The reasons why things is like they are

Acts of commission, omission, and microaggression are just a few examples of how we contribute to the racial divides and socioeconomic disparities in our communities. Nothing earthshattering or new here. The crux of the problem can be found in Tower of Power’s 1976 hit, “Can’t Stand To See The Slaughter.” We want positive change, but not if it comes at the expense of our personal comfort or gain. What is new about this time in our history is that technology and social media make it nearly impossible to live in a state of denial about the widening gap between the Haves and Have Nots, the Ins and the Outs. Is 2020 going to be the year that we take a hard look at how we are living, and take personal and political action to forge a more equitable, compassionate, and benevolent society? If the answer is yes, cue up Tower of Power’s “Ain’t Nothin’ Stoppin’ Us Now.”

When I'm Weary

Right behind the great James Taylor, my favorite performing artist is Dave Matthews. I’m told that I started to follow him and the Dave Matthews Band (DMB) after they peaked in popularity. No worries. At this stage of my life, I like what I like, and Dave’s jam rock takes me to a very happy place in my mind. Favorites include Bartender, Crash Into Me, The Space Between, and my all-time favorite, #41. Over the past few months, and then more so over the past week as I’ve watched, along with you, the protests, riots, and anarchy that are threatening to unravel the tattered fabric of our society, I’ve been thinking a lot about the lyrics to his 2018 ballad When I’m Weary. If you find yourself weary and tired, and seeing the world as a dark place, I admonish you to take off the blinders that kept you focused as a premed, medical student, resident, and fellow, but no longer serve you well as a physician on a 30 year journey. Look to both sides of you and behind you, and you will see that you are making this pilgrimage with legions of fellow healers. We are one body with many parts, and together we must face what lies ahead. You remind me, and I will remind you, to keep on trying.

It's like the 1960s all over again

I attended today’s in-person meeting with CEO Rich Isaacs and Interim KFH President Tom Hanenburg at our Roseville medical center. Our leaders acknowledged the many ways in which our people have performed admirably during the COVID-19 pandemic and emphasized the importance of launching the recovery and reactivation programs that will help us maintain our position in a world of job losses, reduced revenues, and frequent reminders of the deeply entrenched inequities in our society such as the death of George Floyd on May 25th. Dr. Isaacs pointed out that headlines of a manned space launch and riots reminded him of the 1960s, the decade into which I was born. Christopher Booker described that era as “a classical Jungian nightmare cycle, where a rigid culture, unable to contain the demands for greater individual freedom, broke free of the social constraints of the previous age through extreme deviation from the norm.” To my parents’ generation, the Bay of Pigs, the Cuban Missile Crisis, the race riots, the assassinations of JFK and Martin Luther King, and the Vietnam War played out as a protracted nightmare, full of angst, and short on hope. Some of us may feel this way about our current state of affairs. I’m here to remind you that we survived the 60s and will also emerge from our current predicament. According to Dr. Isaacs, the trajectory of our recovery will look more like the subtly sloped end of the Nike swoosh than a V-shape, but the direction will be upward. As I looked around the room at our colleagues who are helping to lead the charge and listened to the meaningful exchange between them and our regional leaders, I was filled with hope. Kaiser Permanente and TPMG will be a leader in this recovery because of our integration, prepaid model of care, and the ability of our people to collaboratively adapt to change. Of that, this child of the 60s is certain.

Over the rainbow

“Someday I wish upon a star, wake up where the clouds are far behind me, where trouble melts like lemon drops, high above the chimney top, that's where you'll find me.” - Harold Arlen & Yip Arburg

I’ve longed believed that 90% of health is mental health, so I’m really glad that that this week’s North Valley leadership communications focused on our emotional wellbeing. I hope that you will take advantage of at least one of the many resources we have made available to help you get more settled. We’re embarking on a three day Memorial Holiday weekend. In addition to creating space for us to honor and mourn members of the military who have died while serving our country, this weekend gives us the opportunity to slow down and reconnect with our thoughts and emotions. I encourage you make a solid connection with your sense of optimism and hope for a better tomorrow. To get you started, please enjoy this Davis High School Madrigals performance of “Over the Rainbow” sent to me by Kathy Eastham, Pediatrics.

Lessons from a fighter pilot

I know a young man who is a US Navy fighter pilot. He’s an elite aviator who engages in high stakes work, under imperfect conditions, at great risk to his personal safety. Sound familiar? I asked him to share some cockpit wisdom that might be helpful for us as we engage our enemy, the COVID-19 pandemic. These are his cockpit pearls (followed by my comments in italics):

“No fast hands in the cockpit.” A misconception in the public is that the best fighter pilots must be those with lighting fast reflexes. However, in reality, our training emphasizes just the opposite. During an inflight emergency, when the Master Caution light is flashing in your face, the urge to impulsively flip a switch or activate a back-up system can be overwhelming. It is during these moments that we fall back on our training, find the checklist that is the best fit for the scenario, and execute with deliberate focus. When things get ugly, take a deep breath, and fall back on your training. Stick to the fundamentals. The 4-P’s mantra comes to mind: “Keep them puffing, pumping, perfusing, and peeing.”

“Bounce Back.” Fighter pilots make mistakes all the time. Whether in dynamic training exercises or in actual combat, there is no shortage of threats that hinder perfect execution. The best among us are those who are able to acknowledge the mistake, mentally compartmentalize the error for the debrief, and continue the mission with a focus on all the other opportunities left to succeed on that sortie. Rapid sequential tasking interrupted by generous self-affirmation is what our patients need from us.

“Show of Force.” Unfortunately, in combat, the enemy gets a vote. This reality can produce moments of intense frustration when the circumstances of the engagement feel dictated by the adversary. In a tactical jet circling overhead as a chaotic ambush below unfolds, our most requested response is a “Show of Force.” This maneuver calls for an extremely low, fast, and loud pass over the engagement and is intended to display to the enemy what a poor decision they just made. Although the desired response is a retreating enemy, often the feedback we receive is that of the uplifting effect the maneuver had on our friendly forces during their time of need. There is no greater show of force than our dedicated teams of health care professionals bringing their best to the fore as we fight the battle of our lives.

The one thing

The topic of yesterday evening’s weekly North Valley Town Hall meeting was Workforce Wellness. The faculty included leaders from psychiatry, human resources, physician wellbeing, and the employee assistance program. It was my pleasure to represent physician health and wellness. During Q&A, a listener asked me to identify the one wellness practice that I have observed to be effective during the entirety of my thirty-one year career with TPMG. My immediate answer was CONNECTION. Why connection? John Travis, the founder of the modern wellness movement, said that “the currency of wellness is connection.” I like to say that “connection is the coin of the realm in the kingdom of wellness.” Connection to what? The answer to that lies in the writings of Dr. Richard Swenson in his book, Restoring Margin to Overloaded Lives.

Connection to other people = your social life. During my first year of work with TPMG in 1989, I was doing weekend rounds on an elderly gentleman on the hospice service. After I completed my bedside evaluation, he asked permission to give me some advice. Of course I said yes. I was a 29 year old newly minted family physician who didn’t know much about anything. He leaned in and said, “Young man, I just want to let you know that at the end of your life, all you really have are the relationships you developed with other people.” His words immediately struck me as pure gold. He died a few days later, but his wisdom lives on, today in this email.

Connection to yourself, your purpose for living, and the story you tell yourself about you = your emotional life. This emotional life is in many ways the most complicated one. I encourage you to consider meeting with a counselor to make sure you get it right.

Connection to God or a mighty transcendent being or idea = your spiritual life. For many people, this is the one abiding life, the one that unifies all elements of life.

To appreciate the importance of connection to wellness, consider the consequences of life without connection: isolation, loneliness, simmering in destructive stories about the self and others, wandering with no purpose or direction, the futile pursuit of happiness based on things and circumstances. You get the picture.

In summary, there is consolation in community, and desolation in isolation. The choice is yours. Make a good choice. If you need help doing this, please reach out to a wise person that you trust. It might be a licensed counselor, a religious leader, or your favorite relative. It might also be a patient who has been through a lot, and in doing so, has learned something important that he/she is eager to share, much like the hospice patient who intentionally connected with me in the sunset of his life.

The making of a miracle

“The only place where success comes before work is the dictionary.” - Vidal Sassoon

We all love miracles. The curing of leukemia, the birth of a healthy baby after prolonged infertility, the ending of a pandemic. In sports, one of my favorite miracles was “The Catch,” Dwight Clark’s leaping touchdown reception of a Joe Montana pass in the 1981 season’s National Football Conference championship game between the perennial powerhouse Dallas Cowboys and the upstart San Francisco 49ers. Trailing 27-21 with 58 seconds left in the game, the 49ers faced a third down and three on the Cowboy’s six yard line. Joe Montana took the snap from center and rolled to his right looking for his primary receiver, Freddie Solomon. Solomon slipped while running his route, forcing Montana to scramble to elude the rush of three oncoming Cowboys, including 6’8” Ed “Too Tall” Jones. A split second before being forced out of bounds, Montana lofted a pass to the deep right corner of the endzone, where Clark leaped above defender Emerson Walls to catch the ball with his fingertips and send the 49ers to the Super Bowl, where they would win their first of five Super Bowls over a thirteen year period. What many people forget about “The Catch” is that it was preceded by a dramatic thirteen play drive that began for the 49ers on their own 11 yard line with 4:54 left in the game. “The Drive” included four Montana pass completions, four runs totaling thirty yards by Lenvil Elliot, and an end-around run by Solomon good for fourteen yards. Just as we remember “The Catch” as being the play that defined the end of the Cowboy’s reign and beginning of the 49ers dynasty, I suspect that historians will attribute the end of this pandemic to a vaccine or drug. However, when we eventually get to the other end of this virus infested tunnel, we should record for posterity that we would not have survived this disease without the people who sheltered in place, the engineers who kept the lights on and sewage flowing, the essential workers who kept us fed, and the many members of the healthcare team who left their homes and families to tend to the sick. They, we, are the unsung Lenvil Elliots and Freddie Solomons, without whom there would be no civilization left for a vaccine or drug to save.