#AtoZChallenge: Opposition and Openness

be the change

Image from Google long ago; I can’t find the link anymore, sorry…

OH, this is a hard one.  Okay, Okay, I just have to write it.  And OMG, I am now two letters behind!

Oppose, Dictionary.com:

  1. To act against or provide resistance to; combat.
  2. To stand in the way of; hinder; obstruct.
  3. To set as an opponent or adversary.
  4. To be hostile or adverse to, as in opinion: to oppose a resolution in a debate.
  5. To set as an obstacle or hindrance.
  6. To set against in some relation, especially as to demonstrate a comparison or contrast: to oppose advantages to diadvantages.
  7. To use or take as being opposite or contrary.

There is so much Opposition in our world now.  I’m thinking specifically of politics.  Like many of my blogging friends here, I eschew writing about politics because it can have unintended consequences and distract from the intent of this blog.  I have alluded to it (Obtusely) here, and commented on another blog here.  Mostly, I don’t feel qualified to comment on politics.  But a Facebook post I wrote a few days ago keeps nagging at me to be shared, and I have struggled around the best way to present it.  So here goes.

When I look at the list of definitions of oppose, I feel tired.  When I think of the energy it takes to constantly stand against something, I feel listless and drained.  Fighting, resisting, combatting, Obstructing, standing in the way, hindering, disputing, dissenting, contradicting—it’s exhausting.  I think of times when I meet someone new and all they talk about are the things they hate, that they can’t stand, that they want changed.  I cannot wait to get away and find levity.  There are two main consequences of the oppositional mindset that put me off:

Polar Isolation

Oppositional mindset pushes people apart—to extremes.  I think now of my Facebook friends who post incendiary words and images.  They blame, shame, ridicule, mock, and degrade Others.  By others I mean those who do not share a common economic background, political ideology, religion, skin color, profession, or even parenting style.  When I see these, I conduct an internal debate.  Part of me wants to engage, to call my friend out for posting something Offensive, distasteful, unprofessional, or unkind.  I try only to be friends on Facebook with real-life friends, so I know these people are not offensive, unkind people in general.  But each time one of them posts something deriding a group to which I belong, I feel hurt.  So I want to ask them, what are they really thinking?  Would they say these things to me in person?  But I know that social media is a poor venue to hold these conversations.  So I almost always scroll over.  Every time, though, there is residue on my figurative shoe from stepping over these posts.  I have to work harder to think of my friend in the same positive light.  I wonder whether we really do share values like I thought we did—because one of my highest values is to be kind to others.  I feel a distance now that I have chosen deflection rather than engagement.  It feels sad and lonely.

This is not to mention the escalating verbal wars waged by our politicians today.  Suffice it to say, I have stopped watching the news and listening to the radio.  I curate my information in small doses and avoid sensational headlines.  Everybody is out to paint the Others as dangerous, untrustworthy, less than.

When all we hear from our Opponents is how much they hate us, how stupid they think we are, how they wish we would shut the f*** up, we will do one of two things.  We will disengage, or we will engage with acute and increasing hostility.  Either way, we push one another further and further apart, and we end up living in polar opposition.  And as we know, conditions at the ends of the earth are harsh.  It’s a desolate and heartbreaking way to live.

Rigidity, Immobility, and Stagnation

The other consequence of a singular focus on that which we oppose is a complete and total lack of progress.  Two examples come to mind:

My child is jumping on the sofa.  “Stop that,” I say, “don’t jump on the sofa.”  She stops momentarily, then starts again in a few minutes, moved by a spontaneous joy that I have long since forgotten.  I keep repeating, “Stop that, do NOT jump on the sofa!”  The focus remains on what I do not want.  I keep a lookout, and each time she repeats the unwanted behavior my frustration mounts.  I may employ negative consequences—the next time she jumps, I take away screen time, or a stuffed animal.  The stakes climb and everybody gets tense.

I hate my body.  I am 20 pounds overweight, I feel sluggish, none of my clothes look good, and it undermines my confidence.  I keep thinking, I don’t want to be fat, I don’t want to be fat.  So every time I’m faced with donuts that someone brought to work, every time I go out to eat with my friends, I brace myself to guard against behaviors that I know will make me more fat.  I succumb sometimes.  I feel shame.  I keep thinking to myself, What’s wrong with me, why do I keep doing things that will keep me fat, when I don’t want to be fat?

There is a saying, “Energy flows where attention goes.”  I don’t know who said it first.  When we focus on what we don’t want, there we remain.  Even when it’s what we oppose, if we continuously attend to it, precious little energy remains to spend on what we do want.  This constant vigilance and guarding keeps us preoccupied with the problem, and impairs our ability to develop solutions.  What if I changed my focus with my child, and let her know what I expect from her?  “The sofa is for sitting.  Can you please sit nicely on the sofa?  How long can you sit still?”  Now I’m generating movement toward something desirable.  I’m making it a challenge, it could even be fun.  Tension is diffused, and I might tap into that long lost joy a little.  My self-talk around weight could also benefit from a subtle shift.  The difference between I don’t want to be fat and I want to be healthy can be profound.  The former keeps me fixated on and entrenched where I am.  The latter helps me move toward a goal, gives me an aspiration.  What does a healthy person do?  She avoids the break room when donuts arrive, finds alternate routes to the bathroom.  She takes the stairs rather than the elevator.  She chooses salad more often than burgers.  I start to envision my best self, and I feel motivated to pursue it (me).

Letting go of my oppositional mindset allows my creativity to shine through, and a world of possibilities may Open up before me.


Open, Dictionary.com:

  1. Not closed or barred at the time, as a doorway by a door…
  2. (Of a door, gate, window…) set so as to permit passage through the opening it can be used to close.
  3. Having no means of closing or barring: an open portico.
  4. Having the interior immediately accessible, as a box with the lid raised or a drawer that is pulled out.
  5. Relatively free of obstructions to sight, movement, or internal arrangement: as an open floor plan.
  6. Constructed to as to be without cover or enclosure on the top or on some or all sides: an open boat.
  7. Having relatively large or numerous spaces, voids, or intervals: an open architectural screen; open ranks of soldiers.

Letting go of opposition means Opening ourselves to new possibilities of thought, engagement, Outcomes, and connection.  I believe my friends are kind and generous at heart.  I can still oppose their offensive expressions.  If I do it with an open heart, ready to hear their point of view, withholding judgment and honestly listening for understanding, then I can maintain our relationships, even deepen them.  If I can make them feel seen, heard, understood, accepted and loved, despite our differences, then they will be more likely to extend me the same courtesy.

Being open means being vulnerable.  Just because I Offer openness and understanding does not mean my counterpart will reciprocate.  I could be rejected, ridiculed more, hurt more.  These are the risks and costs of openness.

But what of the benefits?  What if my openness actually creates a space for communication and mutual understanding?  What if my friends and I can lead by example?  Could we start a movement toward taking time to hear one another, seeing different points of view, and holding multifaceted perspectives?  Humans and our experiences are complex.  We cannot easily be distilled into soundbites, headlines, cartoons, and labels.  We should not accept such oversimplifications—we should Oppose them.  And at the same time we need to stand Open to the validity of our fellow citizens’ experiences.  We need to remain Open to the possibility—the certainty—that we really do share common values, goals, and hopes.  We need to work harder to hold our hearts Open to one another, reach out and come in from the cold, polar regions, and strive together for a better world for all of us.  We cannot hold hands with clenched fists (another quote, no?).  I would rather hold hands.


Here is the video that triggered my Facebook post of April 15, 2016, and the actual post:

I love Bernie. Also, though, I am starting to notice that his severe criticism of ‘the rich’ and his characterization of them as greedy as a group, oversimplifies.  It does so IN THE SAME WAY AS DOES THOSE WHO CHARACTERIZE POOR PEOPLE AS LAZY.  There are greedy rich people. There are also lazy rich people. There are also greedy and lazy poor people.

I agree with Bernie’s core values and his consistently stated vision for our future. I understand that his proposed policies may be unrealistic and unattainable in the foreseeable future, or maybe even ever. But he gives me something deeply meaningful to strive for, and that is the kind of leader I will follow. Even if we never get there, I will happily trudge the path *in the direction* of said future, because it’s where I want to go.  I do not hear or see a clearly stated vision or aspiration from the Republicans.  Bernie inspires me to be a better person, to make my best contribution to society.

We all have a desire to make a contribution. Psychology research over literally DECADES tells us that human nature is wired to be both productive and connected. So these premises that some of us are innately lazy and live for handouts, and others of us are conversely inclined to accumulate wealth only for ourselves and for its own sake, are not only severely misguided, they are dangerous. These toxic assumptions are exactly what keep each side permanently entrenched in opposition. Assumptions turn into accusations, which then engender mutual defensiveness, then offensiveness. It’s no wonder we have devolved into the current political morass.

I want Bernie to soften his language and invite the rich into conversation, collaboration, innovation, and creativity around solving the problems of inequality and disparity.

I want Republican leaders to moderate the voices in their party who blame the poor as personal failures and the sole architects of their downtrodden situation.

I bet most rich people really do care about the poor, just like I believe most poor people really do want to work and be productive members of society.

How much more could we do, how much better could we be, how much movement could we achieve, based on these assumptions instead?

He for She, We for Us

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.

I Am A Lone Nut!

At the end of my recent physician burnout/resilience presentation, I stood wondering if it meant anything to anybody. I did my best to follow Nancy Duarte’s structure in her book, Resonate: Make the audience the hero, contrast what is and what could be in story with texture and emotion, sound the call to action and describe the blissful future! Every time I give this talk I feel energized and passionate by the end, but most of the audience looks positively neutral. Thankfully, a few usually approach me afterward with words of praise and I feel somewhat validated. I remind myself, if only one person is moved, then I have made a difference and it was worth presenting.

When I spoke to editors, writers, and instructors at the Harvard writing conference, they said I should not write for both patients and physicians, I had to pick one. They told me to identify my audience (but keep it broad), and then differentiate myself from all the other authors writing for that audience. It feels like opening a retail shop. What will I sell? Who do I want to shop here? What is my purpose? It’s not to make money; it’s to make a positive impact on the community, to fill a need. Some people will walk in, look around, and walk out without buying anything. That’s okay. If I stay open long enough, they may wonder, ‘What’s so great about her store that she’s still in business? Maybe I should look again.’ They may eventually make a purchase, if they see something of value.

Others will enter, feel immediately at home, and linger in the aisles, soaking up the aesthetics, wishing they had more time to spend. One shiny piece will catch an eye, they’ll snatch it up, and come back as soon as they can, looking for more treasures. They belong here, and so do I. Now I know, I’m not simply writing for patients and physicians; I’m writing for those patients and physicians who, like me, believe that our healthcare system can thrive again only if we all work to reclaim our relationships.

I aim to start a movement.

But one does not accomplish this by barking a generic message to everybody who walks by. Doctors come to noon conference as a routine, a social and academic ritual. We earn one hour of continuing education credit for showing up, staying to the end, and completing the requisite evaluation forms, regardless of how much we actually engage with the presentation content. It occurred to me this time, that there are always a few in the audience primed to receive and respond to my message—they are my tribe. While some parts of my talk may resonate with some people, the whole talk will resonate deeply with those few. They are my target audience. Why? Because they are the ones who will take up the torch, hail the call to action, and participate in the movement now. They feel, like I do, a visceral agitation for this change.

To the attendees who don’t feel it (yet), I must seem like some lone nut, roaming the room and flailing my arms about. They may remember something I say and apply it for a short time, and forget me in a few days. But for my fellow tribe members, my waving and shouting (I don’t really shout) stirs something kindred and profound. They want to wave and shout back, “I get it, I get it! Hallelujah!” They will carry my message with them and share it with anyone who will listen, because it is their message, too. I know because I get this way when I hear someone speak who believes what I believe. It happens at professional meetings; I call it the Hippie-Zealot Conference High.

I get the idea of the ‘lone nut’ from Derek Sivers’ TED talk, “How to Start A Movement.” Sometimes I feel like the one on the amphitheater lawn, dancing unabashedly, provoking expressions of ‘weirdo’ from others. But there will be tribe members there, the townspeople who love my shop. They will get up and dance with me, if only I can connect with them. Maybe all it takes is eye contact, a welcoming smile, or an exuberant gesture to join in. Once they stand up and start dancing, pretty soon the gawkers may feel our collective energy, shuffle cautiously at first, then let loose and get down with abandon. We will all be in relationship for the better.

Derek Sivers calls those tribe members ‘the first followers.’ I prefer to think of them as fellow lone nuts. Lone nut status, especially with a microphone (or megaphone) can feel special, and it also gets lonely. I would much rather live and work among mixed nuts, with complementary and mutually enhancing, yet unique, contributions to the jar.

From now on, when I present on physician resilience, patient-physician relationship, or any other passion, I will make a concerted effort to acknowledge my fellow lone nuts. I will call out to them especially loudly, and invite them personally to join the movement. Then we will all feel empowered to rally the masses, one small circle at a time, until everybody’s up and dancing, happy, strong, and together.