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.

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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.

On Not Becoming Jaded

One night a coworker in the emergency department, who also aspires to be a doctor, asked me if I was worried about becoming jaded as I worked in health care. I answered confidently that I wasn’t worried about becoming jaded, my hope for humanity waning, or burning out like so many medical professionals do. He was skeptical, but I am certain of only that one aspect of my future.

Defining Jaded

Especially late at night when most patients are tired and grumpy, the drunks roll in after exhausting the bars, and the patients held for mental health evaluations decide to spend the early morning hours holding yelling matches that involve nonsensical accusations against staff, it’s easy to see how one can grow tired of working in a hospital (and specifically the emergency department). In medicine, we take care of everyone, even if they’re jerks to us, because the fundamental principle of health care is that we serve all people.

Not so long ago I was greeting patients in the waiting room at the emergency department. We had around 20 folks waiting for rooms, the rooms weren’t changing over, and the wait times for many were over 2 hours. That’s a recipe for an unpleasant experience as a greeter, and the recipe was rich that night. I had a parent repeatedly insult the staff, including me, and ask why we hadn’t brought her child to a room yet. That was annoying, but manageable. What got to me was when she stormed up and demanded to know why we brought back “a drug addict” (her words, not mine) before her child. Her argument was that her child had a bright future while that person was a lost cause. Of course, I couldn’t tell the hysterical mother just how awful it is to watch a person go through withdrawal shakes and then seizure. That’s something you can only understand once you see it. I couldn’t tell her about the alcoholic who came to us one night shaking so badly he couldn’t drink water from a cup. I couldn’t tell her how he had looked me in the eye and told me he wasn’t human anymore. That mother was choosing to believe him, but I knew that that patient was human even if he didn’t feel like he was. That angry mother in the waiting room clearly had never seen a person beat an addiction—winning the daily fight to not give in to a drug or alcohol for years. I have.

It’s not the job of medical professionals to pass moral judgment. Sometimes we are weak and tired, and we do judge our patients’ life choices. But if we were to slip into a world where we used our personal morals to decide who should receive care, we would betray the heart of medicine. Medicine was never meant for only a select few.

In my view jaded is another way to describe losing empathy. There are many presentations—impatience, anger, and hating work to name a few. These feelings come when we are too tired and too worn out to see patients as humans. They come when we no longer find joy in the small things about the job that are awesome. And jaded becomes the norm when we give too much. It’s easy to work hours no one else would dream of working when you’re in health care. Each hour is rewarding because we help someone feel better, but the hours take a toll on the giver.

Considering all the above, how am I so certain I won’t become jaded?

  1. My empathy comes from selfish sources, so I don’t expect that it will fizzle. The first source is curiosity and the second is a love for stories and puzzles. Each human has a story. Each sick person is a puzzle. The curious mind can’t help but wonder about the story plot and the answer to the puzzle. These two factors are some of the main reasons I veered down the medical path in the first place.
  2. I know that I’m brave enough to step away and recharge as well as to shake things up when caring for patients under specific conditions becomes wearisome.

How do I know I am brave enough? Paraguay. While living in the land of Guarani, I cultivated an ability for self-reflection and the bravery to face fears because they were required to survive the Peace Corps. Paraguayans also showed me the value of letting yourself be still. In America, we are so determined to be productive we schedule every moment. I think running around all the times makes everyone miserable no matter what their profession. I also think those who become jaded forget to reflect and change. They fail to see that their job is draining them until it’s too late and, then, they lack the courage to change their work so it’s fresh again. It comes down to the best professional advice I was ever given. When I asked a presenter in one of my undergraduate classes how she knew when it was time to leave a job (she had an awe-inspiring, lengthy job history) she said, “You’ll know. You know when it’s time to leave.”

She was right. We do know when it’s time to mix things up. The hard part is taking the steps to act upon what we know. But, if we do take those steps, then jadedness can never catch us. The moment she gave me that advice, years ago now, I promised myself I’d be strong enough to change my course whenever I “knew” it was time. That strength sent me to Paraguay and brought me back to Vermont. So, no, I’m not worried about becoming jaded. I’m just excited to see where my adventures in medicine bring me.

Human Side of Medicine

Not so long ago I worked a code (cardiac arrest = patient’s heart stops and they neither have a pulse nor are breathing) in the field. The patient was middle-aged and had a complex medical history. The patient’s father, visiting from out-of-town, found him unresponsive, started compressions, and called 911. We did all we could—did compressions, ventilated, pushed epinephrine and other medications, and analyzed for a shockable rhythm. As we worked the father knelt at his son’s head. The patient’s fiancée sat outside the house. As it became clear that we were not getting our patient back, my crew chief reviewed, outload, all we had done. She asked us if we could think of any other interventions we hadn’t yet done and then she engaged the father, explaining why we were going to stop resuscitation. Once we had stopped she went outside to talk to the fiancée.

As heartbroken as the patient’s family was, they were calm when we stopped CPR. They had seen us sweat over their loved one, try everything we could, and ask for suggestions. We included them in our decision to stop our efforts. We lingered after our care was done to answer questions and offer condolences. This call showed me how it is within the pauses between action that we connect with our patients.

The human side of medicine comes through when we take time to ensure our patients understand what is happening and our plan for treatment. It comes when we include our patients and, when appropriate, their family in decisions about their care. And it’s completed by taking a moment to share their feelings, whether of relief after a successful procedure or sorrow after the loss of a loved one, before we scurry on to our next case.

Amid medical histories and assessments of signs and symptoms that lead to differential diagnoses it can be easy to let the presence of a disease or condition consume our attention. We can focus so intently on the disease that we forget humans bear the illness. But, below the clammy skin and wheezing is a person with a family and life experience just like you and me. And, what the patient will remember from their time during the flurry of a medical crisis is how someone treated them. It’s the offering of a kind word or an act of kindness on the worst day of someone’s life, not just the hope and likelihood that we have a cure, that defines good medicine. I try to remember to take advantage of the pauses by offering a blanket or bit of conversation to my patients. There aren’t always many pauses in my day, but when there are I don’t like letting them go to waste. It’s in the shared moments between points A and B that we build our humanity, but we must be attentive or we’ll miss the opportunity.

In Arlington Cemetery

This summer we held a memorial for my grandfather in Arlington Cemetery. His name will be on one of the niches in the columbarium. He was in the Navy and served in the Korean War. The service was short and concise. I think its precision and simplicity was well suited to my grandfather who was a high school and college math professor and liked things to be just right but not conspicuous. The chaplain was empathetic and caring and the soldiers who performed the flag ceremony were on point. As we said our formal goodbyes a trumpet’s song floated in the air above us.

My grandmother used to comment how they enjoyed when I visited because I’d sit all day and laugh as my grandfather told stories. He was a particularly gifted storyteller with the dry wit that ignites my science-loving and logic-focused brain. He told stories of the Navy (usually when he and his comrades were causing trouble), his struggles as a student (he went for a doctorate in math but didn’t finish his thesis because of a disagreement with faculty), or his adventures as a teacher (he had many years of teaching from which to draw).

In EMT lingo, my grandfather had an “extensive cardiac history.” When I called my grandmother after hearing of my grandfather’s passing she told me, “The EMTs who responded to my call were wonderful. You do good work.” She said that even though they couldn’t get him back. His heart had stopped and he had no cat-lives left. When my grandfather died, I’d been volunteering as an EMT for several months.

I’m still an EMT and I also work in an emergency department. An interesting thing about providing emergency medical care is that your mission is to lessen pain and ward off death, but you end up seeing a lot of both. You end up being there when medicine meets it limits and the time of death is pronounced. I sometimes wonder what the EMTs at my grandfather’s death thought. I wonder how they ran their emergency call. What did they do to make my grandmother feel like they’d done the right thing? I hope the families of my patients have the same impression when we determine it’s time to stop CPR.

I used to visit Arlington National Cemetery periodically when I lived in DC. I like cemeteries because I enjoy walking the tombs and imagining the histories of the people they memorialize. Now when I visit Arlington, I won’t have to invent my grandfather’s story because I know it. I’m a product of it. I think of him often, partly because I wish he’d send me some of his math-genius as I continue my medical studies. Mostly, I think of him because he is one of the few people I know who successfully and completely built a life he loved. His only unfinished business is the family he left, especially his wife, but we’ll join him again one day if afterlife exists. Until then, we’ll keep making stories worth telling just as he always encouraged us to do.

Photo Credit: Mary Lou (family friend)

Christof

There’s a guy, Christof, in my neighborhood who collects returnable bottles from the recycling we put out on the corner for the city each Friday. One day when my father was visiting me, he struck up a conversation with Christof. One of Christof’s daughters went to college and the other didn’t–Christof joked that the daughter who finished college doesn’t have a job while the other one does. He collects bottles to help both of them.

I don’t often drink anything that comes in a redeemable bottle, but since chatting with Christof, my father started saving his seltzer bottles…he drinks a lot of seltzer. My father brings the bottles to my house (even though I live about 2 hours away) when he visits so I can give them to Christof.

I work nights, so it’s challenging to put out the recycling before Christof passes. One morning I saw him, though, collecting from the neighbors. As he walked by, I ran out and asked him to wait a moment. He paused, a smile lighting his face. I handed him 2 huge trash bags of bottles I’d squirreled in the garage for a few weeks. He thanked me a million times, wished me a blessed day, and was on his way.

At first, I thought my father was ridiculous for saving bottles for Christof. But, that morning when I saw Christof’s face after I handed him our bags of bottles, I realized that my father was right. We can get so caught up in all the big things we should do that we do nothing. Christof reminded me that it’s the small things that add up in the end. And, luckily, life is full of small things.

Determination: 2 Girls, 1 Hill, 1 Tree, and 1 Ladder

As children, my friends and I spent hours wandering the woods. We lived in rural Vermont in the middle of hills covered with sugar maples. One of my best friend’s families made maple syrup as part of their living—they collected their sap using draft horses. And it is with that friend that this adventure took place.

Far up on one of the hills behind her house, maybe a 40-minute hike across a river and bushwhacking through the sugar bush, was a monstrous tree. It was a Pippi Longstocking tree, a tree of wonder and stories. It was the most perfect tree for a tree fort you can imagine…and the branches didn’t start until 20 feet above the ground.

Those high branches spread out in such a way as to almost make a floor. My friend and I thought that if only we could reach those branches it would be the best thing in the world. We dreamed of hanging a hammock from those taunting limbs and eating a picnic up in the canopy. We thought about our future tree fortress on many occasions, staring up from the ground, until one day we contrived a plan.

Her father had a very tall ladder—one of those aluminum ones that has two sliding parts so it can get even longer than it appears at first.

We started in the morning. She took one end of the ladder and I the other. Those ladders, though hollow, are not light. We discovered this not long after crossing the river and starting up the hill. We also realized that zigzagging through trees was a lot harder when you are attached to another person by an 8-foot, stiff ladder.

We stopped occasionally. We argued about the best way to go through the trees. We sweated and got scratched by brayers.

And, after what seemed eons, we reached the tree. We lay the ladder against it, expanding it to its full length. We observed the ladder. We were scared. It was so tall and the ground wasn’t even. Surely, we’d fall if we climbed it. Surely, if we fell we’d die. We talked about climbing the ladder. About falling. About how amazing it probably was up there. “Fine, hold the ladder,” I said. And I put my foot on the first rung. I was shaky. It was high. My heart pounded. I got about 6 feet above the ground. I paused. The ladder felt wobbly. I wasn’t sure if I should keep going.

Slowly, carefully I reached the top rung. The branches were still overhead. I’d have to grab them and then swing my legs up and hang sloth-style to get up in the tree. I stood at the top of the ladder a long time. My friend first shouted up that if I wasn’t going to do it I should come down so she could. Then she suggested that we not do it at all.

I grabbed the branch and I swung up. “This is awesome!” I said, sitting and staring down at her on the ground. She joined me, with the greatest care because the ladder was unsteady, especially without someone holding it.

We sat up in the tree until we got hungry. The only reason we ever left the woods was because we were starved.

Some people will tell you your dreams are impossible. Don’t bother with them. Someone else will help you carry a ladder.

Defining Friendship

On my EMT shift the day before my birthday, the dangerous topic of religion came up for some reason while we were reviewing the ambulance (something we do at the beginning of every shift) to make sure we had all the right supplies. Like most careful Americans, we ended the religion conversation before we needed to say much about our personal beliefs. It was amusing to contrast the politically correct nature of the conversation with my experience in Paraguay. In Paraguay, religion is not a topic that’s avoided and people have no problem asking you if you’re catholic (the dominate religion there). I went to Paraguay with almost no religious experiences (and most that I had had were very negative)…but Paraguay brought me up to speed on their version of being catholic. And they changed my view of religion forever (though they didn’t convert me).

As I wrote when I was in Paraguay, the Paraguay I know is Catholic. That means that to my Paraguay friends the entire world is seen through the lens of Mary, Jesus, and the saints. A lot of what Mary and Jesus and the saints talk about is how you’re supposed to treat other people. Paraguayans put people, especially family, first.

A little after 9pm on my birthday I got a video message from one of my families in Paraguay. When I say family, I mean I spent every weekend with them. I went to church, out shopping, and to soccer games with them (in Paraguay, soccer is the equivalent of all sports in the US combined). I went dancing all night with the daughters, studied English and history for hours with the son, ate many dinners and lunches with them a week. I showered at their house when my water was out. I was in both daughters’ weddings…

My whole family was there in the video message. First they sang “Happy Birthday” in Guarani…then it was “Happy birthday Jett. May you have a blessed birthday and many blessed years ahead. I hope you’re having a wonderful time. Send us a video, Jett, so we can see you…We miss you Jett. When are you coming back Jett?”

It’s so nice when you realize that the people you think about all the time also think about you. And as my family’s familiar voices and happy words sunk in I thought about friendship. Even friendship is defined using a religious metaphor in Paraguay. And, with the topics of religion and friendship on my mind, it seemed fitting to share (again) one of my favorite stories about both:

Overheard in Paraguay: Friendship
Repost from October 19, 2015

We sat in a half circle around the grill. The men were cooking large slabs of meat, ribs and some unidentifiable cut, for the mother of the family’s birthday dinner. The husband of one of the birthday mother’s daughters sat by the grill passing one can of beer among the men there. A nephew walked up to the daughter’s husband. The husband was around 30 and the nephew was about 11.

The husband hugged his nephew first with one arm and then the other, squeezing him. The nephew squirmed, and they both smiled. The husband held the nephew at arm’s length and put on an almost serious expression. “Will we always be friends?” the husband asked.

“Yes,” the nephew said.

“Even when I am old and you are my age?” the husband asked.

“Yes, even when you are old and I have kids,” the nephew said.

The husband smiled and pulled the nephew into another hug. The nephew pulled away again and they looked at each other, the husband still squeezed the nephew’s shoulder with one hand.

“Even when you are in Heaven and I am old we will still be friends,” the nephew said earnestly.

The husband laughed. “And I will look after you from Heaven.” They hugged again. “And, when you come to Heaven, we will be friends in Heaven. We will be friends forever.”

The boy nodded and ran off to find his playmates.

Happiness Comes from the Heart

Being a pre-med post-baccalaureate student, I take a lot of classes with humans that are 8-10 years younger than me. These young people are a dichotomy of vibrant energy and self-doubt. We are on same footing as we struggle to memorize microbes and how p orbitals shape molecules, yet we are not even in adjacent life chapters.

It’s nice to be a witness, rather than a participant, of the soul searching that comes with learning how to be an adult. I once was an 18-year-old too, but I’m glad that era is behind me. I know my young colleagues will come out just fine without any help. But, there’s one thing that I wish I could tell them so they wouldn’t have to go through the trouble of discovering it themselves. It’s simple but, alas, it’s something only experience can teach us: happiness comes from within.

I think many of us get lost in the weeds when it comes to happiness. We jump from shiny thing to shiny thing. We assume the next great object we possess will fill the holes in our soul. We look to family, friends, and partners thinking they can save us. We search for other’s approval of our look. We act based on strangers’ opinions, hoping that society will label us as “cool.” And as we skip and hop between all these outward forces, our emptiness expands until our core seems more like a beach ball than a rock. Hollow.

It’s not the doldrums, the pits, where the quest for meaning beyond ourselves drives us, but to stagnant waters and ships with limp sails. And, while some of my young lab partners might learn quickly that they are the only ones who can make themselves happy, many of them will take years to realize the truth. I’m not sorry for them. I know their journey will have many fun days and explosions of wonder. But, if they are like me, they won’t find peace until they understand that joy originates inside and spreads from there. I don’t wish the restlessness of the road upon anyone, but it’s a road we all must wander at some point.

While others might make our lives brighter, we’re the only ones who can decide if we’re going to let in the sunshine or draw the curtains. I hope that when the going gets tough and the days seem dark the young folks around me take the time to look inward. There are many things beyond our control, but our emotions and how we respond to the world do not fall among them.

Are you lonely?

“Are you lonely?” is America’s version of the boyfriend question. I thought the coupling obsession was a Paraguayan thing. But, now that I’m back in the US, I realize I was mistaken. It’s also an American thing. Maybe it’s a human thing. Regardless, I’ve gotten a lot of practice justifying why I’m single. So, let me tell you…

…there is no reason why I’m single. I just am.

I know it’s hard to believe that a person can be happy just being. But, try to imagine it. Consider, for example, that I can go hiking on the fly and not wait for a soul. I could move anywhere and would only need to bargain with my future landlord and maybe the visa office. I can (and do) eat when, what, and where I want and don’t feel even a hint of obligation to coordinate with anyone.

Perhaps you’re thinking something like, “Fine, Jett, you’re busy and independent…but really you’re just waiting for the right guy. You’re lonely, but you forge on propelled by the dream of the prince who will sweep you off your feet one day.”

If something like that is on your mind, I must ask: Doesn’t that argument seem archaic? By now we should all know that princes only live in fairytales. They aren’t real, but metaphors for love and good fortune. I don’t need the metaphor. I’m not looking for someone to fend off the dragons. I do that just fine on my own.

Don’t despair, you’re partly right. I’m busy and I have great friends. But that’s the whole point. If I lived my whole life as I am—doing good work, engaging in hobbies, and enjoying friends—then I would have an awesome life. You see, my life’s not on hold. I’m not working toward finding that perfect man. I’m just living…and I also happen to be single. I’m not worried about love. Why should I? It’s spontaneous and stubborn. It will do whatever the heck it wants. Just like me.

I might one day stumble upon someone to be my partner in crime. I might uncover a person who makes me happier than I already am. If I do, I’ll marry him. I also might not find such a human. Either way, the trajectory is grand. I realize that many believe that singletons need to be saved. But let’s remember that when we, you and I, were taught about the American dream it was never said that it could only be dreamt by two.

Thanks for your concern about my emotional well-being. But, the better question is “What do you do?” I assure you the answer is interesting. I have a lot to say about me and my doings. And don’t worry, I’ll let you know if me becomes we.