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.

Wasting of time sitting still?

I’ve made a deliberate effort of late around the concept of mindfulness and of trying to be more present.

In other words, I’m trying not to engage as egregiously in zoning out and checking email and catching up on Twitter when I’m supposed to be paying attention.  Meetings are, of course, a special kind of danger zones for these things. So are completely overprogrammed days, when my entire schedule consists of running from Point A to Point Q to Point L, with no breathing space available and…when was I supposed to have lunch? Days like those are the days that stress me out.  It’s not that I can’t handle the day itself.  It’s that when I’m doing all of the to and fro, I lose the ability to manage my energy.  And when I lose that ability to recharge, even if it’s only for 30 minutes a couple of times, I know I’m not at my most present.  I also know that I get grumpy.

When I “check out,” when I start that multitasking, there’s clear evidence that I’m probably making things worse rather than better (ladies, the link applies particularly to you).  And while I wasn’t successful in keeping it controlled the entire day, late in the day I was cognizant enough to start using the, “Right now, it’s like this” framework to remind myself that days like these are truly exceptional.

Today’s tactical error that I know has been helping of late? I did NOT sit for 10 minutes this morning prior to getting the day going (though, to my credit, I didn’t start with email either).  I’ve learned that 10 minutes of sitting and just breathing after the alarm goes off helps me to feel like I’m setting the tone of my day rather than having it set for me.  Even with that knowledge, after a late evening and with an early morning I skipped it.  Not a great choice because I’m learning that it’s a total set-up for distraction for almost the entire day- or at least the parts when I can be distracted and not seem completely inappropriate.  The day took control of me.

So tomorrow, I’ll sit again for 10 minutes when the alarm goes off (with a purring cat in my lap if I’m really fortunate). That’s the part of it all that I can control, and it lets me set the tone to make the rest of the day go more smoothly afterwards. It’s not like the day was a wholesale disaster; if anything, it all ended up fine. It’s just that process, being present and engaged through all of it, could have been less bumpy. I’m grateful that I get the chance to reflect and do better.

And if you’re looking for ideas to help you be more mindful at work, I am particularly fond of this list.

Sitting still?  Apparently not a waste of time at all.

(And for those who may have caught the slightly obscure musical reference, you’re welcome.  REM from 1984 is as good now as it was then.)


Looking back and looking forward

Ah, 2016.  In some ways it’s felt like a doozy.  For those of us of a certain age (Generation X friends, I’m looking at you), we lost too many icons. Any year that takes Haggard, Prince, and Bowie is a tough year for me to reflect on my musical “upbringing.” Politics have been divisive and difficult. And whether you loved or didn’t love Hilary Clinton as a Presidential candidate, you had the opportunity to witness a huge public display of misogyny.

I had plenty of things in my life that didn’t work, and so many that did.  I’m still trying to stuff 10 pounds of sugar into a 5 pound sack in terms of juggling my clinical, administrative, educational, and research obligations- though 90% of it is stuff I really do love.  Some days there’s simply too much of some of the good stuff, you know? I was part of an amazing group of women who successfully executed a $10 million capital campaign for our sorority’s foundation. I got phase 1 of a qualitative research project I’m absolutely passionate about (effective mentoring in academic surgery) completed and am starting to dig into phase 2 (barriers to careers in academic surgery). I ran 9 half marathons, all of which involved friends and fun and most of which involved travel to terrific places; in the course of that I set a new PR in January then again in May. I completed my term as President of the Association of Women Surgeons and started my term as President-elect of the Association for Surgical Education. I spent 10 days on a river in the Alaskan Arctic rafting, hiking, and realizing that no cell service and mandatory naptime are very, very good for the soul. I got a teaching award from our graduating medical students, and had what I would argue is my proudest career moment receiving an Outstanding Alumna award from the Texas A&M College of Medicine. I fell in love over and over with Bozeman, MT, during my off-time, and I spent more time back in the homeland in a calendar year than I have in a long, long time. My breakfast taco titers are good for at least a while. I yet again had the privilege of caring for people of incredible resilience and beauty. And most importantly, I continued to revel in having my Mom (all around amazing human and my biggest cheerleader) a mile away. None of this crazy, messy, wonderful stuff would happen without her here to manage the “little stuff,” including the animal family when I’m on the road.

Full disclosure:  There were also some really challenging moments, most of which happened in September.  Details aren’t important at this point, and I have to say that as sad/ angry/ hurt/ frustrated as I was about what happened, I learned a huge lesson: I have a group of folks who have my back no matter what, both in my personal life and my professional life. The power of that is not to be underestimated.

So what does the best version of my 2017 look like?

  • New challenges with a big, passionate “YES!” attached to them.
  • More writing because I love it- some academic, some not, all creative and done in joy.
  • Gratitude and appreciation.  Every. Single. Day.
  • Connection and friendship are EVERYTHING.  Keep the coffee date.  Block out the time and hop on the plane. Send the note.
  • Remembering to #choosecourage and #lovelouder.  I learn time and again that these are the two most meaningful things that each of us can do in our daily actions (even the ones that feel small) to generate a tremendous ripple effect.

Onward and upward, friends.  Onward and upward.




Pick your poisons, choose your evils

I’m always a bit more introspective around the Solstice, and this year appears to be no different.

And, of course, we’re living in a time of upheaval.

So with that, for today’s post I give you Wendell Berry’s “Questionnaire.” It seems timely and provides food for thought for us all (though it is admittedly much darker than a great deal of Berry’s writing). Should we be asking this of our political leaders?  I don’t profess to know the answer, but I’m beginning to think it might be “yes.”


How much poison are you willing
to eat for the success of the free
market and global trade? Please
name your preferred poisons.


For the sake of goodness, how much
evil are you willing to do?
Fill in the following blanks
with the names of your favorite
evils and acts of hatred.


What sacrifices are you prepared
to make for culture and civilization?
Please list the monuments, shrines,
and works of art you would
most willingly destroy


In the name of patriotism and
the flag, how much of our beloved
land are you willing to desecrate?
List in the following spaces
the mountains, rivers, towns, farms
you could most readily do without.


State briefly the ideas, ideals, or hopes,
the energy sources, the kinds of security;
for which you would kill a child.
Name, please, the children whom
you would be willing to kill.

…and doggone it, people like me

Many of us remember laughing at Al Franken’s Stuart Smalley character on Saturday Night Live; for those who don’t remember the skit, the character is focused on repeating positive affirmations (and it’s still worth a watch).

I’m currently reading Appreciative Leadership, which I’ve am convinced may be the best leadership book I’ve read ever. The authors provide a framework for using appreciative inquiry as an approach to leadership.  The framework uses five “Is” for appreciative leadership: inquiry, illumination, inclusion, inspiration, and integrity. As I read the chapter on Illumination, I’ll admit I giggled thinking about a Stuart Smalley skit for a moment, then realized the actual value of positive self talk for generating what the authors call “positive power.”

If you think about when you’re at your absolute best, what thoughts are you having about yourself? Chances are that this is not when the word “loser” comes through your mind repeatedly, or when you’re wrestling with a case of impostor syndrome. Now, if you extend this to your team, what thoughts do you have when your team is performing at a crazy-amazing level? Again, I doubt that you’re thinking about how tired you are of Bob and Betty fighting, or what a poor lead nurse Billie Jo is.

Admit it- when you recall situations in which there was great success, you tend to go positive with the things you think about.  It immediately tells you what your and your team’s strengths are, and it gives you confidence to perform at a high level.

Time for a confessional: As I thought about using strengths and success oriented self-talk, I had a moment of self-illumination.  I realized that during the times when I have not been a good leader, when I’ve been petty and difficult, it has uniformly come from a place of insecurity. And what’s put me there? That little voice telling me that I’m not enough, that I don’t belong there, that I really can’t do this.

Additional confession, or wisdom grown from my own lack of it: If I’ve learned any lessons in the last decade, one of the biggest ones is that people “feel” that insecurity and that sort of inner monologue.  They know you’ve got doubts, and if you’re supposed to be leading them they’ll start to doubt themselves and the team too.  It becomes a vicious cycle.

That leader stands in stark contrast to the “I’ve got this, and we’ve got this” leader who instills confidence in the team, makes them more capable, and helps them to achieve at a higher level.

Which leader do you want to be? And what are you telling yourself about your ability to be that leader?


Have you seen my mojo?

Just wondering. I’ve been looking for it, and it’s certainly not been here in the land of writing.

I’ve been busy, though no moreso than usual.

I’ve had “blog” on my to-do list quite a few days and then it’s bedtime and sleep is precious.

I’ve even been stalled on the revisions on my Favorite Manuscript EVER for the last week.

I’ve kept a low profile on Twitter, and I’ve kept my news exposure to a minimum as well.

What I have done:

  • Taken care of the burn unit and our patients
  • Had a few really great runs
  • Went to post-Thanksgiving yoga
  • Finished our book group book for November
  • Kept up with my New Yorkers
  • Got all of my upcoming travel organized (more or less…)

I suspect there are one or two other things I’ve done, but those feel like the highlights to me.

Reading round up at the end of the week, I promise, and more to come in December.  And otherwise, I’ll count this as taking care of me for a bit- which is something all of us in the helping professions probably need to do more of.






The aftermath

It’s weeks like this when I find myself hoping that I’ll sit down in front of the screen and find some magical inspiration.

And yet…I’ve learned this week that many of us in America are scared, and it’s based upon different fears that make it incredibly challenging for dialogue to happen. Some fear economic instability while others fear their stability will be disrupted.  Some fear that social justice measures are taking opportunities away from them while others fear that loss of social justice means they’ll be marginalized. Almost all of us fear the unknown, which is definitely what we seem to have wandered into both socially and politically, with economics almost certain to follow.  Just as polls and pundits were completely unable to predict electoral outcomes on Tuesday, none of us know what’s next (and if anyone did, would the rest of us trust anyone’s speculation at this point?).

And yet…I found myself on Wednesday wishing that I had a “free hugs” t-shirt to wear. It felt like almost everyone needed a hug, even if their reasons were different.

And yet…I’ve taken some of what I’ve seen and heard this week as a lesson that if social justice is truly one of my core values (and in fact may be my Absolute Core Value) that we still have plenty of work to do.  I personally have work to do in this dimension, yes, and I now recognize that it’s too soon to be complacent, too soon to act as if we are post-racial, post-gender, post-LGBT, post-disability, post-any marginalized group.  I’m speaking up more, I’m reaching out to friends who have fears because they are LGBT or Latina or defy gender identity, I’m sending money to organizations that I know do good work in social justice.

And yet…I have long defined myself by the mantra “Work hard, be kind.” This week I added “Choose courage” and “Love louder”.  That’s the response that I’m choosing in the aftermath.  And whatever courage and love look like for you, I hope you’ll choose them and do them a little louder.  That’s my hope coming out of a bitter, contentious, fear-filled election season for each of us.

Or, to quote Anne Lamott, “Hope is not about proving anything. It’s about choosing to believe this one thing, that love is bigger than any grim, bleak shit anyone can throw at us.”

Indeed, it is. #lovelouder


Keep it simple

Opening confession: I’m writing this as much for me as I am for you, readers.  I had intentions of writing about resilience today because it’s been a recurring theme for a bit. Instead, you’ll have to read about it next week.

This morning as I was listening to the weekly dharma message from Susan Piver, her focus was on simplicity in our meditation. As I listened to her incredibly simple (and brief) message, I realized that as I go into a week that is always characterized by absolute pandemonium, simplicity is exactly what I need to focus on right now. If I’m 100% honest, simplicity has probably been a sub-theme for the last couple of weeks for me.  I’ve noticed that I have unintentionally been laser-focused on getting some tasks (which may or may not have been procrastinated upon!) finished; many of them are tasks that involved things cluttering my house and my creative space.  It felt really good to get those things done and get the associated “stuff” out of my way.

So, simplicity.  It seems like an oxymoron if you look at my schedule this week, particularly for the next 2-3 days. I’ve got multiple times that I’m supposed to be multiple places. Yes, I know that I haven’t been cloned (yet), which means I’m going to have to make thoughtful choices and then embrace them. Those choices will absolutely be based upon what is most meaningful to me, and if you’re with me this week you may see me making some tardy entries and early exits. I emphasize the issue about things being meaningful “to me” because that also means that I have time blocked into my schedule to run and for some yoga…because those things are meaningful to me (and, quite candidly, no one wants to be around me if they don’t happen).

I can’t fix the fact that I have chosen these things that will make me intensely busy the next few days, but I can choose how to best manage that busyness. I can be present in the moment (another choice), I can turn off for a few minutes every day (even 5 minutes helps, right?), and I can be grateful (this morning while walking Olivia I reminded myself, “You CHOSE this. And how fortunate you are to have been able to do so.”).

Who’s with me?  Let’s be simple together.

“The key to finding a happy balance in modern life is simplicity.”- Tibetan Book of Living and Dying

Routine Vs. Ritual

Confession: I have a strong tendency to rebel against structure; structure and order simply are not my default modes of living and working.  Yes, I’ve learned to do work within structure and in a way that is orderly, though that is primarily a way of controlling the chaos.  If you look at my weekends when I’m truly off, about the only things you’ll find on my calendar will be “run” “yoga” and (during the appropriate season) “symphony”.

Someone recently observed that I’m reliable about getting my runs in, about writing, about walking Olivia, about going to yoga, amongst other things, and that demonstrates that I am committed to structure and order.

I, of course, argued against that idea, with my argument founded in how I differentiate routine, which is definitely about order, from ritual in my day-to-day life.  See, a routine is defined by pattern and regimen, and it’s characterized by a certain ordinariness (drudgery even?). Routine is doing the dishes after supper, or putting the recycling can out on Sunday nights. Routine is that weekly meeting that you are obligated to at work.  Routine is fixed and rigid, and I had a moment of joy when I saw that Merriam-Webster defines it as “a boring state… in which things are always done the same way.” Routine, in my mind, is obligation.  It’s the “must do” stuff.  It’s what sometimes gets referred to as adulting, which is an activity I’ve come to realize is completely overrated.

Why do I think of ritual differently, when it has some of the same characteristics in terms of patterns? Ritual’s word root is shared with rite, which has a spiritual or religious overtone. It’s more ceremonial, and rites can be part of a celebration. If you look at those habitual things that I’m reliable about, they are things that bring me joy, that I don’t consider drudgery (okay, there’s that rare run, but generally speaking…). They are activities that leave me feeling better than when I started them, that often challenge me, that are the foundation for (hopefully) making me a better version of myself. While I still tend to treat them as obligations, they aren’t the obligations that I see on my calendar and start secretly hoping that they’ll be cancelled.  Yes, there is structure around running on Saturday mornings at 7 with my running tribe, but there’s no question that it’s a challenge that I love. There’s structure around hurrying home after my run for a quick shower and snack before Restore Yoga, but there’s no question that I always leave yoga feeling better than when I got there. There’s structure around walking Olivia every single morning when we get up, but there’s such shared joy in our outdoors time together that I would be foolish to not be part of it.

I suppose the challenge becomes in trying to turn some of those routine things into ritual, which is entirely about changing mindset. Maybe tomorrow I’ll look for some joy in doing dishes…