Tag Archives: communication

Warrior Pride, and a Plea for Preserving Our Connections

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My heart feels unusually heavy this weekend. Two years ago today a beautiful young girl named Claire Davis lost her life to gun violence and her schoolmate’s rage.  It happened at my alma mater, Arapahoe High School, in Centennial, Colorado.  It had been almost two years to the day after the tragedy at Sandy Hook, and not 18 months since the horrible theater shooting just across town, in Aurora.  I remember thinking then, what is happening to us?  How does this kind of thing happen so often, and what kind of pain moves people to commit such violence, against others and then themselves?

I remember high school with great love and (Warrior) pride. Classes were challenging but not overwhelming.  Our volleyball team never had a winning season, but we had fun and learned teamwork.  Our speech team, on the other hand, won consistently, and competed at State every year. The excellence of our choir concerts and musicals rivaled professional companies I have seen (no help from me).  Some of my best friends are teachers I met at Arapahoe.  Their dedication to education, of others and themselves, even now in retirement, inspires me.  I had my core peer group (fellow nerds), but I was friendly with people in almost every social cluster.  I was one of maybe seven non-white students in my class of 462, but I never felt singled out or threatened.  Looking back, it was the relationships, as usual, that made my time at AHS special.

Today, I see so much more vitriol and violence in our world than even just 2013. Our relationships deteriorate faster than ever.  We oversimplify our political views to post on social media, looking for the most searing and aggressive words to make a terse point.  It’s as if we think 140 belligerent characters will make someone with an opposing view say, “Oh, of course, you’re right, I change my mind.”  We reply to others’ combative posts impulsively, defensively, and with hostility.  What good does this do anyone?  It certainly does not lead to any meaningful discourse or mutual understanding.  We write things on social media that we might never say in person, or at least not without thinking twice.  As a result, we feel indignant, offended, and angry.  We ‘unfriend’ one another on Facebook, narrowing our relations to the echo chamber of those who share our exact views, collectively deriding those who don’t.

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy.  We must choose carefully with whom we are willing to undertake such a venture.  And perhaps most importantly, we must be clear about our objective(s).  Do we really expect to change someone’s fundamentally held political or religious beliefs?  How realistic is that?  What other purpose, what other good, could possibly come from such conversations?

I propose that we seek these personal interactions to deepen and strengthen our relationships—our connections.  Social media, and probably media in general, constantly work to divide us.  We need to sit down with one another to reunite, find our common ground, and rediscover our shared humanity.  I believe this can only be done in person. It gives us a chance to practice our best skills in patience, curiosity, and withholding judgment. We must listen to understand, and not merely to reply or refute.   In the best of these conversations, we ask more questions and make fewer sweeping, generalized statements.  We avoid accusatory language, and say more, “Help me understand,” and, “What makes you think that?”  The key is to really mean it, though—we need to honestly seek to understand our counterpart’s point of view.

In the best cases, we each walk away feeling seen, heard, understood, and accepted—even loved—despite our differences. We pledge to continue the conversation, seeking always mutual understanding, bringing always mutual respect.  Let us start with our real friends.  Let us make it safe for those closest to us to express their views without fear of ridicule and contempt. Let us request the same of them, and practice openness and reflective listening in the harbor of established connection.  Emboldened with the courage to stand firm in our own beliefs while generously allowing others theirs, then maybe we can venture out into social media again, and serve to bring openness, generosity, and respect to our virtual relationships.

Maybe you feel confused—how did a post starting with the shooting at my high school end up as a plea for kindness on social media? I suppose blogging is, at times, an exercise in stream of consciousness.  Thank you for sticking with it to the end.  Your willingness to do so gives me hope that we can all move toward patience, generosity, and compassion.

The Marvel of Words

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November Gratitude Shorts, Day 6

Today I give thanks for the gifts of language. To have such a vast array of words, in so many languages from around the world, to express our ideas, thoughts, and feelings—how magnificent!

My friend tells me a story about an exasperating conversation with her boyfriend. I start to remember a similar encounter with my husband.  Before long we’re laughing together, saying, “Yes!  That’s exactly how I feel!”

I read a blog here on WordPress where the author has written my thoughts better than I ever could have. Articles I find on Facebook, my friends’ posts, books that I read or listen to—words are what connect us.  By the way, audiobooks are my new favorite thing, especially when read by the authors. The Art of Possibility, Start With Why, Bossypants, Leaders Eat Last, Rising Strong, Big Magic—it’s like driving to work or sipping coffee in the intimate company of these amazing writers, sharing their divine truths with just me.

There is almost always a precise expression for our experiences:  Queasy. Slothful.  Euphoric.  Hung over.  Resonant.  Cosmic.  Mind-blowing.  Oblivious.

Then there are figures of speech that perfectly capture a concept:

Peeing in the ocean.

Needle in a haystack.

Mess with the bull…

Bite thy tongue.

Own your shit. 

The only other language I know well is Mandarin, and I often find myself thinking of phrases that have no English equivalents. For instance, “shang nao jing” literally means “wound brain scripture.”  It’s used when we feel severely mentally taxed—but trust me, ‘mentally taxed’ just sounds lame in comparison, and does not capture the full meaning.  One of my favorites, “yuan fen,” loosely translates to “fate; destiny that ties people together.”  The Chinese is much more elegant and efficient.  Similarly, my slack foreign grasp of the meanings of “ohm” and “ubuntu” probably fall miserably short of their native speakers’ understanding.

But no matter, language bonds us. I don’t paint or play an instrument.  Though I appreciate art and music, they are not my media for relationship.  The most rewarding moments at work are always when I’m talking with my patients—hearing their stories, getting to know them, relating.  It’s probably no accident that I ended up in primary care, where every encounter carries such potential for rare connection—through words.  And I’m forever grateful for the privilege.

He for She, We for Us

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Ever since my presentation to the American College of Surgeons earlier this month on personal resilience in a medical career, I cannot shake the feeling that we need to do more of this work. Physicians from different fields need to talk more to one another, share experiences, and reconnect.  We also need to include other members of the care team as equals, and let go the hierarchical thinking that has far outlived its usefulness.

I do not suggest that physicians, nurses, therapists, pharmacists and others should play interchangeable roles in the care of patients. Rather, similar to the central tenet of gender equality, the unique contributions of each team member need to be respected equally for their own merits and importance.  As a primary care internist, I must admit that I have seen my professional world through a rather narrow lens until now.  I confess that I live at Stage 3, according to David Logan and colleagues’ definition of Tribal Leadership and culture.  The mantra for this stage of tribal culture, according to Logan et al, is “I’m great, and you’re not.”  Or in my words, “I’m great; you suck.”

“I’m a primary care doctor and I am awesome. I am the true caregiver.  I sit with my patients through their hardest life trials, and I know them better than anyone.  I am on the front line, I deal with everything!  And yet, nobody values me because ‘all’ I do is sit around and think.  My work generates only enough money to keep the lights on (what is up with that, anyway?); it’s the surgeons and interventionalists who bring in the big bucks—they are the darlings of the hospital, even though they don’t really know my patients as people…”  It’s a bizarre mixture of pride and whining, and any person or group can manifest it.

Earlier this fall, Joy Behar of TV’s “The View” made an offhand comment about Miss Colorado, Kelley Johnson, a nurse, wearing ‘a doctor’s stethoscope,’ during her monologue at the Miss America pageant.  We all watched as the media shredded the show and its hosts for apparently degrading nurses.  What distressed me most was the nurses vs. doctors war that ensued on social media.  Nurses started posting how they, not doctors, are who really care for patients and save lives.  Doctors, mostly privately, fumed at the grandiosity and perceived arrogance of these posts.  It all boiled down to, “We’re great, they suck.  We’re more important, look at us, not them.”  The whole situation only served to further fracture an already cracked relationship between doctors and nurses, all because of a few mindless words.

It’s worth considering for a moment, though. Why would nurses get so instantly and violently offended by what was obviously an unscripted, ignorant comment by a daytime talk show host?  It cannot be the first time one of them has said something thoughtlessly.  What makes any of us react in rage to someone’s unintentional words?  It’s usually when the words chafe a raw emotional nerve.  “A doctor’s stethoscope.”   The implicit accusation here is that nurses are not worthy of using doctors’ instruments.   And it triggered such ferocious wrath because so many nurses feel that they are treated this way, that they are seen as inferior, subordinate, unworthy.  Internists feel it as compared to surgeons.  None would likely ever admit to feeling this way, consciously, at least.  But if we are honest with ourselves, we know that we all have that secret gremlin deep inside, who continually questions, no matter how outwardly successful or inwardly confident we may be, whether we are truly worthy to be here.  And when someone speaks directly to it, like Joy Behar did, watch out, because that little gremlin will rage, Incredible Hulk-style.

I see so many similarities to the gender debate here. As women, in our conscious minds, we know our worth and our contribution.  We know we have an equal right to our roles in civilization.  And, at this point in our collective human history, we feel the need to defend those roles, to fight for their visibility and validity.  More and more people now recognize that women need men to speak up for gender equality, that it’s not ‘just a women’s issue,’ but rather a human issue, and that all of us will live better, more wholly, when all of us are treated with equal respect and opportunity.  The UN’s He for She initiative embodies this ideal.

It’s no different in medicine. At this point in our collective professional history, physician-nurse and other hierarchies still define many of our relationships and operational structures.  It’s not all bad, and we have made great progress toward interdisciplinary team care.  But the stethoscope firestorm shows that we still have a long way to go.  At the CENTILE conference I attended last week, I hate to admit that I was a little surprised and incredulous to see inspiring and groundbreaking research presented by nurses.  I have always thought of myself as having the utmost respect for nurses—my mom, my hero, is a nurse.  The ICU and inpatient nurses saved me time and again during my intern year, when I had no idea what I was doing.  And I depended on them to watch over my patients when I became an attending.  But I still harbored an insidious bias that nurses are not scholarly, that they do not (or cannot?) participate in the ‘higher’ academic pursuits of medicine.  I stand profoundly humbled, and I am grateful.  From now on I will advocate for nurses to participate in academic medicine’s highest activities, seek their contributions in the literature, and  voice my support out loud for their important roles in our healthcare system.

We need more conferences like this, more forums in which to share openly all of our strengths and accomplishments. We need to Dream Big Together, to stop comparing and competing, and get in the mud together, to cultivate this vast garden of health and well-being for all.  I’ll bring my shovel, you bring your hose, someone else has seeds, another, the soil, and still others, the fertilizer and everything else we will need for the garden to flourish.  We all matter, and we all have a unique role to play.  Nobody is more important than anyone else, and nobody can do it alone.

We need to take turns leading and following. That is how a cooperative tribe works best.  It’s exhausting work, challenging social norms and moving a culture upward.  And we simply have to; it’s the right thing to do.