Decide in Advance

be the lighthouse

NaBloPoMo 2018:  What I’m Learning

It’s the first Sunday of November of an election year.  The political ads are ramping up.  Tension rises; the agitation is inescapable.  Some media would have you believe that one outcome or another is all but inevitable, the world will positively end if one side or the other wins.  I admit, I have felt my share of darkness and despondence at the words and actions of some (many), not just the last two years, but for a long while now.  It’s hard not to feel sucked into an inexorable downward spiral of animosity and rage.

Thankfully, I still hear voices of uplift, words that speak to the optimist and idealist in me.  Let me share some of those voices and words with you here.

* * *

My friend Donna Cameron, an expert on kindness, reminds us that we have a choice, not just on election day, but every day before and after, about how we conduct ourselves with one another:

We have to ask ourselves now, before we know the outcome of the election: Do we want a united country? Are we still capable of coming together to productively and positively address the complex issues that have divided us?

Civility and compassion are not weak. It takes strength to accept loss and move forward with resolve rather than bitterness. It takes strength not strike back when our buttons are pushed or our values are derided. It takes strength to recognize the pain someone else may be feeling and not belittle those feelings or dismiss their right to grieve.

Don’t look to the politicians or pundits to lose—or win—with grace. They’re going to be gloating in victory and blaming in defeat. It’s up to us to model what constructive behavior looks like and to demand it of our elected officials.

But what can we actually do?  How will we know when to act, and what to do in any given circumstance?  Isn’t it just too abstract to say, “practice empathy,” or “be compassionate?”  Maybe.  But if these are values for us, then we can translate them into actions and practice.  Empathy manifests as active listening, holding one’s tongue while hearing someone else’s story, resisting the urge to interrupt and tell our own story.  It means relating to their feelings and expressing understanding and solidarity.  “That sucks, I know that feeling, Me, Too.”  Empathic listening, validating words, and simply sitting with and holding space are good practices to start with.

The Southern Poverty Law Center offers 10 concrete steps to fight hate.  Examples include:

Repair acts of hate-fueled vandalism, as a neighborhood or a community.

Use whatever skills and means you have. Offer your print shop to make fliers. Share your musical talents at a rally. Give your employees the afternoon off to attend.

Report every incident.  Pressure your representatives.

Finally, look for role models.  If you have not read Ari Mahler’s personal account of caring for Robert Bowers in the ER, please click on the link now.  He is ‘the Jewish nurse.’  What would you have done in his place, called to the trauma bay to care for the man who may have just killed members of your family for their religion?

I’m sure he had no idea I was Jewish. Why thank a Jewish nurse, when 15 minutes beforehand, you’d shoot me in the head with no remorse? I didn’t say a word to him about my religion. I chose not to say anything to him the entire time. I wanted him to feel compassion. I chose to show him empathy. I felt that the best way to honor his victims was for a Jew to prove him wrong. Besides, if he finds out I’m Jewish, does it really matter? The better question is, what does it mean to you?

* * *

Sometimes I wonder if my posts are redundant.  I have decided to think of them as iterative.  Looking back, I found a couple of posts relevant to today, written in similar periods/mindsets of portent, reflection, and seeking.  Right before January 20, 2017, I shared words I had written to friends.

They represent my intentions for managing myself in the coming years, of reinforcing my core values and focusing on my highest aspirations.  As Simon Sinek posted once:  ‘Fight against something, we focus on what we hate.  Fight for something, we focus on what we love.’

Months later I connected with conservative friends in an attempt at mutual understanding. It was not as comforting as I had hoped; I did not really feel heard or understood.  And I learned a lot about managing expectations.

I admit that I felt a little defensive at times, as if anything I said about the origins of my distress would be met with, “You’re overreacting,” and “You’re worried about nothing, please…”  We later agreed that it is never helpful to invalidate someone’s emotional response to a stressor, regardless of whether or not we can relate.

Last week I had a new opportunity to hear a colleague’s conservative point of view on gender.  With practice, I have become so much more comfortable sitting back, listening for understanding, quieting my inner debater.  My urge to counter and convince did not escalate.  I heard earnestness, confusion, some fear, and mostly a desire to understand and integrate, to find balance and peace.  I was not asked for my opinion, and this time I was okay with it.  I hope we can engage again and again in the future.

Today, two days before we all head to the polls (if we have not already—please please vote), we can decide what kind of neighbor, colleague, friend, parent, child, coach, teammate, employee, boss, coworker, and American we want to be.

What if we choose to be the kindest, most empathetic and compassionate ones we have ever known?

What I’m Learning

919_4331873329587_306774116_n

NaBloPoMo 2018

 

ACK!  It starts!

As usual, I have a whole list of ideas for the daily posts this month, and I will likely use none of them.  Who knows, right?  The goal is to practice daily writing and publishing, and do my best to make it non-drivel.

2018 has turned out to be a thick, challenging, and tumultuous year, among other things—would you agree?  What have you learned?  What lessons continue to revisit you?  Is it not all just so fascinating?  What would you write about if you had to publish something every day for 30 days straight…  And try not to bore people to tears every time?

For now, I will start with the books I’m hearing (because I don’t read books as much as I listen to them these days).  So many gifted writers out there, so many ideas—and they all connect in my experience, stimulating insight, understanding, humility, and inspiration.  I’ll list the books here that I’ve ‘read’ this year, and then bring in articles, presentations, etc. the rest of the month—things that have meant something to me personally or professionally—often largely overlapping circles of a Venn diagram.

I predict that the overarching themes will center around self-awareness, integrity, leadership, and relationship (surprise).  We shall see!  As I described to my friend tonight, this will be a practice in discipline, vulnerability, and brevity.  So here goes!  I list the books of 2018 below, in roughly the order that I consumed them.   Starting tomorrow, I will start pulling central tenets and key learnings, exploring how they apply to personal experiences in the every day.  Or maybe I’ll ditch this idea and do something totally different, tomorrow, next week, or whatever.  That’s the beauty of writing every day, I can just go wherever it takes me.

And so the journey begins again (continues!)—thanks for coming along!

ONWARD.

Braving the Wilderness by Brené Brown

A Day in the Life of Marlon Bundo by Marlon Bundo and Jill Twiss

The Righteous Mind by Jonathan Haidt

Big Potential by Shawn Achor

Switch by Dan Heath and Chip Heath

Originals by Adam Grant

Never Split the Difference by Chris Voss

Better Than Before by Gretchen Rubin

The Will Power Instinct by Kelly McGonigal

Mindset by Carol Dweck

The Big Sort by Bill Bishop

Do the Work by Steven Pressfield

How Stella Saved the Farm by Vijay Govindarajan, Chris Trimble

The Art of Possibility by Rosamund Stone Zander and Benjamin Zander

Big Magic by Elizabeth Gilbert

Dare to Lead by Brené Brown

Born A Crime by Trevor Noah

Leadership and Self-Deception: Getting Out of the Box by the Arbinger Institute

A Year of Living Kindly (still reading) by Donna Cameron

200th Post: The Best of Healing Through Connection

Harper Columbine 5-31-14

Happy New Year, my friends!  May 2018 bring us all health, joy, connection, and learning!  And may we all look back one year from now feeling more empathy and compassion, and enjoying better relationships than ever before.

If you are new to this blog, welcome!  I hope you find something that resonates.  If you are an old friend, thank you for your support, feedback, and encouragement the last 32 months.  As I reread the last 199 posts this past week, my favorite parts were the thoughtful and enlightening comments.  I never imagined I could make friends writing a blog and yet here we are, connected, engaged, and holding one another up.

What have you discovered about your own writing when you go back and read?  Turns out I have a pretty consistent theme—it’s all about relationships.  Relationships require awareness, insight, active engagement, negotiation, and adaptation.  This is no less true in our relationships with ourselves than with others.  I have divided my favorite posts below into three categories: Health & Self-Care, Physician-Patient Relationship, and Relationships and Communication in general.  Though I have written pieces on politics and healthcare, I realize that these are critical arenas in which to explore relationships, and not my primary areas of focus in and of themselves.

2018 brings big new projects and responsibilities, yay!  So of course there will be big new challenges, also yay!  Looking ahead, I commit to my self-care practices with renewed motivation:

  1. Get to bed by 11:30 every night—Coach Christine has permission to call me out if I’m caught Facebooking past this time.
  2. Maintain 4+ workouts per week. An aging body needs regular vigorous movement!
  3. Keep up with therapy and resume regular coaching calls—reflect internally and project my best self outwardly.
  4. Maximize intake of stems, stalks, leaves, and fruit; minimize refined sugars.
  5. Nurture my ties to my tribes. They hold me up so I can do my best for those whom I lead.

The coming year will also require pulling back on certain things in order to maintain sanity.  While I refuse to renounce my Facebook use altogether, I have already decreased daily hours spent.  And though I still strive to maintain social/political awareness and activism, I will engage less with opposing voices on social media.  The costs, I have learned, far outweigh the benefits.  I would much rather take a politically oppositional friend out to lunch, or even fly to meet them, and have far more meaningful conversations in person.

For now, I plan also to scale back on the blog.  I’ll continue to write, of course, but likely more in the form of stream-of-consciousness journaling, brain-dumping, and snail mail letters to friends.  I expect that once in a while one of these activities will yield a post or two, and I hope to catch them by the tail and publish them before they escape the moment.  I leave here the list of my favorite posts to date.  Please feel free to dip in and out, leave new comments, and share links.  I suspect I will be drawn back to the page before long, as I already have a list of ideas for future posts.  But in case it’s longer than I anticipate, please know that I appreciate every view, every like, every comment, and every connection.

Thank you for stopping by and taking the time to read.  And may you take something away that makes you glad you came.

Sincerely,

Cathy Cheng


552503_3426810143573_122185844_n

Health and Self-Care

The Sh*tpile  /May 2015

https://catherinechengmd.com/2015/05/01/the-shtpile/

Everybody has one.  We inherit large parts of it from our parents, whose parents passed theirs down, etc.  Life experiences add mass and odor as we grow up.  It sits squarely in the middle of the house of our existence.  For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off.  The surface gets dry and crusty; we grow accustomed to the smell.

 

How Health Begets Health  /November 2015

https://catherinechengmd.com/2015/11/07/how-health-begets-health/

As the kids and I sat waiting to get their flu vaccines this morning, I heard someone blow their nose. It was that thick mucus blowing that feels, at the same time, both gross and gratifying. I took a deep breath through my unobstructed nostrils and looked happily at my uninfected children.

 

Setting Intensions for 2016  /January 2016

https://catherinechengmd.com/2016/01/01/setting-intentions-for-2016/

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare.   After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

 

So You Want to Lose Weight  /March 2016

https://catherinechengmd.com/2016/03/12/so-you-want-to-lose-weight-the-four-as-of-goal-setting/

We set weight loss goals all the time, all of us—physicians included. We choose a number on the scale—an outcome—that represents our better selves, however we see it.  I suggest today that behavior-oriented goals, rather than outcomes-oriented ones, lead to far greater and more meaningful success.  How much are we really in control of what we weigh, day to day?

 

Never and Now  /April 2016

https://catherinechengmd.com/2016/04/17/atozchallenge-never-and-now/

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now.  Never is about the future or the past.  Often it’s a shadowy, catastrophizing perspective of things.  But we cannot predict the future, despite our arrogant human certainty.  And we cannot live every day to come based solely on what has already happened or not happened.  Circumstances and attitudes change.  Landscapes change—at times literally, and in an instant.  We evolve, we learn, we grow.  How can we be so sure that Never is real?

 

Yes, And!  /April 2016

https://catherinechengmd.com/2016/04/30/atozchallenge-yes-and/

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes.  I also remember my own hesitation and self-consciousness.  What do you mean, pimple on my forehead?  Is it really about to burst?

 

On the Critical Importance of Self-Care  /November 2016

https://catherinechengmd.com/2016/11/06/1638/

Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition… I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

 

On the Second Arrow  /November 2016

https://catherinechengmd.com/2016/11/11/on-the-second-arrow/

Eventually, breathing, we can let go the negativity, pull the arrow out.  Breathe.  When assailed by another first arrow, see the second arrow coming and sidestep.  Breathe.  Keep breathing.  Practice self-compassion and forgiveness.

 

On Readiness  /November 2016

https://catherinechengmd.com/2016/11/16/on-readiness/

I confess I am guilty of impatience and judgment.  When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated.  I know you feel it, too.  But know that I don’t blame you. The point is: we don’t make changes until we are ready.

 

Walking the Talk  /July 2017

https://catherinechengmd.com/2017/07/09/walking-the-talk/

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.

 

Just Do It My Butt  /November 2017

https://catherinechengmd.com/2017/11/06/just-do-it-my-butt/

Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys.  But does your doctor’s office have this kind of set up?  Does your insurance pay for these services?

 

Citius, Altius, Fortius!  /November 2015

https://catherinechengmd.com/2015/11/09/citius-altius-fortius/

Every day I live in awe of the astounding miracle that is the human body. It is the quintessential integrated machine.   Almost every part serves a unique and essential purpose in normal daily function, and the parameters for such function are incredibly narrow.  But take something out, wound something else, or trash multiple systems at once, and the whole assembly adapts around the insults, automatically, without any action or awareness on our part.  The body’s compensatory mechanisms exemplify the resilience and tenacity of nature, no doubt about it.

 

Dance For Your Health  /November 2017

https://catherinechengmd.com/2017/11/16/dance-for-your-health/

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun.  How could this not make us all younger?


IMG_3823

Physician-Patient Relationship

The Premise  /April 2015

https://catherinechengmd.com/2015/04/14/hello-world/

Patients and physicians have control over one thing above all else: our relationship with each other.  Relationships live and die by communication.  Barriers on the obstacle course of patient-physician communication loom large and formidable. Our system fails us over and again. And it falls to each of us, not the system, to find our way to connection and healing relationships.

 

What Are You Looking For?  /April 2015

https://catherinechengmd.com/2015/04/22/what-are-you-looking-for/

My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive.  My inner conflict escalated quickly:  Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?

 

More Than Enough Love  /June 2015

https://catherinechengmd.com/2015/06/20/more-than-enough-love/

Like parenting, the path of medical practice is not paved with lollipops and ice cream.  It’s more like an uphill dirt road with pits and grooves, erratic weather, and hairpin turns that make you dizzy and nauseated.  It can also offer astoundingly beautiful scenery along the way—like parenting.

 

Help Me Help You  /July 2015

https://catherinechengmd.com/2015/07/10/help-me-help-you/

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do?  Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these.

 

Closing the Satisfaction Gap  /July 2015

https://catherinechengmd.com/2015/07/20/the-thorn-in-our-collective-side/

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship.  This is how we communicate evaluations to medical students on their performance in clinical rotations.  There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

 

The Burnout Crucible  /September 2015

https://catherinechengmd.com/2015/09/20/the-burnout-crucible/

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out.

 

What Makes You Think You Can Trust Me?  /February 2016

https://catherinechengmd.com/2016/02/01/what-makes-you-think-you-can-trust-me/

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.

 

 

I am Edna Mode  /February 2016

https://catherinechengmd.com/2016/02/20/i-am-edna-mode/

Clearly, Edna trained in the School of Tough Love.  Fortunately for you, I have also studied empathy, compassion, and motivational interviewing.  I can help you persist.  I have patience for your journey.  I can be your pillar of consistency.  Edna is nothing if not consistent!

 

Humbling and Honoring  /April 2016

https://catherinechengmd.com/2016/04/09/humbling-and-honoring/

I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms.  The patients there have no such choices.  If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives.  There are no appointments, and almost no continuity with providers.  It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

 

On Mutual Respect  /November 2016

https://catherinechengmd.com/2016/11/05/on-mutual-respect/

To Patients Who Abuse Medical Staff: Let me be clear: That is not okay.

 

No Substitute for Time  /November 2017

https://catherinechengmd.com/2017/11/03/no-substitute-for-time/

“More information about the value of a physician-patient encounter will always be found in the content of their communication than in what they ultimately do. The difference in… physicians’ behaviors will not be found in any database, electronic medical record, or machine-learning algorithm. I have yet to see data on the contextual information from a history of the present illness in any data set or quality improvement initiative.”

 

Dr. Jerkface In Context: Healing the physician-patient relationship  /November 2017

https://catherinechengmd.com/2017/11/25/dr-jerkface-in-context-healing-the-patient-physician-relationship/

Do patients care about doctors’ suffering?  If they knew how the system harms physicians, would they have compassion for us?  What about if they knew how physician burnout and dissatisfaction directly affects their quality of care, all of it negatively?  What would move patients to stand up with and for doctors?  This is my goal for the indefinite future: to help us, patients and physicians, the end users of our medical system, stand up with and for one another, for positive systems change.


546505_3541050719516_553644737_n

Relationships and Communication

Gratitude, Generosity, and Peace  /July 2015

https://catherinechengmd.com/2015/07/30/gratitude-and-generosity/

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body.

 

Warrior Pride and a Plea for Kindness  /December 2015

https://catherinechengmd.com/2015/12/13/warrior-pride-and-a-plea-for-kindness/

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy.  We must choose carefully with whom we are willing to undertake such a venture.  And perhaps most importantly, we must be clear about our objective(s).  Do we really expect to change someone’s fundamentally held political or religious beliefs?  How realistic is that?  What other purpose, what other good, could possibly come from such conversations?

 

On Belay  /April 2016

https://catherinechengmd.com/2016/04/02/on-belay/

The interview starts with the two men talking about Hank Williams’ troubled life, his ‘formidable demons,’ as Hiddleston puts it. He expresses compassion for this, as I have seen him do in previous interviews about other characters he has portrayed.  He describes how Williams rose to stardom quickly, but ‘with no real support, no one to anchor him.’  Funny how he uses that word, anchor—like belayer.

 

Opposition and Openness  /April 2016

https://catherinechengmd.com/2016/04/20/atozchallenge-opposition-and-openness/

When I look at the list of definitions of oppose, I feel tired.  When I think of the energy it takes to constantly stand against something, I feel listless and drained.  Fighting, resisting, combatting, Obstructing, standing in the way, hindering, disputing, dissenting, contradicting—it’s exhausting.  I think of times when I meet someone new and all they talk about are the things they hate, that they can’t stand, that they want changed.  I cannot wait to get away and find levity.

 

Every Day a Revolution  /April 2016

https://catherinechengmd.com/2016/04/22/atozchallenge-every-day-a-revolution/

Like the turning of an incandescent light bulb, gently, patiently, and consistently in one direction, the steady work of activists eventually leads to sudden and intense illumination.  Darkness becomes light, cold spaces are warmed.

 

Withhold Judgment  /April 2016

https://catherinechengmd.com/2016/04/29/atozchallenge-withhold-judgment/

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.

 

Playing My Part  /May 2016

https://catherinechengmd.com/2016/05/22/playing-my-part/

Given the awesome support network with which I am blessed, I feel an impulse to do something more with my writing—to amplify and project all this love and connection back out onto the world for some positive purpose.  But how can my words possibly make a difference?

 

Holding the Space for Personal Acts of Peace—On Listening  /July 2016

https://catherinechengmd.com/2016/07/11/holding-the-space-for-personal-acts-of-peace-listening/

I know I will not do justice to all the complexities of our issues in one blog post, but I ask your forbearance for my interpretation, as it has led me to greater conviction for what I can do, I, one person.

 

Holding the Space for Our Suffering to Heal Us  /September 2016

https://catherinechengmd.com/2016/09/22/holding-the-space-for-our-suffering-to-heal-us/

For a moment we felt stuck, we connection seekers.  I looked at our leader.  His expression conveyed nothing but humility and empathy.  His posture conveyed resolution.  Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side.  But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

 

On the Golden Positivity Ratio  /November 2016

https://catherinechengmd.com/2016/11/25/on-the-golden-positivity-ratio/

I remembered something about healthy relationships maintaining a 3:1 ratio of positive to negative interactions.  Turns out it’s actually 5:1, widely attributed to observations by Dr. John Gottman, renowned marriage and relationship psychologist.  I think the same thing applies in other realms, too, such as self-talk—a reflection of our relationships with ourselves.  It’s not a far leap to see how this idea pertains to news, social media, and any other human interactions.

 

Train to Withstand the Discomfort  /February 2017

https://catherinechengmd.com/2017/02/20/train-to-withstand-the-discomfort/

We all know the satisfaction and comfort of echo chambers.  Seeing, hearing, and reading that which validates our existing positions feels so good.  But the farther we regress here, the harder it becomes to tolerate a dissenting view.  We must resist this temptation; we are called to be more disciplined than this.

 

To Train or Not to Train  /May 2017

https://catherinechengmd.com/2017/05/08/to-train-or-not-to-train/

…even if we don’t all talk politics, we all need effective communication skills, especially in the arenas of conflict resolution, negotiation, parenting (which encompasses them all), and the like.  We are social beings—we only survive by cooperating and living well within our tribes, and by tribes living well among one another.  That can only happen if we practice getting along.

 

Tribal Pride and Tribalism  /November 2017

https://catherinechengmd.com/2017/11/29/tribal-pride-and-tribalism/

We all need our tribes.  Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health.  And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us.  But what happens when tribes pit themselves against one another?  How are we all harmed when we veer from “We’re great!” toward “They suck”?

 

 

 

Hopey, Changey Hero Making

IVY Litt 11-8-17

NaBloPoMo 2017: Field Notes from a Life in Medicine, Day 8

Funny how I just wrote last night about connecting new dots to old dots.  It just happened again tonight!  A couple of weeks ago I responded to an online ad for an IVY Ideas Night with David Litt, author of Thanks Obama: My Hopey, Changey White House Years, entitled, “How to Inspire, Persuade, and Entertain.”  Litt was a senior speechwriter for President Obama, so I thought I could learn new tips for presentations, and feel a little closer to the president whom I miss so much.

I’ve done public speaking since eighth grade, when our speech teacher first taught us abdominal breathing and I discovered the thrill of holding the attention of a room full of people with only my words.  I work at an academic medical center and I hold zero publications, but my CV documents over 10 years of professional presentations to various audiences.  I thought I was pretty good at this speaking thing.

Three years ago I came across this TED talk by Nancy Duarte, whose ‘secret structure’ of great presentations I have used since I subsequently read her book, Resonate.  Essentially, she recommends that we invite audiences on adventure stories, create active tension between what is and what could be, and most importantly, make the audience the hero.  I have done this better and worse since then, but I always recognize the framework when I see it.  Those familiar with this blog know that I am also a fan of Simon Sinek, whose central message is that we perform at our best when we are crystal clear about our Why.  “People don’t buy what you do, they buy Why you do it,” he says.  Barack Obama employs both authors’ principles with eloquence and finesse, which I noticed reading We Are The Change We Seek, a collection of his speeches as president.  The best speeches delivered in this construction create audiences who are inspired, motivated, and empowered to hail a meaningful call to action.

Obama is could be core values

That’s basically what David Litt conveyed tonight.  When asked what advice he was given that served him best, he said, “Imagine someone in your audience will tell their friend tomorrow about your talk.  What is the one thing you want them to say about it?”  What is the Why of your talk?  Even though he no longer writes speeches for the most powerful person in the world, he expressed a desire to continue inspiring, empowering, and promoting personal agency in all whom his work touches. Make each and every audience member their own hero.

It turns out, however, that this approach applies to much more than public speaking.  On my 50 hour, 500 mile, aspen-pursuing weekend in Colorado last month, I described to my dear friend my favorite moments at work.  At the end of a patient’s day-long physical, after I have spent 90 minutes listening to their stories of weight gain and loss, work transitions and complex family dynamics, and reviewing their biometrics and blood test results, I meet with them for an additional 30 minutes to debrief.  This is when I present an integrated action plan compiled by the nutritionist, exercise physiologist, and myself.  It is a bulleted summary of our conversations throughout the day, centered on the patient’s core values and self-determined short and long term health goals, and crafted with their full participation.  I get to reflect back to my patients all that I see them doing well, and shine light on areas for potential improvement.  It’s an opportunity to explore the possible—to Aim High, Aim Higher, as the United States Air Force exhorts.  I often present the plan with phrases like, “Strong work!” “You’ got this,” and “Can’t wait to see what the coming year brings!”  My friend turned to me as we wound through autumn gold in the Rocky Mountains, a bit tearfully, and said, “You make them the hero of their own story.”  Yeah, I do, I thought, and I got a little teary, too.

Words are powerful.  They are our primary tool for relating to each other, for making another person feel seen, heard, understood, accepted, and loved.  You don’t have to be a public speaker or a presidential speechwriter to make a positive difference with your words.  At work, in your family, with your friends, with people on the street and in the elevator—what is the one thing you want someone to remember from their encounter with you?

Two Buttock Riding

 

Continued from last week…

My objective for the coaching session was to figure out where I really want to put my energy for the foreseeable future.  I felt essentially torn between my paraprofessional activities (writing and speaking on physician health, patient-physician relationship, bridging silos in medicine) and my nascent political activism (community involvement, calling and writing to Congress, thinking of running for office someday??).  It felt like I should choose, and yet something told me they could be integrated.

Highlights from the call:

What is your goal for the end of this session?

Clarity and direction; movement.  Readiness to act.

How close are you already?

85-90%

How will you know when you have it?

Hard to describe…  It will be a dual certainty, like choosing furniture, knowing whether I like a person: cognitive and visceral.  It will feel decisive.

How are you feeling now?

Overwhelmed, distracted.  [Recall Doug the dog, in the movie, “Up”—Squirrel!]  OMG there is too much to keep up with: Healthcare, Russia, immigration, refugees, border security, Russia, EPA, what-the-hell-did-he-just-say-and-what-the-hell-does-that-mean?, racism, misogyny, intolerance, Russia, free speech, NIH funding, science, climate change, women’s rights, the Persisterhood, congressional seats up for grabs across the country, and oh yeah, the rest of my actual life.  Every day five new things to look up, articles on both left and right to compare notes, filtering facts from spin, trying to stake independent and educated positions backed by evidence!  GAAAAHH!

What would happen if you didn’t do that?

I do what do, spend hours a day reading and trying to engage in discussion (in person and on social media), in order to be credible in my conversations, to engage from a place deeper than superficial rhetoric or simple emotional reactivity.  My big fear: If I don’t do it, I will become one of those loud-mouthed, uninformed ranters who has no evidence for my broad-brush, oversimplified generalizations and ad hominem attacks.

What is the 98% truth about that?

Not likely to happen.  That’s just not me, I don’t do that.  I always look for evidence to back up what I say, and when I don’t have it, I own up.  If I don’t know what I’m talking about, I listen more and ask more questions, or I don’t engage until I have something useful to contribute.

And the 2% truth?

There is still a risk.  I may spew sometimes—when I get triggered and e(motionally)-hijacked.  I feel particularly susceptible right now, with all of my core values and our generation’s social progress seemingly under attack.

AND, I never live here.  I may wallow a few days (1-2 weeks, max), stewing in cynicism and resentment.  But I always rise up, usually with the help of others, with writing, and with time.  I always come out having learned something, and resolving to apply the learning (usually about myself and my relationships) to whatever comes next.

***

Insights gained:

I’m okay.

In reviewing my time spent on my screens each day, I realize most of it edifies me and connects my mental dots of current events, social science, and personal meaning.  I know not to spend time on baseless rants and otherwise rhetorical opinion pieces.  I choose articles with links to data, history, and primary sources, and ones that challenge my thinking or oppose my positions (sometimes).  I look for nuance, complexity, examples of collaboration and compassionate leadership.  This is what I spend my time and energy on; it broadens my perspectives and integrates the knowledge and ideas I already have.  It fosters my own creativity and philosophy.  This is who I am.

It’s the blog.

This is what I want to spend my energy on.  It’s my platform, my thing.  All the paraprofessional stuff I do was born of this: What gives doctors meaning is the relationships we get in our work—mostly with patients, but also with one another and society at large—status, respect, contribution.  Physician, wellness/resilience, the intersection of health and leadership, bridging silos (physicians, nurses, pharmacists, insurers, hospital administrators)—it’s all about relationships.  And, so is politics.

Therefore, I will use this blog for all of it. I can share my letters to Congress.  I can continue to write about physician-patient relationship.  I know I have written about this before, but somehow it required some reinforcement:  It’s all connected, and it’s all me.

FEAR.

Of course, that’s what really holds me back (yup, written about that before, too).  Fear of attack, rejection, overwhelming engagement obligation and getting sucked into negative, counterproductive exchanges with strangers.  Fear that I have nothing useful to say.  Someone else has already said it better and reached more people.  Who am I to think that my words matter?  It’s all so paralyzing.

I got this.  

I’m ready.  It’s time.  Because: Nothing I say or write, at work or on Facebook or anywhere, is anything I would not say or write in public.  Integrity is important to me—to be the same person in private that I am in public.  I’ve been practicing, and getting better, as evidenced by the civil exchanges I facilitate on my Facebook page (which I will also share more of), bringing together friends from different walks of life in meaningful conversation.  We exchange important ideas, always concluding cordially, all relationships intact and even, I daresay, strengthened.

And, my blog is my space.  I get to manage who comes on (into my house), and I make the rules for how we engage (no poop flinging).  I don’t comment on public sites like Washington Post or New York Times, or large Facebook groups (usually) because that is like leaping into a flash mob of the worst kind.  There is no meaningful exchange or benefit for anyone.  Here, threads can be more personal, meaningful, and transformative.

***

New Goals:

Shift the Boundaries.

I can push my fearful limits and present myself more confidently to the world.  I can choose to plant more color and texture in my front yard.  I can also dig it up and throw it out if I realize it clashes with the house.  It’s all good.  And I must also mind the costs, especially to my family.  So, I can bring them closer by putting the screens out of arms’ reach when I’m with them.  Easier said than done, and definitely worth the effort.

Focus on the WHY.

It’s all about cultivating productive, contributory relationships–first with myself, then with others, and then between all of us, for more peace, love, and joy for us all.

Publish Weekly.

If this is where I want to put my energy, then I want to have something to show for it.  Plus, it’s therapeutic.  Writing calms me, which I need now more than ever, as you can see.  For now I can stop chasing conference presentations, formal leadership roles, Daily Actions to prove I am an engaged citizen.  I can simply write when I am moved—and I am always moved—and share it here.

See you next week!

 

One Cheek in the Saddle

DSC_0662

Hello friends!  I live!

The blog is now two years old (celebratory post forthcoming).  Looking back, I have strayed often from the declared theme of patient-physician relationship and communication.  I have yet to figure out my optimum writing practice and discipline.  And every day the thing I long for most is to write for fun!  *sigh* Life.

If my world were a horse, happily trotting along a winding dirt trail in the Rockies, oblivious to my riding its back, then I would have fallen off multiple times from confusion, inexperience, fear, overreaction, awe, inattention, and impulse.  Sometimes I roll a ways down the hill, too.  The past two months or so have seen all of these and more.  Thankfully, as dust-covered and disoriented as I stand at times, the horse always allows me to remount.  At this point I’m about halfway back in the saddle again—one cheek on.  The next few posts will document my return to two-buttock riding.

***

So much inner work done to date, and so much yet to do!  And I am infinitely grateful for the dense, strong, and unfailing network of support that surrounds me.  2017 could be my most productive and effective year yet, and I need help organizing.  So a couple weeks ago, I scheduled a session with my life coach of 12 years.

Her pre-call questions for me, and my spontaneous answers:

What do I want more of?

Connection, understanding, civil discourse.

To see people being kind to one another.

For people to truly listen to one another and try to understand each other’s points of view.

For us all to hold our shared humanity above all else, and see one another as fellow humans, all trying to make our way through an uncertain life.

Inner Peace.

Time outside, preferably in Colorado, in the mountains, but pretty much anywhere is good.

To write with purpose, discipline, and impact.

Integration—of everything I do, even the small things—for my Why to show up everywhere I go, with everybody I meet, most of all with my kids—to model the Why for them, in person and out loud.

To read primary literature, writings of the great thinkers and contemplatives, past and present.

Discernment—what is worth my time, contributes to my purpose, vs. what detracts from it?

Focus on what I’m for, rather than what I’m against.

Focus in general—to channel my energy to activities that align most with my central mission.  See Distraction below.

 

What do I want less of?

Rage and seething.

Repression of rage and seething.

Time wasted for lack of discernment.

Distraction.  I feel like Doug, the dog from the movie “Up”—Squirrel!  It all matters, but I cannot do everything at the same time.

 

What thoughts are uppermost in my mind these days?

The daily shit show that is our government and how it vexes me (see above, rage and seething)—sooo many squirrels.

I need to do something useful, to help, to contribute.

We are all in this together, we have to get through it together.

This is a test.  We can pass, and with flying colors, and only if we work together.

Every time I get angry, sarcastic, etc., I contribute to the negativity and morass.  I need to be better.

Why have I so much trouble walking the talk?  Why have I not achieved inner peace althef*ingready?

 

I present thusly to my trusted coach. The process always brings new insights, connections, and openings of mind and heart.  I plan to emerge on the other side of 60 minutes with increased clarity, confidence, and drive.  I’ll let you know! 😉

Oh yeah, and the Rules of Engagement also live, just taking an unplanned hiatus.  More of those to come, also.  Like I said, I’m only one cheek back on right now. 😉

 

 

Sharing an Emotional Request

htc-postcard-screenshot-cropped

Exploring the Rules of Engagement for Healthier Political Discourse, Third Query.

I’m still working on how to balance it all.  Every day I wake up and before long I feel tense, asking myself, “What can I do today to make a positive difference to our country?  How can I make my voice, calling for collaboration and connection, heard?”  It’s a struggle to extricate myself from that, and be present to work, family, chores, etc.

But I think I’m doing better.  Every day I feel an urge to write.  I have ordered postcards with the Healing Through Connection photo, title, and URL, to write to Congress.  I figure, if I’m going to write to them, they might as well know who I am and what I stand for (which, I hope, this blog makes pretty clear).

I’m never sure how effective it is to send emails via senators’ and representatives’ web pages, does anyone know?  Well anyway, it probably can’t hurt, and it makes me feel better that I’m doing something.  Today I started with my US representative, writing about Donald Trump’s conflicts of interest and ties to Russia.  I then copied, pasted, and edited to send to each of my senators.  I noticed that each time I revised, I added a sentence or two that brought my personal perspective on government into clearer relief.  It’s not just about policy.  It’s about how policy gets negotiated–which is about communication and relationships.  Finally, I wrote to Senator John McCain, chair of the Senate Armed Services Committee.  The letter is below.  Ironically, I forgot to include the link to this blog.  But that’s okay, I’ll probably write him again soon.

I’m pretty proud of this letter (email).  I think it’s respectful and validating, while also challenging.  I tried to imagine Senator McCain actually reading it.  I want him to feel seen–to understand that though I am not his constituent or a member of his party, I still appreciate him as a person.  We are all in this together, and I want him to feel supported by people ‘on the other side.’  I want to embolden any part of him that wishes to make an emotional appeal to his colleagues.  Whenever we see the word ’emotional’ we immediately, subconsciously, also think ‘hysterical.’  They are far from synonymous, and I want to take that stigma away.

Two articles I read this week support my conviction for taking an emotional/limbic approach to political conversations.  The first was a detailed piece in The New Yorker that describes the science behind why facts don’t change our minds.  Second was an October article in the Harvard Business Review on how to engage and make it safe for people (Trump supporters in particular) to change their minds and positions.  It does not specifically reference the Harvard Negotiation Project, but it reminds me in many ways of the book Getting to Yes, written by HNP founders William Ury and Roger Fisher.  I plan to write more about principles from this book in the coming weeks.  I have listened to it again since the election, and it helps ground me.

I thought about sharing my letter on one of the many secret, liberal groups on Facebook, and/or on my personal page.  But somehow it felt more appropriate to share here.  I am aware that this makes me vulnerable to public attacks on my politics and positions.  With engagement comes risks, so boundaries are in order.  My boundaries here are the same as on Facebook:

  1. No ad hominem.
  2. Keep your comments respectful and civil.
  3. Read the entire post before commenting.
  4. I reserve the right to remove comments that violate the requests above.  Commenting on this blog is like coming into my home and talking to me.  I would not allow you to fling fecal words in my home, at me or my other guests, and the same principle applies here.

What do you think?

*** *** ***

Dear Senator McCain,

Thank you for your decades of service to our country.

I am a liberal independent from Chicago, a woman, a daughter of immigrants, and a physician.

I remember the 2008 campaign and how you treated Barack Obama with respect and professionalism.  I remember how you corrected the woman at a debate when she claimed he was an Arab.  You made a deep impression on me that night, for manifesting integrity with unwavering conviction.  I see you doing it again now, as we face the profoundly alarming and appalling existential threat of the new administration.

I write today to request that you consider how best to use your influence and credibility, with your longstanding tenure in the military and the Senate, to encourage and empower your colleagues, especially those on the right, to stand up for the conscience of the nation.  We need a comprehensive, bi-partisan investigation into Donald Trump’s many conflicts, and especially those with Russia. I know you already support this.

I have no idea what it must be like in your work.  But as a primary care physician, I talk to people for a living, trying to help them change their behavior to more closely align with their long term health goals.  It takes kindness, persistence, patience, presence, and trust.  Simply arguing facts and positions does not work.  We need to appeal to people’s emotions–to their deeply held (and perhaps forgotten or buried?) values of integrity, responsibility, accountability, and conscience.  We humans are emotional decision-makers, though we think ourselves so rational.  Research tells us that much of the time, we simply rationalize.  Thus, to change people’s behavior, we need to shed emotional light, with compassion and empathy, on the discrepancies between their actions and their integrity.  And we need to make it safe for them to admit to those discrepancies, rather than shame them for it.  Only then will they, slowly, make meaningful change.

I imagine that over the years, you have cultivated the relationships with your colleagues that paved the way for the important conversations that must happen now.  Please, for all our sakes, engage with your colleagues around your common humanity and shared mission of protecting our democracy, and of showing the world that our government is one of integrity.

Thank you, and best wishes to you and your family.

Sincerely,

Catherine Cheng, MD FACP