Thursday, February 12, 2015

People don’t care how much you know, until they know how much you care

An Open Letter to Caregivers

As a new doctor in New Zealand,  I’ve had my challenges. For one, I’m an American, and in a thousand different ways that comes with a legacy. Most people I work with want to know all about how I got here and why I left, and it’s usually a great introduction into building a therapeutic relationship.

But there’s also a little apprehension.

You’re an American. Not from here. Not even from New Zealand. What do you know about me and where I come from? And do you even care?

People take their time thinking about that last part, I assure you.

Do you even care?

New Zealand as a country is probably a lot like America was a hundred years ago. People come here from everywhere. And there were plenty of people here before the white people got here as well.

I heard the quote this essay begins with in a seminar about working with people from the Pacific Islands, and honestly it kind of hit me like a thunderbolt.

People don’t care how much you know, until they know how much you care.

I think every doctor should be locked into a room to mediate on this statement for one solid month. To really think about it and examine it, and truly reflect on why they got into a helping profession in the first place.

All relationships, from the friendship to the romantic to the therapeutic, at their very essence boil down to one important question.

Do I trust you?

Can I tell you things I wouldn’t tell another person? Can I let you behind the curtain of my little life and hope you’ll try and understand? Can I let my guard down with you? Tell you things other people might laugh at?

If I can’t, we’re colleagues. Or acquaintances. Or perhaps we have a business relationship.

But I promise I’m not telling you everything.

I think we as doctors often forget what a tremendous act of courage it is for a patient to even COME to the first session. They wouldn’t be there if they didn't know something wasn’t right. But they were scared to come and see us all the same. They probably worried about what to wear, and wondered if they were going to say the wrong thing, and hoping we wouldn’t see them as a loser or a failure or someone that had no interest in taking care of themselves.

We’ve all been there. Every doctor in the world. Every patient in the world.

But we forget. We get busy. One patient runs into another, and years later we find ourselves with a lot less empathy than we started with when we first heard the words “first do no harm.”

But there’s a real person there. A scared person. A vulnerable person. And they’re there hoping you might be able to make them right again.

There is no greater responsibility.

Interestingly, a lot of the heart and soul of these ideas is supported by research. Doctors who are kind don’t get sued, NEARLY as much as doctors who come across as cold-hearted. Even if they are inferior doctors! It’s fascinating research actually. Here is a summary, “physicians who were never sued were perceived by their patients as concerned, accessible, and willing to communicate. Doctors who were sued the most came across as hurried, uninterested, and unwilling to listen and answer questions.”,485345

The numbers are pretty convincing..

It’s a good reminder for me as a psychologist doing business 10,000 miles from home. No one cares too much about my accomplishments here, as well they shouldn’t. They want to know I care. That’s what counts. Sincerity, genuineness, and empathy. All of those tanks that get a little more worn out with each passing year in business. We all could use a little reminder I think. It’s certainly been humbling for me to think about doing business so far away from home.

Once upon a time we were all that little kid, terrified to go to the doctor and begging mom to forget it and take us somewhere else.

For God’s sake even animals get restless when they sense they’re going to the vet.

All of us have been that scared child. Some of still are at 20, or 60, or 90. By definition we’re seeing people at some of the most vulnerable moments of their lives.

The least we could do is care. It means a lot.

It means everything actually. 

Wednesday, January 14, 2015

Suicide is Painless

The game of life is hard to play
I'm gonna lose it anyway
The losing card I'll someday lay
So this is all I have to say.
‘Suicide is Painless

Theme from TV Show ‘Mash”

 I never had any friends later on like the ones I had when I was twelve. Jesus, does anyone?
Stand by Me

Found out today that an old friend of mine had died. I’d like to be writing an essay on how we remained friends throughout our lives, and what an amazing guy he was right until the end.

But I can’t do that. We lost touch.

It was particularly difficult to find that he had committed suicide. That’s not supposed to happen. He was MY age for God’s sake. Sure we are beginning to navigate all the stuff that comes with middle age, but a lot of the hard part is supposed to be behind us, right?

And why DID I lose touch with him exactly? Why do any friends? At one point he and a large number of us spent practically every day of our lives on the golf course as young guys. It was a lot cheaper than a babysitter for our parents. Man did we have fun. And antagonize people. And have a million laughs with each other on summer nights that seemed to last forever.

It doesn’t seem like anything will ever change when you’re young like that.

But somehow it always does. People go off to college. The first guy gets married. Someone has a kid. And the next thing you know, people you were virtually inseparable with slowly recede into the back of your memory. And soon enough you’ve got your own headaches and problems to deal with.

And time marches on.

We’ve been assisted a bit by living in the facebook era, but even that’s a kind of double edged sword. Sure it helps us keep in touch, but is it real? We get to instantly see a snapshot of people’s best version of themselves. A person’s facebook page is often like one of those annoying Christmas letters people send around detailing all of the ways their family excelled over the course of the year. Personally I’d rather have a fruitcake.

And I fucking hate fruitcake.

In a poignant essay entitled “The top five regrets of the dying” a hospice nurse recounts the major themes she heard again and again from people on their deathbeds. One of the items was, ‘I wish I had stayed in touch with my friends.’ She writes,

“Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying.”

That’s kind of heartbreaking to read actually. And we all let it happen. I’m a TERRIBLE culprit myself. You just figure there will always be enough time.

I’ve come to believe that’s the most dangerous lie there is.

I don’t know what my old friend was going through when he decided to take his own life, but I do know one of the most common things people experience in these moments is a feeling of hopelessness. What happened to my friend’s hope? Why did he feel he couldn’t talk about it or ask for help, or just tread water a little longer until the darkness passed?

That’s the thing about suicide. It’s often a reflection of a life that’s become simply too painful to bare. Nearly every suicidal person has serious doubts about the process.

But in that moment, suicide is painless.

I wish I could have been that friend to him. That one person he could have called to get through that moment. I wish he had any kind of friend like that. We all need them. In our youth potential friends are everywhere, but it gets a little harder as we get older. We don’t share the same history with someone, the same references, music, movies, and understanding of a time and place where we have a completely identifiable language between us. That’s rare. That doesn’t come along very often.

Cherish your friends. There’s a reason you found them in the first place.

So in conclusion, I would like to share a little story about my friend.

I was 15 and he was 17 and we were playing golf together. He hit a nice booming drive into the fairway, and mine went slicing into the trees. He was older, and could hit it a little further, and already I was pissed off.

We walked towards my ball, and found it sitting right at the base of a large tree stump.

“Man, tough break,” he said.

“Not really” I replied, as I preceded to kick the ball out into the fairway.

But rather than a lecture, he gave me some advice. He told me that we hit some of our best shots when we recover from these shitty mistakes, and how I was never going to learn to get any better if I didn’t begin to accept this.

It was a great lesson. In golf, and in life. You got yourself into this mess, now summon your best powers of concentration and get yourself out.

You just might surprise yourself.

So that’s how I’ll chose to remember him. As a guy who called me on my bullshit, and chose to be the kind of friend who doesn’t look the other way.

It’s the kind I want to be as well…

So if you’re (still) reading this, please consider me a friend. You can talk to me, and I’ll listen, I promise. I hope I can talk to you as well. Let’s not lose touch anymore than we already have.

Maybe we can help each other.

It's what friends do...

Saturday, January 3, 2015

Embracing the good ole’ days before you’ve actually left them

So we beat on, boats against the current, borne back ceaselessly into the past.
F. Scott Fitzgerald- The Great Gatsby

Martin Sloan-Then one day I knew I had to come back here.
I had to come back and ride the merry-go-round and eat cotton candy and listen to a band concert and to stop and breath and close my eyes and smell and listen.

Dad- I guess we all want that. Maybe when you go back Martin, you’ll find there are merry-go-rounds and band concerts where you are. Maybe you haven’t been looking in the right place.

You’ve been looking behind you Martin.
Try looking ahead.

Walking Distance- The Twilight Zone

I promised myself I wouldn’t write a New Year’s essay this year. No “new me in 2015’, no weight loss, healthy eating, and for God’s sake no exercise. No one needs to be preached to about those things. If you want something bad enough, you’ll find a way. God speed.

But, I did want to write a few words about the past. The timing is just a coincidence.

I thought about this while I was watching football (and not eating healthy) the other day. A college team had a big win, and when one of the kids hoisted the trophy, the announcer said “looking back, this will likely be the greatest moment of this young man’s life.”

STOP! (Hammer time)

It’s one of those things announcers say that sounds perfectly inspirational. And I’m not trying to piss in anyone’s cornflakes by disagreeing. But I DO disagree with the sentiment. It speaks to the idea that our memories have priority over our present and our future. Many of us get caught in this trap I think. We look back and get nostalgic for a time and place in our past, and hold it up as somehow superior to who and where we are now.

There has been a bit of research on this kind of thinking. Philip Zimbardo calls this a “past positive” orientation, and describes how people who think like this often spend their lives yearning for things that have already taken place. They might be overly cautious in their present lives, content to live on the memories of good times that have already occurred.

I reference the show The Twilight Zone in the opening to this essay, and in particular one of my favorites called “Walking Distance.”  In this episode a stressed out man has had enough of his current life and the pressure of deadlines, bills, and commitments. He wants to go home to a simpler life and a more peaceful time.

He finds he can’t go home again.

What I like most is the simplicity of his father’s advice. “You’ve been looking behind you Martin. Try looking ahead.”

Good advice for all of us.

Maybe we’ll find there are some great characters and wonderful stories just waiting to emerge in our present lives if we just take a little bit of a risk. It’s a wonderful thing to find that we still have the ability to surprise ourselves. I’ve been left for dead several times in my life, but somehow like that guy from “Quantum Leap”, a new incarnation always brings some great new adventures. I’m sure you can find them as well. Take a chance. Leap before you look sometimes. Play the hand you’re holding with some balls.

It just might be fun.

I close with one of my all-time favorite lines from one of my all-time favorite shows. I wish there was a way to know you were in the good old days before you’ve actually left them.” 

Love it. Enjoy the now. Have some fun. Take some risks. Lean into the story you’re currently immersed in.

It’s later than you think.

Tuesday, December 16, 2014

And that's how I got to Memphis

If you love somebody enough you'll follow wherever they go
That's how I got to Memphis, that's how I got to Memphis
If you love somebody enough you'll go where your heart wants to go
That's how I got to Memphis, that's how I got to Memphis

Tom T. Hall

Small Aside (Who starts with an aside?). If you don’t know who Tom T. Hall is, please find out. He’s an icon in my family. All of us. He was an enduring piece of our childhood. Listen to him. It will make you feel good.

Okay. Now. Small disclaimer. I was inspired to write this essay after watching the series finale of The Newsroom.  If you watched it you’ll recognize the song. If you didn’t, no matter. I’ll explain. 

One of the characters on the show carefully explains to another that “Memphis” in this scenario is a metaphor for how someone got to where they are supposed to be in life. In the song he follows someone there that he loves. That’s a good “Memphis”. For someone else it may be their children, their career, or maybe even a desire to return home again.

But you get the idea. It’s an explanation as to how you got where you are now. What was the driving force? The passion? The calling?

It’s such a great question really. And I bet a lot of happy people can answer it. 

I’ve tried. And failed. And tried.

I’m still trying.

But the question itself has a lot of meaning. Are you just plodding along in your life, or is there something you’ve always wanted to do? Is there someone you love with all your heart but can’t quite summon up the courage to take a chance on? Do you have a dream that might take you somewhere? If you can answer that, I suggest you don’t waste another second. Nothing else really matters that much. No one will be too impressed with a tombstone that reads, “he met his obligations” or “she kept a stiff upper lip.”

Who cares about that stuff??

We all do. Sometimes we all do.

And yet, we all have our version of Memphis as well. Maybe we’re already there and haven’t stopped to count our blessings. Maybe we haven’t looked back at where we’re at and all the work and time and relationship building we’ve done to get where we are.

All of our lives are somewhere at the end of a romantic comedy. The part where the movie is over and after the credits have rolled. When the couple doesn’t have sex all the time, and starts wearing sweatpants and gains weight and stops worrying about holding in their gas.

That part doesn’t sell many tickets.

I had a good chance to think about all this the other day when I was sitting in Auckland by myself in a bar. A man approached me, and asked me to join him and some of his friends. I politely declined.

I never politely decline.

It got me thinking about what exactly I was doing here in a remote corner of the world, 9000 miles from home, not really knowing anyone and flying pretty blind for the past six months.

And in that moment I thought of Bill Clinton. Not his women or love of Big Macs or anything like that, but something he said to himself when he had gotten off message during an election. “It’s the economy stupid.” Meaning, don’t get distracted by other things. Talk about the economy. It’s what’s important.

I had a similar talk with myself in that moment.

“It’s the people stupid.”

Meaning, everything that drives me as a therapist and a traveler and as a human being, starts with courageous interactions with other people. If I’m quiet, or fearful, or not willing to take a chance, I’m not going to be good at any of that, and for me it’s all tied together.

I quickly grabbed an armload of beers and joined the table. I remembered now. I’m here to dive in, not stand in a fucking corner like a wallflower. That’s where the experiences originate from. Getting past your fear, and reticence, and not regretting the hand you didn’t shake, the laugh you never had, or the adventure you didn’t take.  It’s why I have a lot of stories and have had a lot of fun. It’s how I worked up the courage to jump across an ocean in the first place. Chances, risk, a desire to take on a new world.

So instead of sitting around in a corner all night, I made a bunch of new friends and came away with a few great stories.

It reminded me what the hell I was doing here. In New Zealand. In Auckland. On this planet.

And that’s how I got to Memphis.

The newsroom- That's How I Got to Memphis

Wednesday, November 26, 2014

Ferguson Missouri, (Just my two cents)

In 1992, as Los Angeles burned in response to the Rodney King verdict, I wrote a letter to the editor to the paper in my little hometown. I was just a kid really. Full of ideals, a sense of fairness and justice, and a desire to change the world. My letter expressed my outrage at the idea that police officers were acquitted after beating a man, on camera, in front of the entire world. I was so proud of myself in that moment. I stood up for something. Something that was important to me.

Later I heard another side of the story. Rodney King was driving like a madman eluding the police in a high speed chase. He was on parole for a previous robbery. He had a long history of criminal offenses. Did he deserve to get beaten like he did? By my viewing, no, he didn’t.

But I wasn’t there. I only know what I saw.

Why is this important?

The answer lies in the idea of critical thinking. How do we arrive at what our personal “truth” is? It’s a combination of our upbringing, our values, our experiences, our parents, and a thousand other variables. Sometimes these things make us quickly rush to judgment and jump to conclusions. At our worst as human beings we get emotional, pick a side, and dig in deep. And God forgive you if you disagree. We have names for those who disagree with us. Both sides. You’re a bigot, a racist, an idiotic liberal, a hippie, a tree-hugger, a nazi, an uneducated republican, a dumbocrat.

And on and on it goes..

But can we get back to me for a second??

Sweet home Chicago. I lived in the city for 18 years. It’s one of the most cosmopolitan cities in the world. I’ve had beers with black friends on the south side of Chicago in one of the worst ghettos in this country. I’ve had beers many times with my numerous cop friends in the Irish bars in the city. I saw more crime than I could ever care to remember perpetrated in the black neighborhoods in Chicago. I saw some cops do some very dirty and dishonest things. Mostly though I saw and befriended, and drank and lived and died with a lot of good people from all races trying to do the best they could in a complicated and difficult city with a hundred years of difficult race relations baked into its history.

Most of the people were good though.

But here’s a story I’ll always remember.

2012 and I’m a psychologist working on the south side in a pretty tough neighborhood. I’m busy with white clients, black clients, and everything in between. One day my buzzer rings and I come to the door. It’s an old friend of mine who is a police officer. A white police officer. He’s with a black kid who is about 16. His pants are hanging low on his waist and he looks pretty pissed off.
I have no idea what they’re doing here.

My cop friend explains to me that he picked the kid up for suspicion of a robbery. The kid told him to go fuck himself. He wanted to smack the kid around. The kid wanted to smack him around. Both of them had deeply rooted ideas about what the other one stood for. This came from a lifetime of socialization, personal experiences, parenting, geography, and a million other little things that lead them to jump to conclusions about one another.

Yet there they stood..

My friend asked me for help. He knew I was a psychologist and knew that there was something about this kid that was worth saving.

He asked for my help. I agreed. The three of us sat down and talked. It didn’t go perfectly, but we all came away with a much deeper understanding of where the other was coming from. No cops, no thugs, no psychologists, but three people that actually took an hour to talk. The kid agreed to come back. I worked with him for two years. When I left Chicago he was enrolled in junior college. He hadn’t been arrested since the day he first came to my office. He was studying criminal justice.

“All cops are racist pigs”

“All young black kids are thugs”

No… Not from my experience. Not even a little bit. One of the best pieces of advice I’ve ever gotten as a psychologist was that each person is an N of 1.

But mostly I’ll base this on the fact that a cop who cared brought a kid to me who was going nowhere good in a hurry. Perhaps my sample size is too small, and I’m overlooking larger social and cultural forces that go way beyond this.

But I don’t think so..

Back to the critical thinking though.. I don’t know what happened on that fateful day in Ferguson Missouri, and neither do you. You believe what you believe because of a number of social forces, your upbringing, your education, your experiences, etc.

But you weren’t there.

Our justice system ruled on the case. Perhaps they simply weighed the evidence to the best of their ability and made their decision. Perhaps they were wrong. Perhaps there is racism and favoritism baked into the system.

Perhaps, perhaps, and perhaps.

But you weren’t there.

What’s one person to do you might ask? A lot. An awful lot. Maybe you can take a chance on someone like my cop friend did. Maybe you can volunteer at a school in a neighborhood that needs some help. Maybe you can do something as simple as broadening your social circle to include people of another race, religion or creed. Maybe you can start purposely and carefully challenging yourself to argue and debate the opposing side of an issue you are absolutely certain you are right about.

That’s critical thinking. You don’t have all the answers. Neither do I. Neither does anyone.

But in the meantime let’s try and be good to one another.

Monday, October 20, 2014

Always something there to remind me

I walk along the city streets, you used to walk along with me
And every step I take reminds me of just how we used to be
Oh, how can I forget you, girl, when there is
Always something there to remind me
Always something there to remind me

-Naked Eyes (Or Engleburt Humperdinck if you prefer)

“I can only note that the past is beautiful because one never realises an emotion at the time. It expands later, and thus we don't have complete emotions about the present, only about the past.”

-Virgina Woolf

 I have a small confession to make.

I have a thing about towers.

My whole life I’ve had profound experiences on the top of a tower somewhere.  I’m not sure what it is exactly. Maybe it’s the view, or the sense of perspective, or the idea that you are on top of life, watching it all go on from up above. I’m not really sure actually.

It all started in 7th grade.

I was still a young kid in my salad days, and hadn’t traveled much of anywhere yet. Our class got to take a trip to the Oregon coast that year, and it might as well have been a trip to the moon. I took it in, every second of it. I remember hustling up the stairs of the tower when we arrived in Astoria in my home state of Washington, wanting to be the first one to the top. Here is a snapshot of the place.

It’s 125 feet tall. At the time it felt like the top of the world. I remember the moment so vividly. “Always something there to remind me” was popular on the radio at the time, and I remember hearing it when I was up there looking at the Colombia River from up above. It was the perfect song in that moment, and at that time I made a deal with myself. I would take a mental snapshot of this time and this place and I would never forget this memory.

And I never did…

There were a lot more moments on towers like that in my life, and it’s fun to connect the dots. 

The Space needle in 1992 as a young man at the cusp of a huge adventure. It felt like anything was possible.

The Hancock tower in 1996 when I first moved to Chicago to be a comedian. I felt like I was about to conquer the world.

Dublin Castle in 2008 when I was just about to become a psychologist. I finally made it to Ireland, the culmination of a lifelong dream!

So it was again on a tower that I found myself contemplating my destiny this weekend in Auckland, the biggest city in my new home of New Zealand. As I hiked up a large hill to get to the tower to take the elevator I was huffing and puffing and feeling pretty old. What the hell happened to me? I used to attack a new city with incredible zeal. Hell I practically ran up hills like this. I was sure of it.

Then I looked at some old pictures of myself.

A chubby guy in a red flannel shirt. Decade after decade.

Time can play tricks on us like that..

So up I went, older, maybe marginally wiser, in a  completely different incarnation in my life. I felt a sudden surge of inspiration and reached down for my phone to find a song.

Always something there to remind me

In the end it was wonderful to take another mental snapshot. As much as my life has changed, I'm still that kid on the top of that little tower in Astoria, craving adventure and excited about what is going to happen next. I looked down at all of the little people down below and felt that old familiar feeling. 

Life folding in on itself. 

I spent a couple hours up there watching the people and looking out at the horizon at places I've never been and people I've never met. Not yet anyway.

There was still a lot of time left. More places to go. More towers to climb. It was nice to be up there though and listen to my song again. It reminded me to look back a little while also taking the time to look ahead. 

Always something there to remind me.