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.

Why leaders fail to understand

I’ve long suspected that I wasn’t alone in the experience of having someone tell me they understood a challenge I was facing when I was certain they, in fact, had NO understanding of that challenge. This HBR post that counsels mentors to stop saying, “I understand” gets to the heart of some behaviors that mentors and leaders may demonstrate that aren’t actually helpful to those in their care. I do want to peel this back a little bit further, thinking about why a mentor or leader would engage in the placating behaviors that the authors describe.

  • They’re scared of feelings– We’re not supposed to have feelings at work, right? Wrong. We’re human, and we are always going to have feelings; being emotionally intelligent requires us to acknowledge, understand, and manage those feelings. Feelings can be Big and Scary; No Hard Feelings is both an excellent Avett Brothers song, and the title of a book from last year that guides us to manage feelings effectively in the workplace. For more on the book (and a sample of the great cartoons it contains), this NPR Lifekit podcast is helpful.
  • They are avoidant of conflict/ dissent- For those who haven’t already learned this lesson, conflict done well can be healthy, and it makes teams stronger. Yes, you read that correctly. Absence of conflict means that new ideas aren’t even being heard or considered, and that’s not helpful for growth and innovation. Much like feelings, conflict seems scary to some, yet fostering respectful, goal-directed dissent within a team is a hallmark of many of the best leaders I’ve worked with. Disagreement does not equate with disrespect.
  • They’re “fake listening”- We’ve all been guilty of this one, be it at work or at home. Sometimes we’re simply distracted. Other times it’s because we’re pretty certain we already know what the speaker is going to say. Deep listening from a place of curiosity, meaning listening to understand, is critical. Making time to do this well is important for fostering trust. And leaders, if you think that those you’re leading can’t tell when you’re fake listening, you have a surprise coming your way.
  • They simply don’t care– Admittedly, this is the least charitable interpretation of placating behaviors, which is why I placed it last. We want to believe that leaders and mentors are invested in the growth and development of their charges and in the improvement of their teams. And yet…we’ve all seen those times when their behavior indicates they’re just not invested. These are leaders/ mentors to be avoided, in case you had any doubt. I recognize that a boss or mentor isn’t in the business of being a best friend and that leaders often have to make unpopular choices. Those things are entirely different than a sheer absence of empathy.

Advice? So show up, be curious, and listen to truly understand. And most importantly, recognize that the team members bringing challenges forward are typically doing it with the goal of making things better for everyone.

The Reading Round-up Returns

I’m going off-schedule, just a bit, because of that little cross-country move that’s coming up this week…

I’ll close out June by resurrecting something I was told many readers enjoyed in the past. At the end of each month, I’ll choose 3 medical/ surgical/ critical care publications, 1 leadership/ management publication, and share what books are on my nightstand with you. So, what have I been paying attention to lately?

More next week from the 406!

Thoughts on Allyship

Ally (noun) someone who stands with or advocates for individuals and groups other than their own (Credit to the Southern Poverty Law Center’s “Teaching Tolerance” project)

Plenty of recent discussion has focused on how those of us who are part of dominant social groups with more power can use that power to give a hand up to those who are not members of those social groups. Between it being Pride month and the myriad race discussions we’re all participating in right now, I’m bringing my own privilege to the table to share some thoughts on allyship. I’ll state clearly that none of these ideas are entirely original to me, and that they are gleaned from a variety of sources I’ve read and listened to, both recently and over time. Two recent HBR Women at Work podcasts episodes have definitely helped me to crystalize my thoughts, both around gender-based allyship and race-based allyship.

Important foundational concept: You don’t get to declare yourself an ally. I don’t get to declare myself an ally. We may participate in actions intended to provide allyship, but that does NOT make us an ally. This isn’t a participation trophy. The title of ally is earned and it’s hard work.

Allyship is not performative (and if you think that folx won’t pick up on performative actions, you’ve got another thing coming). Allyship requires one to provide a measurable difference in the environment for those who are not part of dominant social groups. What is your metric for your own work as an ally? The work of your institution to create a system of allyship (think about culture, practices, process)?

I’ve realized that when we are trying to achieve change that it has to be intentional; we can’t just say magic words and have it happen, and we can’t just make a statement without a plan without doing some work. And, whether we like it or not, our identities impact how we do this work; we have to know ourselves first. The Southern Poverty Law Center has resources designed for classroom teachers, but as someone who identifies as an educator I find this exercise in identity mapping helpful. Not only does it encourage me to reflect on my identities and ways in which they may advantage or disadvantage me, it also lets me consider how I can use my unique self, reach, and influence to do ally work. We each need to seek our “superpower” that is available to us- both in ally work and elsewhere- and intentionally use those gifts as a catalyst for change.

Here’s the thing about being an ally: It’s simply the right thing to do in terms of developing an environment that provides psychological safety for everyone. AND it allows us to understand, recognize, and honor the impact of identity within that broader culture. Doing the work of allyship is ultimately benefits all of us, and it helps us to create a space in which all can and do belong.

I’ll be on my way to a mountain town…

A bit of a diversion this week, primarily in the form of a “what’s going on over there?” catch up…

Some of you have wisely and carefully picked up on the allusion to me moving to Montana. Those who have known me for more-than-a-few-years know that #becauseMontana has been part of my vernacular for a while for both professional and personal reasons.

Work for the last year or so has been rough for me for a variety of reasons. A not inconsequential part of that has been that this Westerner hasn’t thrived here in the midwest, and I’ve got a parent who I don’t relish being quite this far from because of health and aging issues (his, not my own).

I realized just after New Year’s that for me what I was being expected to do wasn’t sustainable. And, of course, job hunting in a pandemic is a bizarre proposition at best.

So I’m implementing “Plan B” that I’ve previously talked about but never executed. Because, as Willy Braun wisely sings in “Snowfall”- if you don’t do it now you’ll be one year older when you do. And, again, if you’ve known me for any length of time, you know that Montana has had my heart for a while.

At the end of the month, Mama C and I are headed back West, this time to Bozeman, MT. I’m taking some time off from traditional work to focus on some creative projects I’ve had to put on the back burner. I’ll be reading and learning and writing and editing (and yes, more blog again). I’ll be tending to my family. I kept my Montana medical license when I moved to Ohio, so don’t be surprised if there’s a little clinical time. It’s pretty likely that I’ll be volunteering on a political campaign or two. Oh, and I’m pretty sure there will be some serious outdoor time.


Rising up

“Justice is what love looks like in public.”– Cornel West

Y’all. It’s been a WEEK, hasn’t it?

Truth that we need to remember: It’s been “this way” for a long, long time (and when I say “it” I mean “unjust American culture that provides privilege to White people”). Centuries. I’m not too proud to admit that I have benefitted, and continue to benefit from these systems. And yet…I don’t want the things that benefit me to come at a cost to BIPOC communities.

It doesn’t have to be like this…right?

Next truth: While the ambient energy right now definitely provides a sense of urgency, we must sustain that energy to make any meaningful and durable change. It’s easy to be distracted by the next shiny object, or to grow tired from working intensely, and isn’t it nice to have the choice to just “turn off” for a while? (Again, privilege.) The work of learning and listening and unlearning and creating deserves better than for us to get distracted or to do it half-heartedly. And if you happen to look like me, you’ve not had to do this work every single day to justify your personal of professional existence like our BIPOC colleagues have; we can (and should) choose to dig deep and sustain.

What I realize that I most need right now, and I suspect I speak for many of us who are exploring how to make a difference, is active hope- hope that is predicated on setting goals, creating plans, and taking action. How can I be an agent for change?

I’ve had to spend some time considering what I love to do and where I can find my greatest contribution, which always drives me towards ideas around teaching and learning, as well as creating places for dialogue. I want for my “active hope” activity to reflect both my skills and my passion so it can be of service.

So, here’s my active hope that I’m committing to, and any of you reading are welcome to (1) join and (2) hold me accountable to keep us going. For (at least) the next 12 months, I will organize and guide an Anti-Racism Reading Group for Surgeons and Aspiring Surgeons. I’ve curated a list of books- more than three years’ worth if we read one a month- and intend to work our way through 10-12 of them over the next year. We’ll meet virtually, which allows for mostly asynchronous discussion, with a wrap-up at the end of each month that we’ll initially try to do synchronously (but still virtually, unless you’re coming to me in Montana). I WANT us to respectfully ask one another hard questions. I WANT us to grow and learn together. I WANT us to make the world around us more just.

Totally Selfish Confession: I know that I need to do this work, and I know that I do my best learning in community. I’m pushing myself and I aspire to at least nudge you too. Let’s be uncomfortable together, please and thanks.

If you are interested in joining me for the Anti-Racism Reading Group for Surgeons and Aspiring Surgeons, please reach out via comment or social media and I’ll get you signed up! School starts July 1, and our first lesson will be Ibram X. Kendi’s How to be an Anti-Racist.

Also, I will be sponsoring a copy of the book for two trainees, so if you are a resident or student who will be joining us, LMK and I’ll get you the July book in your format of choice.