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Thoughts on life and work and family

Confession: I’ve been spending quite a bit of time the last month or two contemplating priorities. I don’t know that there has been a single specific reason for this. It’s more been a constellation of events that have resulted in this pondering.

While I’ve been thinking, this JAMA Surgery research letter examining retired surgeons’ reflections on their careers was published. I think the findings are open to some interpretation based upon lived experiences, but what is clear to me is that you don’t see respondents saying they wish they had done less to support their own health and their families. And, again, how we care for ourselves and our families looks very different for each of us in terms of time, activities, geography…almost in any detail (see below mention of resource allocation).

In addition, this week Clayton Christensen died and the HBR has featured some of his seminal writing. That led me back to his essay, “How Will You Measure Your Life?“, now almost a decade old and no less powerful. He has three foundational questions that he asked his MBA students in 2010:

  • How can I be sure that I’ll be happy in my career?
  • How can I be sure that my relationships with my family can be a source of enduring happiness?
  • How can I be sure I’ll stay out of jail? (Note: I reframe this one as “How can I be sure I’ll live a life of integrity?”)

His discussions of resource allocation and marginal costs in how we live our lives speak to my economic geek’s heart, if I’m honest. Perhaps most importantly, these three questions really are (to me) the crux of our complicated lives. As Simon Sinek says more simply, find your Why?

Calvin and Hobbes has long been one of my favorite cartoons; in many ways I relate to Calvin’s “free-range” childhood with a very busy imagination (Mama C was an amazing enabler!). Cartoonist Bill Watterson is incredibly wise around issues of integrity and what success actually means. And I credit him perhaps most for this statement: “To invent your own life’s meaning is not easy, but it’s still allowed, and I think you’ll be happier for the trouble.”

What does this all mean? I truly don’t know. Yet. What I do know is that I’m thinking more deeply about work-life integration that I have in a long, long time and how to do that in a way that maintains my passion for my professional calling and my dedication to myself and my family. When and if I figure it out (either fully or in part), I promise to share. In the meantime, perhaps I’ll go hang out with Hobbes in that sunny field he wished for…

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#IAmAMentor

January is national mentoring month, and one of my goals this month is to celebrate mentoring and the positive effect it can have. I do think it’s important to immediately state that mentoring is not a “one size fits all”. While we know a great deal more about what effective mentoring looks like and how to develop mentoring programs than we did a decade ago, the reality is that we still have a great deal to learn. Many institutions and organizations have implemented mentoring programs, yet we still don’t have much more than anecdotal evidence of the impact of these programs. Mentoring as a science? It’s definitely a field still ripe for exploring!

My own interest in mentoring blossomed during my surgical residency when I recognized how central mentors had been to my specialty selection, and ultimately to my subspecialty selection as well. I also recognized something that (in the 90s) wasn’t widely acknowledged within surgery- that I had mentors, plural, rather than that one “holy grail” mentor who had guided and were guiding me. What I’ve subsequently learned is that most of us actually have a web of mentors across domains and across time. Maybe the model I built for myself wasn’t so unusual after all.

Most importantly, because of my recognition that mentors had made all of the difference for my career development (thank you Danny Custer, Leigh Neumayer, Jeff Saffle, and David Herndon, amongst others!), a crucial part of my own story was to become the best mentor I can be. Do I get it right every day? Not even close. Do I have good intentions? Always. And do I get to see the rewards? All the time, and that’s the best part. I get to see medical students turn into residents and grow into being young faculty. I get to see junior faculty members get promoted to Associate Professor. I get to see people excited about giving their first professional presentation, having their first peer-reviewed publication, and getting awards for making amazing contributions. I get the text or phone call when something goes phenomenally well…or phenomenally badly and they simply need an ear.

As their mentor, do I get to take credit for these things? Absolutely not! They aren’t my accomplishments, and I didn’t do the hard work. I do, however, get to celebrate the corners on which I left a fingerprint, and the fact that my mentees trust me to want to share their victories (and their struggles) with me. It’s a privilege that they trusted me in the first place to invite me in as a mentor, and seeing them succeed is its own reward.

#IAmAMentor

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A "love" list in the New Year's liminal space

A quick wrap-up of what I’m really loving at the end of 2019…

  • The amount of time I got to spend connecting and re-connecting with friends this Fall by spending several weekends in College Station. I definitely missed a few folks during my crazy travels, but home is always home, and it’s ALWAYS good to be among your people. #youcantakethegirloutofTexasbut…
  • Outdoor bike rides in December. 2 of them, to be precise. I’ll never turn down a chance to be in the sun and on two wheels. Never. #cyclingisactuallymyfavorite
  • For Christmas my mom (or our animals?) signed me up for my second year of the Weiland’s Market Cheese Lovers’ Club. Every month I get three cheeses, along with their stories and recipes. If you know me at all, you understand why I think this is pretty much a perfect gift. #cheeseisanexpressionoflove
  • The New Yorker re-published this Ian Frazier column (Coyote v. ACME) in this past week’s edition. If you’ve ever watched Wyle E. Coyote and the Road Runner, it’s irresistible silliness. #laughterisgoodforthesoul
  • Garden and Gun magazine released their “Best Southern Albums of 2019” list, and I was pleasantly surprised at how many of them I already love (The Highwomen, anyone? And this time last year I couldn’t get enough of Maggie Rogers’ “Light On”). I’ve also found some new-to-me music that’s rocking my world, particularly Caroline Spence. Don’t make me pick a favorite song from Mint Condition…just give it a listen. #musicislife
  • Confession: Dolly Parton’s “Heartstrings” is my not-so-guilty pleasure TV of late. The woman is a national treasure, the show borders on sappy sweet in many ways, and some days that’s just what my soul needs. #positivevibesonly
  • Ingrid Fetell Lee’s book Joyful was one of my favorite reads of 2019. I’m reminded of why through following her Instagram account and all of the color (and messaging) she shares with the world. #findjoywhereeveryouare
  • If you haven’t gotten around to reading Colson Whitehead’s The Underground Railroad ( I’ll admit I’m wondering what took me so long), I’ll make a very strong recommendation for it. Yes, parts of it are challenging for the violence and the racism. The story is ultimately transcendent, though, and provides a magical realism spin on an important part of American history #somanybeautifulwords
  • Tucker the Cat and I are rolling up on 14 years together in a couple of months, and he’s about to turn 16. His jumping skills aren’t what they used to be, but he remains a Zen master in a cat suit, and he can snuggle like no one’s business. No, I’m not getting him a car for his birthday. #snowshoeboysarethebestboys
  • While my always-and-forever brand of joy is grace (because how could there NOT be joy in getting to start over again, every single day?), I’ve been working through my 2020 “word of the year” for the last several weeks, and have honestly been stuck between two. After a little Facebook crowdsourcing and some review of word origins (darn Classics education!), I’ve arrived at “transcendent”. It fits well with grace, it’s got a little mystery to it, and it doesn’t deny the role of hard work. Here’s to a transcendent year, friends! #transcendentgrace
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Offering grace all around

“Childhood is the essence of who we become. The things we work on in our childhood stay with us through our lives.” – Finding Fred

Children’s television from my childhood has had a “moment” this Fall. In some ways, one of the best parts has been witnessing the recognition that Mr. Rogers’ Neighborhood and Sesame Street, while both charming, were also phenomenally progressive…perhaps even a bit revolutionary in what they were teaching us..

Let’s start with “Won’t you be my neighbor?“, which was initially released in 2018 but had a resurgence recently. This movie successfully highlighted what can only be described as the radical kindness of Fred Rogers. Then, while I was listening to the It’s Been a Minute weekly wrap just before Thanksgiving, I learned about Carvell Wallace’s amazing podcast series “Finding Fred“. And, not surprisingly, I’m hooked on listening to so many backstories about Fred Rogers and the development of Mr. Rogers’ Neighborhood. There is far more there to unpack than I ever came close to realizing. Oh, and I’m not going to lie that I’m pretty proud to have a friend who created a Mr. Rogers-inspired sermon series that she delivered in November.

And in November, Sesame Street kicked off its 50th Anniversary season. In December, Sesame Street was honored by the Kennedy Center, the first TV show to achieve that distinction. As an adult who was raised on Sesame Street– and Plaza S├ęsamo!- it’s a little mind-boggling to both understand and recognize how much pedagogy and courage went into the programming for both Sesame and Mr. Rogers.

Lest you think I’m simply going to ramble about children’s television programming, I’ll proceed to tie this back to grace, our subject at hand today. Edutopia published a post last month explaining why Sesame Street’s Muppets are revolutionaries, and Rosemarie Truglio’s discussion of Grover just resonated with me since we share him as a favorite.

Let’s think about Grover, just for a moment. He’s a furry purple monster. He’s a bit (okay, a lot) goofy. He tries on all sorts of roles, from waiter to Super Grover. Grover is unfailingly kind and caring. Grover also arguably makes more mistakes than any other Muppet, yet I don’t think of Grover as a sad figure. Dr. Truglio beautifully describes Grover’s capacity to make mistakes from a place of best intentions, as well as his ability to recover and learn from those mistakes.

Think about that for just a moment. We have this sweet, goofy purple monster who forgives himself and continues to try. He is incredibly imperfect. Those around him forgive him and love him anyway when he makes mistakes (confession: for me as both a child and adult fan it made him all the more lovable!). Grover shows up, loves hard, does his best every single day. In my estimation, Grover is a model for extending grace to oneself. And his community? It’s a model for extending grace to those around us since Grover remains a central part of the Sesame Street neighborhood after 50 years- and he’s a master at offering grace to those around him as well, probably because he’s so practiced at offering it to himself.

Many of us work and live in stress-filled settings, and the holidays in particular are a time of year that can be as sorrowful as it is joyful. What if every day we pause to recognize that it’s an opportunity to start one more time, and to use that to practice offering ourselves some grace? Framed that way, it sounds not-so-hard to offer grace all around.

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Trying a few new things

If you know me well, you know that I’m almost constantly trying to learn new things, or that I’m trying to find better ways of doing things. I’ll openly admit that some of these things are still works in progress, but I wanted to offer up the things I am “playing with” right now.

  • There was an excellent HBR Podcast recently on “Why Meetings Go Wrong (and How to Fix Them)”. While I am still working my way through Rogelberg’s book, I am trying out his suggestion of using questions for agenda items.
  • I’ve moved team meetings off of Fridays. I’ll admit that is in part a selfish move so that I can use the time available to me on Friday for Finish it Friday, another idea from the HBR podcast above. Who doesn’t want to go into the weekend with their major projects for the week finished up?!?
  • You know all of the stuff that’s turning up about “dopamine hits” when our phones ping? Probably a year ago I made a decision to turn off nearly all notifications on my phone (because I can’t turn off messaging when I use my phone as a pager!). Although the relative silence was weird at first, I have come to realize that I don’t miss getting pinged about all things at all times. I raised the bar even higher for myself when I got a new phone in October and didn’t reinstall the app to be able to access my work email. Yes, you read that right. I can still get to my work email, but I increased the “friction” because I have to do so through a browser. Again, this is something that for me is helpful for reinforcing “healthy” interactions with technology.
  • Another recent HBR podcast talked about wellness (“How we take care of ourselves”). I openly confess that I get a little twitchy these days when people use the word wellness because it’s become almost prescriptive. However, the descriptions and discussions in this podcast are frameworks that are particularly helpful overall because they aren’t prescriptive and they do leave room for individual variation. And while they are both relatively “small” things, I’m doing my best to not send emails between 8 pm and 7 am (because, honestly, I don’t want to be expected to respond during those hours either), and I’m trying to keep weekend and holiday emails to a bare minimum with no expectation of response until the next business day. Microsoft developers, if you’re reading this, PLEASE create something like the gmail feature so I can schedule when an email will be sent. Thanks!
  • Current work in very early progress: Using appreciative inquiry tools to facilitate generative discussions. More on this as it happens because I have plenty of homework to do before implementation occurs.

What are YOU working on /trying on for size right now?

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Random things that are on my mind

I’ve spent the last three weeks considering a blog post and trying to pick a topic.

And I’ve been paralyzed with indecision because it’s been so incredibly long since I’ve written here that I am not sure where to start.

So tonight I decided that the best place to start is by writing something, anything, even if it’s just random things I’ve been thinking about, listening to, reading.

In no particular order and apropos of nothing…here you are.

Thinking about:

Listening to:

  • Allison Moorer’s “Blood” (Link to Terry Gross’ Fresh Air interview with her). If you don’t know Allison’s story, it’s worth listening to. She’s undoubtedly a survivor.
  • Miranda Lambert’s new album “Wildcard”
  • Sheryl Crow’s “Threads” – not even close to tired of it yet!
  • Bonnie Bishop “The Walk” (the whole album is magical)
  • Yes, I promise I listen to male artists too. These are just the things that are completely in my ear right now.

Reading:

  • Finally getting around to Colson Whitehead’s The Underground Railroad. I’m anticipating a binge read while traveling this weekend. Next Up: Spring by Ali Smith. Last up: Washington Black by Ese Edugyan. If you haven’t read it, you’ve missed out on a magical journey.
  • Good Habits, Bad Habits by Wendy Wood. It was one of this quarter’s Next Big Idea Club selections, and since I am generally obsessed with habit formation… Next up: Talking to Strangers
  • My own writing since I’m in the throes of finishing up an abstract (and have been trying to write the associated manuscript in almost-real-time).

Doing:

  • Running, coming off of rehabbing my right hip. The piriformis is a mean little muscle.
  • Yoga with Adriene. If you’re having trouble making it to the studio, this is a completely workable substitute to get some yoga done.
  • I’ve spent about a weekend per month back in the Homeland this Fall, and it’s been nothing short of glorious to have time there with friends. You can take the girl out of Texas, but it will always and forever be home. Especially during Texas Aggie football season.

With that, I’m back home here as well. My aspirational self hopes to have something to share a couple of times a month. My actual self thinks that’s an achievable goal.

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Procrastination, habits, and building a better mousetrap

Recently a friend and I were discussing our ongoing attempts at self-improvement, particularly because we were both working on similar concepts using different terminology. Her framework that she’s been using is that of Mel Robbins’ “How to change your life in 5 seconds“. I’ve been using Andrew Mellen’s idea of “Unstuffing” (because although he emphasizes physical stuff, it also applies to emotional stuff and overscheduling). The common framework? Delayed decisions, and the negative impact they have. Those piles on my desk? Delayed decisions. Those two week old emails you haven’t answered? Delayed decisions. Debating about stepping out the door for a run versus reading a few more pages? Delayed decision. You get the idea here.

Mel Robbins does a terrific job sharing the neuroscience of why her 5 second rule is so effective in preventing your from delaying those decisions that are tied to a goal- and relating them to habit formation. Simply put, the 5 second rule allows you to change habits by moving from the narrative network to the experience network in your brain.

So, how exactly do you break a habit you want to get rid of…or start a habit that is to your benefit?

I’ll admit that I’m partial to James Clear’s framework that he expands in Atomic Habits. For the quick, 5-step version of the book’s strategy, this post will get you there (and it’s got fantastic visuals!). Start small. Tiny wins. Use chunks. Never miss 2 days in a row. Be patient.

Confession that provides an example: I’m never going to feel like going for a run at 430 am. I’m simply not. But I do it not-infrequently because I know it’s the right thing to do for my physical and mental health, as well as my personal growth. And I do it because even at 430 am I love the freedom of being outdoors. On the days I know that I need to run early because it’s the only time I’ve got, I get up as soon as my alarm goes off, I put on my running clothes that I laid out the night before, I go downstairs and put on my Noxgear vest (because safety!), flip on the outdoor garage light, and head outside. No negotiation with myself- or with the cat who is sometimes trying to get me to stay in bed. No decisions to be made because I already checked the weather and chose appropriate clothes. My reward? Knowing that I have done something for ME- something that is a habit and is “automatic” and that I love doing even when I don’t love the time of day I’m doing it- before most people are starting their day.

Now that I’m motivated with all of this habit-talk, I’m going to go manage some deferred decisions on my desk. And get out my running clothes for tomorrow morning’s run.

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It’s time for a Reading Round-up!

I know, I KNOW. I hear you. So, here we are at least getting back on track with a reading round-up.

While I’m likely biased because I so enjoyed doing the author interview for the podcast, this article on REBOA has some very provocative findings. There’s obviously still work to be done regarding patient selection.

Whenever people ask me what I’m excited about in surgical education right now, I consistently tell them it’s our moves that are being made towards competency-based models. This Supplement to Academic Medicine provides some excellent background reading.

This terrific work on the use of TMR at the time of amputation was led by one of my plastic surgery colleagues here at THE Ohio State. I look forward to more data being shared on the patient benefits of this technique.

I’m grateful that our burn colleagues at UNC are looking into disparities in rehabilitation following burn injury. I’m curious if their findings would hold in other parts of the country with higher LatinX populations.

Nonfiction read that I just finished and definitely recommend: Farsighted by Steven Johnson. The chapter on personal decision making, particularly its discussion of the impact of a move and the importance of literary fiction in having a holistic view of decision-making, hit close to home for me.

I’ll have a full fiction recommendation for you in April. Hint: I’m reading Washington Black by Esi Edugyan right now and am LOVING it!

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“Once you stop learning you start dying”

I’ve identified that learning is one of my core values (something some of you may have figured out on my behalf long before I did). I also recognize that I spend perhaps more time than I should contemplating learning- to some degree, my own learning, but also the learning of those around me. And when I say those around me, I mean ALL those around me- students, residents, colleagues, team members, everyone. And I don’t mean that I’m the smartest person in the room, either; instead, I’m focused on how we can learn together so that we can all be more effective in our identified roles. The phrase I’ve heard once, and for which I could recall the attribution, is the idea of “never not learning.”

Every day when I’m working with my team, I start with two core concepts:

  • What do I need to learn today? and
  • What do I need to do to facilitate my team learning today?

The first question reminds me to spend even 5 minutes looking up the answer to something that I’m curious about that day (for example, today I spent time reviewing the 2017 Hypertension Guidelines so we could make a good pharmacologic choice for one of my patients who seemed to be on an odd regimen). I’m not saying that 5 minutes is my ideal for learning, but on a busy day it may be what I can grab and I’ve learned to be satisfied with it in that setting. The second question is why sometimes rounds get a little long as I try to walk through clinical reasoning or relevant literature or the ethics of care we are or are not providing for a patient.

HBR recently published a helpful piece discussing how to integrate learning into our “usual” workflow. I’ve written before about my use of Twitter for my Personal Learning Network, and I consider that analogous to the “bottom up” suggestion of participating in a learning channel. I also have a few new ideas from that group of suggestions that I’m looking forward to incorporating into my learning practice- for example, I was much better as a medical student about keeping a “learning list” than I am now, and it’s a practice that it wouldn’t harm me to resurrect. I’m also going to look at blocking in an hour of each workweek that is just dedicated to learning and exploring things I’m curious about. I suspect I’ll spend my first dedicated learning hour considering the “top down” recommendations from the article so I can facilitate learning (cough…faculty development…cough) within our Department.

A practice mentioned in a different article that provides guideposts for becoming a better learner is one that I’ve already incorporated and that I find invaluable in my varied leader roles. Confession before we dig into this: I did an inventory at the beginning of the year that looked at how I manage information/ learn (Kolb’s learning styles), and my “reflection” score was exceptionally high. Thus, the idea of reflecting on experiences to think about what I have learned, what went well and what didn’t go well, and what I would do differently next time is fairly innate to me. If done through an Appreciative Inquiry lens, this can become a really fantastic way to encourage group learning as well (“What made the patient’s care great, and what can we do to achieve that every single time?”).

And with that, I’m off to reflect on my day. And perhaps to start on that cool idea of a learning list…

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Amplify!

I spent my off weekend at Atlanta at a leadership conference for college-age women. No, y’all, I know how old I am and I am fully aware that I graduated from A&M 30 years ago this May…roll with my story here, please.

The first thing I want to say about Adelphean Compass is that I am a bit envious of my collegiate sorority sisters who spent their weekend learning how to lead with self, as well as how to lead with vision, action, and relationships. At age 20 they are getting information that most of us have spent many, many years learning (and often getting not-quite-right along the way). It was POWERFUL seeing that many young women learning how they can be more effective in the roles they are taking on in this world.

On Saturday evening, I had the privilege of being part of a panel designed to share how we amplify those around us and how we amplify core messages. I got to do this with two other amazing alumnae- Aly Merritt and Rae Ann Gruver. The three of us had never met before that afternoon, and I’ll tell you with all honesty…these are women who I want as “marble jar” friends. They’re smart, they’re funny, they’re fully themselves, and they have such love for the work they are doing in the world.

Now that I have had a few days to get out of the glow of the weekend I’ve gathered a few lessons based upon things that all three of us told the audience in one form or another. So what were my take-home messages that I heard?

  1. Do things you are passionate about. Do them authentically.
  2. Find YOUR way to be of service to others. Doing what is special to you on behalf of those who are meaningful to you will ultimately result in joy (and certainly with a sense of tremendous satisfaction of doing what you are on this earth to do).
  3. In your life and in your career, there will be plot twists. You can’t predict what they will be, but if you listen closely as they happen they may help guide your purpose and your passions.
  4. Getting where you are going in life? There’s no Google Maps for that. It’s more like a “choose your own adventure” and sometimes you’re just winging it. That’s okay.
  5. Do it scared. I am certain that at various points in our journeys we each discussed that we have been terrified of what we were doing. Each of us did it anyway, and so far it seems to be turning out just fine.