Seek the Stories

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Do you have time in your doctors’ appointments to tell the story of your problem?  Do you even think of it as a story?  More and more I find myself saying to people, after they have given a list of symptoms in no particular order, “Tell me the story, starting from when you last felt well/normal.”  Then it all comes out in an interesting narrative, often with new insights as to causes, connections, and exacerbating factors along the way.

Do you read more fiction or nonfiction?  I have always been a non-fiction gal.  I appreciated The Grapes of Wrath and devoured the Harry Potter and Percy Jackson series, but usually I avoid novels.  My favorite books this decade are The Art of Possibility, Rising Strong, Big Magic, Start With Why, and Give and Take.  I realize now that these books are also full of stories—just real-life ones.  I have tried to incorporate more stories in my writing, and I find it challenging and awkward.  But I will keep trying, maybe take a creative writing class someday.

I have heard some amazing stories recently, and I will get some details wrong, but I want to share them with you, in case they touch you as they touched me.

A doctor attends a mindfulness workshop because he is interested in mind-body medicine and always looking for new methods to explore his inner world.  Part of the workshop is a professional quality of life survey, on which he scores very high for compassion satisfaction and low for burnout.  He says it’s because this is a second career for him.

He always wanted to be a doctor growing up.  He was accepted to medical school in his home country, but his family could not afford it.  So he stuck with science and went to school the cheapest way possible, and graduated with a biology degree.  Over the years he got married and immigrated to the United States.  He never forgot his dream of being a doctor, but progressed nevertheless in his graduate basic science studies.  When he applied to allopathic medical school here in the 1980s, he was told that since his BS was from abroad and the class was already ‘culturally imbalanced,’ he would not be admitted.

He was offered a spot in an osteopathic school, however, and grabbed it.  Meanwhile his wife was pregnant with their first child.  He had to move away from her and his parents for residency, and while he was away his father died.  Sometime in there his wife also started medical school, and they made it through training and the births of two children (with two weeks maternity leave each for her) intact.  They are now both well-respected primary care physicians in a small outlying community.  He is a physician educator and leader.  They sit side by side at the dining room table on Sunday nights catching up on notes.  They call these their “Epic dates.”  [Epic is the name of a widely used electronic health record.]  Both of their children are doctors.  He never feels burned out; he is living his dream.

Another doctor, a leader in his field and his institution, and a black man, described everyday racism that most of us cannot fathom.  A neighbor approached him on the beach of his own lake house, accusing him of trespassing.  Passing drivers backed up to confront him at his mailbox, suspecting him of stealing some white person’s mail.  A cop pulls him over around the corner from his suburban home in a nice neighborhood, asking, “What are you doing around here?”

A man in his 50s breeds guppies for fun.  It started with his 5th grade teacher, who was his mom’s best friend.  He used to go over to her house with his mom, and got interested in her guppy tanks.  Now he has hundreds of his own tanks, and he knows everything there is to know about inbreeding, crossbreeding, guppy circadian rhythms, and where the world’s experts on guppy breeding live and work.  Now I know this is a thing.

Mr. Rogers is quoted as saying, “There isn’t anyone you couldn’t learn to love once you’ve heard their story.”  I wholeheartedly agree.

 

Hopey, Changey Hero Making

IVY Litt 11-8-17

NaBloPoMo 2017: Field Notes from a Life in Medicine, Day 8

Funny how I just wrote last night about connecting new dots to old dots.  It just happened again tonight!  A couple of weeks ago I responded to an online ad for an IVY Ideas Night with David Litt, author of Thanks Obama: My Hopey, Changey White House Years, entitled, “How to Inspire, Persuade, and Entertain.”  Litt was a senior speechwriter for President Obama, so I thought I could learn new tips for presentations, and feel a little closer to the president whom I miss so much.

I’ve done public speaking since eighth grade, when our speech teacher first taught us abdominal breathing and I discovered the thrill of holding the attention of a room full of people with only my words.  I work at an academic medical center and I hold zero publications, but my CV documents over 10 years of professional presentations to various audiences.  I thought I was pretty good at this speaking thing.

Three years ago I came across this TED talk by Nancy Duarte, whose ‘secret structure’ of great presentations I have used since I subsequently read her book, Resonate.  Essentially, she recommends that we invite audiences on adventure stories, create active tension between what is and what could be, and most importantly, make the audience the hero.  I have done this better and worse since then, but I always recognize the framework when I see it.  Those familiar with this blog know that I am also a fan of Simon Sinek, whose central message is that we perform at our best when we are crystal clear about our Why.  “People don’t buy what you do, they buy Why you do it,” he says.  Barack Obama employs both authors’ principles with eloquence and finesse, which I noticed reading We Are The Change We Seek, a collection of his speeches as president.  The best speeches delivered in this construction create audiences who are inspired, motivated, and empowered to hail a meaningful call to action.

Obama is could be core values

That’s basically what David Litt conveyed tonight.  When asked what advice he was given that served him best, he said, “Imagine someone in your audience will tell their friend tomorrow about your talk.  What is the one thing you want them to say about it?”  What is the Why of your talk?  Even though he no longer writes speeches for the most powerful person in the world, he expressed a desire to continue inspiring, empowering, and promoting personal agency in all whom his work touches. Make each and every audience member their own hero.

It turns out, however, that this approach applies to much more than public speaking.  On my 50 hour, 500 mile, aspen-pursuing weekend in Colorado last month, I described to my dear friend my favorite moments at work.  At the end of a patient’s day-long physical, after I have spent 90 minutes listening to their stories of weight gain and loss, work transitions and complex family dynamics, and reviewing their biometrics and blood test results, I meet with them for an additional 30 minutes to debrief.  This is when I present an integrated action plan compiled by the nutritionist, exercise physiologist, and myself.  It is a bulleted summary of our conversations throughout the day, centered on the patient’s core values and self-determined short and long term health goals, and crafted with their full participation.  I get to reflect back to my patients all that I see them doing well, and shine light on areas for potential improvement.  It’s an opportunity to explore the possible—to Aim High, Aim Higher, as the United States Air Force exhorts.  I often present the plan with phrases like, “Strong work!” “You’ got this,” and “Can’t wait to see what the coming year brings!”  My friend turned to me as we wound through autumn gold in the Rocky Mountains, a bit tearfully, and said, “You make them the hero of their own story.”  Yeah, I do, I thought, and I got a little teary, too.

Words are powerful.  They are our primary tool for relating to each other, for making another person feel seen, heard, understood, accepted, and loved.  You don’t have to be a public speaker or a presidential speechwriter to make a positive difference with your words.  At work, in your family, with your friends, with people on the street and in the elevator—what is the one thing you want someone to remember from their encounter with you?

I Hereby Commit to NaBloPoMo 2017! Day 1: Shitty First Drafts

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2015 November Gratitude Shorts

2016 Letters to Patients

2017 Field Notes from a Life in Medicine

Day 1:  Shitty First Drafts

I first heard this concept listening to Brené Brown’s book Rising Strong.  It refers to Anne Lamott’s writing process, described in her book Bird By Bird.  Brown uses it as a way to work through strong emotions.  When something hard happens, intense emotions can get the best of us.  Anger, resentment, defensiveness, judgment, shame, and a multitude of other difficult feelings can overcome our senses.  How can we keep from getting sucked into a raging emotional vortex, dragging others along with us?

Write a Shitty First Draft, or SFD for short.  I have done this a few times recently.  I take a pen and paper and let loose.  I vent, rant, SWEAR IN ALL CAPS, draw angry faces, scrawl everything I feel, with total abandon.  This is the first, most subjective and raw version of the story I just experienced.  Man, it feels good, documenting everything from this (self-)righteous point of view!  But it doesn’t stop there.  Sometime later—whenever I’m ready, I return to the SFD to edit and revise.  Curiosity is key here.  What other versions are also plausible?  What am I missing from the other side(s)?  What other story will allow me to suffer less?  What makes me so attached to the SFD?  What core value has been violated here?  What is the most generous assumption I can make about the other people involved? I also learned that last one from my girl B2.

Turns out some SFDs are easier to edit than others.  Seems it depends on the circumstances, relationships, and (inter)personal stakes involved.  In the end, though, it’s well worth the effort.  I realized it this week and posted a musing on Facebook, and my friend offered me a chance to expound:

“CC: Curiosity, Transparency, Integrity, and Openness are saving me right now.

“Friend: I’m glad they are but curious to know how they are?

“CC: They are keeping me focused on the best and most meaningful contribution I can make to the team. As more moving parts get added to the process, I can stand on these practices to respond effectively. In the end, regardless of the project outcome, hopefully I can look back and know that I have very little to regret. …And if I do regret anything, hopefully I will have at least also learned some valuable lessons.”

The more I practice my SFDs, the sooner I can get to healthier iterations of my life stories—ones that allow for forgiveness, equanimity, gentleness (on myself and others), and inner peace.  I used to secretly berate myself for not getting to the peace part faster, easier, more efficiently.  But now I know, the healthiest way out of the shitty feelings is straight through.  The Shitty First Draft is the perfect vehicle for getting to the other side, and I get to drive every time.

 

Two Buttock Riding

 

Continued from last week…

My objective for the coaching session was to figure out where I really want to put my energy for the foreseeable future.  I felt essentially torn between my paraprofessional activities (writing and speaking on physician health, patient-physician relationship, bridging silos in medicine) and my nascent political activism (community involvement, calling and writing to Congress, thinking of running for office someday??).  It felt like I should choose, and yet something told me they could be integrated.

Highlights from the call:

What is your goal for the end of this session?

Clarity and direction; movement.  Readiness to act.

How close are you already?

85-90%

How will you know when you have it?

Hard to describe…  It will be a dual certainty, like choosing furniture, knowing whether I like a person: cognitive and visceral.  It will feel decisive.

How are you feeling now?

Overwhelmed, distracted.  [Recall Doug the dog, in the movie, “Up”—Squirrel!]  OMG there is too much to keep up with: Healthcare, Russia, immigration, refugees, border security, Russia, EPA, what-the-hell-did-he-just-say-and-what-the-hell-does-that-mean?, racism, misogyny, intolerance, Russia, free speech, NIH funding, science, climate change, women’s rights, the Persisterhood, congressional seats up for grabs across the country, and oh yeah, the rest of my actual life.  Every day five new things to look up, articles on both left and right to compare notes, filtering facts from spin, trying to stake independent and educated positions backed by evidence!  GAAAAHH!

What would happen if you didn’t do that?

I do what do, spend hours a day reading and trying to engage in discussion (in person and on social media), in order to be credible in my conversations, to engage from a place deeper than superficial rhetoric or simple emotional reactivity.  My big fear: If I don’t do it, I will become one of those loud-mouthed, uninformed ranters who has no evidence for my broad-brush, oversimplified generalizations and ad hominem attacks.

What is the 98% truth about that?

Not likely to happen.  That’s just not me, I don’t do that.  I always look for evidence to back up what I say, and when I don’t have it, I own up.  If I don’t know what I’m talking about, I listen more and ask more questions, or I don’t engage until I have something useful to contribute.

And the 2% truth?

There is still a risk.  I may spew sometimes—when I get triggered and e(motionally)-hijacked.  I feel particularly susceptible right now, with all of my core values and our generation’s social progress seemingly under attack.

AND, I never live here.  I may wallow a few days (1-2 weeks, max), stewing in cynicism and resentment.  But I always rise up, usually with the help of others, with writing, and with time.  I always come out having learned something, and resolving to apply the learning (usually about myself and my relationships) to whatever comes next.

***

Insights gained:

I’m okay.

In reviewing my time spent on my screens each day, I realize most of it edifies me and connects my mental dots of current events, social science, and personal meaning.  I know not to spend time on baseless rants and otherwise rhetorical opinion pieces.  I choose articles with links to data, history, and primary sources, and ones that challenge my thinking or oppose my positions (sometimes).  I look for nuance, complexity, examples of collaboration and compassionate leadership.  This is what I spend my time and energy on; it broadens my perspectives and integrates the knowledge and ideas I already have.  It fosters my own creativity and philosophy.  This is who I am.

It’s the blog.

This is what I want to spend my energy on.  It’s my platform, my thing.  All the paraprofessional stuff I do was born of this: What gives doctors meaning is the relationships we get in our work—mostly with patients, but also with one another and society at large—status, respect, contribution.  Physician, wellness/resilience, the intersection of health and leadership, bridging silos (physicians, nurses, pharmacists, insurers, hospital administrators)—it’s all about relationships.  And, so is politics.

Therefore, I will use this blog for all of it. I can share my letters to Congress.  I can continue to write about physician-patient relationship.  I know I have written about this before, but somehow it required some reinforcement:  It’s all connected, and it’s all me.

FEAR.

Of course, that’s what really holds me back (yup, written about that before, too).  Fear of attack, rejection, overwhelming engagement obligation and getting sucked into negative, counterproductive exchanges with strangers.  Fear that I have nothing useful to say.  Someone else has already said it better and reached more people.  Who am I to think that my words matter?  It’s all so paralyzing.

I got this.  

I’m ready.  It’s time.  Because: Nothing I say or write, at work or on Facebook or anywhere, is anything I would not say or write in public.  Integrity is important to me—to be the same person in private that I am in public.  I’ve been practicing, and getting better, as evidenced by the civil exchanges I facilitate on my Facebook page (which I will also share more of), bringing together friends from different walks of life in meaningful conversation.  We exchange important ideas, always concluding cordially, all relationships intact and even, I daresay, strengthened.

And, my blog is my space.  I get to manage who comes on (into my house), and I make the rules for how we engage (no poop flinging).  I don’t comment on public sites like Washington Post or New York Times, or large Facebook groups (usually) because that is like leaping into a flash mob of the worst kind.  There is no meaningful exchange or benefit for anyone.  Here, threads can be more personal, meaningful, and transformative.

***

New Goals:

Shift the Boundaries.

I can push my fearful limits and present myself more confidently to the world.  I can choose to plant more color and texture in my front yard.  I can also dig it up and throw it out if I realize it clashes with the house.  It’s all good.  And I must also mind the costs, especially to my family.  So, I can bring them closer by putting the screens out of arms’ reach when I’m with them.  Easier said than done, and definitely worth the effort.

Focus on the WHY.

It’s all about cultivating productive, contributory relationships–first with myself, then with others, and then between all of us, for more peace, love, and joy for us all.

Publish Weekly.

If this is where I want to put my energy, then I want to have something to show for it.  Plus, it’s therapeutic.  Writing calms me, which I need now more than ever, as you can see.  For now I can stop chasing conference presentations, formal leadership roles, Daily Actions to prove I am an engaged citizen.  I can simply write when I am moved—and I am always moved—and share it here.

See you next week!

 

One Cheek in the Saddle

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Hello friends!  I live!

The blog is now two years old (celebratory post forthcoming).  Looking back, I have strayed often from the declared theme of patient-physician relationship and communication.  I have yet to figure out my optimum writing practice and discipline.  And every day the thing I long for most is to write for fun!  *sigh* Life.

If my world were a horse, happily trotting along a winding dirt trail in the Rockies, oblivious to my riding its back, then I would have fallen off multiple times from confusion, inexperience, fear, overreaction, awe, inattention, and impulse.  Sometimes I roll a ways down the hill, too.  The past two months or so have seen all of these and more.  Thankfully, as dust-covered and disoriented as I stand at times, the horse always allows me to remount.  At this point I’m about halfway back in the saddle again—one cheek on.  The next few posts will document my return to two-buttock riding.

***

So much inner work done to date, and so much yet to do!  And I am infinitely grateful for the dense, strong, and unfailing network of support that surrounds me.  2017 could be my most productive and effective year yet, and I need help organizing.  So a couple weeks ago, I scheduled a session with my life coach of 12 years.

Her pre-call questions for me, and my spontaneous answers:

What do I want more of?

Connection, understanding, civil discourse.

To see people being kind to one another.

For people to truly listen to one another and try to understand each other’s points of view.

For us all to hold our shared humanity above all else, and see one another as fellow humans, all trying to make our way through an uncertain life.

Inner Peace.

Time outside, preferably in Colorado, in the mountains, but pretty much anywhere is good.

To write with purpose, discipline, and impact.

Integration—of everything I do, even the small things—for my Why to show up everywhere I go, with everybody I meet, most of all with my kids—to model the Why for them, in person and out loud.

To read primary literature, writings of the great thinkers and contemplatives, past and present.

Discernment—what is worth my time, contributes to my purpose, vs. what detracts from it?

Focus on what I’m for, rather than what I’m against.

Focus in general—to channel my energy to activities that align most with my central mission.  See Distraction below.

 

What do I want less of?

Rage and seething.

Repression of rage and seething.

Time wasted for lack of discernment.

Distraction.  I feel like Doug, the dog from the movie “Up”—Squirrel!  It all matters, but I cannot do everything at the same time.

 

What thoughts are uppermost in my mind these days?

The daily shit show that is our government and how it vexes me (see above, rage and seething)—sooo many squirrels.

I need to do something useful, to help, to contribute.

We are all in this together, we have to get through it together.

This is a test.  We can pass, and with flying colors, and only if we work together.

Every time I get angry, sarcastic, etc., I contribute to the negativity and morass.  I need to be better.

Why have I so much trouble walking the talk?  Why have I not achieved inner peace althef*ingready?

 

I present thusly to my trusted coach. The process always brings new insights, connections, and openings of mind and heart.  I plan to emerge on the other side of 60 minutes with increased clarity, confidence, and drive.  I’ll let you know! 😉

Oh yeah, and the Rules of Engagement also live, just taking an unplanned hiatus.  More of those to come, also.  Like I said, I’m only one cheek back on right now. 😉

 

 

Inaugural Intentions

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Things are feeling a bit dark again…  Reminds me of October, when I got emotionally hijacked by current events and found myself anxious and angry, but wouldn’t admit it for a while.  On the eve of a new presidential administration taking office, tensions run high once again and I’m challenged to avoid a similar decent into despair.

It really helped to take the Holiday Break and write to my friends.  I did it by hand, with colorful pens, stickers, and rubber stamps (I love rubber stamping).  I intended to connect more personally, and that’s exactly what it felt like.  As I see and hear expressions of fright, dread, sadness, anger, and pessimism among them, I intend to continue corresponding by pen and paper.  There’s just something more tangible about it, more intimate and permanent than email, text, or Facebook.  I have included excerpts below—the ones that felt particularly inspired.  They represent my intentions for managing myself in the coming years, of reinforcing my core values and focusing on my highest aspirations.  As Simon Sinek posted once:  “Fight against something, we focus on what we hate.  Fight for something, we focus on what we love.”

To my friends who have expressed, “get over it,” and “stop whining,” I respectfully request that you try to empathize with those of us who feel despondent.  Nothing will improve if we keep ridiculing and belittling one another.  If you experienced this from ‘us’ before the election, remember how it felt.  Rise above our worst collective behavior and help us overcome our fears and disappointment by showing us that we really do share more love and connection than we might think.

Unity and true indivisibility require all of us to pitch in and reach out.  I hope that by one year from now, we can all look back and feel proud of the connections and relationships we strengthened, from left to right and otherwise.

***

What a crazy year…  All bets are off, no one can possibly predict what will happen now—so much anxious uncertainty surrounds us all over the place!  …And yet I feel hopeful and optimistic.  This is the time for our best selves to truly shine—the perfect opportunity to call on everything we have trained for—all of the grit, the kindness, the curiosity, the openness, the brave vulnerability~~~all of it, in service of connection, mutual understanding, and forging a way forward to a BRIGHTER future!  Because we now know, again, in humanity’s history, what darkness looks and feels like.  We can’t stay here, and we won’t—we can each shine a light.  And if we stand close, the light amplifies exponentially.

So thanks for being a fellow light shiner, (my friend)!  May we keep our connections with each other and our other fellows ever close—we need us—the world needs us—now more than ever!!  Keep it lit, my friend.

***

…Hope this card finds you well and HOPEFUL.

Because I have decided that that is what we all need to practice more now than ever—HOPE.  Those of use who strive for conscious living and more connection than the superficial have TRAINED for this moment in history—to PRACTICE OUT LOUD and IN FRONT of everybody—to lead by example and make the difference we were born to make!  We don’t need to do big things—we just need to keep the faith and stay the course!

’Small things with great love,’ I think Mother Theresa said?

Please know I am here to support your efforts, as I know you are for mine!  Let’s get together and hold each other up again soon!

***

…Because I know so many people whose core values represent the BEST of our shared humanity—equality, compassion, community, connection, love, and forgiveness.  The world needs these qualities and practices by us more now than ever—so if we hold each other up, we’ll all be able to do the work better—TOGETHER!!  So here’s to long friendships and deep love!

***

I received this handwritten response from an old friend today.  It warms my heart and holds up my hope:

“While we may snarl a bit at anticipated political shenanigans, let us remember we have strength in numbers and determination to keep life in this country respectful and fair—simply by the ways we live and interact.”

***

And finally, I’m also encouraged that our international leaders express a similar optimism:

Angela Merkel: “I am very much convinced that we as partners benefit more if we act together than if everyone solves problems for themselves, and that is a constant fundamental attitude on my part.”

Peace to all of you, dear friends.  Let us manifest our best every day.

On Experiencing and Expressing Gratitude

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NaBloPoMo 2016, Letters to Patients, Day 23

To Patients Seeking Words for Gratitude:

I found them!

As we head to gatherings tomorrow and seek words to honor and express the occasion, I’m particularly grateful today to see the post below by David Whyte.  Where, you ask?  Why on Facebook, of course!  Back tomorrow with my own original words.  Until then, peace and gratitude to you all!

***  ***  ***

GRATITUDE

is not a passive response to something we have been given, gratitude arises from paying attention, from being awake in the presence of everything that lives within and without us. Gratitude is not necessarily something that is shown after the event, it is the deep, a-priori state of attention that shows we understand and are equal to the gifted nature of life.

Gratitude is the understanding that many millions of things come together and live together and mesh together and breathe together in order for us to take even one more breath of air, that the underlying gift of life and incarnation as a living, participating human being is a privilege; that we are miraculously, part of something, rather than nothing. Even if that something is temporarily pain or despair, we inhabit a living world, with real faces, real voices, laughter, the color blue, the green of the fields, the freshness of a cold wind, or the tawny hue of a winter landscape.

To see the full miraculous essentiality of the color blue is to be grateful with no necessity for a word of thanks. To see fully, the beauty of a daughter’s face across the table, of a son’s outline against the mountains, is to be fully grateful without having to seek a God to thank him. To sit among friends and strangers, hearing many voices, strange opinions; to intuit even stranger inner lives beneath calm surface lives, to inhabit many worlds at once in this world, to be a someone amongst all other someones, and therefore to make a conversation without saying a word, is to deepen our sense of presence and therefore our natural sense of thankfulness that everything happens both with us and without us, that we are participants and witness all at once.

Thankfulness finds its full measure in generosity of presence, both through participation and witness. We sit at the table as part of every other person’s strange world while making our own world without will or effort, this is what is extraordinary and gifted, this is the essence of gratefulness, seeing to the heart of privilege.

Thanksgiving happens when our sense of presence meets and fully beholds all other presences. Being unappreciative, feeling distant, might mean we are simply not paying attention.

© 2015 David Whyte
from ‘GRATITUDE’
In CONSOLATIONS: The Solace, Nourishment and Underlying Meaning of Everyday Words.
© David Whyte and Many Rivers Press 2015