Thankful

“There is no joy without gratitude.” – Brené Brown

I don’t know how many of you have a gratitude practice per se, where you make a conscious daily effort to identify at minimum one (and ideally up to three) things each day for which you are grateful. I typically tend to be pretty informal with my approach to gratitude, though lately I have been deliberately making myself write down one thing each day for which I am grateful, trying to be more intentional in my approach to gratitude.

I do tend to think of gratitude as going into one of two buckets- one is the “basics”, those things that allow us to do life on a daily basis.  For those who know my life, my number 1 on this list would be my Mama, who keeps my home and non-professional existence “on the rails” so I can focus on (1) work and (2) chasing joy. While Mama C is anything but basic, she is definitely the key to my daily life. Other basics? My menagerie. This beautiful home. Having a career that I am truly passionate about and feel blessed to “do.” My teams- clinical, administrative, and scholarly. Adventures. My running friends. Hopefully you get the main idea.

Bucket #2 for gratitude is more complicated because it’s predicated on those hard things that happen in life.  While I’ve had at most a handful of these things (again, another basis for gratitude!), it can be too easy to “silver lining” them and to not dive into the real learning that happens from them. In 1990, as I started my 2nd year of graduate work at CU-Boulder, my apartment burned and I lost everything except for a cat I carried out with me and the pair of pajamas I was wearing at 3 am. The easy lesson here would be that it led me to what I’m really supposed to do with my life (partially true), or that it gave me an opportunity at age 21 to start over (really true, but not an experience to be wished for). While those things may be true, the basis for gratitude around the experience is more complicated. I learned how resilient I am. I learned how amazing people in my life were and are. And I learned how to live the Buddhist principle of non-attachment in a way we seldom get to in our lifetime.

The gratitude for hard things should be rare, and it’s something that takes both time and distance to fully process; it was more than a decade before I could make it past September 10 without being conscious of what had happened on that date. Basic gratitude is where that daily practice comes in that helps us find meaning, joy, and keeps us whole.  It can be incredibly easy to forget to be grateful for some of those things- after all, I did just throw a cat out of my lap for sinking her claws into my thigh- but they are the things that provide that day in, day out rhythm of life that ultimately can and should be a source of deep and abiding joy.

“Those days when I keep my gratitude higher than my expectations…those are the really good days.”- Ray Wylie Hubbard

You never even called me by my name…

I continue to think about civility and its importance in how we interact with one another. 

And then I hear tales of medical students who feel completely excluded from their clinical teams because the faculty never learn their name, much less anything about them as people, and the residents may or may not include them in patient care and learning. Passive incivility, perhaps, rooted in simply ignoring our learners.  Passive incivility that results in dehumanizing our learners.

Y’all…really? We can do better.  We have to do better. When this happens in surgery then we wonder why students won’t pursue surgical careers, we have no one to blame but ourselves. Had you been treated like this during a clerkship, would you have chosen that specialty? My gestalt- and some of my older research-tells me the answer is no.

How can we be more welcoming for our learners and help them recognize that we are walking the walk of #youbelonghere?

  • Learn names!  Introduce yourself to them. And introduce your learner to the patients when they haven’t already met.
  • Where is their hometown? Where did they go to college? What was their major? WHY did they choose that? What got them interested in medicine?
  • What identities do they have besides “medical student”? Do they have hobbies? What excites them?
  • What do they want to learn from you? (Reminder: They’re paying tuition.  While our patients always, always come first, we actually are working for the students.) What do they hope to get from their time on your service?
  • What are they curious about today?

I wouldn’t expect one of us to pepper a student with all of these questions in the first 15 minutes (in fact, that could have the opposite of the desired effect!), but they provide healthy, welcoming starting places. More importantly, can you share questions with me that you use to get to know your learners and to help them feel welcome?

(Those of you with appreciation for 1970s Country music may get the reference in the title.  For those who don’t have that appreciation, or for those who haven’t spent evenings drinking beer at the Dixie Chicken in College Station, the title is “The Perfect Country & Western Song”)

R-E-S-P-E-C-T

The context:

I could start with the horrible, saddening week filled with nothing short of rage-fueled crimes in our country.  Really, I consider them a more extreme manifestation of a key issue.

Instead, I’ll refer to a Facebook post from the Association of Women Surgeons networking breakfast that apparently incensed some women because (as has been the custom for many years) there were fashion tips and tricks provided by a professional stylist. While some of the commenters applauded what was for them a fun social activity, others were incensed that AWS felt this was appropriate.

Or a Twitter post today by one of my mentee/ friends, showing her a year ago today when she was VERY pregnant and scrubbed for her last case prior to delivering her 4th child. While some of the commenters were supportive of her ability and willingness to “have it all” (a daunting task that isn’t exactly how it actually works…thus the quotes), others (none of whom had full context) were highly critical of her choices.

What if, for just a moment, we all paused to take the perspective of someone else, someone who thinks differently from each of us?

What if we held that perspective with as much care and thoughtfulness as we would want our own perspective held?

Rest assured, I am not asking you to hold the perspective of someone who is mailing pipe bombs or shooting Holocaust survivors during a bris. I’m a practical person, and there are certain behaviors and thought processes that are simply beyond the pale.

But what if we were able to ease our everyday frictions, particularly those on social media (y’all, it’s the INTERNET for heaven’s sake…it didn’t even exist in a recognizable form 30 years ago!), by taking the perspective of the other?

Is it possible that just for a moment we could add to the kindness that is so desperately needed in our world today?

Our world is filled with injustice and violence.  Let’s figure out how to work together to ease those things, not compound them. Ask more questions. Stay curious.

Priorities FTW!

I’m going to start with a scenario that I suspect isn’t unique to me, but I’ll tell the story from my own experience.

It’s been a long day.  I got up at 4 to run before catching a 7 am flight. I then hit the ground running in the city I’m visiting with lunch followed by a series of meetings on a variety of topics. I have an hour and a half, give or take, to unwind, then it’s off to a working dinner.  Then I’m back to my hotel room at 930 pm (give or take). This is about the time when I realize that I’ve got a LONG list of things that I perhaps should do.

Perhaps.

Should.

And won’t.

The primary reason for this choice is that if I delve into some of those things that are out there, it’s a bit like going down a rabbit hole in terms of the commitment involved. Sleep is a precious commodity that has a strong influence on our ability to perform at a high level. If you don’t believe me, this recent HBR podcast provides additional terrific information on the benefits of sleep, nutrition, and exercise. Given a choice in the evening, it’s never a bad option to shut down and shut your eyes.

Now, I didn’t go immediately to bed. What I did was triage the things that I could do: read to learn something new, answer emails, work on drafts of two different manuscripts I’m in the midst of finishing, have some dedicated creative time and draw something, do some yoga, “play” in my workbook/journal for the day, read everything on Twitter for the last 3 hours…plenty of options, right?

Instead of choosing some dreadful hodgepodge of things that results in Brownian motion (and ultimately feeling like I’ve done absolutely nothing), I stopped to instead consider what was more important for me to rest well and be ready for my day today. 

I triaged email for 15 minutes, and only 15 minutes.

I did my pre-bedtime rituals (skincare and dental care matter, and I have those pesky asthma medications to keep up with).

I laid out my workout clothes for this morning.

I played in my workbook/ journal to document my day, think about what’s been inspiring me, and to consider what creative thing I did yesterday…because that’s part of my wind-down ritual at home.

I set the alarm for 5 am.

I turned off the lights before 1030 pm.

It could have been really easy for me to make some less-optimal choices that would leave my brain busy-busy with that original list of things I should do. It required a moment of being really intentional about what was most important in the moment, and the things that I identified were all designed to help me sleep well (which I did, then I had a great workout and amazing cup of coffee before my day got truly started today).

We’re all faced with almost-endless lists of things that we must and things we should do.  That’s unlikely to change (though that should list is often negotiable). What we can change is the intention we bring to managing those lists. By asking what is important in this very moment we can make the best choices and set the best priorities.

So, what’s important now?

Don’t call it a comeback…

Nope, the blog isn’t dead. It’s just been taking a really, really, REALLY long nap.

The easy thing to do would say, “I’ve been busy.” It’s true for me, as it is for all of us.

The underlying truth is that I was busy when I was writing routinely- and may have been even more busy then, if I’m completely honest. While I’m in this moment of honesty, there are few things I detest more than people telling you how busy they are.  Again, we’re all busy.

Factually speaking I’ve made other choices with my time for the last several months. For those who haven’t done it, moving as an adult can be exhilirating and a really good life choice and (by the way) require huge amounts of cognitive bandwidth and energy.  I had to spend a few months consciously thinking about where the grocery store is, or which turns I take to get to work, or how long it takes to get anywhere. It’s been amazing for my brain plasticity to do this.

And learning to work in a new place for the first time in a really long time- even if it’s a great place (and it is) it’s still all new. I spent the first three months at work reveling in those days when I would walk around the building and actually see a familiar face. That’s a huge change from 20 years of social capital and not being able to walk down a hallway without seeing someone you know, even in the middle of the night. Not good or bad necessarily, just different, and what is required to learn to navigate a new place and new system is not inconsequential. It’s decreasing all of the time, but it’s still a real “thing.”

Of course there’s also the whole piece of moving as an adult and having to rebuild those social networks away from work since I refuse to maintain a unidimensional identity as a surgeon. For those who missed the memo, I am actually an introvert and socializing requires moderate amounts of energy for me until I’m completely comfortable with someone. Making new friends, finding new people to do things with is work- worthwhile work, but work nonetheless. Running has definitely been the facilitator for several new friendships, and I am so grateful for that.

I also had some health “stuff” this summer that really impacted my energy levels and my ability to sit here and type. It’s nothing life-threatening and it’s slowly and surely improving; I’ll just say if I never see poison sumac again it will be too soon.

Why the rambling story? To make the point that I could have kept writing this summer and it probably would have been okay. Instead, I made other choices to focus on learning how to be in my new life here in Ohio and to manage my energy when I felt pretty crummy for a while. Everything we do in life is a choice, not just to do that thing we choose but also a choice to not do something else. Hopefully both of those are deliberate and intentional since we really are saying no (whether we mean to or not) when we say yes.

I’ve been saying no to the blog, and that’s okay. I also have realized in the last couple of weeks with the change in the season that I’m craving more reading, more writing, and more creating. It’s time to say yes again.

 

 

 

 

#WholebeingWednesday

To give proper attribution to the term “wholebeing” (which I adore perhaps a bit more than work-life integration), I need to link you to a post on Karen Walrond’s blog from a few months ago. If you know me at all, you know I’m a HUGE fan of Karen for many, many reasons. Her post knocked my socks off, primarily because she very eloquently and effectively described what many of us are aspiring to in our wellness programs.

Please note my use of the word “aspiring.” And please note that she explains that they aren’t all things that you have to do every single day. For example, I know that yoga is good for my physical flexibility and my mental processing, and I recently learned while reading When that practicing yoga in a class may also benefit my ability to sync with people around me.  Does it need to be an everyday thing to reap those benefits? For me, no. Once a week is adequate, twice a week is ideal, and when I can get to a long-weekend yoga retreat once a year or so, it’s simply bliss. It’s all about figuring out our personal “sweet spot” in those various areas of our lives, then having the discipline to make them happen.

And making them happen…it’s not about “shoulding” all over ourselves.  It’s doing them because we know it’s a commitment to our best selves and our healthiest selves. We do this for our present and future selves. We do it for the people who love us (even on the days we’re pretty sure we don’t deserve it). We do it for our patients. We do it for the people on our team. We work on our #wholebeing because that’s how our best self can keep showing up every single day.

I’m putting a challenge out there because a holiday Wednesday during the first week of the academic year in medicine seems the perfect time. This Wednesday, July 4, will you join me on your favorite social media channel for #wholebeingWednesday? Share an image of you doing something that keeps you whole- reading a book, drawing something, running with a friend (that will be mine), whatever it is that helps you be your best you, and even if it was only for 2 minutes. I can’t wait to see what all of you are up to!

 

Whatever happened to waiting your turn, doing it all by hand?

It’s time for several random observations, because that’s where I am right now.

  • The hardest part of moving somewhere new after being somewhere for a long time? For me it’s been that every single thing I do is a conscious act. It was possible in Salt Lake for me to zone out and remember nearly nothing of my drive to and from work…going to Whole Foods was pretty well an autopilot activity…I would head out for a six mile run and suddenly be back at the house with the run done…everything was routine, perhaps even automatic. Now, not so much, though I know at some point some of those things will start feeling easier (or at least will require less cognitive bandwidth). I do think that in general I’m down to using Google maps a few times a week, as opposed to multiple times each day. It’s a start.
  • I miss quite a few people, and I miss some aspects of the “old” job. Overall, though, I am loving the new work adventure, and I really love Columbus/ Worthington. The change has been good for me. It was time for new challenges.
  • My biggest source of normalcy outside of the house and the menagerie? Unsurprisingly, it’s been running, and I’ve only made one route error wrong turn since arriving here (and it wasn’t dangerous, just took me on a bit of an adventure, and was easily righted with Google maps).  Today was the first run I’ve “dropped” since sometime in the winter, and the only reason I dropped it is because I have an injured ankle. I had some hopes for a triathlon this summer (ha!), but adding swimming and biking in to my schedule along with learning all of my new jobs would be about two too many things. So, in summary, running = normal. And, as ever, a source of sanity.
  • When I’m in the midst of a flurry of academic activity with lots of writing and editing and writing and thinking and writing, the blog seems to go by the wayside. The good news is that I need the blog less to keep my writing skills up when I’m doing copious professional writing.  The bad news is that I miss the creative outlet. Missing that creative outlet is why you, dear reader, are the beneficiary of tonight’s brain dump.
  • Tonight’s blog title is courtesy of Miranda Lambert’s song “Automatic”, in case you were wondering where it came from.

Fall down seven times, get up eight

General comment: Moving and starting a new job is HARD. Nothing in life is “automatic” right now. Nothing. My learning curve is vertical every single day.  That said, it’s all going well and I’m loving it.

While there will ultimately be a manuscript from my Presidential address last week at the Association for Surgical Education meeting, I wanted to share some key points sooner than later.  The address was entitled “You Belong Here” and was focused on how we create an environment of belonging for each other and for our learners.

As you might expect of me, I issued a series of dares for those in attendance with a series of action items. If you weren’t there, or if you need a refresher, here are the dares and their associated action items:

  • Dare #1: Have a conversation with someone who “pushes your buttons”
    • Action item: Take a hard look at your core network (and find people who are different from you in any way in which they can be different)
  • Dare #2: Nurture two-way relationships
    • Action item: “How can I help you?”- This question will completely change your relationship with everyone around you.  Especially if you ask it of people who “push your buttons.”
  • Dare #3: Know who you are
    • Action item: Lean into the mess.  No one can be you as well as you can, even when you’re imperfect.  Especially when you’re imperfect.
  • Dare #4: Practice “Radical Candor”
    • Action item: Speak your truth. Respectfully.  And listen, listen, listen.

Stay tuned for more details on any/ all of these items.  Oh, and I know it’s reading round up time.  Look for that later this week!

 

March 2018 Reading Round up

I know…it’s about time.  Boxes all were successfully packed and made it out of Salt Lake and now we relate their arrival in Columbus.  This month’s reading round up will focus more on general media than the medical literature, mostly because there have been plenty of juicy tidbits out there recently.

OHSU has added “compassionate communication” to their medical school curriculum.  The rest of us should likely follow suit.

While the letters in response to this New Yorker article appropriately took issue with the failure to represent the perspectives of the staff who cared for Jahi McMath, her story itself remains fascinating.

Increasing amounts of research demonstrate the benefit of self-compassion in staying healthy both physically and psychologically. Many of y’all know I’m an Eric Barker fan, and he had a recent blog post on how to be our best selves that focuses on the role of self-compassion in success. The question of “How should you treat you?” is incredibly important as a cornerstone.

Here’s my one medical journal contribution for this month: opioids for chronic back pain and for osteoarthritis really, truly are the wrong answer. Changing our practices around opioid prescriptions in any specialty is urgent.

Last but not least, in honor of the time change tonight, can we just make the nonsense stop? Here’s some interesting information regarding why (at least in DC) year-round DST isn’t a bad idea.

Happy reading, y’all!  And more soon as I get settled in.

February 2018 reading round-up

Apparently moving and travel and…well, life have all been a little hectic.  Let’s get back on track with the February reading round up, if we may.

Opioids and our role as surgeons in the current “opioid crisis” is an ongoing hot topic.  This study helps to establish an evidence based for duration of postoperative opioid prescriptions.

If you’ve worked with me clinically you know that I am a big advocate for our pharmacists having a high level of engagement in the care of our patients, particularly those who are critically ill.  Not surprisingly, this new French study shows that having our pharmacy colleagues enforce quality bundles decreases LOS and drug costs.  Friends, listen to your pharmacists.  They are very smart people!

Sexual harassment is yet another hot topic; I wish that Academic Medicine had made this statement free to all readers, but I want to let people know it’s out there if they have access.  We’ve all got to work together to get harassment and discrimination of ANY sort into the “historical interest only” category. Zero tolerance is a key piece in that.

Closely related to this Academic Medicine viewpoint are two things from HBR.  First, their current Big Idea focuses on “Now what?” around the #metoo movement.  HBR podcasts also have a new “Women at Work” series that so far is worth the time invested in listening.

My other reading right now is Shawn Achor’s new book Big PotentialIf you are leading a team or aspire to lead a team, or simply want to succeed in life, I would call it “highly recommended.”