True Love

Not so long ago in the ED, I was helping a patient in one of the acute care beds. Through the curtain that divided the room I was in from the next patient room, I heard someone reading out loud. Where the reading was coming from, a post-retirement man was the patient and his wife was with him.

I saw through a gap in the curtain that the wife was happily reading a book to her husband. Her voice rose and fell with the emphasis of someone who had read aloud many times. Her voice mixed with the sound of her husband’s snoring. When she stopped reading, he stopped snoring and became restless. Sometimes she paused and looked at him. She’d smile and then continue reading before he fully awoke.

The sleeping husband and reading wife seemed so content and peaceful despite being in the middle of the ED on a day when people around them were having their worst days. The husband could have been very sick too but, unlike many of our patients waiting to be seen, he wasn’t sitting alone staring into space as he waited.

That woman reading to her husband was the clearest example I’d seen of true love in months. We see a lot of couples and families come through the ED every day. Accompanying a sick loved one often brings out the caring side of people, however there was something about the calm, closeness of those two (sleeping and reading) that highlighted the strength of their connection. I was reminded, for the millionth time, that it’s the little things that add up to indomitable forces.

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Empathy

One busy day in the emergency department (ED) we had a psych patient in a hallway bed. I don’t remember if he was visiting us to stay safe while struggling with suicidal thoughts or if he had come to the ED for some other mental health reason. We try to put patients with mental health complaints in a room as soon as possible, but sometimes the hallway is all we can do for a few hours. This patient fled even though his condition required him to stay in the hospital. He outran hospital security and escaped hospital grounds. Police brought him back to the ED.

I’d seen him sitting on a stretcher in the hall before he fled, staring into space calmly. When the police brought him back, he was slumped forward in a wheelchair with blood running down his shins. He hadn’t had those scrapes before he fled and they caught him. I knew they must have tackled him, but I couldn’t say because I wasn’t there. Later, I’d rinse those scrapes and the ones on his torso, arms, and hands. Nothing too deep, but the iron smell of blood was strong. The patient was NOT angry about the scrapes; he just didn’t want his mother to see him until he was clean again. I couldn’t help thinking that sometimes the price seems steep for safety and medical treatment.

It was a terrible feeling to see someone start in the ED without a scape and then end up with many before their stay was done. I was shaken. I spoke to a coworker about it. I like to discuss things during shift so everything that happened stays at the hospital when I leave. My coworker listened to me carefully and acknowledged the challenging aspects of the situation. It’s always hard to see someone’s mind betray them and, in their worst moments, need restraint from medical staff or police. It’s hard knowing that the violence is part of the route to recovery. My coworker said, “It’s okay to be bothered. If you weren’t, then you’d know it was time to leave this job. When you don’t feel empathy anymore, it’s time to change careers.”  

Empathy is a harsh beast. I believe most of us are able to ignore empathy at least some of the time because it is too much to always feel our emotions and, also, those of someone else. Which has led me to ask several questions about empathy’s nature. How is empathy turned on and off? Is there a time when empathy is out of place? Is it right to push empathy aside to protect oneself? Why are some people more empathetic than others? What does being very empathetic say about a person? Can empathy be taught and untaught?

The Rhetoric of -est

As Mother’s Day whizzed by and we race toward Father’s Day I am reminded of one of my favorite Mother’s Day Facebook posts (posted by a fellow Peace Corps volunteer on one of the Mother’s Days we were in Paraguay). She wished her mother a happy day and stated that she didn’t believe she needed to call her mother “best” to tell her how much she loved her.

The post made me think. It is tempting and common to say “the best mom or dad” or the “coolest” or the “kindest” or add “est” to the end of any description we’d like to use for those we love. But, if there is a “best” it implies that there is a worst and that there are many almost bests or not bests.

Ever since my colleague’s post, I’ve actively avoided the description “best” for anyone, even though it is tempting. I don’t think we need to rank humans or suggest a hierarchy as a means of showing someone we love them. I also don’t think there is such a thing as the “best” mom because no two moms are the same.

I believe language shapes our thinking and if we focused more on describing individual’s good traits without comparing them to others we might create a society with fewer divisions based on arbitrary markers and we might be more likely to recognize the good in humans. Is it a stretch to say how we talk about people will change how we view them? Maybe, but I will argue that framing theory supports my hypothesis that the words we use to describe someone shape how we view them. You can test it though. I dare you to change your rhetoric about people in your life and see if it changes how you view them over time. Try a longitudinal study over 3 years. Report back in 2022, I’ll be here.

What You Look for Is What You Find: Look for Strengths

Not so long ago a friend and I were discussing our workplace culture, the individuals in it, and how the people scheduled to work on a particular day determined how hard the day will be (because some people work more than others). It was a discussion after too many hard hours; we were tired and burnt out. We started spiraling down the path of complaining about everything. Halfway down the trail, I paused to remember that all things are a matter of perspective.

It is easy to complain about coworkers. To gripe how so-and-so doesn’t do or know enough or how they make our work lives harder. Sometimes all we need to do before we can move on is vent, which is productive, while other times we get caught fixating on what makes a particular person terrible, which solves nothing.

I believe anyone can change, and everyone does, but only when they want to change and only when they’re ready. As such, we each can defend ourselves and what we believe in, but expecting others to bend to our will is futile for enacting change in my view. I have NEVER seen anyone work harder after I wished they did. On the flip side, I have seen people work harder when complimented on what they do well and asked to join in the fray when they were surrounded by good examples. This is where perspective comes in. Before you can complement a peer or ask them to do something you know they’ll do well, you must know their strengths. The only way to notice strengths is to look for them, which requires quite the opposite type of astuteness used to identify weaknesses. 

We can’t avoid noticing when others seem to be slacking while we are working too hard. But, as we muddle along, we can also strive to notice if those same slackers do a particular thing well. Once you notice a strength in a peer, you can look to and rely on that person to step up in situations where their strength is vital. This is particularly helpful if their strength is a weakness of yours or if they like tasks you dislike because it transforms a colleague that you found difficult into a resource. We are stronger when we play off each other’s strengths, rather than focus on each other’s weaknesses. Of course, noticing strengths doesn’t negate the wearisomeness of having to pick up another person’s slack or negate a personality clash, but it does lighten the burden and give us an avenue to find common ground. You will see what you look for, so I strive to look for the good. When I get derailed, I vent and, then, try again. Usually, I can find something wonderful within any human. I bet we all can if we try.  

Go Vote on November 6

Elections are November 6. That’s a few days from now. If you haven’t registered, there’s still time. There’s also time to figure out where to go to vote. There’s time to review the candidates and pick which ones you want to lead us. Now’s the time.

Recently, a friend shrugged when I encouraged her to register to vote and fit a trip to the polls into her busy Tuesday. Elections are this Tuesday, November 6, 2018. “I haven’t been affected by the current president,” she said.

“Are you sure?” I asked. I wondered how she hadn’t noticed the ways in which our leaders’ decisions were posed to shape American lives for generations. I wondered when we thought the only person we voted for was the president. I wondered about the apathy of the masses. I wondered when we had forgotten how much politics matter.

We don’t only vote for the president. We vote for the school budget and those who decide how our towns and cities and states should be run. We vote for congress men and women every 2 years and we vote for senators every 6 years…and those two groups make up the Legislative Branch. The Legislative Branch is important because it’s a counterweight, a check and a balance, to the Executive Branch (the president) and the Judicial Branch (the judges, picked by the president on the national level).

US democracy only works if you care about all 3 governmental branches because the 3 keep each other in check. US democracy only works if you care about federal, state, and local politics because they work with and against each other in a constant tug-of-war between different beliefs. When one fraction of the government is ignored by most voters, the voices of a few predominate, and those vocal individuals then make decisions for other people whose lives they don’t understand.

But, let me stop ranting. I have a few points that are more concise. A few issues to keep in mind. A few things I remember when elections come.

  • What’s the price of gas these days? Did you know tariffs and trade agreements made by our politicians can lower the price of gas for the period leading up to elections?
  • What is your voting district? Did you know district borders are drawn by politicians? The lines are often drawn to ensure the current party always wins.
  • How do you feel about access to health care? For the elderly? For the poor? For those who have pre-existing conditions (those who are already sick)? Access to and education about birth control? Your politicians decide how hard it is to see a doctor and get the medications you need to feel well.
  • What is love? Who are you allowed to marry? Who gets legal rights to visit a loved one as they lie dying in a hospital? Who can adopt children? Your politicians decide.
  • Who’s protected by civil rights laws? Your politicians get to set legal definitions of things like gender, sex, and race. Did you know children used to not have protection under the law? They had fewer rights than animals. Politicians changed that—with pressure from lobbyists and people who thought it was wrong to beat children or make children work.
  • Where and when do we go to war? How to we care for veterans? Who do we allow to join the armed forces? Your politicians set those guidelines. What are we doing in Iraq and Afghanistan now? What are American soldiers doing in Syria? Are we going to attack Russia or China? It’s your government that makes those decisions.
  • Are billboards allowed? Billboards are illegal in Vermont, thanks to local politics. Vermont depends on tourism…so were billboards banned for economic reasons or was it because some politicians thought billboards were ugly?

The above are just the beginning. There are so many other things that depend on politics. The price of food, for example. The minimum wage. Life is a complex web. Claim: our immigration policies influence the price of oranges…can you puzzle out why?

The thing about politics is that it permeates life in subtle ways. In the US, we are lucky because political decisions don’t often lead to obvious shortages of essentials or the disappearance of dissenters (we don’t have camps where we hold people prisoner, or do we?). It’s naïve to believe that everything from our wallets to privacy or marriage to jail terms are not shaped by the decisions our legislators, judges, and political leaders make.

My point is simply that your opinion matters. Make yourself heard and go vote. Take part in democracy. Be a citizen of the US and go vote. Go vote because it’s what you should do. Go vote because it’s what others are doing. Go vote because you can. Go vote because your country needs you to vote. Go vote.

English Social Vocabulary Cramps My Style

While I can bore you with a VERY long laundry list of why I love speaking Spanish more than English—especially the Guaraní-Spanish mix (called “jopara”) spoken in Paraguay—I won’t. There’s one term, however, above all the other turns of phrase that I still (years after returning to the US) struggle without. The term is “guapa” (“guapo” for males).

In the Paraguayan context, “guapa” means hardworking. It’s a compliment that’s dished out like gravy at Thanksgiving—in copious amounts and without restraint. If you show up at a friend’s house, you’re “guapa.” If you do the dishes, clear the dishes, or help in any minor way, you’re guapa. If you study like crazy, you’re guapa. If you work long hours, you’re guapa. If you remember someone’s birthday, you’re guapa. If you take two seconds do to anything for anyone else, you’re guapa.

Despite its prevalence and low-barrier for use, I think “guapa” is the most wonderful term. Why? Because it promotes a spirit of teamwork. The word builds into social culture an easy way to constantly appreciate others for their contributions to the wellbeing of the whole. Anyone can be guapa and multiple people can be guapa at once because the more guapa-ness there is the better off everyone ends up.

In my workplace and social spaces, I’ve tried to substitute in English words for “guapa.” “Rocks star,” “champion,” and “genius” are among my favorites, but none of these words hold the shared meaning that “guapa” does in Paraguay. In Paraguay, when you call someone “guapa” it as if you’re saying, “Not only do I notice that thing you’re doing, but also I appreciate both the outcome of your action and you for making it happen.”

In the US, we are busy. In the US, we have high standards. Why the heck don’t we have a word whose sole purpose is to cheer on our colleagues, friends, and family as they undertake their daily adventures? Sometimes I wonder if it comes down to our emphasis on individualism. But, in my mind, even the strongest individual required a village to reach their full potential. I believe we (American English speakers) do more harm than good not having a term to thank folks for all their small acts that make our lives a tad bit brighter each day. “Guapa” makes appreciation a natural part of interaction, not something done out of obligation or because it improves outcomes. I miss being able to use “guapa.” I miss the community feeling words like “guapa” create.

What Is a Hero?

Quandary and Claim

Recently, the discussion as to whether the football players who took a knee during the national anthem were heroes has been zooming across my social media feeds. Often those who do not believe they were heroes show a side-by-side of a sportsman next to a soldier and proclaim that the soldier is the real hero. The first time I saw the comparison it irked me because it is an-apples-to-oranges argument. Further, I think the logic is founded on false pretenses because it says that what title you have determines your hero status. History has shown us many times that title and profession have little to do with heroism. Think of any recent disaster you’d like, you’ll find a story of some common human stepping up to be a hero. Further, being a hero is not exclusive, which is to say that just because one human is a hero does not mean another cannot also be a hero.

Being anything, even a soldier, does not automatically make you a hero. Many soldiers grow to become heroes, their line of work can be a selfless one, but not all. It is unwise to overlook the crimes specific, individual soldiers have committed—the pain they caused soundly rules them out as hero candidates. It would also be foolish to say that any highly-paid athlete is a hero—providing entertainment and winning games does not a hero make.

Some Incomplete Definitions

Google defines hero as, “a person who is admired or idealized for courage, outstanding achievements, or noble qualities.”

My Merriam-Webster dictionary ap defines hero as, “a person who is admired for great or brave acts or fine qualities.”

These definitions leave a bit to be desired because they do not define what exactly an “outstanding achievement” or “brave act” is nor do they define what “noble” or “fine” qualities are. So, let’s explore those concepts.

Outstanding Achievements and Brave Acts

I do not believe that just any outstanding achievement or brave act makes you a hero.

For example…

Getting into medical school is an outstanding achievement, but all medical students are not heroes. It is brave to ride a motorcycle down a curvy, highly-trafficked highway (if you worked in the emergency room you’d think that too), but not all folks who ride motorcycles in dangerous places are heroes.

Selfless acts make heroes.

The acts and achievements that bring “hero” into the dialogue are those where an individual does something that will help another person or group (family, peers, race, gender, nationality…etc.) even though the cost of that act for the individual outweighs any potential personal gain.

For example…

The firefighter who rescues a kid from a burning building. A bystander who helps an old lady cross the street even though he is then late for work. MLK who scarified his freedom and life to fight for equality. The soldier who threw himself on a grenade to protect his comrades. The teacher who stayed after school every day to help a struggling student grasp the material. Malala Yousafzai who spoke up for women’s rights even though it put her in harm’s way. The list goes on…and on…

Noble and Fine Qualities

Similarly, not all qualities that are noble and fine are heroic qualities. Being kind is a noble quality. But kindness alone doesn’t make you a hero, it just makes you a decent human.

Qualities that heroes often embody are selflessness and a fierce definition of right and wrong. I would argue, however, that a hero need not exhibit these qualities every moment of their life.

So, what is a hero?

A hero is someone who changed the course of another’s life (or many others) in such a way as to reduce their suffering, increase their happiness, or protect their individual freedom to reach their full potential (I’ll leave you to define “full potential”) without directly benefiting themselves. Heroes can be local, national, or global. The scale does not detract from the heroism, it simply describes how widely known the hero’s story is. I believe a child who stands up and stops other students from bullying a classmate on her playground is as much a hero as Nelson Mandela, even if the impact is smaller. It is not easy to act selflessly. It is true, however, that some professions and circumstances provide more opportunities to be a hero. I would also argue that “hero” is not inherently a permanent title. It is fleeting and describes a specific act during a specific time. However, some people are so often heroic that they earn the description again and again.

Conclusion

It is not productive to nitpick whether Colin Kaepernick is more of a hero than a soldier. It is worth acknowledging that Kaepernick did something that many football players have not. He brought race discussions to the forefront of entertainment. He forced us to examine if our country is living up to what we claim our guiding principles are in a time when public figures have attacked just about every minority and women. In making us question if our country is truly fighting to give ALL its citizens the right to life, liberty, and the pursuit of happiness Kaepernick made me wonder if we are giving our soldiers the chance to be national heroes or if we are putting them in impossible situations where they can only be heroes within their unit because their country is sending them into battles that cause more harm than good. I think it is important to remember that even if not every soldier is a hero their profession is asking them to put country before their own life. That is a big request; it would be worth reminding our leaders that such a request should weigh heavily on every decision they make.

Leader vs Boss

The many teams I work on (of varying sizes) throughout my shift in the emergency department have provided ample opportunity to experience different team leads. And, in recent weeks, I’ve been reminded of a lesson I once taught my Paraguayan students (I taught life skills classes to grades 7-12 as a Peace Corps volunteer in Paraguay for 2 years). The lesson was during our leadership unit and it was on the difference between a leader and a boss.

Lesson

I started my class with the following image:

I defined the differing titles as follows:

Leader

A leader is someone who leads by example. They are skilled, trustworthy, and levelheaded. A leader is confidant with their abilities, but they are willing to change their tactic if any team member has a better idea. A leader gets their hands dirty. A leader reminds you of your strengths and approaches weaknesses as learning opportunities not permanent shortcomings. A leader is willing to have that hard conversation or make the decision no one else wants to make. A leader makes every team member feel like the project belongs to them, not just the leader.

Boss

A boss is someone who leads by giving orders. They think their way is the only way and expect others to follow them. A boss is an expert, but they are not someone you go to when you’re having a problem. A boss is the first to address a shortcoming or mistake and says little when a job is well done. A boss stands above the work, but tells you how you should complete each task. A boss makes all the decisions, but when something goes wrong blames it on the team. A boss expects you to pledge allegiance to their project.

Reflection

It’s not the breadth of knowledge or the level of skill that distinguishes a leader from a boss. They are differentiated by how they approach their colleagues. When I was a teacher, I asked my students to reflect on which type of team lead they’d rather follow and they always picked the leader. I asked them, then, how they were going to be leaders rather than bosses.

“Listen and be kind,” they said.

We could all remember my students’ advice. For some it comes easily while others have to remind themselves to listen and be kind. However, as long as the end is reached, it’s okay if being a leader doesn’t come naturally at first.

When work is slow, the opportunities to dish out compliments are obvious and abundant. Amid the chaos of a high census (lots of tasks all at once) or when faced with a critical patient, it can be harder. Leaders always find a way to lift us. That’s why we follow them. When the going gets tough, leaders bring us together while bosses push us apart.

Choose to be a leader. Your team needs you.

Work-Life Balance

Why do some people always seem to have time for vacation, camping trips, and concerts while others always seem to be working? How do some people function on what seems to be no sleep? What exactly is work-life balance? Is being a workaholic a problem or just one way of giving life meaning?

Some Case Studies

Hospitals

Health care is full of people who work almost around the clock—nights, weekends, and holidays are fair game. But, for example, the shift work of nursing can allow for many days off every 2 weeks. Plenty of nurses I know take advantage of 36-hour, full-time work weeks (broken into 3, 12-hour shifts). A sample biweekly work week is 3 days working, 1 day sleeping, 3 days working and 7 days off. Despite the exhaustingly long shifts, these nurses enjoy 4 more days off every 2 weeks than a person who works a job Monday through Friday.

My American Family

In my immediate family, there are many models of work. Several of my family members are self-employed. They may work every day but they might also take long stretches off. Some days are long; some days are short. My sister is a trainer and fitness queen. While she often works fewer than 40 hours per week, her hours are spread out across every day of the week and at different times of day such that taking even one day off requires scheduling magic. There’s my step-mom who has the stereotypical workaholic, business schedule which is based on an 8-hour slot Monday through Friday. Of course, a few hours are tacked onto each day and she works additional hours over the weekend. In the end, she works something like 80 hours a week even though she’s on paper for 40—and, stepping away for any stretch of time seems impossible.

Paraguay

In Paraguay, holidays are sacred, summers are lazy, and commutes are so long they seem unreal. Except for the man I knew in the Navy and some small business owners, no Paraguayan I met while living there worked during a national holiday. Perhaps that’s different in Asunción (the capital) and in major hospitals (of which there are few) but generally Paraguayans don’t work holidays. Additionally, few people work on Sundays. Almost nobody works past midnight. While many Paraguayans have long commutes to work and work long hours, the number of days off they have in a year dwarfs the number of days off many Americans choose to take.

Paraguay vs US

In Paraguay, family comes first for most people. Most people work to support their family and buy nice things. Most Paraguayans prioritize time off visiting, eating, celebrating, and watching soccer over working endless hours. Most Americans prioritize working. Many Americans bank hundreds of vacation hours that they cash out or lose entirely. Of course, these are stereotypes…but, during my experience living in both countries, the stereotypes of family-first for Paraguay and work-first for the US seemed justified. I’ve often asked myself, “Who has it right?”

The Perfect Balance

The balance between work and other activities isn’t static. The perfect balance, the one that yields the greatest happiness, is unique for each human. Neither the Paraguayan approach nor the American life approach is better, they are just different. Paraguay taught me the importance of downtime while the US emphasizes overtime and constant production. Regardless of who you are, there are times when work should come first and times when family, vacation, rest, or anything else must come first.

Winning the balance comes down to being willing to reflect on your life and to make changes. For example, when one of my friends frequently complains about working too much or is always exhausted, I often ask if it’s time to scale-back or change their work schedule, job, or approach to working. When another friend often talks about being bored at work or not making enough money, my thought is that it’s time for them to invest more effort in professional growth. Is it easy to change things up and move toward something different? No.

It’s hard to reflect on your life and make meaningful changes. What I do to face the challenge is break my life into chapters and then identify what made me happiest and saddest during each chapter. I use what I identified to inform my guesses about what I need to do today to tip the scale more towards happy going forward. I tend to be work-centered (mostly because I love learning and feeling productive). As a result, the life side of my balance always requires more attention and energy than the work side. Knowing this, I put extra effort into “life” to keep my scale level. My scale often dips one way or the other, but I try not to let the off-kilter stretches jar me. Rather, I make small adjustments until I waver around a mix of experience that feels right for the time.

Sirens

Life boils down to tidbits like sounds. These days as I walk the sidewalk—scuttling, rambling, or strutting from one place to another—I listen to the sirens. Since running (EMT talk for “working”) on an ambulance, I accidentally developed the ability to distinguish fire truck, police car, and ambulance sirens. Since studying the Doppler effect, I can tell if the sirens are approaching or withdrawing. And since learning to drive an ambulance, I know that a change in siren tune or the blast of an air-horn indicate that the vehicle is at an intersection.

I never cared much for automobiles. I still don’t. I’m not particularly proud or impressed by my siren radar. Nor am I gleeful about that fact that I always notice ambulances, no matter where I am. Before joining a rescue squad, I hardly ever processed sirens or saw ambulances because I lived in a city where there are so many of both they become part of the background. But, since moving to the countryside again and joining the world of emergency medicine, my consciousness has changed. I find myself almost subconsciously tracking the progression of sirens around my large Vermont town. A cop car went first—drugs or a car accident maybe? Just an ambulance—maybe the firetruck is out already and it’s just a medical call? Firetruck and ambulance—maybe cardiac arrest?

I started noticing that I listen to sirens because I was thrown into a different world of sounds: the soundtrack of the emergency department. The emergency department is noisy. There are the heart monitors that beep along with patients’ heart rates and alarm whenever the heart rate or oxygen levels deviate from a norm. There’s the clicking of blood pressure cuffs inflating. There’s the sound of wheels scraping as wheelchairs and beds and carts with supplies skid across the linoleum floor. There’s the clacking of those typing about what medications they gave and assessments they did. There is the thud of quick footsteps and the shuffle of walkers. Patients groan and puke and roll in their beds. And that is only the beginning.

I think all the noise is why, after a long week of work, I seek a few hours where people are scarce. It’s hard to think when there is so much to grab your attention. In the bustle of life, we can forget what the wind and the waves and the trees and the birds sound like. But more than anything else, we forget the sound of silence. I’m not talking about the strained, artificial silence of a library during finals week. When I say “silence,” I mean those moments when no one else is there to drop a pin. I’m talking about the silence that can’t be found in a city and is endangered by our social lives. If nothing else, I think true silence helps us ground ourselves and gauge when life’s racket is distracting us.

When I stroll about my town, I always hear the sirens. When I visit the woods where I grew up, I erase the ringing of so many sounds and soak in the quiet of the trees. I’m grateful that I can experience both.