Finding Peace in the Morass

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Friends, how are you feeling and doing today?

Three weeks ago workouts and bedtime went to hell for me, as it became clear that coronavirus would soon turn our lives upside down and inside out.  I could not read fast or widely enough.  At the end of that week I posted three times in four days, discharging all that I was learning, attempting to convince anybody I could that the tidal wave was coming.  I felt like Chicken Little.

The last two weeks saw myriad conference calls, reorganizations, virtual team huddles, sleepless nights, workflow changes, text threads, mood swings, mass emails, sporadic workouts, and also moments of connection, both personal and professional.  In an effort to stay informed, I put Facebook back on my phone, to keep up with the medical COVID groups sharing information and experience.  It’s exhausting.  As of this moment that app is once again deleted.  I need a better new normal.

I’m not doing my usual in-depth, in person interviews and exams with patients.  I really miss it.  But my phone conversations have been no less meaningful.  I hear about my patients’ cough, fatigue, fevers, headaches, and sore throats.  Some have diarrhea.  Some can get tested for coronavirus, others cannot.  We work through it day by day.  I also hear anxiety, confusion, frustration, fear, and uncertainty.  I do my best to be objective and evidence-based, as well as compassionate and empathetic.  I always wish I could do more.

I think it’s uncertainty that people fear the most.  When we don’t know what will happen, especially when the possibilities are as divergent as COVID-19 outcomes, everything is nebulous and scary.  What can we expect?  How should we prepare?  If we choose one path, what if it turns out differently, and we did the wrong thing?  How will we cope?  All this social distancing and sheltering in place—it’s decimating the economy.  Those voicing concern over this must not be dismissed.  Meanwhile, what do we do?

If I feel sick, am I infected or not?  Am I contagious or not?  I can’t get a test.  What should I do?

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Over the holidays I read Being Mortal by Atul Gawande, my favorite physician writer.  His eloquent and accessible writing on aging, illness, and the American end of life experience should be required reading for every physician, and really every adult.   After finishing the book, I decided that in order to die at peace, we must live in peace.  And peace must be cultivated.  It’s not something you can invoke in the midst of crisis, unless you have practiced.

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Let Your Breath Lead You

I learned about box breathing at the International Conference on Physician Health in 2016.  It resonated because I had already attempted a mindfulness meditation practice for some years, with varying success.  Inhale, hold, exhale, and rest, each for a count of four.  This is not a normal breathing pattern.  So it’s both a mental (attention) and a physical (parasympathetic stimulus) practice.  It lowers blood pressure and heart rate, and eventually cortisol levels.  It is also known as tactical breathing, as soldiers train for combat with this very practice.  The objective is focus and calm at the same time.  I have practiced since 2016, also with varying consistency and success.  These three weeks I have pulled on this technique as a matter of course, and it has saved me.  When the mind is full and chaotic, we can call on the body to lead us to peace.

Accept and Embrace Paradox

Human nature is to overgeneralize and oversimplify.  We seek simple, compartmentalized solutions to complex problems, often in binary form:  black or white, open or closed, good or bad.  But much of life is simply the opposite of simple (ha!), especially during a pandemic of a novel virus.  What we need is a way to tolerate the inherent ambiguity and uncertainty that life will always bring.  Here I must credit “The Big Bang Theory” for teaching me about Schroedinger’s Cat.  It’s a physics thought experiment in which a cat inside a box with a toxic radioactive substance can be thought of as, paradoxically, simultaneously alive and dead until the box is opened and its true state revealed.  In the case of coronavirus:  If you have had an exposure and you feel fine, or if you feel sick but it’s not that bad, and you cannot be tested, your true state is either infected or not infected.  But since we cannot know, we can consider you to be both.  So what should you do?

  1. Be grateful that you are not gravely ill.
  2. Act like you’re healthy, and live your life.
  3. Act like you’re infected, and don’t do things that will infect others.
  4. Practice, with deep, box-like breaths, the skill of accepting and embracing paradox.

Make a Choice

Even as I advocate vociferously for people to stay home, I understand the economic consequences of this intervention.  Rock, meet hard place.  For a while I asked myself  which I would regret more:  Executing defensible drastic measures in response to those who warned us for months, and then having it be ‘not that bad’ (because we all already know it will be some version of BAD), or doing less than was recommended and having it be unfathomably bad, like it has been in Italy, and what New York City already is?  Lives will be ruined either way, and deaths will escalate, directly from the virus and indirectly from all kinds of other things.  But I could not live in good conscience if we knowingly chose the latter path; I personally would regret that more, and I think our leaders and my profession would be crucified.  Because there are very few ways to prevent the direct deaths now—we missed the boat of containment.  Now our only hope is to slow the spread so as not to overwhelm our hospitals.  But there are myriad options to prevent and mitigate the indirect suffering and death, economic and otherwise.  That is where we can still exercise agency, creativity, collaboration, and innovation.

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Nobody knows what lies on the other side of this morass.  Life will never be like it was before—but that has always been the case.  Make no mistake though: we are all in it together, like it or not, know it or not, want it or not.  At no other time have we seen more clearly how the actions of one affect the outcomes of the many.  In another example of paradox, each of us is both victim and agent at the same time.

So how can we achieve peace?  Look for the helpers, as Mr. Rogers’s mom advised.  Be a helper, as much as you can.  Breathe through the anxiety; connect with those who help you.  Let go false dichotomies and breathe some more.  Plan and execute your small and significant contribution to maintaining and rebuilding the economy.

And please, please—for now—stay home.

 

Onward from 2019: Learnings and Intentions

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Friends!  WHAT a year, no?  How are you feeling here at the end?

In this post:  3 key learnings, 3 high intentions, and my 6 recommended life readings.

What resonates with you?

What would you add?

For a thoughtful and inspiring look on the coming year, check out Donna Cameron’s post from yesterday.

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3 Key Learnings of 2019

Complexity

“When we try to pick out anything by itself, we find it hitched to everything else in the Universe.”  –John Muir

“All that you touch, you change.  All that you change, changes you.” –Octavia Butler

We all live in inextricable connection, like it or not, know it or not, want it or not.  Every interaction has potential for benefit and harm, and the scale is exponential.  Some may find this idea daunting, overwhelming, or untenable.  I find it reassuring.  The idea that some cosmic life thread connects us all, that we are made of the same stuff today as that which existed at the dawn of the universe—this gives me peace.  It encourages me that everything I do in good faith could make a difference.  You really never know how far a small gesture or sharing will reach for good.

The 3 Tenets of Relationship-Centered Leadership

Not so much learnings as a synthesis from LOH training, these are the current foundation statements of my personal and aspirational leadership tenets (iterations likely to evolve over time):

  1. Founded on curiosity, connection, and fidelity to a people-centered mission
  2. Attendant to the relational impacts of all decisions, local and global
  3. Respectful of norms and also agile and adaptive to the changing needs of the system

Having defined these ideals for myself, I am now fully accountable to them.  And I hold them as a standard for those who lead me.

Being >> Saying or Doing

Saying and doing compassionate, empathic, and kind things are necessary and noble.  And they are not enough.  These actions ring hollow without honest sincerity behind them.  People feel us before they hear our words.  Our authentic presence, positive or negative, originates from within.  It manifests in posture, facial expression (overt and subtle, intentional and subconscious), movement, and tone and cadence of voice.  Fake it ‘til you make it—saying and doing things because we know we ‘should’—only gets us so far.  We humans possess a keen sense of genuineness—it’s a survival instinct.  If we accept that a meaningful, productive life and effective leadership in particular, require strong, trusting relationships, then we must cultivate true compassion, empathy, and kindness.  That means suspending judgment, managing assumptions, and holding openness to having our perspective changed by all that we encounter (see first key learning above), among other things.  This may be life’s penultimate challenge—our role models include Mother Theresa and the Dalai Lama.

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3 High Intentions for 2020

  1. Continue to ask more and listen better for people’s personal and unique meaning making—not just patients but all people—attend to souls
  2. Let go perfection
    1. All relationships are not great, and it’s not all my fault
    2. Some people/relationships and circumstances challenge my best self and skills more than others
    3. It’s the honest, sincere, good faith effort, and the learning from imperfection and failed attempts that matter
    4. Some relationships are better ended
  3. Guard against judgment, arrogance, and cynicism

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6 Recommended Life Readings—the 6 most personally impactful books I have read in the last decade:

The Art of Possibility by Rosamund Stone Zander and Benjamin Zander.  Scarcity thinking, competition, and looking out for number one hold us all back.  Stepping fully into our central selves, claiming our full collective agency for creativity and collaboration, and manifesting all the good we are capable of—that is the discovery of this book for me.

Start With Why by Simon Sinek.  In my opinion, the most eloquent and resonant writing on the purpose-driven life.  The freedom and creativity that flows forth therefrom—it all just gives me goosebumps.  Sinek’s The Infinite Game may eventually make this list too, once I have integrated its content and learnings more fully.

Rising Strong by Brené Brown.  Strength and vulnerability, confidence and shame, individuality and belonging—these are the essential human paradoxes that Sister Brené reconciles with gritty aplomb through real life stories as well as grounded theory research.

Big Magic by Elizabeth Gilbert.  Be you, all you, all in.  Love thyself—flaws, failures, and falls all included.  Make things.  Because that is what we are put here to do, for ourselves and for one another.

Leadership and Self-Deception by The Arbinger Institute.  Perhaps no book explains the profound importance of being better in order to do better, better than this.  And it took me almost all year to really comprehend, and then begin to apprehend, the concept.

Being Mortal by Atul Gawande, MD.  I started and finished this one on vacation this past week.  Dr. Gawande is my favorite physician writer.  I consider this book required reading for all physicians for sure, but really for all people .  “The death rate from life is 100%,” a wise patient once told me.  In modern western society and culture, multiple intertwined and complex forces hamstring our ability to live and die well and at peace.  This book is a brilliant compilation of heartrending personal and professional stories, neatly folded with history, research, and practical information for improving this sad state of things.  It is also a guide to the hard conversations that we all should really have—now.  It has both validated what I already do in my practice, and profoundly changed how I will do things hereafter.  Thank you, Dr. Gawande.

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Best wishes for Peace, Joy, Love, and Connection to all.

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