Pee-Colored Glasses

I had not seen jaundice that bad in years.  He was Caucasian, in his fifties, about five feet, ten inches tall, 150 pounds, maybe less.  He wore straight leg jeans and a thick leather bomber jacket zipped all the way up, and his face was noticeably yellow, even from 100 feet away.  We walked toward each other along a busy sidewalk, on an overcast spring day.  I immediately scanned down to his hands, looking for a hospital patient ID bracelet.  “Why is such a sick man walking around on the street?  Which hospital did he just escape from?” I thought.  I saw no ID band, and his hands were not yellow, though they did look slightly thick—maybe swelling from liver disease?  He walked at a normal pace, no listing or shuffling.  Aside from his yellow face and apparent thinness, he actually did not appear ill.  As I got closer, I noticed that he wore Top Gun, Tom Cruise-style sunglasses, with lenses the shade of a perfect urine specimen.  His skin color was normal.

Would a non-medical person have immediately assumed he was an escaped liver patient, wandering the streets under the influence of hepatotoxic encephalopathy?    “How fascinating,” as Ben Zander would say, that I jumped to these conclusions, having only glimpsed this man from a distance.  What if I had turned an early corner and not gotten a closer look?  In the space of a minute or so, I perceived something shockingly abnormal, and with just a little more observation, reconciled it as only mildly out of the ordinary (I think not a lot of people wear pee-colored glasses).

Weeks later, a headline appeared on my Facebook feed: “Dad’s reply to school on kids’ absence is best response ever.”  The school principal had sent a letter to the family informing them that absences for family vacation were unexcused.  The father replied with a page-long justification of the high educational value of their trip.  Like many, I congratulated the father on his response, feeling righteous and indignant on his behalf.  My sister posted a subsequent article on my page, pointing out that the principal’s letter was merely informational and a formality, not a personal indictment of his choice of vacation timing, and that the father’s public shaming of the principal was both uncalled for and petty.

I feel embarrassed for holding him up like I did.  I don’t condone public shaming, what was I thinking?  I believe now that the headline attracted me for a reason.  Maybe I myself feel defensive around my own children’s school absences for family vacations.  I think I was preconditioned to take the dad’s side, to take the principal’s letter personally, as my medical training led me to see that man’s yellow face as evidence of end-stage liver disease.  Now I am the one wearing pee-colored glasses.

When I first read the father’s response, I wondered about the principal’s purpose in sending her letter.  But I did not take the next step to answer my own question.  Had I read it again, as I did after my sister’s post, I might have realized sooner that it was simply an informational form letter, and did not at all deserve the father’s negative public retort.  How was I able to correct my initial conclusions about the man on the street, and not about the principal?  My observations of the man were objectively inconsistent—apparently jaundiced face but normal colored hands and not otherwise ill-appearing—and I have no personal feelings about people with jaundice.  I do, apparently, have feelings about receiving notices from school about my decisions regarding my children.  My judgment of the principal’s letter came from that emotional place, and impaired my ability to see objectively.

These two very different situations remind me to monitor and manage my biases–inspect the tint of my glasses–early and often.

The Sh*tpile

Everybody has one.  We inherit large parts of it from our parents, whose parents passed theirs down, etc.  Life experiences add mass and odor as we grow up.  It sits squarely in the middle of the house of our existence.  For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off.  The surface gets dry and crusty; we grow accustomed to the smell.  No big deal.

Once in a while, something moves us to start digging, like that sudden urge to clean out the closet.  We quickly learn that sh*tpile insides stay fresh and painful, like unhealed wounds when scabs suddenly get torn off.  Our eyes water, our senses are overwhelmed, and we want to escape, and fast.  Maybe we avoid that room for a while, or we come back driving a tank to flatten the pile, to the destruction of other property.  Maybe we get so disoriented, overtaken by the sheer mass and stench of sh*t, that in fits of rage and confusion, we start flinging. Unknowingly we pelt innocent passersby, or even friends and family, just because they live closest and walked into the line of fire.  Exhausted, we step out, try to clean up some of the mess, shower, and long for the pre-poop-flinging state of things.

To live a truly conscious life, though, we know we need to revisit the sh*tpile regularly.  It’s not good or bad, it just is–everybody has one.  Maybe each time we come better prepared.  We call up our gardener friends, and invite them to the hardware store with us.  They help us choose the right picks, shovels, and wheelbarrows for hauling sh*t out.  They stick with us through the dirty, ugly process, because they know us for more than our smelly piles.  We may pick up some books or otherwise learn about cultivating with manure–what tools we need, what to expect in the process. We start to envision a flourishing garden.  Maybe we enlist professionals–landscapers–to help us bring the vision to life.  Slowly, we may even find a whole community of gardeners, tending their own sh*tpiles, one crumbly corner at a time.

Parts of the pile will always remain.  It’s not good or bad, it just is.  We pass them onto our children, much of them long before we die–multiple sh*tpiles in the same house, imagine that, whew!  And hopefully the kids also benefit from the beautiful gardens that grow from our best selves–play in them, feel safe in them, and see that excrement is just a natural product of living a full life.

One day we may become exactly the gardeners who helped us first. Then we can compassionately help others shovel their own sh*t for the better. Or we can just start now.

Practicing My ABCs

I lifted the boulder that was my head, looking once again at my clinic schedule.  Suddenly the day ahead loomed heavy, dark, oppressive.  No, not really, but I did feel abruptly bummed, when I had arrived that morning in a cheery mood.   My medical assistant noticed the change in my affect and inquired; I pointed to a name on my screen.  The same curtain of dread fell over her being.  “Oh no, I know him.  He’s a jerk!”  We had both made this diagnosis with conviction months before.

This day, I entered the exam room prepared to meet The Jerk.  I took a deep breath and noted my negativity.  I made myself ask extra questions to make sure I wouldn’t miss something, despite the urge to exit the room as soon as possible.  I reviewed medications, discussed his next colonoscopy, all in a perfectly professional manner.  The visit went without incident, nothing to write home about.  Was my care of him medically standard and objectively sound?  Absolutely.  Was I my best self?  Absolutely not.  The difference?  My best self is healing, and he got none of it.  I left Best Me at the door, along with my ability to connect to him as a person.  The other difference?  I suffered through that visit.  Physicians’ work fulfillment comes in large part through meaningful relationships with patients, and I got none of it—it was a lose-lose.

My son’s fourth grade teachers developed a resilience curriculum a few years ago.  The ABCs lesson resonated with me in particular.  (See the links below for more information on the concept.)

A stands for Adversity: The bad thing that happens to us.  In this case it was my patient’s previous behavior, which made my staff and me feel used and ignored.

B stands for Belief: The one(s) we make up based on adverse events.  For example, he is a jerk, a whole jerk, and nothing but a jerk.

C stands for Consequence.  Here’s the rub: The belief, not the adverse event, determines the consequence.  My diagnosis of Jerk hijacked my entire experience of him, precluding the human connection that could have benefited us both.

This story almost repeated itself months later, after a particularly contentious interaction with another patient.  I ranted colorfully to my colleague, who wisely reminded me that the patient might not be a jerk, that I could withhold that judgment yet.  When the patient came next, I took another deep breath.  Maybe she wasn’t a jerk, I repeated internally.  Prepared to meet her best self, I brought mine.  I could literally feel the difference—the tension in my neck loosened; my smile arose more naturally.  Our conversation hit some speed bumps, but we connected, somewhat—there was still something off about her behavior.  As I discussed her case with other specialists who met her, we all agreed that she probably lived somewhere on the autism spectrum.  Now in her late 50s, she had achieved remarkable success in her career, likely with little to no acknowledgement of, or accommodation for, her social challenges.  We genuinely admired her, when at the outset we could have dismissed her as just another Jerk.  In the end the whole team felt satisfied that we had brought our best to meet her needs, and we all learned along the way—a win-win.  By changing my beliefs after a typical adverse event, I steered the consequence of my own experience to a positive, productive place.

Life will never cease to hand us opportunities to practice our ABCs, and as with any skill, we will improve with each occasion.

Below are links to pages that describe the ABCs concept and it’s origins. I have no financial or other interests in these entities. 

http://www.dartmouth.edu/~eap/abcstress2.pdf

http://www.edutopia.org/blog/teaching-the-abcs-of-resilience-renee-jain