Tag Archives: physican

Holding the Space for Our Suffering to Heal Us

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Hello again, dear friends.  Peace, love, and joy be with you on this, the autumnal equinox.

This post marks the conclusion of the Healing Through Connection Summer Series, 2016:  Holding the Space.  The story I will tell is important to me, and I love that it’s the series finale.  I wish I had posted on the last day of summer, but the first day of fall is okay, too.  Two days ago I was privileged to witness a whole lot of people, hold a whole lot of space, for a whole lot of suffering.  And I posit that we all came away better for it.  I invite you to sit back, get comfy, and take your time with this one.  I’m feeling particularly fulfilled as I sit to write, and I hope to convey the deep gladness I gained from the experience.

***

It was day three of the International Conference on Physician Health, in Boston.  I had anticipated this meeting giddily for nine months.  From the moment I heard the call for abstracts, through the iterative preparatory steps, to the final emails, texts, PowerPoints, and conference calls with collaborators, through the personal connections and learning, I was now positively beside myself with zeal.  It was everything I had hoped and more.  I was surrounded by colleagues from three continents, all gathered to share and unite around making our professional world more humane.  We explored ideas like awe, joy, mindfulness, empathy, presence, and vulnerability.  I had lived two glorious days in a cocoon of safety, love, and resonance.  I was among my people.

This day’s workshop focused on compassion, and aimed to tap its deepest reaches within each attendee.  The presenter prepared us for the exercise by describing his work with previous groups—CEOs breaking open in anger, shame, forgiveness, and finally compassion.  He asked that we hold the gravity of vulnerability with reverence and respect.  We understood the solemnness asked of us, and responded in kind.  This was the exercise:

On a blank 5×7 index card, write a personal story.  You will have five minutes.  The cards will be collected at your table, redistributed, and shared anonymously at another table.  Be aware that your writing may be shared aloud with the whole group, later in the exercise.  Instruction:  Write the story of a time in the past year that was really hard for you, when you suffered.  It could be personal or professional.

For a split second I felt a catching in my chest—‘Yikes!’  And in the next breath, ‘Bring it.’  I knew this tribe.  They would hold it for me, with me, no question.  And because I was also a tribe member, I would do it for them.  I looked forward to it, actually.  I wrote with surprisingly little effort, concisely yet in detail, about a particularly challenging relationship and my struggles with perfectionism.  How could my other relationships shine so brightly, feel so easy, and flow so freely, while this one so regularly caused me angst and turmoil?

At the end of five minutes my tablemates and I placed our cards in an envelope provided.  I felt oddly relieved, as though a great weight I carried all this year had been lifted.  The envelope was marked, then passed three or four times between tables, so we didn’t know where our cards ended up.  They were as letters in a corked bottle, cast into the ocean, released to an uncertain, but hopeful, fate.

Our presenter explained that at this time, the envelopes would normally be opened, and each of us would take one card and read it.  We were to hold it and its anonymous author in the space of compassion, then share with our tablemates.  We would help one another hold one another.  Then, if so moved, each table would choose one card to share with the larger group.  Our task was to connect, with ourselves and one another, to feel deeply now, to remind us how to do it out in the world.  This was where it would get real, we all knew.   And though he had warned us earlier about an unforeseen shortening of the workshop schedule, we did not see the abrupt end of the exercise coming.  He told us we would not have enough time to do the exercise justice, and so the envelopes would remain unopened this day.  He acknowledged the conflict we all felt, the urge to look.  But he stood firm that experiences like this cannot be rushed, and he respected the time constraints of the meeting.

The tension in the room was palpable, even as we all sat in silence.  It felt jarring, painful, anxious.  What would happen to the cards?  What about all that suffering contained in them, people’s hearts and lives scribed with intention to be seen, known, understood, and held?  Surely they would not just be thrown in the trash?  One colleague voiced so poignantly our core conflict:  We all wanted closure for this vulnerable exercise, and that need competed with honor for the time required to complete it.  Our leader gracefully acknowledged this truth, and solemnly held the space for us all to be present to its discomfort.

For a moment we felt stuck, we connection seekers.  I looked at our leader.  His expression conveyed nothing but humility and empathy.  His posture conveyed resolution.  Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side.  But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

I wondered what would physically become of the cards.  Would he take them home with him?  Would he burn them in a reverent ceremony of sorts?  I knew he felt responsible for us and our predicament.  Would he read each one, hold each of us and all of our suffering, all by himself?  I felt immediate compassion for him, and hoped that he would not take that route; none of us would want that for him.

I wanted to suggest that we be given the option of each pulling one card, to hold in compassion privately, as we left the workshop.   But we were spread out in a big room, feeling separated from one another rather than connected, and I felt sheepish.

Within a minute or so we had decided to collect the envelopes together, stand surrounding them as if around an altar, and offer a benediction of sorts.  I could not shake the urge to reach out, to take one person’s suffering and hold it for them, love them, send energy of compassion and solidarity to them, whoever they may be.  I realized also that this was exactly what I wanted for my card, for my suffering.  And now that we stood shoulder to shoulder, at least physically if not emotionally proximal, I felt more comfortable to speak.  “I really want for someone to take my card and hold it for me, and I really want to do that for someone.”  Another attendee immediately looked me in the eye and said, “I’ll do it.”  The group consented; each of us would take a card at random, if we wanted.  I pulled one from the third envelope from the top of the pile.  I held it to my chest and returned to my seat.  I forgot all about my own card, and my anxiety evaporated.  I no longer cared if anyone saw mine; I had released it.  My task was to hold my colleague’s sorrow with my own heart, and wish with my whole being for their peace and healing.

I’m so proud of all of us.  We attended to so many needs that morning, all with respect and kindness.  The presenter set the tone for the workshop from the beginning and we all understood the learning objectives: Practice opening up to let the healing in and practice the inner work of holding another’s suffering with your own.  Connect with our shared humanity.  We all learned an important lesson in flexibility, creativity, collaboration, and acceptance.  We held space like champions.

I’m proud of myself for finally speaking up, for asking for what I needed.  That I was met with such generosity and tenderness speaks to the remarkable power of mutual understanding and compassion.  I took a deep breath and read the card in my hands.  My colleague’s story was short, about the 5 year anniversary of his/her father’s death, and memories of loss and helplessness.  Tears came when I read it.  I hugged the card and said a prayer for its writer.  I’ll keep the card someplace safe, and eventually release it in some respectful, peaceful way.

I don’t know if anyone pulled my card.  It’s okay.  Just the hope that someone might have seen it and given it some consideration is enough.  I learned the lesson I needed: Offering my pain for someone else to hold a while, and accepting another’s sorrow to hold for them, constitutes the cycle of healing.  We are not here to go it alone.  We need one another in the best ways.

Holding the Space for Expectations Challenged

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Ray Great Wall 2016

Those of you who follow this blog know that I meet regularly with a group of insightful and engaging medical students. I have written about them here and here. At our meeting last month, one of them described his recent rotation in China, and I invited him to share his experience here. I’m so grateful for this continued connection to physicians in training—it keeps me grounded. It reminds me that no matter how old and wise I may consider myself, I always have much to learn from others.

Enjoy, everybody:

 

Expectations. In the United States, we have come to have certain expectations for how things should be. A meal at burger joint should include a burger, with a side of fries and a Coke. When we check into a hotel, there should at least be a TV and a coffee maker with complimentary coffee. These have become essential (American) assumptions, and because we are the “best in the world,” our way is the best way.

Similarly, when you go see a doctor, there are certain expectations, both good and bad. You expect that it may take a few days to get an appointment. You expect a reminder prior to your appointment. You expect to wait a certain amount of time to see the doctor and to fill out a ton of paperwork. You expect the staff to be courteous. You expect to see a nurse first, and to wait again in an exam room until your doctor arrives. You expect the doctor will listen to all of your health problems closely, and offer helpful suggestions regarding imaging and medications you can take. You expect those prescriptions to be sent to your pharmacy, and that you can to pick them up after your appointment. You expect to get better.

What if your reality ended up very different from these expectations?

Last month, I went abroad to see what the healthcare system is like in China, at an academic teaching hospital in the nation’s capital of Beijing. After spending a year deeply entrenched in the clinical wards of the United States as a third-year medical student, learning from the best of the best doctors, I thought I knew what it meant to provide good medical care. I expected that I could teach them better ways of delivering care based on what I learned in America. I soon found out that I was the one who had a lot to learn.

To provide some perspective on just how different the healthcare system is in China, imagine this scenario, based on an amalgamation of different patient experiences that I witnessed:

You are sick and want to see a doctor. You wake up the next day at 5 in the morning so that you have enough time to take the subway to get to the hospital by 6. When you arrive, there are already 30 people in line ahead of you, and the specialist you want to see only gives out appointments for 25 people for his morning clinic today. You don’t end up getting an appointment.

You go into the doctor’s office when he arrives at 8, bursting in the door with 10 other people who are sick but were unable to get appointments. You fight for the doctor’s attention during his first patient’s appointment, and, luckily, you get an add-on appointment, for after his 25 other morning appointments. You sit in the waiting room until 12:30PM, when you are finally called in.

You see the doctor. He only has 5 minutes to spend with you. As he is doing your physical exam, his next patient enters the room before being called, and watches everything. The doctor says you need imaging, which you need to pay for and schedule yourself. You then need to pick up hard copies of the images and bring them to your next appointment, so that he can make a diagnosis. You also need some medical equipment, and he suggests shopping for it online. He says you may need to be hospitalized, but it may take 2 weeks to get a hospital bed spot, so you should sign up for the waiting list now. You get the imaging and medical equipment, the doctor makes a diagnosis, and you get better.

Your total cost for everything was less than $50.

Your gut reaction to this story may be, “this is madness!” You may feel that your expectations of healthcare delivery, based on your experiences in the United States, are very different from the care provided in China–not only different, but almost certainly better. At least, that was my gut reaction. I was appalled on my first day of clinic; my mind raced with questions: How do patients put up with this disregard for their time and rights to privacy and respect? How are doctors able to treat patients adequately without hearing the patients’ stories? Can patients have a good understanding of their medical condition in this system of care? It made me feel grateful for what we have in our current healthcare system back home, with better customer service, shorter wait times in the doctor’s office, and more privacy during the appointment.

However, take a second to reflect: is our healthcare system universally better? In this compiled scenario in China, you got seen by a specialist on the same day you got sick, which happens on a regular basis for patients familiar with how the hospital system works (even those unfamiliar with the system can still be seen within one or two days). Your overall costs were low and did not involve convoluted paperwork from third and fourth parties. And, most importantly, you were still able to get better. These are all things that hospitals in the United States hope to improve on. By the end of my first week in China, I realized that my gut reaction on the first day was irrational, stemming from discomfort with things I was not accustomed to. As I distanced myself from my premature judgment on what I was seeing, I found that the differences were not bad, just different. China has the challenge of providing healthcare to the largest patient population in the world, and with that, factors like cost containment and short visit times are prioritized. In the United States, we have also had to prioritize certain factors, specifically patient satisfaction, due to our cultural values and our legal system. In both countries, though, positive patient health outcomes are the highest priority.

Dr. Cheng asked me what three things I learned primarily from doing a clinical rotation abroad. First, different does not equal bad. While China and the United States do not have the same priorities for or access to healthcare, both have well-functioning healthcare systems. Second, withhold judgment from your expectations. Your gut reaction may not always be correct and may limit you from fully understanding things unfamiliar to you. Third, be grateful for what you have. Though our own healthcare system has its problems, we should be grateful for everything that works well, and we should not take it for granted.

Summer Series 2016: Holding the Space

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LSD tree June

Well, hello again, friends! It’s been a while–again!  *sigh*

Sometimes things happen that we can’t quite explain… Like why, after writing 26 enthusiastic posts in 30 days, I could only manage to publish one thing in the ensuing 42 days?  How fascinating!  I’ve entertained several intersecting theories…  And while it’s been a fun and frustrating exercise in introspection, it is now time to let go the analysis, take what I’ve got, and move on.  I know I will integrate it all in the long run.

So today, I officially launch Healing Through Connection Summer Series 2016: Holding the Space.  For the rest of June, July, and August, I will explore the various meanings and applications of this concept, and what its practice teaches me.

To me, “Holding the Space” means slowing down. It means being with things the way they are, without rushing to criticize, blame, judge, intervene, reject, fix, suppress, resolve, deflect, escape, annihilate, deny, or ignore.  When we practice Holding Space, we allow more.  We tolerate better.  We find peace.  For an excellent description of the practice as it relates to caregiving, see here.

The concept has swirled in my mind almost nonstop these last few months. It’s triggered mostly when I see conflict and controversy, and also in times of transition, challenge, agitation, growth, and uncertainty.  I have referenced it in my writing before, sometimes using the actual words, other times alluding indirectly.  Here are some recent examples:

https://catherinechengmd.com/2016/04/29/atozchallenge-withhold-judgment/

https://catherinechengmd.com/2016/04/20/atozchallenge-opposition-and-openness/

https://catherinechengmd.com/2016/04/01/assumptions-and-appreciation/

https://catherinechengmd.com/2015/11/19/look-for-the-helpers/

https://catherinechengmd.com/2015/11/11/reconciliation-is-for-kids/

https://catherinechengmd.com/2015/10/27/he-for-she-we-for-us/

My purpose in this series is to share personal reflections on Holding Space, as I grapple with important social, professional, and personal questions. As I wrote in my previous post, I may venture into controversial territory, but my intent is not to argue a particular position.  I wish, as always, to focus on relationships.

Please join me on this journey. Solitary reflection is helpful and necessary, but it’s almost always more fun to welcome companions on the expedition.