May 12, 2019

People : Trust

Lately, I've had many conversations and interactions with my colleagues who have made me think hard about what it means to try, and keep trying, in our work.  With people at the beginnings of their impact, already sparking change and with so much potential, who have established the goal to try everything possible, over and over--and ask: why don't others understand the value of this ideal?  With people who have forged their way into the thick middle, who are all in and can't sleep at night because they can't find themselves anymore--and ask: how do we keep going?  With people who decades into this have faced disappointment and resistance, internally and externally, and stay immersed in conflict and paradox--and ask: how do we respect experience and stay open at the same time?

In a team of people with a wide spectrum of past and future experience, I'm learning that each one of us is a shifting layer.  So thin amidst the stack of all that we do and see, it can be hard to give each slice the weight it deserves, to be mindful of how much each one fluctuates and evolves.  For me the continual far-from-attainable goal is the balance between separating the layers to allow every one a full frame, and reinforcing the common shape that enables us to form a whole.

I'm grateful for being pushed to ask these questions. If I had to choose an answer to all of them, it would be: we're all the same.

I trust that we all believe in the same mission.  This doesn't mean that we do things the same way as one another.  We give and express and care differently.  It doesn't mean that a single person is the same every day.  There are days I'll go the extra mile and there are days I'm too tired.  There are days that I'll stay calm through every frustration and days that I'll inwardly cry about every petty bump.  There are days when I manically oscillate between these points of emotion over the course of minutes and hours.  We encounter each other at different points in our belief and effort, and that tries our trust. Trust doesn't mean a stable, unquestioning faith. I'm plenty guilty of wondering why someone else doesn't do something the way I would, or why I didn't put forth the same effort as another. Shouldn't they care; shouldn't I care?  Trust means working through these natural judgments and returning to the truth of our sameness.

I trust that we all face the same challenges. This doesn't mean that we vocalize them or cope with them in the same way. But hearing from my colleagues lately about what is hard for them about their work, I'm struck by how much the same things from such different people resonate for me.  The lack of power, the sense of abandonment, the absorption of injustice, the invalidation of our ideals and efforts, the feeling of failure.  Recently having had several conversations lately about my perceived calmness and positivity, I'd like to dismantle those coping mechanisms and fully share how deeply difficult my job can be for me.

I hate the complete fissure of a three year relationship with a patient, in which I sidestepped differences in values that affronted core parts of me to put caretaking first. It hurt that he fired me after I made myself available over and over at unscheduled, unpredictable times; after I reached out over and over to ensure continuity, to ensure that regardless of outcome he knew we remembered him. I'm angry at the substances that unhinged him, I'm sad that this feels personal even though I know it isn't, I dislike the parts of me that couldn't stick with him, I wonder if someone else would have tried harder, I'm embarrassed about the ego that makes me think that I could or should be more than a rung in the ever turning wheel of this person's life.  I feel guilty for feeling traumatized when so privileged, when he needs me to be stronger and better than that in the midst of his much more severe, much less controllable trauma.

I hate the validation of inevitable failure, even as I know the ultimate goal is not to achieve but to try.  It hurts to hear about a patient dying too young, and know that I'm not surprised because early trauma made every subsequent attempt at establishing trust feel worse than Sisyphean because I could never once push the stone to the top of the hill for it to drop again.  I'm angry at the emptiness of those 15 minute visits I had with him, so many months in between of what we'd call paranoia but what is, in reality, well-founded skepticism of the world around him.  I want to throw the rawness of that insecurity in someone's face but it hits me instead because at the end of the day, I was his doctor.  I hate the reality of how little that means. I hate that on the day I learned about his death, appointments and tasks and conversations crowded me such that I forgot it happened until it suddenly resurfaced later.

I hate the fragility of our kindness and understanding. On one day, it might be enough to listen in the face of so many limitations and it seems so easy to be perceived (and function) as a giver. On another, we are the reason for all these limitations and it seems so easy to be perceived (and function) as someone who takes away. I've mostly accepted that someone who mistrusts the medical system or society at large, may at any time lose trust in me. Still, each turning of tide makes me question my behavior and my perception.  More than that, it reinforces my own mistrust of our system and society and reminds me hard that while the structure we battle is amorphous, it is strong.

And so, the trust that keeps us going isn't steady; it bends under the weight of conflict, loss, and doubting of self and others.  But through these undulations, I stay tethered to the sameness that is our frame and foundation.

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