Tag Archives: resilience

Beyond the Rant

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For the better part of 20 years, I have had the humble privilege of working with medical students.  Whenever I spend time with them, I learn at least as much as I teach, and I come away inspired.

This day was no different, and I will never forget it.  We gathered in the stark conference center for a day-long communication skills workshop—physicians, nurse practitioners, residents, and medical students.  The facilitators came from the Alan Alda Center for Communicating Science; if you ever have a chance to learn from them, I highly recommend it.  I could almost palpate the group’s shy, tense, anticipatory excitement—this was a high-potential learning situation.  After time-travel role playing, imaginary ball-throwing, and Zip-Zap-Zopping with abandon, we relaxed into the liberated format that is improv-based learning.  That’s when I experienced an unqualified quantum leap in consciousness.  It came in the form of a rant.

The instructions:

Partner A: Rant rant rant, HARD, about something that really makes you angry—that truly enrages you, nothing small.  Not allowed to make it up, must be honest, let loose.  Yell, stomp, swear, etc., for two minutes straight.

Partner B: Listen, be present, no talking.  Introduce A to the group afterward.  The catch:  At no time during the introduction should the group be able to tell what A ranted about.

I paired up with Erik, a fourth year medical student.  I did the rage gods proud as I cursed and flailed for two full minutes about the victim mentality.  Your parents ignored you?  Your boss is a jerk? You’re stuck in a dead-end job in a crime-ridden city, hovelled in a grungy apartment with no view, and it’s all someone else’s fault?  Suck it up!  And on it went.  Erik stuck with me through it all, looking me straight in the eye and never flinching.  He introduced me thusly:

“This is my friend Cathy.  Cathy believes strongly, with her whole being, that each and every person has the strength and capacity to overcome any adversity, and lift himself out of whatever situation holds him back.  She believes in people, and wants to see them succeed, no matter what the circumstances.”  Nailed it.  What a powerful thing, to have someone distill and give voice to my core value, and after I had just raved like a lunatic, no less.  I had never met Erik before that exercise, and I felt an instant bond.  He saw me, and showed me a part of myself that I had not seen before. I am proud to know him.

Often when we witness ranting, we pile on and trigger an avalanche of mutual self-righteousness, or we unwittingly invalidate the person by arguing a counterpoint.  The practice of listening beyond the rant, hearing the core value, and then reflecting it, serves a higher calling.  It connects, validates, and settles.  It offers the ranter a mirror, an opportunity for self-reflection and awareness.  If we practice consistently, on each other and ourselves alike, we can hardly help but emerge transformed.

The Sh*tpile

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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

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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