Enough. Or perhaps too much.

It’s been a weekend that has highlighted some of the baser instincts present in our society, hasn’t it? While so many of us want to believe that we as a country are better than this and are achieving our ideals, events like Charlottesville provide an incredibly harsh reminder that we aren’t even close yet.

It’s easy to look and think, “I’m not in Charlottesville, and I’m not in Virginia. This isn’t about me or my neighborhood and there’s nothing I can do.”

I’m going to challenge you and tell you that this is about your city, your state, your community and that there is PLENTY that you can do. Reading the news, seeing the remarkable photos from Charlottesville, I’m using this as an opportunity to double down on my commitment to peace with justice and inclusion, and trying to not just provide lip service.  We have GOT to move from words to deeds, friends. Or, as you’ve heard me say more than once in this space, we must #lovelouder.

While you need to do what works best for you, here’s what I’m doing.

  • I sent yet another contribution yesterday to the Southern Poverty Law Center. The SPLC was founded in 1971 and is doing some of the most important work today on civil rights FOR ALL. I hope that you will familiarize yourself with their work and that you will consider providing them with financial support. What they are doing makes a real difference and is so critical in a time when hate crimes and racism are so prominent.
  • I’m speaking up. Yes, I know, y’all are used to me saying something when people are unkind and unfair. I’m going to be even more tuned in to comments that show bias…and I’ll be letting people know that’s not acceptable.
  • I’m educating myself and my community. Earlier this year I did a pretty good job sharing #TuesdayTeachings on Twitter, which were items that provided more understanding of the underpinnings of various forms of discrimination. I’m recommitting myself to learning more and to sharing what I learn with you- and I’m trying my VERY best to get that information from members of the communities experiencing discrimination.
  • I’m looking at my circle of friends for diversity and inclusion.  I like to believe that my circle of friends is pretty diverse- immigrants, POC, LGBT are all well represented. But I’m looking again to see how I can expand my circle, and I’m seeking guidance from those friends on how to be more inclusive both personally and professionally.
  • I’m listening. While I may not agree with or understand everything that people put in front of me, I will do my best to respectfully hear them and learn from their experiences. Sometimes that is really, really challenging!
  • I’m promoting minority friends and colleagues. It’s unfortunately easy for us to put names forward for awards/ panels/ leadership roles of people who look like ourselves; I refer to this as nominating the “usual suspects.”  While I’ve long sought to make sure to include the not-usual suspects, again, I’m doubling down here. As an additional comment, I am carefully looking at the program we are developing for Surgery Education Week next Spring to ensure that our speakers, moderators, and panelists are diverse. I want everyone to believe #Ilooklikeasurgicaleducator
  • I’m walking the walk. If you have seen me in action, you know that all of the above are more than words on a screen.  One of the most important ways that we can influence those around us is role modeling the behaviors we want to see in the world. I won’t say I get it just right every single day because, as I have said before, I don’t know what it’s like to be a member of many of the targeted communities. But I can make a good faith effort, I can ask for feedback from people I trust, and I can apologize when I mess up (and not make the same mistake twice). For those of us trying to be strong allies, these are important concepts.

I’m going to challenge each of you who are part of my reader community to choose something- no matter how small you think it is- and make that your focus to #lovelouder this week.  If you want to share in the comments or in social media your intention to make you more accountable, that’s great.  If you want to write it down on a post-it and put it on your computer, that’s also great.

Words and deeds that diminish any of us ultimately diminish all of us. Remember that, and please act accordingly.

August 2017 Reading Round-Up

It was the 4th before I realized it was time for a new reading round up.  How did August happen?!?  And, of course, we’re back to business this month after last month’s not-so-light reading.

The “opidemic” is an issue getting plenty of press right now. And, of course, while patients deserve proper pain relief after we do things that hurt them (surgery, for example), we have an obligation to be responsible in our approach. Here’s more data about how often prescription opioids go unused after surgery. I’m proud of our group’s practice of carefully monitoring our prescribing practices, educating on safe storage, and providing lockboxes to patients.

There’s no question that Oregon Health Sciences is ahead of the curve in their development and implementation of the concept of the Academic RVU.  Here’s their story on how this happened and what it means for faculty.

Intraoperative teaching is not easy, and we know less about it than we should.  This systematic review synthesizes what we do know- particularly that there is often a disconnect between faculty and learner perceptions.

And a recent nonfiction read that definitely provides some good food for thought: A Selfish Plan to Change the World by Justin Dillon. Any book that instructs readers to “find their riot”?  That’s good enough for me.

 

But I don’t WANT to!

Now that I’ve channeled my own inner toddler, I’m willing to bet I just channeled a few of your inner toddlers as well.

What is it I don’t want to do?

Networking.

Admit it, you might have cringed a little when you read that word. It’s something that’s foisted upon us as a necessary evil in career development. And it’s something that makes many of us feel…well, icky, for lack of a more professional word.

Certainly there are a group of people for whom networking comes naturally; the are able to dive in and meet people and find ways to connect to them. For the rest of us, networking is a more deliberate process, and one in which to keep our integrity we also need a way to remain authentic. If you want a quick fix, here’s an HBR article on learning to love networking that has four key steps.  I want to focus primarily on the idea of finding a common interest (which I also associate with help-seeking), one of them that’s quite easily controllable and that creates a specific type of culture.

Think for a moment about someone you know who is an amazing connector (I’m going to use that word to remove any negative connotations). That person who seems to know everyone, and whom everyone seems to know, and that familiarity is consistently in a positive sense. Chances are that person will in some way align with Adam Grant’s definition of a “giver,” which may be a secret to getting ahead, and certainly fosters a specific type of positive culture.

Where am I taking this?  I’m trying to move us from the idea of networking being transactional, because that seems to be when we get that dirty feeling about it. What if we thought about networking in a purely relational sense? What if we sought things that we have in common, and we asked questions and actually listened to the answers?  To quote from Eric Barker‘s recent book, what if we shared our Twinkies by finding small ways to help one another?

When we use a relational framework, networking seems strangely akin to friend making- it’s all about liking and being interested. Or, as Glennon Doyle Melton wisely phrased this a couple of years ago, “I really, really think the secret to being loved is to love. And the secret to being interesting is to be interested. And the secret to having a friend is being a friend.”

One more tangentially related thought: if you have friends you haven’t connected with recently, take this as a reminder that it’s time. I’ve not once regretted the coffee date, the run, the weekend when I’ve made time for it.

 

It’s lonely at the top

Some of you may be aware that I’m about three years into a two year project** examining barriers to careers in academic surgery; in its current form, the project focuses on women in academic surgery.  In what isn’t likely to be a spoiler alert, while some gender-specific factors are identified, the preponderance of what we’re seeing is both systemic and cultural, therefore impacting the pipeline in general, not just for women.

The major gap in the information that we have to date involves hearing the stories of those who choose to leave academic surgery. I’m aware of this limitation and have plans to address it, which means that this Sunday Review from the New York Times struck a special chord with me. The glass ceiling is real in business and in academia, and while the need to fix it is widely acknowledged, we still don’t entirely understand its etiology. What we do know is that theoretically it should be less of a pipeline problem than it was 20 years ago. In spite of more women entering surgical training, a recent study shows that gender parity in academic surgery will not happen in my lifetime.

Advice on how to get ahead, while well-meaning, doesn’t serve to fix the deeply embedded cultural issues. Preaching to already high-achieving women about how to fix themselves is likely too little, too late, and engages to a degree in the “victim blaming” I’ve been known to rail against when discussing burnout.

Interestingly, there’s a tie between the loneliness described by the high-achieving women in the Sunday Review and burnout. While the basis for loneliness is complex and is only in part attributable to a sense of “other-ness” in those who aren’t historically represented in leadership roles, it quickly becomes obvious that it plays a substantial role in burnout…burnout can result in exit…exit results in loss of (diverse) talent…you can see the downstream effects here.

I’m offering myself some thought challenges that I want to extend to each of you (yes, you, as you say, “I’m not a leader!”).

  • What if today you tried today to bring more compassion to your team through a kind word or supportive act? Hint: “Thank you” counts as a kind word. If you can be specific in that thanks, it’s doubly valuable.
  • What if today you worked to get someone connected into a network of some sort? Confession: being a “connector” is one of my FAVORITE things to do!
  • What if today you helped someone celebrate a “win,” no matter how small that win feels- or if you celebrated your own? If you’re on Twitter, please share your own with #WednesdayWins.  We need for this to become a “thing” to remind ourselves of what’s going well.

 

**Not actually joking about the time line.  Anyone who has experienced the joy and misery of qualitative research and grounded theory understands exactly what’s going on here. 

Taking care of you, because no one else will

The concept of “self-care” is definitely a cornerstone of wellness discussions. It also appears to have become something of a generational battleground. Staying at work for a week and eating poorly and not seeing the light of day is no longer considered the badge of honor it might have been. Nevertheless, we all have these pesky adult and professional commitments that preclude us from focusing on ourselves all day, every day.  Surely there’s a happy medium in there somewhere?

A lesson I learned about 10 years ago is that I need to have a list of the things away from work that bring me joy, and that it also helps me to recognize how often I need for them to be part of my life.  Examples?

  • Walks with Olivia– daily, at a minimum. This is important head clearing time for me.
  • Running– the benefits for me are myriad.  It keeps my head on straight, it gives me time to think, and I just feel better for completing a good run.
  • Yoga– I know that going to a weekly group practice is best, and it makes a difference when I keep this in my schedule
  • Live music– A couple of times a month.  The rules match my OR music rules: No rap, no metal, no Britney Spears.  I love Americana and “alt-country” (again, as many of you know) and also have a great fondness for outings to the symphony and the opera.
  • Reading, particularly literary fiction- I still remember getting halfway through my intern year and realizing that I hadn’t read a novel all year (and that I really missed it). The moment our in-training exam was done in January, I dug back into good novels and haven’t stopped since.

I put my own list out there not with the goal of making it your list, although I’m always happy to share ideas in any of these areas. I put it out there so that you can see that none of these are majorly time-consuming unless I choose to make them a Big Deal in my schedule.  In fact, it’s pretty easy with some practice to prioritize all of them in a way that I get to push the reset button for an hour or two AND still manage my grown-up responsibilities. And even though I fight it sometimes, I know that these things really do contribute to helping me be my most effective self.

So, what about making sure we’re our most effective on a day-to-day basis, even in the midst of a chaotic day?  I loved this piece in last month’s HBR, probably because all of the ideas they raise are things that I’ve espoused or embraced in one place or another.

  • Cut yourself a break: I’ve previously summarized this blog post from Karen Walrond as “Try your best, cut yourself some slack at the end of the day, rinse, repeat.” Why is it so much easier to be kind to those around us than we are to ourselves?
  • Value time, money, and resources: No is a complete sentence if something doesn’t align with what you want or need to get done.  Truly.  Practice it often.
  • Take a victory lap:  How often do we celebrate our “wins”, either individually or collectively?  This week I started something new to me on Twitter with #Wednesdaywins. If you’re on Twitter, I hope you’ll join in there.  If you’re not, I hope you’ll develop your own practice.
  • Surround yourself with good people:  Maybe it’s a product of being in my 40s, but I simply no longer choose to have time for people who drain my energy (see “value time, money, resources” above). I definitely view friendships as a mutually supportive enterprise, and have chosen to surround myself with spectacular people whom I LOVE having as part of my life.  Some of you have heard me say, “Find your tribe. Love them hard.” It’s key when things get challenging.
  • Update your workspace: Okay, I really don’t have much to add here.  I am better than I used to be controlling my desk piles.  Mostly.
  • Recharge and reboot: Those walks with Olivia?  That’s part of it when I get out of the hospital.  At work, sometimes I’ll just go for a walk between the Burn Unit and my “real” office. I’ll pause and fix myself a cup of tea. I’ll walk through our therapy gym so I have an excuse to stop and visit with one of our rehabbing patients. Or I’ll sit down and simply chat with someone I find interesting; this person can be a co-worker, a patient, or a family member. Sometimes just getting your head out of what it’s stuck in can make a HUGE difference. If you want to be Zen about it, it helps you detach from whatever is troubling you.

So, what can you do this weekend to be more effective for next week? It doesn’t have to be onerous, and ideally it will be fun.  Most importantly, I hope it brings you some joy.

 

 

 

You can have it all, just not at the same time

“The price of anything is the amount of life you exchange for it.” -Thoreau

Common refrain from faculty (that may be a symptom of Impostor Syndrome):  “I just can’t do everything.”

My response: “Yes, you’re correct.  You can’t. None of us can.”

We have essentially two key limitations in the battle to do everything, as I see it.  First, our day has 24 hours in it.  We can fight that one all we want and pretend it’s not true, but that’s the day we’ve got.  Then there’s the second limitation of energy.  We’re not set up like the Energizer Bunny to simply go…go…go…quick battery change…go…go…go.  I’m sure almost all of us can think of the last time we tried that (all nighters in college, anyone?) and the net effect is never what we hope it will be.

As mentioned in the July Reading Round-Up, I’m working my way through Eric Barker’s Barking up the wrong tree right now.  Chapter 3 has a great section talking about someone brilliant who has a chronic illness that can be incapacitating. This individual adopted a strategy for many years of accomplishing one thing a day, even on the bad days.  Sometimes that meant that he was only able to cook dinner if that was the day’s goal; the key was to choose that one thing and do it.

Here’s what he had to learn that we all try to superhero our way out of at some point in our career: every single choice that we make to do something means we are choosing to not do something else.  When we spend hours on Facebook, we’re choosing (perhaps only subconsciously) to not work on that research project that needs our attention. When we spend time working on that research project, it comes at the time expense of watching Game of Thrones. When we spend time with our family, it comes at the expense of finishing the day’s charts.  If you have a background in economics, you’ll recognize this immediately as every choice we make in life having an opportunity cost.

If you have a young family or an aging parent, focusing on them may be your first choice for a few years and it may require you to choose to let something slide from a scholarly or administrative perspective. If you’re building a career as a researcher, you already know that forces choices about what you can and should do from a clinical perspective. If you’re trying to stay mentally and physically healthy, you might choose to save that manuscript where it is right now and leave for yoga or go out for a run (note: I often find that by doing this I end up being more productive, perhaps because it gets my brain into a different space).

Again, every time we choose to do something, we are choosing to not do something else.  That alone means that we can’t do everything.

Here’s a thought experiment for you, cribbed directly from Chapter 3.  What would you do if you were ill and could complete only one task per day?

There’s your answer to what matters most to you, and what should be done first.

And when you thought, “It would NOT be clean my house!”, that’s probably a hint to you too.

Here’s to a week of making wise choices, one at a time, that allow us to do those things that matter most.  What is your big goal this week?

(Title credit to Leigh Neumayer, content idea credit to Jamie Lewis)

 

 

July 2017 Reading (and listening) Round-up

It’s that time! Here’s the July, 2017 edition of what I’m reading, supplemented with some of what I’m listening to. Here’s a hint: It’s summertime, and I’m not going to give you any academic reading right now.  So there.

Fiction:

June’s book group novel was La Rose by Louise Erdrich.  The writing is lyrical, the story a bit magical…so much goodness, and it resulted in a juicy discussion.

I’m just settling into July’s selection: Case Histories by Kate Atwood.  I’ll report back, but the first 50 pages have been fascinating.

Nonfiction:

Barking up the Wrong Tree by Eric Barker– I’ve recommended his Sunday blog/ email more than once.  The book is a terrific complement to his usual investigation style that helps enhance personal success.

Other:

From HBR, ways to weave self-care into your workday.  I love that they also support the idea of not “shoulding” all over yourself.  It’s an unhealthy practice.

From the New Yorker, “America’s Future is Texas.” It’s a great explanation of how my home state really is a bellwether for current American politics.

Listening:

Sam Sanders (from NPR) is also an expat Texan and recently started his podcast, “It’s been a minute.” Tuesdays are a “deep dive” with another public figure, and Fridays are a catch-up for the week.  Highly recommended- I’m listening to his interview with Timothy Simons as I type.

For my foodie friends, I recently stumbled across “The Food Chain” from BBC.  Each week they focus on a food or food culture related topic in a very approachable manner.

Last but not least, a plug for NPR’s “Up First.” It comes out daily Monday-Friday and gives you 15 minutes of news highlights for the day.

Happy Dog Days of summer, folks!

 

Perfect Circle

Wednesday was a bittersweet day for me.

I’ve previously mentioned Danny Custer, whose last day operating at Baylor Scott & White was Wednesday of this week.  Danny had a remarkable career as a pediatric surgeon.  He was also our clerkship director when I was a medical student, and proved to be a huge influence on me. Even though I had no intention of becoming a surgeon when I started medical school, between he and Sam Snyder (and some really spectacular residents, including the husband of a college roommate) I was a “clerkship convert” to this crazy life.  Anyone who has been in my OR when I’m directing how long I want suture to be cut has heard the words “bunny ears” more than once.  I inherited that phrase from Danny. Danny was amazing with families, adored the children, taught with the patience of a saint, and made every day of “work” an incredible amount of fun.  His passion for his calling was contagious and I always, always mention him as part of my own story in medicine and in surgery.

Wednesday morning I got a text from one of my former student mentees who is now a resident at Texas A&M/ Scott & White. Kyle went to Temple knowing that Danny was one of my mentors, and I appreciate that he texted me the first day he operated with Danny as an intern.  Wednesday’s text was to let me know that it was Danny’s last day and that he would be operating with him for his last case.

My first reflection was one of gratitude that I have mentees out there who stay in touch.  Those moments are why those of us who teach pour our hearts and souls into what we do.

My second reflection was also one of gratitude that Kyle was operating with Danny on Danny’s last day as a surgeon. There was something incredibly special in knowing that someone I have influenced for good was helping to close out the career of someone who had such a positive influence on me.

Bittersweet.  And an absolutely perfect circle.

 

Coming clean…

Obvious confession:

The blog has been a bit of a ghost town for the last few months.  You’re aware, I’m aware. Twitter hasn’t been an echo chamber, but I’ve not been as present there either.

Not-so-obvious confession to most:

Professional life has been messy and hard, and I’ve struggled with how to process that. Heart and Brain provide a near-perfect summary of what it’s been like (though I’m not sure the brown stuff would have been quicksand had I drawn them).

Personal life has been fine, great even. I have professional friends whom I’ve entrusted with what has been going on and who have been amazing advocates and supporters. I have other professional friends who haven’t been in the loop on things but who have consistently reached out with a kind word when I’ve needed it most (serendipity, FTW!). I have running  friends who have stuck with me when I’ve stopped for an ugly cry in the middle of a 10K. I have friends who have been around seemingly forever who are simply there and constant and kind. While you might not think that in your late 40s your sorority sisters would provide a life raft for you, they have done precisely that. As I told one of them a few weeks ago, “ADPi has saved my sanity the last 18 months.” Mom is great and healthy.  Dad is navigating the indignities of Parkinson’s with grace. Other than Belle!’s anxiety (maybe she’s channeling for me?), the animal support team is awesome. If you look at the ledger strictly from this side, I’m incredibly fortunate, and I won’t deny that. I am grateful for all of these things every day.

Then there’s the professional side.  Lots of things on the “good” side of the ledger there too. I work with the best team that anyone could ask for.  I take care of the most remarkable and resilient people that I could ask to be entrusted to care for. It’s a rare day for me to walk through clinic or the burn unit without getting a hug from a patient, family member, or both. Outside of my clinical work, I’ve been entrusted with leadership roles that I consider both a privilege and an honor. Again, these are the things that keep me going and for which I am grateful.

And yet…there’s this body of literature (which I am in the process of contributing to) that describes why women leave academic surgery and academic medicine. That literature has become intensely personal over the last 6-9 months for me. I’ve found incredible irony that the system that I’m trying to help fix, to make more equitable, has nearly chewed me up and spit me out. While I always found it tragic that many talented women were exiting academic surgery, even 10 years or more into what should have been remarkable careers, I now “get” how this happens. I would be a liar if I didn’t say I’ve thought about walking off. I don’t do disappointment and disillusionment well.

So what?

I’m still working on the answer to this question. What I do know is that I’ve moved past taking it all personally and simply being hurt. If anything, I’m realizing how important some of the intellectual work that I started out to do a few years ago truly is and that it’s time for me to double down on those efforts. I’m focusing more on my core mission(s) and doing the things that are the most meaningful to me. And I’m reminding myself at the close of every single day of those things I am grateful for; there are plenty of them, and they help maintain that sense of purpose that I need.

If you’ll excuse me now, I’m off to tilt at some windmills.  Thanks for joining me.

May 2017 Reading Round-Up

Brand new month!

So what’s out there that is catching my eye?

We all spend quite a bit of time thinking about how to improve teaching of technical skills.  What about using video-based coaching to supplement OR teaching?

What does the public know (and want to know) about overlapping surgery?

The 2016 State of the Science articles for burn care are out. These cover everything from burn resuscitation to community reintegration, and are all important comments on where we are in burn care (and how far we have to go).

And bringing out my inner policy geek, here’s a great overview from Politico on what the impact is for the GOP if/ when Obamacare repeal fails.

Catching my ear is the “Up First” podcast from NPR. I seldom have time to listen closely to the news throughout the day, so this is a great summary of what’s happening.

Happy reading (and listening).