Amplify the Important Stories

This weekend we lost another selfless leader, Dr. Joseph Costa of Baltimore.  Chief of his hospital’s intensive care division, he continuously led his team on the front lines of pandemic patient care, despite his own high risk medical condition.  He succumbed to COVID-19, in his husband’s arms, surrounded by colleagues turned caregivers. 

My friends, are you exhausted like I am?  4.2 million American COVID cases (about a quarter of total global cases).  At the current rate we will likely cross 150,000 deaths by the end of this week.  And it won’t stop there.  We will lose many, many more mothers, fathers, sisters, brothers, grandparents, sons and daughters in the coming months.  This, all while PPE shortages still put healthcare workers at risk across the country, caring for those who follow prevention guidelines the same as for those who do not.

Read Dr. Costa’s story.  Remember him.

Then honor his memory and those of the almost 600 healthcare workers who have died of COVID-19 by wearing your mask and protecting the people around you.

***

“Oh, are you from Maryland?”

Her name is Odette Harris, MD. 

She is a neurosurgeon and the director of brain injury care at Stanford Medicine.  She is a Black woman.  “Something as absurd as putting the initials of your state next to your name seems more plausible than the fact that ‘MD’ stands for doctor.  I can’t even tell you how many people ask that.”

Someone handed her their car keys outside of the venue where she gave a keynote address, thinking she was the car valet.  [Michael Welp mentions this in Four Days to Change—it is a common occurrence for our Black sisters and brothers.]

During an all-day meeting, after she stood up from the conference table to stretch her legs, her own colleague asked if she was going to set up for lunch.

Nobody has ever asked me if I’m from Maryland because ‘MD’ comes after my name.  I have never been mistaken for a car valet or wait staff at a professional meeting.  And I am not the chief neurosurgeon who runs traumatic brain injury care at my hospital.  Let us white and white-adjacent folks meditate on Dr. Harris’s experiences for a moment.  Because that’s all we have to do—consider them for a minute or two.  Our Black colleagues and peers live such denigration their whole lives.

***

The Wall of Misogyny

It started with, “Your hair smells incredible.” Followed by, “My hands may touch you. They are hard to control.” It even went as far as, “You were in my dream last night. Did I mention it was wet?” He made my skin crawl. I spent more time focused on trying to be where he wasn’t that I had no space left to focus on why I was there in the first place, and that was to learn. The awkward stares from OR staff looking upon me with pity made me want to vomit. And the number of male physician on-lookers who seemed to watch this behavior for sport did nothing but enable his behavior (when one brought his daughter to work with him, it was all I could do but hope she never had to experience from a man what I was experiencing from him). The lack of shock of such behavior from everyone aware in the system confirmed its normalcy.

Read this stark essay by Dr. Megan Babb, a fellow physician mom.  Inspired by Alexandria Ocasio-Cortez’s incisive speech on the floor of the House of Representatives this week, Dr. Babb published her own story and those of many other physician women.  They recount the everyday misogyny that for too long we have blithely accepted as ‘the way things are’ in medical culture.  Peruse them slowly (a few choice samples below).  Imagine they are your mother, your sister, your daughter, your friend, your colleague.  How would you upstand for them? 

I was asked by a male patient if I needed to practice my prostate exam technique because he was happy to allow me to do so on him. When I asked the administrative team to move him to the service of any one of my many male colleagues I was told, “These are the sort of things that build character. I think we need to thicken your skin. The patient will remain on your service.”

I recently gave a presentation at grand rounds in my hospital. When I walked to the podium, I overheard a male physician say to a group of others, “Isn’t the lecture today supposed to be given by an orthopedic surgeon?” I am the orthopedic surgeon he speaks of.

 As a medical student I was on a surgical rotation with a male urologist. While assisting him with a TURP [trans-urethral resection of the prostate] he asked me, “Would you like to see what a well-endowed penis looks like?”

***

And There Is Still Hope

A specialist physician and woman of color consulted on a patient in the hospital, a white man.  He was frustrated at having to see so many doctors and answer so many questions.  So he demanded that she sit in silence until he was good and ready to talk.  After the 25 minute hospital visit, she rightly documented his behavior in the chart, as she had done for so many episodes of patients’ abusive behavior in the past, especially since these patients often levy complaints against her for treating them badly.  To her surprise, the white male attending hospitalist paged her later to discuss the occurrence.  He had read the chart and apologized for the patient’s behavior.  He also called the patient out, asserting that if our colleague had been a white male herself, the patient would never have treated her like that.

An authentic white male ally, wow. 

…White men are more likely to listen to and follow other white men, I thought.

So I wrote her, “Can his actions be amplified so that he feels empowered and inspired to do this more?  So that other white men can see his example more easily and feel safe to follow?  Can someone mention his actions on rounds, share them in a newsletter, make them as visible as possible?  Examples like this can go such a long way to recruit white men to the cause—so many men sit on the fence, and just need to see one of their own lead the way, and then they get off on the side of doing what’s right.”

She agreed to highlight his actions in an upcoming community spotlight, noting that now he would likely be the target of any patient complaint.  We agreed that he would then need the support he gave her, given back to him, and then some.  We reflected on this great opportunity for colleagues to unite in solidarity for one another, standing up to cultural norms that oppress us all.

***

Stories like these humanize ‘others’ to us.  If we are honest, we may recognize that the ideas of ‘healthcare workers’ and ‘women of color’, among others, too often float on the surface of our consciousness as abstractions.  It does not occur to us to try to relate or empathize, to see them as real, flesh and blood people like ourselves. 

But that is what the world needs the most right at this minute—for us all to relate and empathize with each and every other human who suffers, who lives a different life from our own.  Our connections are the only thing that will heal us.

Even the ‘Oppressor’ Deserves Safety and Support

This weekend I reflected in gratitude at my LOH experience in the past year. After resonating with Dr. Suchman’s moving keynote at a physician health conference in 2018, I sought him out to express thanks. He encouraged me to apply for the program. Then he coached me twice on getting institutional support, something I had never done before. All through the program, he and Diane Rawlins, two of the best teachers I have had (and that is saying a lot), led us all through ten months of complex conceptual learning and skills practice. Even better, they helped us synthesize and integrate learning between sessions, applying concepts through practice in our natural habitats, knowing we could report back to the group to debrief and trouble shoot before heading back into ‘the trenches.’ LOH runs annual reunions, refreshers and mixers during which attendees from different cohorts can meet, bond, and both expand and tighten our community of lifelong learners. In the time of COVID, alum meetings have occurred about every two weeks over Zoom, from the comfort of our homes all across the country. The more I think about it, the more I wish everybody had this kind of safety and support—this loving learning lab and community—to acquire scary new skills that, when practiced, benefit many more people than just us learners.

I imagine this may be what participants in the White Men’s Caucus feel. Read all about it in Four Days to Change, which I started and finished in about three sittings. –No really, read this book. It provides a unique and profoundly important perspective on the true meaning of inclusion, that is, white men absolutely need to be included in leading and benefiting from systemic change for equity, not just passively doing the changing for others’ sake. During the Caucus retreat, white men are both challenged and supported to dig deep into their own privilege. Inescapable mirrors of truth and profound discomfort, and also of love and compassion, surround them for four days. They are expected to feel tremendous guilt and shame, both natural emotions that occur on the path of self-discovery and humility. But rather than weaponizing these feelings, facilitators love the attendees through them, shepherding them through the emotional (shit)storm to a place of self-compassion and forgiveness. This is where their outward humility, openness, and sincere advocacy for inclusion and diversity take root—because they experience it first hand from their teachers and peer learners. Leadership is hard enough, but leading initiatives in diversity, equity, and inclusion is a whole other dimension of complexity. How can we expect any leader, white male or otherwise (but white males especially), to do it well alone, without a core peer group willing to hold their feet to the fire with both love and conviction?

I wrote earlier this year, “Practicing inclusion INCLUDES the OWG (Old White Guy) ‘oppressor’!  If we talk only about him needing to include others, while we make him feel excluded himself, how can we ever expect to enroll him in our cause or even behave in the way we ask? We do how we feel. And when we feel threatened and marginalized, especially from a place of loss, we act accordingly.” 

Michael Welp writes in Four Days, “(My mentor) inspired me when he (said), ‘The only way to touch other white men is through love.’  His words have always stayed with me.  However, the overall pattern observed in my dissertation was that white male diversity advocates disconnected from other white men and drew most of their support from white women and people of color.  They were frustrated and angry toward other white men.” 

Imagine people of your own tribe, a tribe you may lead in good faith, suddenly confronting you about biases and prejudices that you never knew you had, telling you how you’re harming people all around the tribe, and that you have to change it all now, adopt a new set of beliefs and initiatives today, and they will accept nothing less than your complete and unquestioning compliance because you are simply in the wrong.  Would you respond better if they came at you with such accusations and demands, or came alongside you with a grave and critical invitation to curiosity and learning together, for the good of the whole tribe, yourself included?  Which approach is more likely to yield tangible results in the near term?  Which one is more likely to still engage you in the long term?

We can learn important lessons from addiction medicine.  Patients succeed in rehab with a lot of grit and commitment.  They also benefit from the unyielding support and dedication of treatment staff and various environmental safety precautions.  But relapse rates are high (40-80%) in no small part because the safety and support so crucial to getting sober in rehab too often simply do not exist in an addict’s natural habitat.  

The converse was found to be true among American servicemen who fought in the Vietnam War.  Up to 20% of them were found to be addicted to heroin while overseas.  But upon return, only 5% of those who recovered relapsed.  After rigorous study (by a well-respected woman researcher, whose results and report were initially questioned and even derided—but that’s for another post), it is now widely accepted that the environment plays a key role in our behaviors, habits, and ability to change.  Soldiers in Vietnam, as James Clear writes, “spent all day surrounded by cues triggering heroin use: it was easy to access, they were engulfed by the constant stress of war, they built friendships with fellow soldiers who were also heroin users, and they were thousands of miles from home. Once a soldier returned to the United States, though, he found himself in an environment devoid of those triggers. When the context changed, so did the habit.”

The system often dictates, or at least strongly influences, how we perceive, think, behave, and relate. And we are the system, every one of us. By assimilating to the dominant white male culture, even as we see ourselves as resistors, we perpetuate it. But when we resist by only opposing our white male counterparts, without also enrolling them in the resistance movement as equals, we also undermine our own progress. Everybody deserves the safety and support to do their own personal Reckoning, Rumbling, and Revolution, as Brené Brown describes in her book Rising Strong. Real positive change is grounded in vulnerability, humility, and courage. If we really expect our white male leaders to change in ways fundamental and profound enough to advance equity in any meaningful way, they need the safety and support to reckon and rumble with their resistance, their rage, their fear, culture, identity, relationships, memories, realizations—all of it—with people they can relate to and who can hold them up fully, who will not turn away from or against them. As I wrote last week, more and more I see that perhaps only other white men can truly do this.

To be clear, this post is not an apology for white male supremacy and the vast suffering this mentality has wreaked all throughout history.  I just think it’s important, and too seldom attended to, that white men also suffer in and from the culture they dominate.  And in order to really change this culture for the better, we all need to support one another, white men included.

Challenging the Cisgender White Christian Male Default

Old new Dillon Reservoir

What do you take for granted?

How must you adjust your words, your actions, your facial expressions—your very presence, to fit into the world around you?

These questions arose for me again recently reading Seth Godin’s blog post from June 17, “The Dominant Culture.”

One of the great cartoons involves two goldfish in a tank talking to one another. One responds in surprise, “wait, there’s water?”

When we don’t see the water, it’s a sign we’re benefitting from being part of the dominant culture.

Visit a country where they don’t speak English and you’ll probably remind yourself all day that you speak English, something you didn’t have to think about last week. You’ll have to work overtime to understand and communicate. Back home, that stress disappears.

Living within a dominant culture means being reminded of this all day, every day.

It reminded me of the famous 2005 commencement address given by David Foster Wallace, the transcript of which was later published, entitled This Is Water.  He admonishes graduates of Kenyon College to open their eyes and minds to the automatic, mindless ways they make meaning from mundane life experiences, to acknowledge and exercise keen awareness of the inescapable interconnectedness of humanity (my interpretation):

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom all to be lords of our tiny skull-sized kingdoms, alone at the centre of all creation. This kind of freedom has much to recommend it. But of course there are all different kinds of freedom, and the kind that is most precious you will not hear much talk about much in the great outside world of wanting and achieving…. The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.

I started to think and wonder…  For cisgender, white, Christian men (CWCM), the dominant culture in the United States, the ‘rise’ of ‘other groups’ to ‘power’ can be understandably threatening–Black Brown Asian Gay Trans Muslim Female Other…

But there are CWCM who seem not to feel threatened, and who actively ally/accomplice to help other groups rise, to help them claim agency and work toward inclusion and equity.  They are what I imagine Chip and Dan Heath might call the ‘bright spots’ (see Switch: How to Change When Change is Hard) of the Patriarchy.

While engaging (fighting, overcoming) those who resist, why not also study and amplify those who assist?

What is it about these men, their networks, their environment, or whatever else, that facilitates their allyship with marginalized, non-dominant-culture people and groups?

Or even better, how does their conversion occur?  How do they overcome the perceived threat, conscious or not, to see the benefits of equality, and then join the fight to advance it?  What happens there, and how can we replicate and scale that conversion?

Last week on vacation I started reading Four Days to Change by Michael Welp, recommended to me by a wise old white man.  Welp and his partners run the White Men’s Caucus, the flagship retreat program of White Men as Full Diversity Partners.  As I understand it, the organization strives for exactly this conversion of awareness, enlightenment, and action.  On retreat, white men are provided the space and safety, as well as the excruciating challenge, to explore, without shame or suppression, their personal and shared experience of cultural privilege, entitlement, and responsibility.  I have a feeling this will be a transformational book for me, a cisgender, East Asian, Cathuddhist woman.  How’s that for intersectionality?

The author, speaking to White Men’s Caucus attendees:  “’If we created most of the institutions we dwell in today, they are going to reflect our culture.  But we don’t see this cultural water we swim in because we never have to leave it.  So we equate it with just being a good human.  Others assimilate into it, so it looks to us like it’s everyone’s culture.’”

He goes on to list the ‘core threads of the fabric of white male culture in the United States’ (how do they land on you?):

  • Rugged Individualism
  • Low Tolerance of Uncertainty
  • Action over Reflection
  • Rationality over Emotion
  • Time Is Linear & Future Focused
  • Status & Rank over Connection

After discussion with participants he notes, “’Notice that the guys who bring the skills less emphasized in the culture can more quickly identify how the culture works against them.  You might imagine the same experience for women and people of color.’  …It’s even more critical in today’s global world that we as members of the dominant group understand our water.”  I can’t wait to keep reading and see hearts broken open, as Parker Palmer says, to the power and potential of inescapable interconnectedness.

Lastly, I watched again Michael Kimmel’s 2015 TED talk on gender equality. I mentioned it on this blog in 2016, writing about Brock Turner and white male privilege.  At 1:08, listen to his story about the moment he realized he was a middle class white man.  In 16 minutes, he eloquently addresses gender and racial inequity, with evidence for the myriad societal benefits of dismantling them both.  “Privilege is invisible to those who have it…  It is a luxury, I will say to the white people sitting in this room, to not have to think about race every split second of our lives.”  It’s the water we swim in.  To white men the water is body temperature, almost like a sensory deprivation river, holding them up, always flowing in the direction of their dreams and aspirations, never a hindrance.  For too many others, it’s exactly the opposite.

It’s not that we should make water harder for CWCMs to swim.  It’s that white men can and must learn to see how the water hinders so many others, and then use their advantages to help those who struggle.  The collective benefits far outweigh the costs, as Kimmel describes.  The perceived personal risks loom large, however, and it’s ever clearer to me that only white men can truly lead other white men to overcome their visceral, existential risk aversion.

I’m still figuring out my own role in all of this Work.  I trust that I will know soon enough.