The Mark You Make

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Friends, Ozan has written another book!  I know it may seem like it, but he’s not paying me to promote his work, really!  He has offered perks for Inner Circle members, however, like an advance digital copy for preordering, and signed copies when the book is released next April.  In considering what I would ask him to inscribe to my friends in the books I will give them, I realized yet another evocative dimension of my relationships.

If you were to describe your friendships to a third party, or make a meaningful introduction in service of connecting two amazing people, what would you say?  I call it ‘connecting fellow Awesomes,’ and it’s always a pleasure and privilege to serve in this capacity.  I thought to ask Ozan to write to one friend something like, “Cathy thinks the world of you—happy to make such a positive new connection!”  Then I thought, this friend has really made a mark on me.  Then I thought of the mark Ozan has also made, in just 9 months of virtual contact.  And then my mind was blown with the realization of my cosmically marked-up self—the finger, hand, and footprints of all those whom I have contacted.

Years ago I attended the orthopaedic surgery resident graduation dinner with my husband, a happy and fun annual event.  At the end, mingling with faculty and trainees, one of the graduates looked at me and his eyes widened.  “You’re Dr. Cheng!  You were my teaching attending during my third year medicine rotation [7 years prior] at [the hospital where I used to work]!”  I was gratified that his expression was cheerful, rather than distressed or awkward, surprise.  He went on to tell me that I held the team to a high standard of discussion, and that he appreciated my presence and teaching.  I will always remember this encounter with pride and appreciation.

In the past year three patients from my past have resurfaced and told me the positive difference I made it their lives.  I remembered two of them so clearly, both their faces and their names (after 20 years and thousands of patients, I can usually only remember one or other).  Talking to each of them reminded me of all that we had been through together, and I was glad that I had done my job well.

But what about those for whom I have not been a great doctor?  I have had my fair share of patients who left me, for various reasons.  I know I have been seriously disappointing for many.  I wonder how many times I have contributed to patients’ negative overall experience of medicine, and further widened the divide between doctors and patients in our fraught and flawed healthcare system?  Sometimes I look back on my early years of practice and cringe a little—all the writing I do now on empathy, compassion, curiosity, openness, and humility results from years of lessons learned in real time, on real people.  I’m definitely much more adept at it all now than in the beginning.  And I’m still learning—I still get triggered, still fall into old, counterproductive thought and behavior patterns.  Sometimes it feels like I will never be good enough, or enough in general.

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I also think about the people whose marks on me were/are hurtful, dismissive, and otherwise wounding.  It reminds me of carvings I see in the trunks of the beautiful aspens I walked among this weekend.  Did the folks who made them set out to harm the trees?  If they thought the tree might die from their knife marks, would they think twice?  Maybe they were overcome with their profound experience in nature and just wanted to mark it in some way, especially if they shared it with someone they loved (so may initials with plus signs and hearts)?  Sometimes we just want or need to be right, competent, respected, and acknowledged.  So we mark our encounters with stubbornness, aggression, or even violence (in its many forms, overt and cloaked).  Like the strong and flexible aspens, I bear scars from such encounters and still continue to thrive.  Such marks have taught me how to care for myself, and also how not to be toward others.

In the end, how do I reconcile these relationship phenomena?  Sometimes we can see and know the mark we make on others.  Many times we cannot.  Nobody is perfect.  My whole life I will scrape and nick those around me, hopefully never with malicious intent.  I can only hope for their generosity and grace, and forgiveness.

Sister Brené Brown, once again, helps me continue.  In her book Rising Strong, she describes a choice, a mental attitude, that can help us all suffer less.  If you have not read or heard the book, I highly recommend it—it’s my favorite of the 5 of her books I have read.  Assume, she says (with the help of her pediatrician husband), that we are all doing the best we can.  That’s it.  We are all imperfect.  Our circumstances mess with us, our patterns mess with each other, and sometimes it can feel like a strange and inexplicable miracle that we have not all killed one another already.  But choosing to give each other this one, simple, and at times colossally difficult benefit of the doubt, could be what saves us all.

We simply cannot extricate ourselves from each other.  So we can just do your best to take care of one another.  And be prepared to apologize, early and often.

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All Hail Your Dark Side

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What triggers you?

I don’t mean your pet peeves (please, stop using “there’s” when speaking about anything in the plural).  I mean what gets under your skin and affects you viscerally, really hijacks you?  I’m talking about the thing that escalates you so fast or intensely it’s like an out of body experience—you know you’re overreacting, you know it’s irrational, and yet all you can do is sit by and watch it unfold, powerless to control or direct it.

I had the pleasure of self-witnessing two such episodes recently, and it’s all so fascinating I had to write about them!

Bad Mom

A leader whom I deeply respect has asked me twice, in separate conversations, with slightly different words, how I manage my time.  The second time his words were, “How do you prioritize?”  Interestingly, I immediately altered his question in my mind to What do I prioritize?  I answered easily both times about strategies for handling emails, task lists, time with family, workouts, etc.  But after the second time I started to worry.  What’s behind this questioning?  Is he worried for me about something here?  Does he think I’m neglecting my family for work, and/or my clinical duties for all the extracurricular stuff?  Does he think I can’t handle it?

Over the next several days I had to chuckle with that sly, knowing expression when I realized it didn’t really matter what he was thinking.  The question, repeated, was a stealth trigger for my Bad Mom fear.  It wasn’t that I worried about his concern for my work life balance.  It’s that I was worried for it, and that I secretly question, more than I like to admit, whether my kids really feel loved enough by me.  This despite my previous blog post claiming that I actually don’t question it!  Blaaaaahahaha, how cosmically ironic!  Looking back, the article that incited that post touched pretty much the same trigger, and it has taken me this long to see it (better late than never).  How fascinating!

In my defense, I really do think I’m a good mom—mostly.  But like being a good leader, it’s definitely not always easy, and that I question my competence/proficiency/mastery does not necessarily detract from my real, ever developing, occasionally flourishing skill set.  Thanks to this new awareness of the Bad Mom Trigger, I have adjusted my strategies and tools, and rebalanced, for now, time and energy between work and home.  I look forward to receiving more gracefully the signals for future opportunities to readjust.

Canned and Rote

Last year I was leaving an evening work gathering.  A nice man saw me departing, got out of his seat, and approached me, apparently to introduce himself.  He said he had heard my ‘shtick’ something something something—I did not really hear anything else, as my abhorrence of that word had made me stop listening.  I think I was polite, and I exited with as few words exchanged as possible.

Readers of this blog know how much I admire Brené Brown.  Followers of Brené also know that her work is always evolving, new theories testing, refining, and building on prior ones, always with deeper and more meaningful understanding and application in relationships.  So I was deeply offended when I recently heard someone refer to her presentations as ‘shtick’ and ‘spiel.’  These words feel dismissive, mocking, and pejorative to me.  I have only heard them used in a disrespectful way about a speaker or their speech.  But why should I be so offended on Brené’s behalf?  She knows the value of her work; she does not need me to defend her.

Of course, as usual, it hit me later:  I identify with Sister Brené, so I took these words personally.  To me, shtick and spiel are how we describe presentations, and thus people, who stopped learning and growing long ago.  We utter these words and roll our eyes at having heard it all before—nothing new here, folks.  David Litt has said that when preparing a presentation ask yourself, what is the one thing you want someone in your audience to tell their friend about your speech the next day?  If the words ‘shtick’ or ‘spiel’ appeared within a hundred yards of someone describing my work—if someone thought I had not prepared but just shown up with canned, stagnant drivel—I would be mortified.  I pride myself on constant learning, self-awareness, and self-improvement.  I want every audience to feel that my presentation was uniquely relevant to them, that I worked hard to meet them exactly where they needed me.

I understand that everybody may not see or hear these words the way I do.  I can respect that and monitor/manage my reactions from now on.  But wanna trigger me?  Tell me you heard my spiel.  Go ahead, I dare you.

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Debbie Ford and Your Dark Side

OH it’s all so funny, the things that trigger us.  Because if we don’t laugh we will absolutely cry.  Or pick fights with our spouses that last weeks on end.  That’s what happened to me when I read The Dark Side of the Light Chasers about 10 years ago.  I was young yet in my adult development journey, and I had a few (just a few) more emotional hang ups than I have now.  On page 69 of the paperback edition she lists negative words like greedy, liar, sleazy and freak, and suggests an exercise:

Take a few minutes and identify any words that have an emotional charge for you.  Say out loud, “I am _____.”  If you can say it without any emotional charge, then move to the next word.  Write down the words that you dislike or react to.  If you are not sure that the word has any charge for you, close your eyes for a minute and meditate on the word.  Repeat it to yourself a few times out loud and ask yourself how you’d really feel if someone you respected called you this word.  If you’d be angry or upset, write it down.  Also spend some time thinking about words that are not on this list that run your life or cause you pain.

I didn’t get through the whole book back then, so I don’t know what she wrote about ‘embracing your dark side,’ ‘reinterpreting yourself,’ and ‘letting your own light shine.’  But I think I have figured it out for myself, at least a little bit.  It’s about self-compassion, acceptance, growth mindset, forgiveness, connection, learning, and joy.

Every light casts a shadow, and we need both light and dark for balance in life.  I’m learning to hold it all a little more lightly (ha! Pun!).  Debbie Ford felt too heavy for me ten years ago.  I’m looking for a new book this week.  Maybe I’ll pick hers up again and see how it feels.  …Makes me a little nervous, actually.  I wonder what I’ll find this time?

The Status of Women, 1999-2019

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What happens for men when women speak Feminism?

I intend to ask this question to more men in my life from now on.  What do you hear as Feminism?  Where do you think it comes from?  What do you think women are trying to accomplish by talking about equity and representation?  What moves a man to ally with women in this movement?  What keeps him from doing so?  What are the risks, costs, and benefits for us all when he does and does not?

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Women in Sports

The US Women have just won their fourth World Cup Soccer title, kicking balls and ass, I like to say.  What an accomplishment, and how far they’ve come since winning the first ever Women’s World Cup in 1991, the year I graduated high school.  I don’t follow soccer, but as an American woman, this victory carries meaning for me.  At halftime this morning I read about Brandi Chastain, the 1999 US World Cup champion midfielder who famously, spontaneously, took off her jersey in unadulterated celebration after firing the winning penalty kick in double overtime against China to win it all.  The New York Times featured her story yesterday, commenting on the evolution of our perceptions and treatment of female athletes over these 20 years:

In that pivotal moment of arrival for women’s team sports in the United States and around the world, viewers saw Chastain removing her jersey and twirling it like a lariat, spinning around and falling to her knees, pumping her arms in exultant triumph. What resulted was perhaps the most iconic photograph ever taken of a female athlete, a depiction of pure spontaneous joy.

It was a moment of freedom and liberation, Marlene Bjornsrud, a longtime women’s coach and an influential sports executive, once told me. She called it a “casting off the burden of everything that kept us down and said, ‘You can’t do that because you are a woman.’ It was a moment that screamed, ‘Yes, I can.’”

Title IX was signed into law by President Nixon in 1972, one year before I was born.  So I took it for granted that girls could play sports just like boys in school—not every sport, but most.  I also took for granted the inherent assumptions about women in athletics—that we cannot be as fast, as strong, or as competitive as men.  I have so much more appreciation now for icons like Billy Jean King, Martina Navratilova, and Pat Summitt. I think about the WNBA, and women coaching in the NBA, NHL, and NFL, and I marvel at how far we have come.  Take a look at this timeline of women’s sports in the US to get a fuller perspective.  I know many will say we have a long way yet to go.  But today, let us joyfully celebrate all that we have accomplished already.  Wahoo!! [fist bump and dancing woman emojis]

 

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Women at Work

I’m thinking about the culture of orthopaedic surgery.  In the twenty years since I graduated from medical school, I see more and more women in this field (as well as other surgical specialties), which makes me proud.  While women comprise only 5% of practicing orthopaedic surgeons, 15% of American orthopaedic residents are now women, which is roughly double the percentage in 1999.  But what’s it like to be a woman in orthopaedics?  How do these women present, perhaps differently, at work compared to in their personal lives?  Is it truly safe for them to be themselves as surgeons?  The American Orthopaedic Association held their annual meeting recently.  My orthopod friend returned from the conference and commented that the rare women leaders in his field seem ‘fierce’ and ‘tough’—but in a good way?  It struck him to wonder if they are just like that in general, or do they have to be that way to navigate their male-dominated specialty.  He wondered how they would be seen if they displayed sensitivity and emotion, “because a man can be seen as sensitive and kind” and not only does it cost him nothing, his social status is likely to be elevated because of it.  My friend was not sure this is the case for his female colleagues, and he seemed both empathetic and powerless at the idea.  Looks like gender parity may take a bit longer in medicine than in sports.

At work in general, women’s status varies considerably.  But research points to common issues such a 22% pay gap and too few women in leadership (5% of US corporate CEOs), though these are improving.  One need not look far for abundant evidence that having more women on the corporate team improves earnings and morale.  Much is also written on strategies for improving gender equity at work.  Two of my favorites are exit interviews and work-life balance initiatives for all employees, not just women.  But as I wrote last week, it’s not just about including women as participants in the workforce.  It’s about truly appreciating the diversity of experience, biology, and contribution that women bring to any group they serve.

 

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Women and Men

There is no way I can do justice to this topic in the remainder of this post.  So let me just share some ideas and resources I will continue to explore in the months and years to come.

I asked at the beginning what happens for men when women speak Feminism.  A corollary question is what happens for all of us when we hear the words ‘toxic masculinity’?  My guess is men get defensive and women get aggressive.  Personally I love the phrase because it’s so incisively descriptive.  But it can also be a flashpoint phrase, one that immediately incites conflict and emotional hijack.  Let me be clear: toxic masculinity does not imply that men and manhood are toxic by nature.  Quite the contrary, the phrase refers to a culture of expectations of men that is just as toxic for men as it is for women.  Male surgeons may well benefit from being sensitive and kind, but not too much so, lest they be seen as weak.  This is a vast oversimplification, by the way; the history and complexity of toxic masculinity are explored articulately here.

Readers of this blog know how much I love Brené Brown.  Her explanations of how shame (where toxic masculinity is born) manifests and organizes around gender—and why it is toxic for both men and women–are the most poignant and real.  Read her first hand comments to Ms. magazine here, and a stay-at-home dad writer’s interpretation of them here.  If you seek a nonjudgmental, objective, and real-life exploration of the complex dynamics between men and women, read The Gifts of Imperfection and Daring Greatly.  Sister (she’s not old enough to be Aunt) Brené’s books are the most accessible form of evidence-based, all-around relationship advice I have ever read, and I’m so grateful for her.  From the Ms. Interview:

What role do you think vulnerability played in the #MeToo movement?

Know what I love about the #MeToo movement?—and, me too—I thought until I was 25 or 30, that sexual harassment was just the price of entry.  The greatest casualty of trauma is the ability to be vulnerable. So this #MeToo movement is re-defining and re-claiming vulnerability, and putting vulnerability in the context it belongs in, which is power and courage. 

 What gives you hope?

The thing that scares me about the world today is the same thing that gives me hope. I believe we’re witnessing white male power over. It’s making its last stand right now. And it’s scary because last stands are dangerous, and people get very backed into a corner. I think this is the last stand, and that we’re going to see a shift, mercifully, from white male power to inclusive power with it too. And I think from that paradigm, we can do anything, change anything, and be anything. 

And it’s not just women who can claim agency against misogyny and sexism.  Men who identify as feminists serve as allies for gender equity and respect.  But men can also help themselves and each other break free from the restraints of machismo and chauvinism.  Movements like The Good Men Project and Evryman give men a forum for honest, vulnerable emotional expression and connection.  Just like women surgeons and corporate executives, all men need inclusive spaces where they can feel true belonging, where they are free to be all of themselves—hard emotions and all—for all our sakes.

Men I admire in this space include Nate Green, Ozan Varol, and David Brooks.

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To lift my spirits here at the end of this long post, I’m listening to a song on repeat: Woman, Amen by Dierks Bentley.  It’s such a shining anthem of a man’s unabashed love and appreciation for his partner.  I can also imagine modifying the lyrics and hearing Faith Hill singing about her man Tim McGraw.

Thanks for reading to the end, friends.

Our relationships kill us or save us, and we really need to be better at taking care of each other, locally and globally.  We, men and women alike, are all in this together, inextricably, in sickness and in health, forever.

Only Love can save us.  Let’s get on it.