November 9:  Steady Pacing Makes Me Better

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NaBloPoMo 2019

*sigh*

I’m not a swimmer or a runner, but isn’t there something in these athletes’ training about breathing, pacing, and strategies for long distance endurance?   The last 22 days have felt like a physical, mental, and emotional marathon of sorts.  I’ll spare you the list of meetings, engagements, and tasks—you may have already read about them!  Looking back, I realize I have had to live every day in acute mindfulness, attending to whatever was right in front of me in the moment, including the unexpected.  Prioritizing was key, completing one task/event/conversation before moving onto the next.  I had to put my head down for some parts, come up for breath and a brief aerial view, then dive deep again.  Today I crossed a finish line, and I feel proud.

I started my journey with Better Angels in May of this year, at a skills workshop.  Since then I have attended two additional workshops, one that was featured on the Van Jones Show.  I committed to moderator training, and today I led my first skills workshop.  I had the honor of working with the three Wonder Women who ran the workshop back in May.  They prepared me so generously, so kindly, and I am forever grateful.

There was a hiccup, though.  When we initially arranged with the Wilmette Public Library for the event, we mistakenly told them the event would last two hours.  The workshop is designed to last 2.5 hours.  We could not change the website or registration, so we meticulously shaved 24 minutes from the schedule.  We warned participants of our impending heavy handedness on time, and dove in.  Mande and I set timers on our phones for each segment.  Mary Lynn gave me hand signals from the back of the room (though I did not always look or see).  I had the handy timeline that Sharon typed out for us all.  We ran ahead at times and behind at others, and ended right at 4:06pm, as planned.  We kept pace.  Engagement and discussion was lively, and attendees gave overwhelmingly positive feedback.  Many people stayed afterward to talk more, explore ways to get involved, and exchange information.  We were invited to present at other organizations.  Overall we felt it was a wild success.

Workshop timeline 11-9-19

Everything was a group effort these last three weeks. Each meeting, workshop, video call, or presentation, whether for the American College of Physicians, my clinical practice sites, or Better Angels, required a team of people, each with delegated and specified roles and task lists.  We all had to agree on timelines and deadlines.  Text, email, Zoom; more email and text—it felt like running through a Venn diagram of relay races, passing batons in and out of each circle as I crossed from one to another.  I had to pace myself, and also match the pace of others as I came alongside.

Having a calendar with everything written in one place definitely helped.  I keep a checklist of every task, no matter how small, and carry it with me everywhere.  Excellent hydration is key for optimal mental and physical performance—I’m always reminded when I forget.  Timely, frequent, and clear communication—need I say more?  All of these practices help me plan and maintain a steady pace, checking off the list, completing each day, each trip, each week, slowly, surely, and competently.

Now I can slow down, breathe deep, and tread more lightly for a little while.  Every athlete, even an amateur, requires rest and recovery between races.  Once again I dedicate this month of daily blogging—a quintessential practice in steady pacing—to all those who go before me, showing me how it’s done.  Thank you.

 

 

November 8:  My Students Make Me Better

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NaBloPoMo 2019

Oh how I love my medical students!

Every other year I meet a new group of about 10 third year students, at the dawn of their clinical careers.  What a privilege!  I lead a monthly small group for a class called Personal Transition to the Profession.  I have written about this honor before, describing how

  1. My only job in this class is to love these students into the amazing doctors they are meant to be
  2. They help me see physician burnout from different perspectives
  3. Their experience of medical culture resonates with my own

Monthly group meetings are just enough to start to know any one person after two years, and then they disperse and I grieve the loss, just until my new group starts.  After ten years of stimulating conversations on professionalism and the humanity of medicine, I still feel anxious about my impact on these bright, insightful learners.  Did I do a good job?  Did I make a difference?  Did their time with me matter at all, or was it a monthly waste of time?

This June, I finally faced these questions head-on during a coaching call with Christine.  What are my strengths, what value do I bring?  How can I distill the central learning objective each month?  How can I connect more effectively?  We settled on some ideas for setting expectations and being more direct about goals and touchstones.  I instituted check-ins at the beginning of each meeting, something I should have started years ago.

This month’s topic was open; students were invited to write and discuss whatever was on their minds.  Blog posts and check-in comments resonated around words like exhaustion, sleep, and longing for connection.  So rather than delve into the content of their writing, I simply asked how I could help.  One student, ever honest and forthright, said, “let us go home and get to bed.”  The air felt heavy, almost forlorn… but not hopeless.  I found myself monologuing a few minutes about appreciative inquiry, and finally asked them, a little desperately, “What is the most loving thing someone has said to you this week?” and then, “or how have you felt loved this week?”

Slowly, small vignettes of connection, meaning, and hope emerged.  The student who wanted to get home to bed had received an email from a former preceptor, whose patient finally started and stayed on much needed antidepressant medication, which the doctor attributed to our student’s contact with the patient during his primary care rotation.  Another’s parents had driven into the city early in the morning to lend her their laptop after she had spilled water on hers.  Other students had connected with family members and friends, who expressed pride and encouragement.  Once again I was overcome with love for these young colleagues, and I could not help but tell them:  I have one job here, and that is to make sure you know you’re loved in your training.  I am not here to evaluate you.  You will all finish, you will all succeed.  In the time I have with you, my only objective is to hold you up in the process.  I made sure they all have my cell phone number.  I encouraged them to call me if they ever need anything.

Two students (and one’s wife) came to my house for dinner tonight.  It was supposed to be everybody, but I neglected to send a confirmation email so people weren’t quite sure if I meant my invitation last month (probably because I had planned for them to come over last month and then cancelled on them that week).  We ordered pizza and salad, I fried some potstickers, and we sat around the kitchen island with my kids, just talking.  We are all nerds.  We love to read, to learn.  S’s wife is a resident at my former hospital, and knows my friends there.  They have a book club there now, and this year’s theme is wellness.  She asked for suggestions, so I lent her my copy of My Grandfather’s Blessings.  She and S also borrowed our season one DVDs of The Big Bang Theory.

Our group will meet at a local restaurant after next month’s class.  We will plan (better) another evening meal at my house in the spring.  In the meantime, I will extend an invitation to each of them to come down if they ever need a break from school, a change of scenery, or just to feel a little extra love.  I have been where they are, and I remember how much I appreciated the empathy and compassion of my elders in the profession.  I still do.

How does this all make me better?  In medicine we talk all the time about the calling to care for patients.  But caring for one another, our colleagues and trainees, is equally important.  It keeps us and our souls whole, feeds us so we can keep doing the work.  My students recharge me, inspire me, and keep me young.  What an absolute honor to know them.

November 7:  Feedback Makes Me Better

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NaBloPoMo 2019

This post is about power.

Two friends provided important feedback on last night’s post, and I am, gratefully, much better for it.

* * * * *

“You are a woman of color?”

My college friend commented on Facebook.  “Are you being serious?”  I asked him.  Yes, he replied.  He went on to point out that he sees the term being used more broadly, and that he thinks it’s been co-opted.  He made me think, which always makes me better.

In the original post, I described myself as a “petite, young, woman of color doctor,” standing up to an older white man. My friend wrote, “I think disadvantage is baked into the term, why else use it?”  Looking back, I admit I was exaggerating.  I had power on my mind, and I was trying to think of all the ways I should not have power in the situation, and yet I absolutely did, and I recognized it.  But labeling myself a person of color, I realize now, was at least somewhat inappropriate.  I have changed the text to “petite, young, Chinese woman doctor.”  I sincerely apologize if I insulted or offended anyone.

In medicine, East Asians are not considered a disadvantaged minority in the conventional sense (although while we are over-represented compared to the general population, we hold proportionally few leadership roles).  In general, however, I would argue that any non-white person in the US may still experience myriad disadvantages, in any field or situation, even if subtle.  At any point in an encounter, even with ‘MD’ and years of training and expertise behind my name, a white man can always hurl some racist, sexist remark to make me feel small.  He could just as easily attack a fellow white man on the basis of weight, sexual orientation, stature, or some other peculiar distinction, but somehow it feels like my white male colleagues just don’t have to think about this possibility as much as I do.  I feel self-conscious about my gender and race every day at work.  That is why this past spring, when I attended a negotiation skills presentation at the American College of Physicians (ACP) national meeting, I felt particularly gratified that the presenters were two East Asian women and one white man.

* * * * *

“You may want to include physicians as victims in your blog.”

A colleague responded to my post by sharing her story of being verbally attacked by a patient.  She was alone, no witnesses, and he treated staff politely, unlike in my story.  She was ‘dumbstruck and said nothing.’  She wrote, “I think as physicians, we are targets for verbal abuse because we have a privileged profession and would look foolish or weak in defending ourselves.”  In other words, since doctors hold such high societal status (power), people think we should just accept being taken down a notch or two?  That if we express an expectation of respect we are lording our status over others and thus even more justifiably open to insult and ridicule?  I see now how this can make a physician feel like a victim of societal stereotypes and expectations.

That said, I think it doesn’t matter what we do for a living; every person has an absolute right to expect respect from anyone else.  Years ago, another older white male patient made a series of passive aggressive remarks in the space of several minutes at the end of a visit.  I felt they were unfair and uncalled for, as I had spent the entire visit doing my best to connect with and care for him.  After a moment of consideration, knowing it was a risk, I was respectfully direct with him.  I repeated his words and told him that they felt like digs.  He admitted that they were and apologized, and congratulated my courage to call him out.  He never came back to see me.  I feel good about how I handled it; was it a power struggle?  I would have been open to cultivating a mutually respectful and honest relationship, had he returned.

Feedback definitely makes me better.  I will never grow if I only attend to my own point of view.  I don’t have to abandon my own perspective when facing an opposing one, and I am not obligated to incorporate anyone else’s point of view.  But if I expect anyone to take my writing and message seriously, I am required to listen to and try to understand any feedback that is offered in good faith.

Thank you, my friends, for keeping me honest and grounded.