Wide Open Spaces

DSC_0681

What to write on vacation?  Depends on the schedule, no?  Happily, on my Rocky Mountain escape this week, time lolls wide open.  How rare and precious to have these days with no commitments, no agenda, and a true feeling of detachment!  Wow.  How refreshing, nourishing, relaxing, and challenging.  No patients to see, meetings to attend, immediate work crises to solve.  I feel at once liberated and anxious—as if I enjoy the bright Colorado sun now, but there must be some black cloud looming over the ridge to the west.  *sigh*

The LOH retreat positively saturated me last weekend—mind, body, and soul.  I had Hippie Zealot Conference High, for sure.  And as so often happens, synthesizing learnings and insights proved challenging off the mountain and in real life, especially with only four intense days of re-entry before leaving again for spring break.  But now I have time and space—physical and mental—to process, hallelujah!

It never ceases to amaze me, the cosmic collision of ideas and insights that simultaneously shape my personal and professional development.  It’s like I feel the universe’s Michelangelo, Van Gogh, and Einstein hands sculpting and unifying my consciousness at all levels—it’s awesome!!

Weeks prior to LOH, my own coach Christine and my coach friend Donna each independently introduced me to the work of Jennifer Garvey Berger, expert in adult development and leadership coaching.  She incorporates ideas of complexity and systems, central tenets of LOH training, in her philosophy.  I started listening to her book, Changing on the Job, the week before LOH started.  My friends came to Berger’s work separately (they don’t know each other, which I intend to remedy soon), and the temporal overlap of their new learning with my own makes my heart leap—my friendships are, without question, divinely inspired.  The central learning for me so far is recognition of my current and aspirational states of development as a person in all aspects of life.  I look forward to acquiring and practicing more skills for growth—it is a lifelong process!

Two weeks ago, while searching links for my Thank You post to Ben Zander, I came across Rosamund Stone Zander’s book, Pathways to Possibility, the follow up to their co-authored book, The Art of Possibility, still my favorite book of all time.  I started PtP days before LOH; the synergism of ideas almost overwhelmed me.  I finished it last week and holy cow, this is advanced practice personal development.  The stories we tell, the ones that rule our relationships and lives, can be so deeply entrenched that even when we recognize their dysfunction, revising them feels almost impossible.  In my personal life, I recognize intellectually that I hold onto some seriously destructive stories—ones that cause chronic and palpable suffering not just for me but those closest to me.  I lose circulation in my figurative hands, my emotional grip on these stories is so tight, and I still refuse to let go of them.  It is positively frustrating and fascinating.  I know this stubborn intransigence has untoward effects on my leadership capacity and style at work, however indirectly, because I firmly believe that ‘how we do anything is how we do everything.’  It just kills me—like a padlocked steel door in the long hallway of self-awareness, behind which live insight and psychological freedom—I know I have the key somewhere, I just can’t find it yet.  I will return repeatedly to integrate the practices in this book, like I do to AoP.  And, I get better every year at holding myself with a little more compassion.  We’re all here doing our best; I am no exception.  Nobody is better supported in this work of self-discovery than I.  So I journey on mostly joyfully, surrounded by fellow wayfinders, working on ourselves for the benefit of us all.  Onward!

Spring break writing

I started this post with at least two other ideas to write about, but I’ll hold off.  I have four more days here in the mountains.  More time and space to think on, manipulate, and start to apprehend all of these ideas and learnings of late.  My thank you cards, washi tape, journal, and laptop are spread out over the coffee table.  My favorite movies play on DVD and cable as pleasant and entertaining background ambiance.  What a gift and a blessing are time and space.  May I savor these days with deep and sustaining gratitude.

Culture of Medicine, Part I

12657_4331869529492_1472680046_n

NaBloPoMo 2018:  What I’m Learning

Recently I met with a group of medical trainees from different institutions, ranging from pre-med to senior resident.  The topic was leadership in medicine and culture.  My objective was to lead a discussion on how we see leadership, and to encourage physicians at all levels of training to see themselves as leaders, regardless of designated status.  I often invoke Benjamin Zander’s invitation to ‘lead from any chair.’

We started out discussing the current state of medical culture.  My summary of the labels, in the order we discussed them, follows here.  I strive to hold these observations with minimal judgment, and to practice radical acceptance.  This is simply the way things are, not good or bad, it just is.  That includes how we feel about it all, and that we want to change the parts we don’t like.  Tomorrow I will continue with Part II, characteristics of Culture of Wellness leaders.  For now I invite you, especially my friends in medicine and healthcare, to review the list dispassionately, objectively, from a distance.  See how it lands.  How do you feel reading this list?

  1. Intense
  2. High stakes—we hold people’s lives in our hands.
  3. Imbalanced. When asked to say more, this trainees explained, “It encourages a lack of balance—we are not supposed to mind the long hours.  Our priorities are skewed—we say patients first (but it feels like patients above all else, at any cost?).  There’s the paperwork, the burnout.  You can’t go home if the patient needs you (internal medicine), and in some fields there is no such thing as a shift.  It never ends. (surgery)”  These trainees felt no work-life balance.
  4. Resistant to change. It’s an attitude—“When I was your age…”  Anything different and new in terms of work hours, work load, etc. is deemed bad or inferior before it’s even considered.
  5. Hostile. Between staff members, between doctors and nurses, between doctors themselves, nurses themselves.  The trainees saw this as a key contributor to everybody’s burnout.
  6. Hierarchical—especially surgery (they pointed this out explicitly). For example, walking in the halls, there is an order in which people enter patient or operating rooms.  One student reported entering before her team, because she knew the patient, and making small talk.  Later, she reported, “the senior resident yelled at me, said to go in order, and do not talk to the patient.  In 2017.”  In the OR, when students cut sutures, they must always cut the attending’s suture first.  One medical student was admonished loudly in the OR for this.
  7. “You’re expected to know everything already, even though you’re supposed to be learning on the job.” Trainees agreed that they expect to have to prepare for each day at work.  But as trainees, they cannot always know how to prioritize information as they study in advance for what feels like daily examination.  And they are belittled and shamed for not reading their instructors’ minds and knowing exactly what the teacher is asking for (‘pimping’ the students, as it’s known).  “I never feel like enough.”

At this point you may suspect that I somehow planted the seeds of negativity in these trainees’ minds, goaded them on to blast our profession and everybody who had ever said something mean to them in the hospital.  I assure you I did not, and I marveled myself at how easily these labels flew onto the table.  I hurried to take notes.

Thankfully the vibe circled, as it often does.  One woman commented:

  1. “Family medicine seems actually anti-hierarchy.” Attendings, she observed, often defer to students, who usually know the patients the best, when discussing patient history and data.  Team members may all address one another by first names.  Another student piped in:
  2. Pediatrics is similar. Attendings cover for the team during signout, answering pages and signing orders—everybody pitches in.    On rounds students are allowed to be students—to make mistakes, to show gaps in knowledge.  And a resident pointed out:
  3. In anesthesia, team members take breaks, and she felt a sense of autonomy and support of residents—no shaming. “Maybe it’s the nature of the work,” she said, “it’s easier to tag team.”

Fascinating.  I was practically trembling with excitement—here were ten strangers, from different specialties and at various levels of training, men, women, people of diverse colors and cultures.  And we all had the same experience of our chosen profession, much of it negative.  Yet here we all were, committed and still excited to be doing this work—we all still hear the call.  Whatever keeps us going?  How do we get up every morning and come to work in this ‘toxic’ environment?

I’ll tell you tomorrow.

On the Second Arrow

wound-man

NaBloPoMo 2016, Letters to Patients, Day 11

To Patients Who Suffer:

Which arrow causes you more pain, the first or the second?

Fellow blogger Michelle at The Green Study recently posted a piece in which she distinguished between pain and suffering.  It reminded me of a Buddhist teaching that inspires and humbles me.  Blogger and curator extraordinaire Maria Popova quotes it in this article she wrote last year, on a book by Tara Brach:

The Buddha once asked a student, “If a person is struck by an arrow, is it painful?” The student replied, “It is.” The Buddha then asked, “If the person is struck by a second arrow, is that even more painful?” The student replied again, “It is.” The Buddha then explained, “In life, we cannot always control the first arrow. However, the second arrow is our reaction to the first. And with this second arrow comes the possibility of choice.”

The first step to suffering less is cultivating awareness of the second arrow.  This takes practice, and we must resist the self-judgment that comes the moment we realize we have not only shot ourselves again, but have been twisting that second arrow deeper and deeper.  This shame and self-revulsion is, after all, another drop of poison on the second arrow’s tip.  Instead, I like to apply Ben Zander’s acclamation when he finds himself or his students doing something ‘wrong’: “How fascinating!”  Look what I did!  No judgment, just lighthearted observation.

The second step to suffering less is, of course, to avoid the second arrow.  Once we notice, learn how to remove it and tend the wound.  Breathe deeply.  Identify the sources of anger, fear, resentment, blame, contempt, shame, despair, anxiety, bitterness, envy.  Breathe again.  Loosen our desperate grip on these feelings.  Hold them more loosely, ever more loosely.  Breathe.  Breathe.  Hold also the Space, emotional, cognitive, and temporal, for them the move through and exit us.

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.

Life will continue hurling arrows at us.  Some will miss, others will land in our most vulnerable spots.  Mindfulness practice, centered in attention to the breath, helps us evade the wounds and anguish from our own second arrows.  The data, accumulated over the past four decades, is all but irrefutable for the benefits of mindfulness for depression, anxiety, chronic pain, burnout, and overall well-being.  Prolonged practice even changes the physical structure of the brain, and it’s never too late to learn.

If you’d like to learn more, I have included a few more links below.  You may find it worthwhile to invest in the practice.  Be patient with yourself.  And let me know how it goes!

http://www.wildmind.org/texts/the-arrow

http://www.huffingtonpost.com/susan-bernstein/dont-shoot-the-second-arr_b_5102701.html

http://www.nscblog.com/miscellaneous/avoiding-the-second-arrow/