Category: Medicine

Posts that are specifically tailored around the practice of medicine.

Categories
Being human Medicine Reflections on Life, Being Human, and Medicine

The Assignment

If you could be anyone who would you be?

That was the assignment. I was in Mr. Dow’s 5thgrade class and that was the assignment. And it was a very troubling assignment for me.

I had a secret and I wasn’t ready to tell anyone. I wanted to be a doctor. I don’t even really know why I knew this. From adulthood I can remember the assignment and the dilemma, but I cannot remember when or how I had decided that I wanted to be a doctor. I didn’t know of any doctors in my family. I didn’t know of any friends who wanted to be doctors. It wasn’t like I had watched doctor shows and idolized them. I just knew that within my heart that is what I wanted to be.

It seemed bold and maybe prideful to me. I was afraid that people might laugh at me. It meant so much to me that I couldn’t bear to have people laugh at me about it. I was in a dilemma. I was raised to always tell the truth. The truth was I wanted to be a doctor. But I didn’t want to put it on paper. So, I did what a mature 5thgrader might do. I didn’t do the assignment.

Mr. Dow wasn’t happy. There were a couple of us at the table where he sat the “advanced” kids. We were the ones that had the harder assignments. He pushed us to turn in our assignment. I continued to procrastinate, hoping that my dilemma would just “go away.” It didn’t. Mr. Dow wouldn’t accept just letting me not turn it in.

Finally, reluctantly I wrote it and turned it in. I don’t remember what I wrote but I wrote the truth and revealed my deepest secret. It was really scary.

My friends started talking about how they answered the assignment. One told me that he said he wanted to be “Abraham Lincoln.” Another was “George Washington.” The others told similar historic figures. My heart sank as I realized that I had misunderstood the assignment. 

If you could be anyone who would you be? The assignment was not what do you want to be.

Abraham Lincoln would have been a far safer answer. And yet I had revealed my deepest secret. Graciously Mr. Dow did not reveal my secret. I didn’t tell my friends. I was able to continue with my secret dream.

Why did this upset me so much? 

First, I heard the assignment wrong because of my anxiety. It seems that we often worry so much about things that are not real. 

I read a book where every day for a year the author challenged herself to do something that scared her. It brought about tremendous growth for her. One of the things that she did during that year was to go meet with her ex-boyfriends to find out what they really had thought of her.[1]She had huge anxieties. But in doing this she discovered that most of what she had worried about was never real. Her anxieties had driven her to assume the worst. She was not able to see, believe, or know the truth until she had been bold enough to ask.

That is a big lesson. It is hard to know the real truth about ourselves. We fly between the extremes of a sort of “Walter Mitty” over glorification to a false self-denigration. Neither are the truth. We all have some pretty cool and pretty average (and some pretty crummy) things about us.

It is important that we try to live in reality and not let our anxieties drive us to neurotic behavior. For me, as a 5thgrader, my anxieties were to the point where I would have let them drive me to a failing grade for not doing the assignment. If I could have seen through the fog of my anxieties I might have actually read and listened and done the assignment. Maybe I would have written a very nice and safe essay on wanting to be Neil Armstrong stepping foot on the moon. 

Is there more to learn from this story? I think so. 

Honestly – I don’t know why I was so anxious for anyone to know. Perhaps it comes from being the youngest of 6 children? Perhaps it came from being afraid to actually dream and tell the truth about who I was and what was important to me? Oddly – I have no idea now what I was so afraid of. My family and friends would have been quite happy to indulge me in my dream. They probably would have been happy for me and proud of me. It seems strange now that I would keep it so private.

This blog has been an odd experience for the introvert that I truly am. 

I have found power in being able to write in secrecy. I write a lot and then store it away. I don’t worry about whether I will ever post it or not. There will be time later to decide that. Writing in this way is immensely liberating. I can be myself. I can be honest. I can say what is on my mind.  

If only the 5thgrade me would have thought of this. I could have written a full essay on my hopes and dreams. I could have worked through my thoughts about someday going to medical school and becoming a doctor. I could have fully explored what I was thinking and why. I could have better understood myself. I could have tested out my thinking secretly at first. I could write it down but keep it private. Having done this I would then have understood enough about myself so that I could then safely explain it to others. I could have been bold enough to know myself and then be open about what was important to me.

It may sound silly but the Disney song, “Let It Go”[2]has a strong appeal. “Let it go, Let it go, Can’t hold it back anymore…” “I don’t care what they’re going to say…”  Even though we may not admit it, I think many of us feel the pull of this song when we hear it. We spend a lot of time hiding. Shielding. Protecting ourselves. Maybe sometimes we should really, “Let it go.”

So, lesson number one: Live in the truth not what you worry people might think about you. For me I know that it is ok, important and good to be honest with myself. I should look objectively. It is ok to be average – excellent in some ways – and not so good in others. I don’t have to be good at everything. And I had better not let anxieties or worries about what people might think about me drive my life. 

Lesson number two then is this: It is good to have dreams and deep thoughts and feelings. I do not have to be afraid of them. I do not have to be afraid to be myself. We all may have thoughts and dreams and ideas inside of us that we keep safely and secretly hidden. I am not saying that you or I have to reveal anything and everything to the world. I have things buried on my computer that I may never post. But there may be real value from time to time to “Let it go.”

It has amazed me how people have responded to this blog. By putting myself out there many have told me that I have helped them. Some tell me I hit points that make them better know who they are or what is going on in their life. That is pretty cool. That makes me really happy.

Who did I want to be? I wanted to be a doctor. And to be honest I wanted that more than I would have wanted to be Abraham Lincoln or George Washington or Neil Armstrong (although it would have been really really cool to be Neil Armstrong!). 

There. I said it. I “Let it Go.” That is who I was as a 5thgrader. I was a nerdy little boy who dreamed of being smart and studying hard and having people come to me for answers as their doctor. 

It still is easy for me to want to hide a lot. But in this blog I have let you see a little bit of who I am now.

Who are you?

[1]https://www.harpercollins.com/9780061875014/my-year-with-eleanor/

[2]https://www.lyricsondemand.com/soundtracks/f/frozenlyrics/letitgolyrics.html

Categories
Being human Medicine Reflections on Life, Being Human, and Medicine

Listening

“You seem upset that we did surgery on the wrong side of your body.”

Reflective listening. They taught us about this in medical school. It was in our history and physical exam course. We were specifically taught how to handle an upset patient. The technique was to reflect back what they were saying to you. You were to do this even if you couldn’t provide an answer to what they were saying.

“You seem upset that your surgery was delayed.”

“You seem upset that your son is not doing well.”

 “You seem upset that you had the wrong leg amputated.”

It seemed ridiculous to me. We had to practice it on each other.  They gave us all sorts of goofy scenarios to emphasize the technique like that. We all thought it was a bit ridiculous, but we followed the protocol and learned it. 

Oddly – it works. 

Even with someone who is very very upset, reflecting back their concern can calm them and help the dialogue to go forward.  It has been an invaluable tool through the years. In retrospect that was probably one of the most valuable classes that I had in medical school.

Why?

We need to listen to others. On the other side of it, all of us need to know that we have been heard.

I confess that I am not perfect at this. It is so easy to talk to get my points out rather than actually listening to what other people are saying. And when I do this the conversation can go in circles. Each of us keeps repeating the same thing hoping to be heard. The conversation can get louder and louder and more and more jumbled. 

If I would stop and just intentionally acknowledge what you are saying it would go a long way to improving our communication.  I am frankly pleased that I have a little bit of a reputation for using some of these phrases.  “What I hear you saying is…”

I have found reflective listening to be very effective in working with patients. I have found it to be even more important in meeting settings. 

In an ideal world, every person at the meeting has a purpose for being there. This means that they bring some special training or purpose or value to the meeting. Every person deserves to be listened to. More than that – they really deserve to be heard. If we as a group do not hear them, we have robbed ourselves of the perspective and value that they might bring to the conversation. And often the most junior person might just bring the fresh perspective that helps the rest of us see through the cloud of confusion to what is really going on or what really needs to happen.

That is reflective listening. But there is another lesson that sticks in my mind.

We had a controversial issue during my training as a flight surgeon in the United States Navy. Eventually it came to a special board of flight surgeons (SBFS) to make a decision. This was where the data was presented to all the flight surgeons present in the area and they could then all vote on what was appropriate. The idea is that in the setting of unclear issues, we fall back to expert opinion, and the more experts you can have, the better the decision.

In this case however, the commanding officer interjected a comment. It had wisdom in it. He said of one person presenting, “This doctor is my expert in this area. I either need to trust him and listen to him or fire him.”

That was a fascinating example of empowerment. Suddenly the specialist was being heard. More than that, the specialist felt the burden and duty of his position. He was being asked to have a real impact on the decision making for the entire group. There was an immense weight put upon him. It was an appropriate weight however. He was indeed the expert. His opinion in the matter should really matter. And he should feel and shoulder that responsibility. He shifted from just telling his opinion and “washing his hands” to helping us all struggle with the decision. When he spoke, it was with a much different “gravitas” than it would have been had the commanding officer not empowered him in such a way.

Of course, not everyone is correct. Even specialists can be wrong sometimes. And this does not mean that the rest of us can abdicate our judgement or our conscience. But if we have someone who is supposed to be bringing a special view on something, we had better really listen to them, or we had better “fire” them.

I would call this, “empowered listening.” We really ought to do this more often.If we fail in this people can keep their opinions at a superficial and frankly not very helpful level. But if we truly empower them, then they are pushed to a much greater depth. What they say suddenly has more intensity and meaning. 

I do think there is one even deeper level however.“Fools find no pleasure in understanding but delight in airing their own opinions.” “The heart of the discerning acquires knowledge, for the ears of the wise seek it out.”[1]

This is a lesson that I learned from my college roommate John. He may not even know that he taught me this.[2]I was the one that always wanted to talk. We would come away from talking with someone else and I would discover that John had learned more than me. He had been listening more deeply to the person we had been with. He taught me by example some very valuable lessons. I will call these lessons collectively, “Treasured listening.”

  1. Go into each conversation hopingto be surprised.If someone says something that does not fit, you might just have discovered an area where you might actually learn. That is a golden and precious opportunity. Do not lose it.Push it forward. Reflect back what they say if need be. Ask more questions. Like pursuing a nugget of gold under the water, go after it. Grab a handful of the sand if need be and sort through it hoping to find the precious within it.
  2. Assume that everyone brings a little different perspective. Value that difference and celebrate it. Push yourself to learn from it. That is another opportunity to grow and be changed. No one likes a movie in which you can predict the entire plot and ending. Look for how people think differently. Try to put on their perspective as you might try on their jacket or their gloves. See what it feels like. We seem to all assume that others think like us. They do not. Even though they might be similar in their thinking, there are always subtle differences. Look for them. Celebrate them. Try them on. In so doing you can really learn. I tried this with John’s Dad one day. He told of his profound disappointment in not being medically qualified to fight in WWII. This has stuck with me. It made me realize how wildly different the times were then. Everyone really wanted to go and fight. They were ready to be put into harm’s way. That conversation taught me that tomorrow we all might see things completely different than today. September 11, 2001 was a classic example. In an instant many of us changed how we thought. Tomorrow might bring an event into our lives that will change our thinking again. We can learn today from other’s experiences if we are just wise enough to truly look for it, celebrate it, and listen to it.
  3. Value other people.It amazes me the number of times that I go into a conversation and all I really care about is what I am going to say. I walk away empty from those conversations. Everyone has value in the eyes of God. They were created in His image and as such I should value them. I am a fool if I do not push myself to give everyone value. I squander the opportunity of knowing them.If I do this, I walk away emptier. But if I truly value them, I can grow and have a rich experience of them. It does not matter how young or old, rich or poor, educated or uneducated. People all have value. I remember one older patient. He was slow of speech. I wanted to rush in and rush out. I wanted to assume he had little to contribute. It was only because he reminded me of a family friend that I slowed down. I sat down. I listened. And I was richly rewarded. He was in there. He was not only in there, but he carried the wisdom of his age. He was mostly alone because most of us where moving just too fast to notice. But for the wise person who would sit down and slow down and listen, there were precious jewels of wisdom. 

Reflective listening:Bounce back what you hear people saying so that they can know that you heard them. This is powerful.

Empowered listening:Let people, or even make people, take responsibility for their position and training.

Treasured listening: People are a treasure. You can learn and grow each other from every conversation if you are willing to work at it. Look for surprises. Find the difference in their perspective. Value them. If you do this, you will be richly rewarded.

[1]Proverbs 18:2, 18:15 (NIV)

[2]Thank you John!