Tuesday, August 21, 2012

Welcome to Neurology


I sent a text to a small audience: Got z call! I’m top o z list and I accepted! So z factor that most affects a start date is z re-credentialing pkg. Mahalo!!! U may un-pretzel now! (keepg all appendages crossed). More soon!!! Xoxo   ~L

Amid the yippees, yee-haws, and congratulatory texts, one stood out at the end of the day: SUPER NEWS!!!! Congratulations and welcome to Neurology. Welcome to Neurology... they can’t take it back now; can they?

After a six-year hiatus, I would soon return to Kaiser Permanente (KP) as a Nurse Practitioner (NP). I held my breath and spoke not a word. Beyond that core group of friends, I shared the news with no one. I waited in disbelief, bracing for the call rescinding the offer with sincerest apologies for their error. When a week had passed without retraction, I told my Mom and called my manager.
“This has been a great place for me to land,” I said. “It expanded me and in doing so, it expanded the NP team at Mercy General, where we now manage the diabetes of all post-op open-hearts.” The ripple effect through my life is seldom so clear. “But it is one of my heart’s greatest desires to work as a nurse practitioner for Kaiser.
“I understand,” she said, “Were I in your shoes, I’d do the same. You have been an asset to this department and we will miss you.” Ditto.

Six years ago, my job with Kaiser's Hospital Based Service (the internist group that cares for hospitalized patients) was mortally wounded by line-item veto during a budget battle. I found employment as a staff RN in the ED (Emergency Dept.) overnight. A year later, I moved into diabetes management where I have flourished in an expanded-RN position. But an expanded-RN role is far from an NP role.
Saturdays at the General, I round independently, write orders, confer with other clinicians, and sometimes call for specialist consultations. Mondays at KP, my orders require approval and a doctor’s signature. The weekly demotion is acute, the loss of status - sometimes humiliating.

In a recent conversation, a physician said, “Your diabetes work is inspired, and authentic, and transparent. You’ve found expression there, and joy, and it enlivens you. It’s kind of a sweet spot.” 
“Yes,” I nodded.
“I am wondering how you reconcile this sweet spot as you look about for something else in your want to work as a nurse practitioner.”
“Well, you know,” I started slowly, “There is growing where I'm planted AND I am not my circumstance. The quality of my life will not be determined by my circumstance... and sometimes it is.”
“So you have a commitment to growing where you’re planted?” 
“Yeah, I guess,” I cast a long, backward look through my memory. “It’s always kinda been that way. Growing where I’m planted is certainly one way I live and I am intrinsically happy; I make lemonade. There is also recognizing when I am planted in fallow ground. My life is not a spectator sport. If I can’t play ball, if I can’t put down roots to nurture me, I’ll take my ball elsewhere.”
Diabetes Management had been anything but fallow ground.

If I knew then what I know now... I turned my nose up at two jobs in 2005-2006. One job involved migraines. Migraines? Does that have anything to do with the heart? 
Pause in think: When my favorite cardiovascular surgeon is particularly playful, he will respond to my questions saying, “Wait a minute, does this have anything to do with anything between the zenith of the aortic arch and diaphragm? Hmm? Then why are you asking me?” At which time we bust a gut. Thus my tangential, rhetorical question regarding migraines. But I digress.
The other job involved caring for Kaiser patients in skilled nursing facilities - the smells of which make me wretch, while managing monthly blood work held little appeal to daily, even hourly labs.

But if I knew then what I know now... that the KP tide would turn from NPs and I was in for a six year drought through which I would work split days-off to keep a particular skill-set alive. 
“I’m proud of you, at your persistence and creativity in the face of disappointment,” my friend said.
Yes, I’ve made lemonade and enticed many into drinking the Kool-Aid. Its been fun, rewarding, expanding, all that... and underneath it all has been my deep and sometimes despairing disappointment in not working for KP as an NP.

So its back to from expert to novice yet again for me. This is what I noticed... fear.
Fear that my friends Jack and Rochelle (neurologists both) will find out that I’m not very smart, and not all that teachable, and stubborn, and argumentative, and that all my work in diabetes was flukey and coincidental. Basically, I fear they will find out I’m a fake.
“Oh,” Blake said, “You’re suffering from the Imposteur Syndrome.”
“Impostor Syndrome; what’s that?”
“The Imposteur Syndrome,” he explained, “Usually felt by someone who has taken on something big and it’s working. They feel a little out of their league, hence a fake. And they are usually playing a bigger game.”
“Yep, that’d be me, z imposteur.”

Self-censoring internal dialogue - we all have it and it flares, fanned by circumstance. They’ll find out I’m a fake is some version of I’m not good enough - a primordial conversation for human being along with: There’s something wrong, I don’t belong, and I’m on my own. 
When these conversations run hidden in the background like elevator music... ever leave an elevator humming the song that played within? It’s so subtle. When self-censoring, internal dialogue plays in the background without our awareness (Landmark calls this undistinguished), and our actions and decisions are based upon disempowering beliefs about ourselves and others... life can be reflexive and knee-jerk.

In a recent training THE take-home message for me was this: A key aspect of integrity is knowing how I occur for myself.
How I occur for myself is like a brown pair of shoes at a black-tie affair, like an imposteur, a fake. How that manifests is that I withhold and keep secrets because if I told you of the fourteen patients who have weaned themselves from insulin and countless others who have lost weight and take a fraction of their previous medications, you might look deeper and finding that some have backslid - deem me a charlatan.

On a conscious, rational level, I know that inspiring and motivating people into new action is no different from that which supports them once change is made. However, my workflow does not include both. I am paid to do one and work in the other steals time from that for which I am paid. So I move people to take action but once they achieve the goal, I work elsewhere. 
And truly - if I didn’t have this justification, this human being would likely find another. My Landmark training helps me distinguish that the entire conversation is in service of: I feel like a brown pair of shoes at a black-tie affair. When I can see that, when it is distinguished, I can set my concerns for hiding, faking, and looking good aside to share my excitement in life with others.

It takes enormous courage to try out new ways of being in the face of fear and by choosing to do so, we become less reflexive and more author of our own experience. Choosing requires courage - and courage leads to the ontological discussions of being
Ultimately, there IS no reconciliation with where I am and what I want. Sometimes, rarely, I have been resigned that I might never work for KP as an NP. Nonetheless, I show up and play. The venue may change but my heart is not tied to the venue. My heart is tied to being: who I get to be and how I get to play. 
As it turns out - my new playground is spelled NEUROLOGY.

Those who know me well, know this as my creed, BaconiOS, if you will:
A person who is a master in the art of living makes little distinction between their work and their play, their labor and their leisure, their mind and their body, their education and their recreation, their love and their religion. They hardly know which is which, they simply pursue their vision of excellence and grace, whatever they do, leaving others to decide whether they are working or playing. To them they are always doing both. ~ Lawrence Pearsall Jacks

I must be re-credentialed at KP. The background checks should fly as I am a KP employee and currently working as an NP (thus possess a DEA number, furnishing license, etc.) Ultimately, the credentialing process allows me to write orders, prescriptions, and bill for my work. It is a two-three month paper-chase. I now await arrival of the tome, a two-inch-thick packet from Human Resources.
Realistically, I expect to land in Neurology (fingers crossed) in November.

Mahalo for your support through these many years. 
Play on and I’ll keep ya posted!

Tuesday, August 7, 2012

Mating in Captivity ~ Unlocking Erotic Intelligence


Love never dies a natural death. It dies because we don’t know 
how to replenish its source. - Ana├»s Nin 

I have just read a riveting page turner, Mating in Captivity - Unlocking Erotic Intelligence. Written by couples and family therapist Esther Perel, I’d say its underlying question is (in the words of Dan Fogelberg), How do we make love stay? 

“Monogamy easily slides downward into celibacy,” Perel asserts, and relational celibacy is seldom, mutually acceptable. Perel examines long-term relationships beneath an uncommon lens, dissects common pitfalls, and builds bridges back to love, sex, and eros where sex and eroticism are not equivalents. 
Many marriages simmer in resignation, enduring versus endearing. Entrenched behaviors and disempowering forms of communication create callous combatants versus convivial compadres. “I’m often amazed at how couples can be up on the minute details of each other’s lives, but haven’t had a meaningful conversation in years.”

Over time, we build barriers in lieu of bridges and our relational dance floor becomes  increasingly cordoned by the taboo. We point to our boundaries, training others to avoid  the out-of-bounds. We don’t address drunkeness or acerbity that reopen festering wounds. We waltz around sensitive topics and the elephant in the room. 
Bridge-building occurs in dialogue - dialoguing through the minefield of fantasy and fear - getting nakeder than naked.

What Perel lacks is access to ontology - the nature of being and relational technology that allows partners to see the impact of their being-ness and behavior on the other, the ability to step outside oneself and become what Eckhart Tolle labeled the watcher.  Without that, partners can stay very, very stuck, entrenched in the rightness of positions and perspectives. You wanna be right or you wanna be happy? So while I agree with bridge-building, from a Landmark perspective, her methods lack trusses and bolts. 
Nonetheless, it is a powerful book and in its reading I gained appreciation for the difficulties of relationship and the capacities, or lack thereof, of its constituents.

“Your friends, don’t understand how you could let your life devolve to a state where you have no partner and aren’t interested in one,” she said.
“We were put here to be in relationship,” he said. “What about you Lorin; when are you going to be in relationship?”
“When I meet someone who inspires me to it,” I defended.

I defend myself weekly and weakly against the onslaught asserting that I should be dating or in partnership or seeking partnership.
I hear their concern and... I have gobs of relationships. If there is one thing growing-up in a large, extended, Asian family teaches - it is to be in relationship. But that is not what my friends point to and against which I defend.
To some degree, I agree with them. Should you have told me that seven years later I would have no real appetite for an intimate, romantic relationship, I would have disagreed. Nonetheless, there it is. I have no explanation other than I have no heart for it. And that, my friends, cannot be conjured ... so I defend. 

Dating to placate my friends or to meet some mythical deadline seems pure folly. I am not lonely or lacking. I am whole without a man. It is what it is.

“I’m a happening guy, I’m cool, I read,” one gentleman asserted while lamenting he lacked “Yummy Man” status. And he is cool ... but he lacks tools and is unwilling to acquire them. Pouting and defending one’s unwillingness to have conversations for workability and alignment is certainly one way ...

“You don’t have a TV?” he looked surprised. “You mean we can’t have a TV in our bedroom? That’s a deal-breaker.” Whew! Was my sigh of relief audible?

“My wife can’t have conversations like that. She can’t hear them and she can’t be with them.”
“C’mon!” my voice rose, “You can’t set things up? Frame them and have conversations for alignment and workability?”
“No,” his head shook. “No,” he reiterated more forcefully when I my jaw gaped and eyes popped. “And pointing out where communication doesn’t work is perceived as nagging. There’s all the make wrong and ... baggage,” he gave me a pained, pinched look.
“That SUCKS Cameron.”
“Uh-huh,” he nodded with an expression that unequivocally said, Yeah, so what?

If life is indeed created in language, then I seek someone who can language an intention to create and recreate love on-goingly, one who can generate conversations for workability and stay with them through breakdown to breakthrough.

Why is it okay with you to be treated that way?
Such a question can look like a nudge toward the door rather than the mine shaft it is. Mine shafts are for mining. They are dark and scary - to which we can bring light and discover treasure. My friend Paki would say, “There IS cheese down that tunnel.”

We know one another through language - and language can be sorely limiting. That limitation gives rise to music, poetry, and prose... the arts. Nonetheless, language is what we have and our reticence with our “outside voice” is very often the cause of our suffering: our unwillingness to have difficult conversations, to express how things are for us, to create alignment, and jointly forge new paths. We weren’t trained in this and there are painfully few examples that it works. 

Perel points to deliberate, parental orchestration of our children’s lives and the channeling of eros from partner into children. The birth of the first child often leaves parents (particularly fathers) surviving in an emotional desert. “I do believe that sex matters for you and your partner. How did it come to be that, on the extensive list of things your children need, parents who have sex isn’t one of them?”
Take home message? Orchestrate for ourselves, for and despite our children.

The cornerstone to the entire structure of marriage is a promise to love, honor, and cherish. Loving with our hearts, our souls, and our bodies. I assert the real work of marriage is an intention to restore and re-presence love on-goingly - with our hearts, our souls, and our bodies. We lose sight of this, we don’t speak it into existence, we don’t point to its starts and stops and pull for it  in the moment it wanders. Often, we do not row together but drift, oars up.
Further our focus on till death do us part is flawed and stigma prevails, albeit dissipating, in divorce. We have our eye on the wrong ball. If we had our eye on love, honor, and cherish - till death do us part would be a forgone conclusion. How do we do that; keep our eye on love, honor, and cherish?

When is pointing to love’s starts and stops like nagging? When one feels at fault. Its all in the delivery; is it not? We can hear anything if we are not made wrong. I think the cornerstone is an intention bigger than marriage itself, bigger than staying together till death do us part or the habit of it or inertia or fear or to preserve public persona and looking good or for the kids or because its the right thing to do or from a commitment to it or a bigger commitment to honor one’s word. 
Consider a marital commitment as old news unless that commitment gives rise to an intention to nurture the nature of its constituents. What? Nurture the nature of its constituents? What would that look like? It would look like knowing and providing that which makes your partner feel loved, honored, and cherished without regard for oneself.  What is today’s intention for my beloved? A relationship from a commitment might look very different from a relationship rooted in a commitment that inspires created and re-created intention.

Some years ago, a bleader (blog reader) said, “You’re not in relationship; you don’t know.” I let that silence me for many months. ...I was married longer than most. Without the distractions of children, I had years to cogitate and ruminate. When I expound on marriages of resignation and unwilling partners - I know from whence I came and daresay, it lends a particular perspective.
Writing brings my life and thoughts into focus. I often write when I am troubled or seeking clarity. Writing helps distill my seemingly random and disconnected thoughts into something orderly and meaningful. T’was the case here. I feel like a big chunk dropped into place. ... I can see the barrier and the opening.

I am primarily unattached to whether couples stay together. I am committed that they find peace, joy, and love versus suffering and struggle. More than love, what people seek in relationship is to be heard, known, and accepted for who they truly are.
This year, I am being trained by Landmark to “listen.” My hope is that people find themselves in my listening and discover the soft landing and sweet spot where who they are can unfold and express. That’s good relationship material in anyone’s book!

Mahalo for your bleadership, ongoing dialogue, and email threads - stirring the reduction of blog.