Illuminate

2017.

I’ve experienced grace. And light. And wonder. And inspiration. And joy.

Some days it’s been a genuine struggle to find any of those things, but they’ve always been there in some measure, no matter how small it has seemed at the time.

I’ve dreamed big, even when sometimes that’s meant not having any idea about some of the details.  Honestly, there’s been plenty of “I don’t know exactly what this is going to look like, but I know it’s going to happen.” Consistently leaping has resulted in a net appearing, and I attribute that to more than luck.

I’ve asked hard questions of myself and of people around me. I’ve listened to the answers to those questions, and when I’ve found them unjust I’ve made it clear that’s not acceptable to me. In other words, there’s been a lot of integrity and authenticity, even when it’s uncomfortable (usually moreso for the person who doesn’t like my lack of interest in tolerating BS than it is for me).

I’ve said yes to things I’m excited to do, particularly when it involves people I adore.  I’ve said no when it’s strategic. Hint: I have never, ever regretted a no.  Not once.  I can’t say the same for a few times when I’ve said yes and ended up resentful. I suspect there’s some wisdom in there.

Don’t be fooled: parts of this year have been arguably the most challenging of my life. But the group of people I alluded to last year who have my back no matter what? Yep.  They’re still here.

Each year I select a “word of the year”. For 2018, I’ve known for a while that it had something to with light, or shining, or glowing. Christmas Eve I finally got it right with a word that lets me shine as I help other to do the same.

illuminate– to light up, to shine, to throw light on. Or…to help clarify or explain, to elucidate, to give insight into, to demystify

I’ll be doing more of that this year, friends, and I hope you’ll join me to let your light shine as well.

 

 

 

Make a wish, dreams come true, go on sail the ocean blue

Christmas night.

All is calm, all is bright here.

There’s the obvious “everything’s a little chaotic as I get ready to sell the house” going on, but other than that…I’m enjoying my first Christmas off in more years than I can remember. It’s been a long time.

Rather than pontificating about the end of the year, what 2017 has or hasn’t been, I realized that what I really wanted to was to share wishes for you for Christmas, or 2018, or Monday, or whatever it is that you choose today.

  • I wish you good health and safety
  • I wish you justice
  • I wish you kindness, both given and received
  • I wish you the ability to feel the fear and do big things that you’re passionate about anyway
  • I wish you the opportunity to create something meaningful to you
  • I wish you time with people for whom you care deeply (and who reciprocate that care)
  • I wish you moments of magic and wonder
  • I wish you both happiness and joy

And, as I sometimes provide with posts like this, a musical interlude that seemed just right for the occasion.

We are shame-full

A couple of weeks ago I was out for one of my routine dinner dates with Gia Lewis and Tom Varghese; dinners like these are something I highly recommend as a way to stay connected to your core values with people who share them.  And, of course, we manage to resolve plenty of the world’s issues and discover that we’re all wickedly funny.  I also walk away from these dinners learning at least one new thing.

Other than encouraging you to hang out with people you adore (because we ALL need more of that!), there really is a point to the story about our recent dinner. We got into a fairly intense discussion of surgical culture and the fact that moving the needle to be more inclusive and kinder is just plain hard. Sure, there are all of those things that we learned in kindergarten (credit to Mind Shift for this great infographic).

But somehow in the moment of being an adult and trying to get ahead, we lose sight of so many of those things. Or we’re taught that they aren’t actually cultural expectations where we are, and slowly we become less connected to the value of not hitting people (perhaps not physically, but you get the idea) or telling people we are sorry. Most importantly, we transition from the idea of feeling guilty (“I did a bad thing”) to feeling shame (“I am a bad thing”). As Gia astutely stated, in surgery we are cultivators of artisan shame: “We water it, we cultivate it, we sell it at the Farmer’s Market on Saturday morning.” (See, I told you we’re funny, even when we’re speaking painful truth.) And, of course, shame is highly correlated with maladaptive behaviors and burnout.

So what is a surgeon to do to help herself and her colleagues function in a less shame-full world? Besides warm cookies and cold milk, how can we help change things? Brené Brown has some ideas, of course, since she’s made a career of researching shame- and I’ve had a couple of interesting email exchanges with her about shame and surgical culture.

Brené on surgical checklists: “When they teach those folks how to suture, they also teach them how to stitch their sense of self-worth to being all-powerful, and all-powerful folks don’t need checklists.”

Yep.  This is us.  This is who we are. And watching her TED talk again left me with so very many questions if we’re going to do this and foster a place that supports creativity and innovation…

How do we help each other be less afraid to fail?

How do we help each other to conquer impostor syndrome?

How do we help each other be “enough”?

How do we apologize to each other, to our patients, to their families when things go wrong and we make those mistakes?

How do we help our female colleagues understand that we do NOT have to do it all?

How do we help our male colleagues understand that it’s okay to be weak, it’s okay to fall down?

How do we get rid of secrecy, silence, and judgment that allow shame to flourish?

How do we help each other to show up being our best- and imperfect- selves?

Perhaps the secret starts exactly where we were on that Friday night- hanging out with people we adore.  I want to believe it’s a first step.

 

 

December Round-Up

Yes, you notice…I left “reading” out of it.  I’m going to share exactly one article today relevant to academic medicine; I believe it’s that important and I don’t want you to miss it as many of us consider issues of “talent acquisition and development” in our profession.

We don’t have many WWII Veterans left out there.  I’m grateful for the story from this one, and what a treat to see him fly in the plane he jumped from on D-Day!

Many of y’all have heard me say I have no designs to run a marathon, and I persist in that stance.  That said, this woman’s description of what motivates her to train for a marathon aligns almost-perfectly with my thoughts on running. #irunbecauseigetto

We run because we get to

If you’ve kept up for any length of time around here, you know I am a fan of Eric Barker and his “Barking up the wrong tree” blog.  In mid-November he dropped some wisdom about the friends we need in our lives, and there’s no time better than the holidays to look at that list (and the list definitely relates to the picture above from yesterday’s run-these ladies and I have referred to one another as “hide a body” friends more than once!). Related, his book that came out this year is the best leadership book I’ve read in the last 3 years.  Truly.

I try to throw some good listening in here every once in a while.  Chris Stapleton has a new album out as of Friday, and it’s worth your time. I promise.

And because I do believe we can all use some levity, I think this may be the best story of 2017. Can we make #drunkpossum trend on Twitter?

November 2017 Reading Round-Up

What’s piqued my interest recently? The usual “quite a few things”…

After last weekend’s latest horrific mass shooting, this article about converting bystanders to responders seems more relevant than ever. If you want to learn how to Stop the Bleed, look for a class here.

We should trust our OR staff when they tell us there are patient safety issues.

Faculty development anecdotally is a common pain point for surgical educators. This survey data confirms that we’re trying, and we’re struggling.

I really, really love stories because they provide so much meaning to us.  Apparently narrative comments are also helpful for understanding trainee performance.

Fun reading for November: Another Brooklyn by Jacqueline Woodson.  I’m about 5 chapters into this, which is our book group reading for the month, and it is wonderful.

And now, an added bonus per a Twitter request-

Mis novelas favoritas en español:

Como Agua Para Chocolate– Laura Esquivel

Cien años de Soledad– Gabriel Garcia-Marquez

La Casa de los Espíritus– Isabel Allende

Tía Julia y el escribidor– Mario Vargas Llosa

Cristóbal Nonato– Carlos Fuentes

“It’s not your time”

I’m hopeful, dear readers, that we can have a bit more of a dialogue this week.  I need to learn something, and I particularly need the wisdom of the men in the audience.

One of the undeniable joys of spending last week on the road at the American College of Surgeons Clinical Congress is the time I got to spend with surgeon-friends from many places and at varied career stages. Yes, there was learning and thinking and organizational work, but at the end of the day the connection is (as ever) what means the most to me as I reflect. I came home so thrilled to know more about the work that my friends are doing, and feeling supported in my own.

As one would expect if I’m spending time with varied surgeon friends, it also means that I got to spend time with some phenomenal surgeons/ scholars/ leaders who happen to be women. As one would expect, plenty of stories get shared.  As a qualitative researcher, I’m always looking for themes in stories, and last week was no exception.

What I heard was quite a few amazing, talented, accomplished women with tales of leadership roles deferred or denied, with the standard rationale of, “It’s not your time” or “We need to give Brad* a chance.”

This is where I need the crowdsourcing help, because I only know the female experience of many of my colleagues and myself. I feel like in the last year I’ve heard more and more of this sort of deferral or denial. Is “It’s not your time” code for implicit or explicit bias that keeps women out of leadership roles they have legitimately earned? Or is this a reflection of generational shift, and is something that’s being used to keep men and women who might buck the status quo a bit out of roles that, again, they have legitimately earned?

If this is simply reflective of old institutions dying with a long exhale, we need to address it.  We need the best leaders in the most crucial roles, and we don’t need to wait for that.

If this is truly a “new” form of gender bias, it’s even more imperative that we address it. Nothing will change unless we do, and, again, we don’t need to wait.

Help me learn, readers- is this gender or generation bias at play?

 

*”Brad” is simply the standard guy, and is usually the standard white guy who doesn’t upset the apple cart. My apologies to any Brads out there because I do, in fact, know that some of you are amazing people and leaders who do think beyond tradition.

October 2017 Reading Round-up

I ran away to Montana for a few days and suddenly it’s October.  I don’t know why these things often surprise me, yet sometimes they do- particularly the months that change on the weekend.

So, what do I think is interesting at the moment?

In the world of burns, this article is one of what I hope will be many looking prospectively at blood product transfusion in our patients. Thanks to my friend Tina Palmieri for her fearless leadership of this important multi center trial.

I’m excited to share this systematic review by my Utah colleagues examining endovascular vs. open repair of AAA. Hint: lower mortality, higher complication rate.

The October issue of the American Journal of Surgery is the annual Association of Women Surgeons issue.  Regardless of gender or specialty, there’s pretty much something for everyone in there.

I hope this piece in Academic Medicine can help some of my pre-tenure friends and colleagues normalize their experience a bit.  It’s not easy.  It is worth it.

In place of a bonus reading recommendation this month, you get a bonus viewing recommendation. I am completely smitten with Simon Sinek‘s work right now and am obsessed with finding ways to incorporate it into academic medicine. Don’t know who he is?  Here’s his TEDTalk on “How great leaders inspire action.”  18 minutes well-spent, I promise.

Happy Fall, y’all!

 

Step outside your comfort zone. Do scary stuff.

I had good intention of getting this post up early in the week.  And, like many good intentions, it’s now Friday…but I’m still within a week of doing something a little scary (for me) so it’s still sort-of news.

In July and August I took part in a fitness challenge that encouraged us to try activities that were new or different from our “usual.” I’ll confess that new things I have now tried include mixed martial arts workouts (hard and fun!) and ballroom dance workouts (harder than you expect! and good grief I’m not a dancer!). Most importantly, this challenge got me into the pool a few times and reminded me that I’m actually a reasonably competent swimmer.  And, interestingly, when I’m not swimming because it’s all I can do with an injury, I kind of like it.

Since I have a history with both cycling and running, some of you might see where this swimming revelation is leading. I haven’t totally pushed myself outside of my comfort zone since my first half marathon (December, 2014, for those who are keeping score), and I’ve been trying to figure out what I could take on that would challenge me.  Semi-logical answer?  Triathlon!

So, with only about four weeks to get swim training under my belt I signed up for the Brineman, sprint distance.  I put a few bricks- riding followed by some running- into my workout schedule. I stayed up late deciding if I needed a wetsuit for the race or not (decision was yes, and with the 45 degree temps that morning I was grateful!).  I ordered the cutest (and most functional) tri kit ever to wear and tested it out during my brick workouts. I practiced open water swimming in the Willamette River when I visited Portland over Labor Day weekend because that was the truly intimidating part of this whole crazy idea for me.

And last Saturday, I got up really early so I could swim, bike, and run. I was incredibly fortunate to have three friends who signed up to do the Sprint as a relay so I had an awesome cheering section.  And… another of our friends who has been on “injured reserve” from running magically appeared at the swim start and helped to sherpa gear, take great pictures, and cheer for all of us.  I know some of y’all have heard me say, “Find you tribe, love them hard” before, and Saturday morning they were there full-force.

Here’s the before.  And yes, I’m thinking, “I don’t have to do this…it’s not too late to chicken out!” when I’m standing there contemplating it all.

The tribe. I may be a little jealous of the two who have dry land legs for their relay. Also jealous that J has done a full Ironman so this swim is just a little thing for him.

 

 

Once I was out of the water (I just don’t want to discuss it other than my celebratory phrase being,
“I didn’t drown!”; in truth my performance in the water was Very Respectable), it was on to the bike.  Confession: this is my favorite leg.  Shh…don’t tell the people who think of me as a runner. Also, I love the dryland segments because of all of the cheering one another that goes on between athletes.  If you’ve run or ridden with me, you KNOW how I am about encouraging people!

Game face coming out of the Transition.

Then, the run.  The part that I know I can do and can do without trouble (3 miles is NO problem!). And I can’t tell you how much I loved the folks who commented, “Looking strong!”  That’s such a powerful reminder that yes, I’m strong, and I’m rocking this.

Coming out of Transition 2. Legs feeling a little weird. But I’m running and that’s my joyous place.

And…scene. I’m a triathlete!

If you’re wondering, yep, I’ll do this again, and with more than a month to train for swimming I’ll even look at a longer distance. I mostly loved it. I learned a lot about myself and my ability to be brave.  And I was totally outside my comfort zone (swimming, people, swimming) and did a Really Good Job with my first triathlon.

What’s my hope in sharing this story with you? Don’t be stagnant! What’s something that you can do that will challenge you, maybe even make you uncomfortable? Set a goal.  Go for it. That’s how we change ourselves.

Coeur Sports logo, which is pretty much my life mantra.

Heart and courage, as the logo on my tri kit says.  Heart and courage.

 

September Reading Round-Up

Yes, we’re almost a week into the month. In a somewhat unusual turn of events, I actually took the holiday weekend OFF.  I thoroughly enjoyed it.

So, what’s caught my eye recently? A few things.

  • Which surgery residents are most at risk for attrition? We have some ideas based upon this outstanding paper. Now we need to figure out WHY this happens.
  • We tend to be generous with pharmacologic therapies in the ICU setting, generally for good reason.  Nevertheless, medication errors are one of the most common safety report issues in hospitals. This Clinical Practice Guideline from SCCM reminds us that we do need to be good stewards and identifies the opportunities for doing so.
  • Are you struggling with giving your learners feedback?  It’s not a surprise with the dearth of high-quality, evidence based recommendations.
  • For those who aren’t aware that Montana has lost over 1 million acres to fires in the last two months, here’s a relevant online piece from the New Yorker. Between Harvey hitting my cultural homeland last week and watching a state I’ve grown to love burn, I’ve got a lot of sadness about events largely beyond anyone’s control right now.  Irma is the proverbial frosting on the cake.

Fun reading? I may have too many books going right now.  I pulled out some Brian Doyle (The Plover) for my trip to Portland last weekend because it only seemed appropriate. If you’re not familiar with his work, this essay gives you a lovely taste of it. I’m reading (and learning from!) Michael Bungay Stanier’s The Coaching Habit.  September book group is our annual foray into nonfiction, this month with Ta-Nahisi Coates Between the World and Me.

Happy almost-Fall, y’all.  Stay safe!

The rest of the story

Some of y’all have been helping me to celebrate a not-so-little piece of work that was published last week, and I truly appreciate the enthusiasm for the manuscript and what it means for our understanding of mentoring in academic surgery. When I posted that this work was a labor of love for me I meant it; I started looking into questions around mentoring in surgery when I was a resident through my ASE SERF project.  At that time, what I really wanted to do was a qualitative project that would help us better understand what mentoring should look like. Alas, 16 year ago I had neither the resources, the time, the know-how, or the patience to do this.  I’m still proud of the work we generated that year but it wasn’t what I really wanted as my major contribution in this area.

So, fast forward to 2014 (yeah, I know, that’s a long fast forward). I started on one of my curiosity/ passion projects, intending to expand upon work we’ve done describing barriers to careers in academic surgery. Again, the first pass was survey based and more quantitative, and just like the original mentors work I worried that something was getting lost in translation.  I believe in the power of story, I had learned quite a bit about grounded theory method through our professionalism work, and I had a couple of VERY willing accomplices who are also patient when projects take a while.  In this case, “a while” means 3 1/2 years from Interview #1 to online publication of the first manuscript from the project.

The interviews that I started in January, 2014, and that extended over the course of the next 16 months were intended to illuminate the barriers to careers in academic surgery.  I believe they’ve done that, and the barriers manuscript associated with it is in the works.  However, I realized about 6 interviews in that I was going to have the stories to write the mentoring paper that I wanted to write in 2001-2002; mentoring was raised as a critical factor in every single interview about career barriers, and this happened without any nudge from the interviewer. Of course, once the interviews were done my collaborators and I spent a few months working out our conceptual model, and once that was done there was manuscript submission, revisions, more revisions followed by rejection, selection of a new journal, resubmission, revisions, then acceptance.

Submitting this manuscript was arguably one of the hardest things I have done; in truth it was harder emotionally than submitting my professional paper in graduate school was, primarily because of the level of personal investment I have in this topic. Mentorship is something I am passionate about, it’s something I think is incredibly important (thanks to the interviewees who confirmed my bias!), and I love the work that Leigh and Will and I generated about it.  When you send a manuscript like this one out you want everyone to love it as much as you do, even though you know that’s probably not what will actually happen. That rejection HURT, particularly because of how long it took to get there after trying really hard. Perhaps it reminded me a bit too much of my last bad boyfriend.

Anyway, back to the relevant story. As part of the mentoring process I wanted to share with people (particularly junior faculty!) the time line behind all of this.  I know that the tenure clock doesn’t encourage projects of this nature, and I recognize that’s one of the shortcomings of our academic system as it currently exists.  My take home message would be if there is something that you MUST figure out, if there are questions that you MUST ask, don’t let go of them. It might take you 15-ish years, a fair amount of heartburn, incredibly patient friends/ collaborators, and some late nights puzzling over getting something that seems really minor “just right.”

It will be worth it.