”

A friend tried to make light of the situation, pointing out that Donald Trump is the youngest of the three.  This attempt at levity (from the Right) felt like a nemesis rubbing salt in my fresh wound.  Twice I rebuffed; twice he persisted.  Finally I (voiced):  “I feel ignored and dismissed when I express distress and you make light of it.  Perhaps my distress is not clear to you, because you only know me through social media [we were friendly acquaintances in high school]; you may not know how upset I am.  But after two replies by me rejecting your attempt at humor, to have you schooling me [that humor is a ‘primary’ way] of dealing with [politics] just makes me more angry.”

Turns out he had mistyped; he’d meant to write that humor is one of his primary ways of coping with the absurdity of politics.  He apologized to me.  It felt sincere.  I was consoled, and I thanked him.

Competent and vocal.  Confident and unapologetic.  Respectful and humble.

We need all of these qualities and more to be true leaders.  Women, arguably, must work harder than our male counterparts to prove that we possess all of them.  Then we get punished when the proof proves irrefutable.  How sadly ironic.  The truth is we need many more of our leaders, men and women alike, to own, exude, and model these virtues.  The last two are not weak, though they may feel profoundly vulnerable, which is not the same thing.

I feel urgent impatience at the state of sexism in America.  But I know how to soothe and manage myself; I can reclaim the patient urgency of fierce optimism at my core.

I will persist.

Aunt Eliz has shown me how.