Training My Better Angels

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First, Happy Mother’s Day to all!

So friends, what do the Better Angels of your nature feel like?  What do they do, how do they speak and act, especially when encountering those with opposing political views to yours?

A New Tribe

Yesterday I attended a skills workshop run by Better Angels, an organization I have admired for a while.  Their stated mission:

Better Angels is a citizens’ organization uniting red and blue Americans in a working alliance to depolarize America

  • We try to understand the other side’s point of view, even if we don’t agree with it
  • We engage those we disagree with, looking for common ground and ways to work together
  • We support principles that bring us together rather than divide us

On the garden level of a Lutheran church on a drizzly afternoon, we sat quietly in a big circle of folding chairs.  I noticed one black woman, one other Asian woman, and everybody else was white.  Most of us were at least Gen Xers; I estimated maybe one third were Baby Boomers.  It seemed about equal numbers of men and women.  Among the 30 or so participants, 6 of us identified as ‘red-leaning.’  The moderators set a clear and firm expectation that we all respect one another, and especially attended to those in the political minority.  As the facilitator explained the objectives and skills, people listened attentively.  Expressions and postures demonstrated eager engagement.  A sincere and almost sad, desperate longing for bipartisan connection permeated the air.

We were all there to practice listening skills to help one another feel heard.  Speaking skills would also be taught, to facilitate ourselves being heard by our counterparts.  Though I felt confident in these skills already, I looked forward to strengthening them in a new group setting.  When I saw we would do role plays I got super excited!  The method, designed by family therapist Bill Doherty, was brilliant—we paired with a same-color partner, and took turns playing blue and red, challenging ourselves to resist judgment, stay open, tune in to our own and each other’s whole presence, and imagine the minds of ‘the other side,’ inviting all of our whole selves to connect.  The central objective was to create an atmosphere of openness, non-judgment, and balanced, mutual engagement.

The Spark

Even before the activities started I thought, “I want to learn how to lead this.  I want to participate, to contribute in a bigger way.”  So when they invited us to stay afterward if we were interested in moderator training, I practically leapt out of my seat.  Turns out you have to apply—no problem—and good, they have standards, yay!  Once accepted, you complete about 15 hours of online training and a Zoom call with established moderators.  Then you commit to moderating three workshops in the coming year.  Woo hoooooooooo!  There are only 8 moderators in all of Illinois, all from north of I-80.  Better Angels holds firm a 50/50 ratio between red and blue volunteers, and disproportionally more blue folks apply, so I may have ‘competition.’  That’s okay—we’re truly all on the same team here!

Ready, Set, Wait–I’ Got This.

When I got home and opened the application, I hesitated a moment.  They seek, first and foremost, volunteers experienced in group facilitation.  Yikes, I don’t have that, I thought.  And yet I felt intrinsically comfortable in that group setting, imagining myself co-leading with relaxed confidence and grace.  Huh, interesting.  I own this communication skill set, as well as the ability to teach it—I feel eminently qualified for this role.  Where did I get that?

Part of the application required a condensed resume, so I pulled up my CV.  Maybe I’ll find something in here to make the case that despite my lack of group facilitation experience, I’m still qualified, I hoped.  I laughed out loud when I realized, I have been facilitating groups for ten years now—every month with my medical students, discussing topics like professionalism, medical errors, burnout, difficult patients, and interacting with industry, among others.  I’ve also conducted workshops teaching motivational interviewing, the quintessential skill set in open and honest dialogue!  In all of these settings it’s my job to make the environment safe for candid discussion, to model non-judgment and open, honest questions.  I lead role plays in which people take on both patient and provider roles to practice empathy for their counterparts.  I have written on this blog multiple times about how much I learn every time I meet with these groups.  No wonder I felt so at ease in the workshop yesterday, I’ve been doing this—training my and others’ Better Angels—for a decade already, and I did not even realize it.  How cosmic.

So my application is submitted!  I should hear in 15 days.

* * *

Friends, would you consider joining this group?  What are you curious about?  What makes you hesitate?  Who in your circles would be great at this work, and will you share this information with them?

Thank you for reading, and wish me luck!

Elephant to Elephant:  How to Change People’s Minds

 

Friends!!  If you read only one thing today, stop here and click on this link to James Clear’s essay on why facts do not change minds.  It’s very similar to Ozan Varol’s post of a similar title from last year.  That piece prompted a prolonged conversation on my Facebook page two months ago, which I described and shared here.

The Trigger

I’m thinking hard again about facts and changing minds now, as the number of new measles cases skyrockets not just in the US but around the world.  I’m so angry that we have to fight his war again—a war we had won as of 2000.  I’m so frustrated that because of the actions of a relative few, the health and safety of the very many and vulnerable are once again at risk.  I know my colleagues and many in the general public share my sentiments, and we often end up shaming and deriding our ‘anti-vaxxer’ peers.  We hurl facts and statistics at them, incredulous at their intransigence to the truth of science.

In the end everybody digs in, feelings get hurt, relationships suffer, and the outbreaks progress.

There is a better way.

James and Ozan (I imagine them as friends and so refer to them by first name) explain it eloquently in the posts I share here, and I really encourage you to click on those links.

The Metaphor

Personally, I return often to Jonathan Haidt’s analogy of our mind as an elephant (the emotional, limbic brain) and its rider (cognitive, rational brain).  We think, as rational beings, that our riders steer our elephants.  But psychology research and evidence tells us that the elephant goes where it wants; the rider rationalizes the path.  That is why facts do not change people’s minds—they are the rider’s domain.

Chip and Dan Heath, in their book Switch, take Haidt’s idea further in their formula for behavior change:

  1. Direct the rider (provide the facts, rationale, and method),
  2. Motivate the elephant (make the message meaningful on a personal, emotional level), and
  3. Shape the path (shorten the distance, remove obstacles).

It occurred to me recently that when I flood you with facts about measles and vaccines, I speak only through my rider.  You listen (or not) as both rider and elephant.  But as Simon Sinek describes eloquently in Start With Why, the elephant limbic brain has no capacity for language.  And facts, conveyed in words, have no emotional meaning or context.  So unless your rider is somehow really driving in this moment, my rider’s appeal will not move you.  Your elephant does not understand my rider, thus I cannot steer you where I want you to go.

The Approach

So how can I motivate your elephant?  If I’m using words, I can tell a story.  But the words of any story matter far less than the emotions the story evokes.  If I can relate with your own past experience, point you to a loss, a gratitude, or some shared connecting experience between us, then your elephant may hear me.  If I tell my story with honesty, authenticity, and humility, then my rider serves as translator for my elephant, communicating directly with your elephant.

But the most important connection between our elephants, if I really want to change your mind, is my presence.  Researchers agree that a vast majority of communication, up to 90%, occurs non-verbally.  Even if my rider interpreter tells a great story, my attitude carries the real message.  This manifests in my tone of voice, facial expressions, posture, stance, and all kinds of other subtle, nonverbal, subconscious cues—all seen and understood by your elephant, because they emanate from mine.  Even if my story tugs at your heart strings, you will defend your position if you feel me to be righteous, shaming, condescending, etc.  Elephants are smart; they know not to come out if it’s not safe.  And if my elephant is at all on the attack (see anger and frustration above), your elephant knows full well not to show itself.

It’s not the words we say or the things we do—it’s not the method that counts.  It’s how we are, how we make people feel—the approach—that gains us access to people’s consciousness and allows us to influence their thinking (which is really their feeling).

So I calm my rider and elephant first.  Deep breaths.  Then instead of my rider jumping off my elephant and charging at you with a wad of sharp verbal sticks, she sits back in her seat.  My elephant humbly ambles alongside yours on the savannah of community and (humanity), shares some sweet grass, points to the water hole where we both want to go.  I invite your inner pachyderm lovingly on a shared adventure toward optimal health for us all.  Rather than rush, berate, or agitate you, I wait.  I encourage.  I welcome.

James Clear writes, “Facts don’t change minds.  Friendship does,” and “Be kind first, be right later.”

My elephant fully concurs.

 

Some Facts, because I’m a doctor after all:

  • As of last Friday, May 3, 2019, there were 764 known cases of measles in the United States. According to the CDC, “This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.”
  • About 2/3 of patients are unvaccinated; 1/10 have been vaccinated, and the vaccination status of the rest is unknown.
  • 44% of patients are children under 4 years of age.

See this article in the Washington Post from today for more statistics.

For answers to frequently asked questions about Measles, please refer to the CDC measles FAQ webpage.

Please talk to your doctor if you are unsure about your risk.

 

The Optimist and the Cynic

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Are you an optimist or a cynic?

I consider myself to be, wholly and without question, an Optimist—with a Big O.

In The Art of Possibility, Ben and Roz Zander describe a cynic as a passionate person who doesn’t want to be disappointed again.

By this definition, cynics are not altogether hopeless and negative; they are simply wary and cautious based on past experience.  Still, I judge cynics and find them tiresome.  I reject their gloom and doom outlook.  Sometimes I really just want to throttle them.  In their presence I turn up my outward optimism to happy headbanger volume.  I can tell this makes them a little crazed—they see me as Pollyannish, idealistic, and naïve—and likely wish to strangle me, too.

And here’s the thing:  I also possess a deep cynical streak; one that can really overtake my consciousness sometimes.

Every day I campaign ardently to empower myself and those around me, pointing to all the ways we can claim our agency and effect positive change.  I advocate for using all of our kindness, empathy, compassion, and connecting communication skills, in every situation—take the high road!  Be our Best Selves!  And yet at the same time, a darker part of me, my shadow side, silently tells a contemptuous story of the forces we fight against.  I paint a sinister picture in my mind of impediments made of ‘the other’ people—the small minded, the pessimistic, the underestimating, unbelieving, rigid, unimaginative, distrustful, conventional, supercilious, and condescending themThey are not like usThey are the problem.

Of course this is not true.  It’s just a story I tell—a counterproductive and self-sabotaging story.  How fascinating.

Sometimes I tell this unsympathetic story aloud, out of frustration, impatience, and exasperation.  Sometimes I actually name people and label them all those negative things I listed.  It feels justified and righteous.  But then I feel guilty, as if my worse self kidnapped the better me and held my optimism hostage until I vented against my better judgment.  I wonder when my words will come back and bite me in the butt?  What will I do then?

I suppose I can only claim passion and disappointment.  Sometimes I let the latter get the best of me and allow shadow to overtake the light.  It happens to the best of us; I can own it.  There is no need to disavow the disappointment and disillusionment, the dissatisfaction with what is.  If I didn’t care so much—about patient care, public policy, physician burnout, patient-physician relationship, and relationships in general—I would not suffer such vexations.  And it’s because I care so much that I fight on, to do my part to make it better.  I stay engaged in the important conversations, even if I have to take breaks and change forums at times.

Yes, I, the eternal optimist, harbor an inner, insubordinate cynic.  While most of me exclaims, “Humanity is so full of love and potential!” another part of me mutters subversively, “Also people suck.”  Some days (some weeks) the dark side wins, but it’s always temporary.  The Yin and the Yang, the shadow and the light, the tension of opposite energies—that’s what makes life so interesting, no?  We require both for contrast and context, to orient to what is in order to see what could be. 

The struggle for balance is real and at times exhausting.  And it’s always worth the effort.

On Easter: Separate and Unite

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What does Easter mean to you?

It occurred to me as I sat in the second pew today, coming to church on Easter labels me.  I declare myself Catholic on this occasion, in this place.  I separate myself, in a sense, from all who are not Catholic or Christian, from all who do not celebrate.  You might consider that I do this every Sunday at church, or every time I say I’m Catholic.  But on Easter it feels more intense, because this mass is all about the definition of Christianity—He died for us—we hold this to be true (I still have questions about that, actually) and that is what makes us Christian.  I apply this label to myself by my attendance at this mass.

I generally dislike being labeled, because of the assumptions that inevitably and automatically accompany labels of any kind.  You are Catholic, therefore you must be pro-life and thus anti-woman (I am pro-choice).  Your church is full of pedophiles and those who abet them; your religion, and you as an extension, represent the worst kinds of repression of the reality and diversity of human expression (if you think this please read about Father James Martin).  You are Chinese, you must be so smart and have a Tiger Mom (I am so smart but I don’t attribute it to being Chinese, and my mom is not Amy Chua).  You are a doctor in executive health, you must have done it for the money (this one slapped me recently, and I still seethe a little over it).

I have attended my church for 28 years this fall, starting my freshman year in college.  I was confirmed here, my children were baptized here, and I would have been married by the priest here, had it not been New Student Week that year.  I have so many friends here, from the couple who sponsored me for confirmation to the woman who ran the nursery where both of my kids played, to the director of the prison ministry who has kept the pencil record of my kids’ heights on the wall in his office.  I return to this community not for the ‘body and blood’ mass parts, which I could get at any Catholic church.  It’s how the people here put their faith into action that I admire—seeking connection across diversity, holding space for differing viewpoints and discoursing with respect and compassion.  Next month there will be a dialogue on the Ten Commandments led by our pastoral associate and a Northwestern campus rabbi, entitled, “The Big 10.”

I consider myself not religious at all, rather faithful and spiritual, and this is where I practice.  So while I separate from non-Christians this Easter, I unite with this particular Catholic tribe.  And let me be clear: separating into tribes is a GOOD thing.  Humans are wired for belonging and shared identity.  Support from those we identify with and relate to is essential for survival and thriving, especially in chaotic and uncertain times like now.

But it is in exactly such times when we must be wary of over-identifying with those we perceive as similar to ourselves.  Separating (or sorting, as Bill Bishop calls it) ourselves by religion, ideology, profession, or any other in-group carries risks for us all.  As I looked around the chapel today, I saw a widely diverse group.  Most people were white, many at least a generation older than I.  But there are always college students here, bringing balance, which I love.  I see also families like mine, our children growing up as members of the community, making it a whole of many assorted parts.  No doubt we are not all of one political persuasion, and we each have our own reasons for whatever opinions and positions we take.  We must not assume that just because we attend the same church, in this little building or the Catholic church of the world, that we are all the same, or wholly different from those outside of our church or faith.

As we unite as Christians this Easter, then, separating ourselves from ‘non-believers,’ what is the best object of our spiritual focus?  When we think of ourselves in terms of this religious tribe, how does it impact our identity and relationships in the tribe of humanity?

What are we called to do with this faith of ours, how are we meant to best manifest it here on Earth?

I hear Brennan Manning’s words in my mind all the time, like a warning:

The greatest single cause of atheism in the world today is Christians who acknowledge Jesus with their lips and walk out the door and deny Him by their lifestyle. That is what an unbelieving world simply finds unbelievable.

By the end of mass, I decided that if I choose to accept this ‘religious’ label, oversimplified and overgeneralized as it is, then I must represent it well.  I must not personify the corruption and hypocrisy that so many identify with Christianity—I must demonstrate the opposite.  My faith in action must be driven first and always by love, and never by fear, never by suspicion.  If I can pull this off, then separating myself as Catholic or Christian serves wholly to unite me with all of humanity, because that is what my faith, and what I believe the best of all faiths, calls us all to do.

Reconnecting to Mission, Patients, and Colleagues

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What’s the most personally fulfilling aspect of your work?  In times of uncertainty, threat, and transition, what holds you up?

This past week, I had the privilege of standing alongside giants in the fight against physician burnout.  In a series of presentations at the annual meeting of the American College of Physicians (ACP), we did our best to acknowledge and validate the current state of physician burnout (about half of all physicians in all specialties report at least one symptom), and then present as many strategies to reduce it as time would allow.  We showed how changes in workflow, task distribution, and technology, such as pre-visit labs and scribes, have been shown to improve physician satisfaction, team morale, and patient experience.  My role was to attempt to inspire my fellow internists to claim their individual agency, model a culture of wellness, and advocate for systems change in their home institutions.

The content felt dense but manageable, and the audience appeared engaged.  Our colleagues from all around the country approached us afterward to clarify studies of efficacy and ask about local representatives for advocacy in the ACP.  In the end, I think we achieved our primary objective of having most attendees leave with just a little more hope for our profession than they came in with.

Over the four day conference, however, what consistently grounded me in professional mission and meaning, not only in our own presentation but in others, were the personal stories.  That is how we humans relate to one another, after all—through narratives.  And connecting to mission and colleagues is key to maintaining a healthy and productive workforce, physician or otherwise.

Our attendees participated in two practices that I’ll share here.  Both were “Pair and Share” activities, meant to stimulate reflection both internally and externally.

Who In Your Life Really Changed You?

First we asked our colleagues to think of a patient who changed them, how, and to what end.  I know there have been many patients who changed me, but I always think of one particular woman.  She was middle aged, obese, diabetic, depressed, and severely disabled from osteoarthritis.  She lived alone and had a sparse social network, and her life partner had died unexpectedly a few years before I met her.  At every visit we struggled through the same fundamental challenges of weight loss, glucose control, and pain management.  How could she take her diabetes medications more regularly?  How could we control her pain without having to take opioids every day?  How else could we manage her depression, as some of the medications were raising her blood sugar?  She may have cried at almost every visit; wailing was not uncommon, and once she even vomited from cumulative distress.  Our relationship was good overall.  I overcame my impatience with her non-adherence to the treatment plan as I understood her life situation better.  But for four of the five years we knew each other, I saw few if any indicators that her thought, emotional, and behavior patterns would change.

Then things started to turn around.  She started coming consistently to appointments, no more no-shows.  She got online and found a community center that was accessible by bus.  She connected with a knitting group and started going to art fairs to sell her creations.  She started taking her medications more regularly, and lost enough weight to have her knee replaced.  By the time we parted ways, she had transformed from a weeping victim of circumstance to a woman with agency, self-efficacy, and goals, dammit!  And most of this had nothing to do with me.  I simply had the privilege to witness and support her intrinsic revolution.  From her I learned what perseverance looks like; I learned about hope and self-redemption; I learned that I should never make assumptions about anybody’s future.

Who Supported You in a Time of Vulnerability?

They said do the hardest thing that you know you don’t want to do for a living as your first rotation.  So I chose surgery.  In July of my third year of medical school, my days started around 5:30am and could end the next night at 10pm if my team was busy post call.  Most faculty physicians were kind and wise, or at least non-abusive.  Some, however, not so much.  What buoyed me most through that rotation was always the support and protection of the residents on my team.  I would watch them get abused by our attendings, but that sh*t never rolled downhill when the boss left the room.  I did not fully realize until years later what a gift that was and how much it spoke to the character of these men (they were all men).  This was in the 1990s; verbal abuse of medical students and snide comments about one’s appearance, gender, and just about everything else were simply to be expected.  But my favorite residents always pulled me aside and asked how I was.  They always made sure I felt confident about my role on the team, and they taught me basic skills with conviction and encouragement.  As I was about to insert a patient’s bladder catheter in the operating room, my elder brother in training told me firmly, like he really believed I could do it, “Don’t be afraid, hold it (the penis) like a hose.”

As we did this reflection exercise at the meeting last Wednesday along with our audience, I was so moved by these memories that I looked up one of my old residents that night and sent him a thank you card.  I bet he won’t remember at all who I am, but he will hopefully feel validated that he is in exactly the right position now as program director of a surgery residency.

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Recalling stories like these, and then sharing them with a person who truly listens, receives them generously, and simply helps you hold them (that was the instruction to the group—when it’s your turn to listen just do that, no interruptions, no jumping in), reconnects us to our calling in medicine.  It’s not just about the patients or the science.  It’s about all of the relationships and how we tend them.

We will not solve the immensely complex problem of physician burnout overnight.  It will take a concerted effort at all levels of healthcare, and physicians cannot and will not do it alone.  And it’s not that we are stoic, arrogant, and somehow intrinsically flawed, and thus dissatisfied with our work and leaving the profession in record numbers.  It is a systems problem, no question.  And, while we call our congressional leaders and professional advocacy groups to change policy, while we lobby our hospital administration to hire more support staff and move the printers closer to where we do our work, we can all take a few minutes each day and reconnect to the core meaning and purpose in that work.  Let us all remember a cool story and share it today.

Pain and Desperation

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When was the last time you used any narcotics?  I think I took some of my mom’s cough syrup with codeine over a decade ago, when I felt like I might actually cough up a lung.  Before that it was one dose of Darvocet after having four impacted wisdom teeth extracted at age 18.  I don’t really remember much after swallowing the pill and lying down on the sofa.  I was given multiple opioids during knee surgery last year, but needed only Tylenol and Advil afterward.  Looking back on the post I wrote about that experience, I realize even more how I was influenced by this piece in the New York Times just a month before my surgery.  In it the author is reminded that pain serves an essential purpose, and it’s better that we not necessarily seek to obliterate it at every turn.

* * * * *

Four or five times in the last two weeks, I have received calls from local pharmacies to confirm opioid prescriptions that I did not write.  They were all paper prescriptions for patients I have never met, caught by astute pharmacists who suspected fraudulent activity.  This is the first time it has happened to me, and I know many of my colleagues have experienced the same.  Pharmacies in the area have now flagged my name and license number, and they know not to fill any controlled substances without direct confirmation from me.

What a morass.  How did we get here?  It’s a rhetorical question, really, but not a simple one by a light year.  When I started my training, we were taught to consider pain the ‘5th vital sign.’  Every patient assessment included the cartoon face pain scale.  Anesthesiologists’ prioritized rubrick for pain control started with long acting opioids around the clock, then regular anti-inflammatories if no contraindications, then short acting opioids as needed for breakthrough pain.  In the hospital I never questioned this method, especially since I almost never interacted with these patients after discharge and was oblivious to follow up issues.

It was not until I started in practice that I experienced the multidimensional challenge that is pain control and opioid prescribing.  After 15 years I am still learning the layers of complexity, unique for every patient, and I see that even if we understand it (which I think we do not), most of us feel helpless to address it.

The pharmacist I spoke to today told me that his store’s standard procedure is to inform the patient that the prescription was proven to be fake, advise the patient not to attempt such an act again, and let them know that the prescriber is aware and the police will be contacted.  It was that last part that made me pause.  Because even as I intend to file a police report (as advised by my institution), the answer to the problem is not, in my opinion, rounding up patients with chronic pain and throwing them in jail.  In order of importance, I think the opioid crisis is first a social, then a medical, and only then, a criminal problem.

* * * * *

Increasingly, we have become a society of immediate gratification and entitlement.  We want and expect a magic pill for and complete relief from whatever ails us—because it’s the twenty-first century for crying out loud, how could we not have that already?  Also, medicine has become increasingly transactional.  We, patients and physicians alike, experience ‘care’ in predetermined packets of protocol and procedure, and spend considerably less time in conversation, education, expectation setting, and actual caring.  The advent of the internet has accelerated this immediate gratification expectation.  It also gives many of us an illusion of connection through social media, when in reality, we are actually less and less connected to one another.

Pain results from myriad causes.  We all have varying thresholds for feeling and tolerating pain, which vary themselves depending on circumstances, mindset, expectation, and meaning making (think childbirth versus bike accident).  There are so many factors that impact our pain experience, including dehydration, sleep deprivation, low mood, and emotional and/or mental stress.  Loneliness, depression, anxiety, sleep disruption, suicidality, and substance abuse are all on the rise.  And all of these conditions lower our thresholds for pain and the harm it does to us.

For many, opioids are indeed the immediately gratifying magic pills.  But the magic wears off faster and faster, and both pain and the desperation for relief accelerate in the wake of short and long term withdrawl.  As physicians, we feel an intense desire to alleviate suffering.  Once a patient has experienced the profound relief (both physical and psychological) from opioids, it feels cruel for us to withhold them, even when we understand fully their risks and the long term harm they cause.  And we have less and less time to explore with and educate patients about adjunct pain management practices, such as mindfulness, biofeedback, and movement.  Everybody feels despairing and impotent, and this drives people to do things they might not otherwise do, like make a fake prescription for hydrocodone and try to get it filled.

I know there are real criminals out there, people not really in pain, who do this to make money—to take advantage of people in real pain.  I don’t know who’s who.  But the story I tell myself is that this is not most people.  What we need is a stronger infrastructure to address chronic pain at multiple levels—individually, in community, with policy, and culturally.  As I write this, even as a physician with a leadership title, I feel powerless and a little hopeless.

But maybe a good start, at the individual level, that we can each do the next time we look ourselves in the mirror or meet another human being on the street, is to just exercise a little compassion and generosity.  I assume that those patients presenting the fake prescriptions, if they are real patients, are not criminals at their core.  Pain makes us do unthinkable and unbelievable things.  I hope we can all help one another find better sources of relief and support.

The Beauty of Repeating Patterns

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Last week I wrote about our stories and how they perpetuate despite their dysfunction.  Tonight I consider patterns and how they also resist change—for better and for worse.

We had a wedding in the family recently.  Aunts, uncles, and cousins flew in from all over the country to attend and celebrate.  I have graduated to the parents’ generation at most weddings now; it feels strange and natural at the same time.  ‘Kids’ these days do things very differently in some ways (everything was online—no paper!), and exactly the same in others (there was a beautiful dress, an aisle, rings, kissing, and I saw her wear something blue).  Sitting with my fellow zhang bei (elder generation), I recalled when each of us got married, all on the order of 15-20+ years ago.  Like the happy couple, we were all young, most of us were thinner, and we had darker hair.  Our Chineseness and its influence on nuptial activities felt a little heavier than for the next generation, and yet that cultural heritage still shines through today—that makes me proud.

How will the new couple choreograph their marriage dance?  When the rest of us started out, could we have predicted our tangoes to look and feel how they do today?  Part of me says yes, absolutely—just look at how our parents boogied—we humans learn by mimicking.  Just imagine your spouse’s father dancing with your own mother, or some other familial counterpart pairing, and you probably see something resembling your own relationship.  Psychology research tells us that our stories and patterns of relating form very early in life, and persist for decades.  We carry the lessons, traditions, and burdens of our families of origin in our neurons and even our DNA—we cannot escape them.

Not that we need to or should.  Each of us is the product of all the atomic, molecular, cellular, interpersonal, and interstellar interfaces that created and continue to recreate us, in an infinite and complex web of moments and contexts.  It’s really quite beautiful, when I stop to think about it.  We can hear echoes of our ancestors in our children.  We pass on core values and family traditions with tribal pride, maintain bonds that hold us up through adversity, and anchor to relationships of identity and belonging.   We can also choose to forge new paths for discovery and growth, diverging from generations of redundant dysfunction and suffering.  Through iterative tribal mergers our children inherit all that came before them—the good and the bad—and the universe both differentiates and unifies with each succeeding generation, with every single individual.

Each dandelion seed is a miniature version of the whole flower itself.  Each human family is a subset of the family of humanity.  We are all uniquely ourselves, and we also belong wholly to one another.

Nothing stays the same for long.  And some things never change.

It’s just a thing of beauty, no?