Category: Medicine

It doesn’t matter who or when this was. But he was brilliant. He had incredible drive and vision. He would dream, plan and then execute. But it didn’t come off the way he wanted. Why not?

It was because he did it as a “Ta-da!”  

It was an inappropriate “Ta-da.”

What do I mean by that?

We think that we can perform like showmen in a circus. We dream, plan, and prepare the show. We practice so that we can perform flawlessly. We plan and get the supplies and decorations and everything in place. We do it ourselves, in secret, so that to the audience it is a wonderful surprise. You wouldn’t want to take away the mystery of the surprise by showing them the tedium that went into the planning. It should come off in presentation suddenly. And when it does, they will be in awe. You jump out with your arms held wide and yell, “Ta-da!” They will stand and applaud at the wonderful thing that you did in front of them.

At least that is how it is supposed to work.

And if we were working for the circus, for people who were coming to be entertained, it would be the right way to do things.

But in business, in the workplace, and often in life, that is not how things work.

It made me sad to see him jump out with his arms held wide. The loud “Ta-da!” was met with an awkward silence, or even worse, with anger and disapproval.  There were people who were impressed and clapped. But they were not the people around him who worked with him. 

And it is not just him. I too have done the same thing. For someone who is young, passionate and driven it is not an easy lesson to know and embrace.

What is wrong? Those who are experienced in the working world and in management immediately understand. Success is not about just achieving results. Results are important but there is much more. Success is about having “us” achieve results. Success is about a team that grows and develops so that the results are reproduceable and sustainable. It is not about one dazzling performance. It is about excellent sustainable operations. And for that, the process is as important as the end result.

When he yelled, “Ta-da!”, those around him suddenly felt hot, disappointed, and left out. They could have done things. They could have contributed. But instead he didn’t involve them. They were excluded. They were a part of the team. But he left them out. He made them miss out. They couldn’t celebrate the success because it was only his success. It was not their success. It was even worse than that. It was an opportunity or a success that he stole from them.

Him: I am going to do something great for the department. This will be so good for everyone.

Them: He never involves us in the important things. He runs away from us and works in isolation. He is not a part of the team. He is all about only himself. 

What is the lesson? Be very careful if what you are planning is a “Ta-da!”  

When you have an idea or a vision – think about the team. Who will care about what you want to do? Who can and should contribute? How can you have them go on the journey with you? 

It is not as easy. In fact, it is a lot harder to push yourself to have others be a part of things with you. We all have hated the “group projects” in school. We know the challenges. But it is better. In the end, your success will be magnified by a multiple of how many people you have involved.

Step 1:Vision – This you can do. This is when you get the idea. You may see the need or the opportunity. 

Step 2:Change management: Communicate the need (even declaring a crisis) to get others on board. That is the start. They have to see and feel the problem. Then you can move on. Get them motivated and enthused about your vision. If you are really good at this – get them to think that the vision is coming from them rather than you – or ideally – that this is a vision that came out of the group. Please do not think you have lost something if others don’t recognize that the idea started with you. The victory is so much better bringing the group with you that it is worth sacrificing this little bit of “credit.”

Step 3:Determine the team. Who should be involved? What roles should they have?

Step 4:Get people working and keep them working. Even if you have to do most of it yourself, look for ways that they can be contributing. Instead of going to a meeting with a polished plan, go with an open agenda with a presentation of the problems and guide them to help develop the plan. If you are really skillful, you will be able to guide them to develop the plan that you have thought of in advance but it will be so much better with their contributions. 

Step 5:Deliver. A lot of things never go forward because they need a person or persons to push them to completion. But in the process keep going back to the team and pull them into contributing their aspect of the project.

Step 6:Celebrate. Not a “Ta-da!” But instead a group celebration that is really worth it and meaningful.

My mind can race forward at times. I can dream up things. I run forward with them. I can type fast and it is easy for me to go from problem to resolution to plan in a single bound. It is oddly easier for me to come in with a 4-page document with problem, background, research, and solutions than it is to slow down and masterfully guide a process. But it is the wrong thing to do. 

I hand them my 4-page document. It surprises me when people get stuck on the 1^stparagraph. It shouldn’t. I have had time to sit alone and work through it all already. This is their 1^stexposure to it. They need to understand the problem, and then walk through a process of how to solve the problem. If I give them the solution immediately, they are not ready for it.  

The 4-page document actually ends up achieving much less than I would have achieved if I had only brought the 1^stparagraph.

How about you? Do you understand that victories that you achieve alone are generally empty and meaningless? Do you know that the process, building the team and sustainability are much richer victories? Are you able to be a “master?” Can you be mature enough to intentionally move more slowly, bringing people with you as you go? Even if you may be so clever as to be 4-5 steps ahead of everyone else, can you bury that for a while for the rich blessings that come from doing it with everyone else?

I tried to explain to him how he could easily alienate others.

He didn’t hear me.

The “Ta-da’s” didn’t work.

People from Michigan know what Vernors is. For those of you that don’t, it is a ginger ale type of soft drink. It originated in the Detroit area and still has about 80% of its sales in Michigan. I will explain later the significance of Vernors.

It was 1989. I was a 3^rdyear medical student doing my general surgery rotation. I was on the trauma surgery service. It was really very intense. I learned a lot. 

One of my earliest patients was a man who was seriously injured right at the end of his 4^thyear of medical school. As an inexperienced medical student, it was kind of intimidating taking care of another medical student / new physician. He was intubated (breathing tube down his throat) and on the ventilator. His sedation had been lightened enough however that he would open his eyes as I came into the room to examine him.

Every day I would go to check on him and examine him. Each time he would look at me as I was in the room. I would talk to him, explaining that I was the medical student and that I was on the service that was taking care of him. I wondered what he was thinking. I was very anxious that he was silently critiquing my technique. Did I listen carefully enough to his lungs? Did I spend enough time examining him? Was I doing everything the way I was supposed to? Each time I entered the room it felt a little bit like a practical exam from our physical diagnosis class.

The pattern continued for days on end. I continued to try to do my best. Every day I felt anxious as I went into his room. Every day I wondered what he thought of me.

The resident paged me to tell me that he was doing well enough that he could be extubated (have the breathing tube removed). This would mean that he would be able to talk to us. I went to his room. I anxiously watched and waited while the endotracheal tube was removed. What would he say? Would this be the moment when he would berate my inexperience and my incompetence? Would he criticize my performance over the past several days?

I held my breath as the tube came out. He coughed and we suctioned his throat. We waited to ask how he was doing and to see what he would say. He had gone from a full and active and healthy life to sudden severe injuries. So much had changed. This was the first time to hear from him after all of his experiences.

Here were his words: “I want a Vernors.”

Really? That was it? Nothing profound? No commentary or criticism of me and my performance?

It was indeed it. He wanted a Vernors. The nurses had to make sure his swallowing was intact and then they would work to get him a Vernors. And so our care of him continued to go on.

There are some very important lessons buried within this story, however.

First, it isn’t about us (me). How ridiculous I was to think that this story had anything to do with me or my performance. Honestly. It had nothing to do with me. This wasn’t my story. This was his story. We absolutely have to remember this in medicine. We are indeed impacted by our experiences in taking care of patients. We have to find ways to cope and deal with the stresses that we feel. But the focus in our care of the patient is on the patient. It really is not about me and how I feel. 

Rana Awdish’s^[1]is a physician who survived a terrifying sudden illness. In her book she tells about a resident who was focused much more on himself than on what was happening to her as the patient. The resident even came back not to check on her, but instead to tell her how traumatized he was by her near fatal experience. Reading her well written book you become shocked by the lack of insight of the resident. When you read it from her perspective it becomes crystal clear that while we all need to learn how to process, in medicine the focus is on our patients.  

So also, in life others are going to have traumatic experiences. When we see what happens to them it can impact us also. But I would hope that we would have the maturity to look at what is happening from their perspective. It is about them, not you. 

Are we mature enough to look beyond our own needs to be true friends to those who are in need. We of course might have feelings about what is going on. But our first focus should be on what they are feeling, what their needs are and how we can help them. 

It amazes me how easy it is for me to fall into selfishness whenever I am stressed. He wanted a Vernors. Of course. His throat was dry and sore. He was sick. He wanted what he had as a child when he didn’t feel well. He wanted a Vernors. That was what was important.

The second big lesson is about our false self-consciousness. I was so focused on what he was thinking of me. Frankly, the vast majority of people are not thinking about you. They are thinking about themselves. They really are not noticing us. We obsess and worry and fret about what others are thinking about us. But instead they are fretting and worrying and thinking about themselves! I do not mean to imply that we are all selfish all the time. But what I am saying is that I think a large amount of the time when we are worried what others are thinking about us, they are not thinking about us.

Relax. Be real. Stop being so self-conscious. People may not be noticing the little spot or pull on your shirt. They may not be noticing that annoying hair that keeps falling out of place. They may not be obsessing over the mismatch between your belt and your shoes or whatever it is that is worrying you. Most of the time they are thinking about something else entirely. And really, we would all be much happier if we would just stop worrying so much about what others are thinking of us and instead would just enjoy being with them. 

Sometimes, they just want a Vernors. They are not spending all of their energy judging what I am wearing or how my hair looks or grading my physical examination technique. In fact, patients are far more concerned with what is going on with their health, whether I can help them, and what I am going to say about them and their health than about me.

He wanted a Vernors.

• Can I be a really good friend to you and think about your needs instead of my own when life has really thrown you off? There are times that it is not my story, but it is your story. Please forgive me if I sometimes forget this.
• Can I be a mature human being and stop obsessing about myself and instead just accept you and let you accept me? Can we just be friends and enjoy our friendship?

Maybe that could just be a secret phrase we could have. “Maybe he/she just wants a Vernors!” Then we will know – it is time to think about things from their perspective. It is time to support rather than take. And we will also stop obsessing about ourselves. The hair out of place may not matter. They might be more worried about their hair that is out of place! 

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^[1]“In Shock” by Rana Awdish, https://www.ranaawdishmd.com