Sunshine and rainbows and killer rabbits

I’m going to go out on a limb and say that some (all?) of you may have noticed at some point that our workplaces can take a toll on our mental health. Sometimes it’s due to things beyond our control (I remember a dreadful July a few years back in the Burn Unit that was no one’s fault). Sometimes it’s that painful stretch between work responsibilities and “life” things that can’t wait. Sometimes it’s a result of unhealthy behaviors or personalities that permeate the culture of a place. And, of course, in years like this one the factors influencing how we’re all doing when everything is uncertain are almost innumerable and the workplace is at best one piece of that.

I’ve also realized that when we are working as a leader that we have a responsibility to support the well-being, including the mental health, of those around us. That means actually listening when they’re explaining why they are struggling, and figuring out what solutions can be implemented. It means communicating effectively, perhaps to the point of having a sense of overcommunication. It means making sure that people are getting the down time (away from work responsibilities) that they both need and deserve. Sometimes it means being vulnerable- authentic- by admitting what’s challenging you or what changes you’ve had to make to adapt to “new normal”. Sometimes it’s having your child or your cat Zoombomb that conference call.

As it should have pre-pandemic, supporting your team’s mental health means asking people how they are doing and actually probing for an honest answer to that question. And when you DO get that answer that tells you they’re actually not okay, it’s your job to provide a more nuanced response than, “It will all be great!”

Positivity is an important feature of resiliency, and we all naturally want the “feel good” of being around people who are positive and make us feel good. However, sometimes the strategy of pushing positivity can have the opposite impact on the intended recipient, who will instead find that they are disappointed that they’re not happy, or frustrated thinking that they might be missing out on something that’s great. There’s a recently described concept of toxic positivity out there that is simply not helpful.

So, how can we support our friends and colleagues who might be struggling right now when we want to give them a gentle infusion of hope while we recognize it’s not all sunshine and rainbows? That’s when we try to achieve support and validation instead of, well, gaslighting people we’re invested in (HT: Mel Charbonneau, both for the reference AND for the acknowledgement of her own struggles right now).

Sometimes we all really just do need that reminder that we’re walking each other home, and some days that includes sitting with our friends and colleagues who are having a tough time. It’s okay to not be 100% okay, or even 50% okay; let’s offer ourselves and each other some extra grace. Don’t be a killer rabbit.

(Bonus points if you got the somewhat obscure Monty Python reference; here’s the clip from Monty Python and the Holy Grail if you didn’t.)

Working while friends

I’ll start with a not-apology for taking last week off; I was in the mountains and didn’t feel compelled to drag my laptop with me (even though the WiFi is better where I was than when I’ve been there in the past). Unapologetic sample photo of weekend activities here:

Prior to heading off for my R&R, I had been inspired by this HBR podcast on the benefits of work friends. I suspect it’s one of those things that many of us know but find challenging to articulate- while we don’t go to work with the explicit purpose of making friends, it’s a bit like school when we’re younger; it’s where we spend most of our hours, and those hours certainly go easier when we’re around peers who “get” us.

And, as one does, I started contemplating my work friends. From residency, there was an obvious choice. We spent almost every evening on the Shoreline Trail walking her dog, having those discussions you can only have with someone else who is surviving the indignities of surgery residency (especially under Old School Dinosaur Rules). When we both took off for our fellowships, we had regular phone calls because it’s hard being in a place for just a year and not having an actual peer group during that time.

Some 21 years after we first met (and 5 kids and a husband later for her!), it’s not possible for us to adore one another more. The best part? We’re only about 2 hours apart right now, something neither of us take for granted.

And, of course, when I went back to Utah, I was fortunate to have a mentor who became a dear friend. We worked closely enough with one another that we absolutely understood the other person’s challenges, but not so closely that we were in each other’s business. We had often been roommates at meetings when I was as resident (budgets, you know), and as faculty we continued that tradition. At one point, one of our colleagues pointed out to us that we didn’t have to stay together for budgetary reasons anymore, a comment we thought was hilarious mostly because it showed that they didn’t understand that it was about having time to catch up with each other, and we would often use the quiet time away from “regular” life to work on shared projects.

And then…we hired my junior practice partner, who is affectionately referred to as my “little sister.” When schedules permitted, we had opera and ballet nights, when they didn’t because of clinical service my Mom would feed us dinner, we supported each other with struggles, and somehow I even convinced her a trip to Cuba would be a good idea last year. I’m that friend…the one who convinces you to do the things you wouldn’t do on your own, but that are so good for you to do.

I’ve been fortunate to have had some tremendous work friends over my career, and particularly so since we’re all still on speed dial with one another. The pandemic has been hard on work friendships due to the loss of proximity. And sometimes work friendships go really, really wrong if someone has more needs than you can meet. I don’t want y’all to think that work friendships are perfect because they aren’t. But when done well (and with the right people) they make work life infinitely better.

August 2020 Reading Roundup

I’m quietly sitting here wondering how it got to be the end of August, but somehow it is. So, what’s caught my eye this month?

I don’t want anyone to miss this PNAS article showing that physician-patient racial concordance and disparities in newborn mortality. Take home? It’s another take-home for supporting DEI in healthcare since Black babies do better with Black doctors, particularly if they are a difficult birth. Let’s keep doing better in terms of expanding who we’re inviting to the “table” in medical school, and let’s also look at other racial/ethnic groups.

Colleagues at Northwestern did some terrific work that confirms what we all have long “known”/ suspected that patient outcomes are impacted by surgeon technical skills. I’m biased as the interviewer, but the author interview was a lot of fun as well.

I have a notorious soft spot for trying to improve rural/ urban disparities in healthcare, and I found this JAMA Network Open article looking at postacute care to be particularly interesting.

HBR (I know, I know, I’m not sponsored…) had an article on the importance of having friendships at work. The accompanying podcast is also worth a listen, and was a real reminder to the impact of work friends on job satisfaction and engagement. Stay tuned for another post next week on work friends.

And my other reading right now?

Fiction- lyrically written, and the story just wraps you in

Current nonfiction, which has been nothing short of fascinating:

And for our Antiracist Reading Group, the August book (which I have learned a great deal from was:

Happy end of August, all, and I hope you’ll all get a brief break for the holiday weekend.

Oh, and register to vote if you haven’t, okay?!?

What if it’s all actually going to be okay?

As often happens, and I hope it’s reflective of me listening to things that are contributing to my growth and learning, I got really curious after listening to a recent HBR Podcast interviewing Richard Tedeschi. He’s an authority on post-traumatic growth, and this interview in particular addressed the potential for traumatic experiences in the recent and current environment, and how we can use this as an opportunity to grow and to create something better, both at the individual and the systemic level.

I’ll openly admit that I’m generally in the “glass half full” camp. I also understand that a global pandemic (and our national mismanagement of said pandemic) is a horrible thing. The racial inequity that the pandemic has helped to place into the open? Again, a horrible thing. The greatest economic “mess” since the Great Depression? Yes, a horrible thing. But one of the questions I’ve been asking myself since March has been a principle that I learned during a post-traumatic growth experience in my early twenties.

What if it’s all actually going to be okay?

The backstory: Two weeks into my second year of graduate school at University of Colorado, my apartment burned (as did our entire building). The fire happened in the middle of the night, and I managed to get out- uninjured- with the pajamas I was wearing, my Aggie ring that was on my hand, and a cat. At 7am on September 10, 1990, those were my worldly possessions.

The month following was a blur…but the things I remember most clearly are my Mom magically appearing within a day, my best friend’s then-boyfriend helping me reconstruct what all was on my bookshelf for the insurance claim (PhD students in English are useful friends at times like this), my graduate advisor and his family taking me in for a couple of weeks followed by our Wesley minister and his family doing the same until my new apartment was available. I also clearly remember the two things that felt almost-normal in that fog: my academic work, and running. So much running…and once I replaced my bike, cycling.

I somehow made it through that semester and the next, and even got my thesis written. The plan was for me to simply forge ahead towards my PhD.

Until it wasn’t. In July, I let my advisor and our director of graduate studies know that I wanted my assistantship put on “hold” because I needed to take some time off. I packed up and headed back toTexas to sort through that last year of my life and to try to make sense out of any of it. I honestly believed I was going back to Boulder eventually. My director of graduate studies told me a few years later, once I was in medical school, that when I left he knew I wasn’t coming back.

I moved home. I nannied. I ran. I saw old friends. I had time and space to think and to try to make sense out of it all. And I realized that I didn’t really want a PhD in International Relations…I was back to Plan A from childhood and wanted to go to medical school. I’m not going to say that by the time I started medical school that all of the pieces were put back together, but I was on the way. In truth, it was more than a decade before September 10 wasn’t a hard day for me. And while it wasn’t okay in the moment, I’ve realized that I grew a lot from a pretty lousy experience. It gave me a heck of a story about my own resilience, as well as the ability to recognize that even in the face of great loss, good things still happen and things are ultimately often okay.

What if it’s all actually going to be okay?

Rest as a radical act?

In mid-June I shared the fact that I was heading west to take some time off from the madness that is our life in academic medicine. I’m not going to lie….time off has been good. Really good. Some of that is location (#becauseMontana), and some of that is simply having the time to think clearly without the pressure of running from one thing to the next. I’ve commented more than once that this has been my first summer off since 1989, and I’m mostly kicking myself because I’ve realized that 31 years is quite a few too many.

Although I’m not a fan of quite a few things found in Leviticus (!), the idea of allowing fields to lie fallow every 7th year has merit. I understand that the Biblical principle was to allow the earth time to rest and heal, but why should we think that doesn’t apply to us as living beings as well? In “regular” academia, the idea of taking time away from one’s primary appointment, typically a semester but sometimes as much as a year, has been woven into the fabric for many, many years.

In medicine, we keep talking about burnout and mental health and asking ourselves how we can better support wellness. In academic medicine, in addition to those pressures faced by all physicians as we take care of humans, we have the role conflicts that arise from trying to publish and administrate and lead and teach; how can we expect academic physicians to have almost any hope of psychological health under stress burdens of that magnitude?

Research on sabbaticals is limited at best, but what is out there does clearly demonstrate a benefit to the individual (decreased stress, increased psychological resiliency, improved overall well-being, new ideas to implement) and a benefit to the organization if someone took a sabbatical leave (stress test of the organization’s “bench”, leadership development for individuals on the cusp, enhanced collaboration). What if I were to say that perhaps, just perhaps, sabbatical needs to be the routine, rather than the exception? Sure, it’s a radical idea, but rest seems to still be a radical idea for us as well (hint: it shouldn’t be).

Late last winter when I was contemplating my options with a dear friend on one of our 5 am runs, she wisely asked, “Have you thought about taking a sabbatical? Maybe it’s your season for that.” Based upon that bit of pastoral wisdom, I’m thinking that we should put the good Reverend Anna in charge of our academic lives…

And if you need me, at least for the time being, I’m here in Bozeman, spending time outdoors (which is balm for my soul), working on a personal writing project, and maintaining a commitment to taking a picture of something that resonates with me every day for at least my first 100 days here. This was Monday’s contribution from the Bridger Mountains, looking East:

What is enough for today?

Concept credit to Jennifer Louden, who graciously posted two questions yesterday…and the one about what would be enough for today really resonated with me!

Confession 1: I feel like I’m crawling my way into the weekend. Confession 1b: I may feel a little guilty for saying that.

Last week I crossed the two month mark of this sabbatical thing, and I’ve still got zero regrets. I realize I haven’t truly been on sabbatical for all of those two months- thanks, cross-country move- and I’ve been awestruck at the number of ways I’ve found to keep myself entertained with scholarly work, collaborations, and ongoing projects.

I also have a (personal) writing project I’m working on and this week I got STUCK. I mean, I don’t know that I wrote 10 words this week, and if I did they were during the process of editing. Stuck-stuck. And when I tried to distract myself by working on a concept for this week’s blog post…same. Stuck-stuck. I mean, I have notes for an idea, but just can’t get the concepts to coalesce. Maybe next week we’ll talk about creativity and post-traumatic growth; it won’t be today.

So here we are, Friday night, with me sharing my awesome case of writer’s block with y’all. I know it’s not permanent, and if history proves anything to me, when it passes the floodgates will open. That’s how my Master’s thesis got written- I did the research but couldn’t pull it together, gave myself some grace with lots of runs and long bike rides to process information and ideas, then BOOM! I think I wrote almost all of it in about 2 1/2 weeks. Since 2020 Bozeman feels not terribly different from 1990 Boulder, I’m hoping it will deliver the goods for me.

I’m not going to go all “Woe is me” either in terms of not getting much (any) writing done this week for my pet project; I’ve done some background research, I’ve talked to a couple of people who have been phenomenally helpful for starting to pull my ideas together (and for reminding me that I can do this), and I’ve figured out what the steps forward will be. It hasn’t been wasted time by any means.

So today, or this week, taking care of me and moving this project forward looks like a reminder that I don’t have to push right now. I can ask, “What is enough for today?” and I can honor the answer to that. Some days that may be lots of words. Some days that may be no words at all and just taking my daily photo of something that strikes my fancy. And some days…some days it’s just reminding myself and all of you who are patient with my writing that we owe ourselves that grace.

For today, that’s enough.

July 2020 Reading Round up

Perhaps somewhat literally in terms of “round up” since I am in Montana now? Anyway, enough with the silliness. For now.

  • As I am likely to do, I want to highlight research on either race or gender with one of my recommendations; the July print edition of JAMA Surgery includes a fascinating examination of the effects of gender bias and stereotypes in surgical training. I’ll also put in a strong recommendation for the accompanying author interview– it was a particularly good conversation (in this interviewer’s opinion).
  • The truth is that we all like to complain about electronic medical records (not unfairly since they really haven’t lived up to their promise). The most recent Annals of Surgery includes two well-written articles debating the impact of the EMR.
  • I’m going to go a little “critical care geek” for just a moment and recommend that you look at this update on basic and translational research priorities for the Surviving Sepsis Campaign. This type of research is definitely not my wheelhouse, and it’s incredibly important work for us to advance the care of critically ill patients with sepsis.
  • You know I’m an advocate for self-care, and that I consider rest to be an act of meaningful revolution. What if I told you that making sure that you get adequate sleep is actually mission-critical to your career development? I understand that in medicine that call schedules obviously impact sleep cycles..but when you CAN get adequate rest, you should. The evidence continues to mount in support of this.
  • July was a busy reading month for me! Between the reading group and my own usual goal of one fiction + one nonfiction book (and doing research for a writing project), I’ve seen a lot of words this month.
Lots of ideas to unpack with this…I’ll be coming back to it, I’m certain.
Definitely well-written, and lots of food for thought about the “urbanization” of many Native Americans in the 1960s and 1970s.
Honestly, it’s a fun read. I’m not sure it was life-changing for me, but I did enjoy it.

Onward, into the dog days of summer…

Practical (but unexciting) career development tips

Earlier this month, I had the privilege of leading a session for our Women in Burns virtual group discussing care and maintenance of one’s C.V.. The reality is that it’s the best common currency we have for demonstrating our professional achievements, and my experience tells me that particularly as women that we often omit or understate things we have done. Hint: that’s not helpful when applying for a new professional role or a promotion.

Rather than re-hashing what I had to say, I’ll just include a link to it here. I will also include a response to a question received off-line from a Very Smart Mentee who just completed general surgery training: No, as a resident or fellow (or even junior faculty member), you don’t need to have each of the sections on your C.V. Just don’t forget to add those you can’t populate yet when the time is right.

A question that also arose during the conversation was how should those trying to get promoted as an educator capture their work. The goal of the educator portfolio is to provide documentation of educational accomplishments, which should encompass not just teaching, but also administration and scholarship. Importantly, scholarship in education typically has a more broad definition based upon the work of Boyer and Glassick (summary document), and often education activities are not adequately captured by a traditional C.V. The educator’s portfolio is a supplement to the traditional C.V., and, again, is important in applications for positions or promotion, as well as for many education awards.

AAMC MedEdPortal has a terrific resource on educator portfolios that is open access, and that provides a good starting point for anyone who thinks they might need one. UCSF also has an excellent resource. It is important to remember that while most institutions will ask all faculty for a teaching portfolio during the promotion and tenure process, that the educator portfolio has a broader scope and is designed explicitly for individuals who identify as educators.

Arguably this may be my least “exciting” blog post ever. I hope it’s practical, and please don’t hesitate to reach out with follow up questions or suggestions.

Well, that wasn’t on my 2020 Bingo Card…

Caveat before I go any further: I took my Board exams in Fall 2004 (QE)/ Spring 2005 (CE) for General Surgery, so I’m well removed from the process. I am not a Director of the American Board of Surgery.

Yesterday afternoon on Twitter I started to see comments from general surgery examinees about technical issues with the QE, and as the evening progressed it became downright horrifying to learn about the experiences of the day…much less the subsequent weird interactions with proctors. By the time I woke up this morning, the QE was cancelled, and refunds for the exam are now being generated. I know many of the people working on behalf of the ABS on the issues of yesterday, as well as a path forward, and I retain faith that a reasonable process will be developed (there’s simply no way to call it a good process)- I say that recognizing that I cannot understand the 1000 things that examinees have gone through in the last 2 days.

Many examinees are surgeons who just finished their general surgery training, and this event compounds the trauma of a Chief year sent sideways by COVID with the uncertainty of how the Board certification process will proceed. And, of course, there are those life stressors many are experiencing with moving, taking new jobs/ fellowship positions, and whatever the “usual” family stress is in a pandemic (because, really, we’re all making it up on that front right now). If there has ever been a time to recognize that the health and well-being of our colleagues is at risk, this is it.

So, a reminder, followed by a mini-sermon about staying healthy in the face of unimaginable stress. Reminder: Yes, passing board exams is important. And one high-stakes exam does NOT, believe it or not, define you or your ability to succeed as a surgeon. Thank you to my wise and thoughtful burn surgery sister Laura Johnson for starting those observations this morning.

And the mini-sermon is this: Do what you need to do right now. If it’s be angry, be angry. If it’s playing your favorite kiss off song at maximum volume on repeat, do it. If it’s hiding in the back of your closet, build a blanket fort for yourself and settle in. I’m always going to encourage you to do things that aren’t self-destructive, but if you happened to have an extra cocktail today, I don’t think anyone would fault you (but please don’t drive or ride your bike afterwards!).

And tomorrow when you wake up, I hope you can take some time to think about what self-compassion looks like for you right now. I personally love this sketchnote grid as a starting place. Your version of being generous and kind to you will look different from your best friend’s version for themself and mine for me. There are no right or wrong answers, other than the fact that self-compassion can be a saving grace…right now, and on into your future.

So, figure out what works for you, then spend some time doing those things while you dust yourself off. I will not be over here doing a puzzle, for the record, but I’m pretty likely to be over here with my giant box of colored pencils.

To all involved in this debacle, “I’m sorry” feels inadequate, but I am hopeful that it helps in some way to know that you are seen and that MANY of us who are out here care about your future.

Medicine’s unspoken epidemic

The good news: The medical literature- and more casual medical publications- is replete with discussions of burnout and “well-being”. Somehow over the last decade an epiphany has occurred that physicians aren’t actually the superheroes that we’ve always been assumed to be.

The not so good news: By many accounts, mental health within our profession is still a taboo subject and we’re simply not doing enough. Prior to COVID, plenty of our colleagues were experiencing everything from stress responses to major depression, with or without anxiety, and with a mismanaged pandemic on top of that…well, it’s hard for even the most resilient to be in a good place.

Before I go on, I want to be clear: I am grateful that we’re talking about burnout and wellness, and I am grateful for those who generously and bravely share their stories on those topics. Because of the nature of our work, we tend to bury and minimize and we just push on through because we were trained to “suck it up, buttercup.” And I hear you those of you loud and clear who speak in derisive tones about your employer organizing a yoga class to check with wellness box (note: I personally LOVE yoga and find it helpful, but I also understand it is not everyone’s jam, and if you say the words “hot yoga” to me, I get downright twitchy).

And yet, I’ve become acutely aware that we’re doing ourselves and one another a disservice when we euphemistically talk about wellness and burnout. We need to stop the sugar-coating around mental health and call it what it is.

Wait, what?

We need to call mental health exactly that, and we need to treat the components of it with the same relevance and priority that we do physical health. Think about the things that you do to maintain your physical health…brushing your teeth, wearing sunscreen, taking medication for a chronic health condition, washing your hands. Those things are all “normal” in day-to-day life, and the last time I checked we had no stigma attached to any of those things- quite the opposite, in fact, since I will definitely judge you for NOT washing your hands!

In contrast, how routinely do we incorporate things that support our mental health into our day-to-day lives? And how often do we feel guilty when we do? We convince ourselves that it’s a luxury and a form of privilege to rest, to say no, to check in with ourselves (or someone we care about) to see if we are REALLY okay.

Then, of course, within medicine there’s the issue of licensing and credentialing and how much more complicated they can become in many places if you’ve had formal treatment for a mental health disorder. We don’t challenge someone’s medical competence for a history hypertension or asthma, but institutions and organizations can make it hard(er) if you’ve got depression or anxiety. When untreated mental health issues have been shown to impact how clinicians are able to function, it only seems logical to me that we would WANT to have people ask for help when they need it. Lives, and not just their own, may depend upon it.

We need to check on each other. We need to check on ourselves. We need to advocate for not just wellness, but for mental health and all that comes with that.

And remember…it’s okay to not be okay. It’s okay to ask for help. It’s not okay to do nothing about it.