What have you learned about networking in the second year of your Fellowship? How has your understanding of your leadership capacity or potential changed? What are your major learnings as a result of the Fellowship?
When I became a Bush Fellow in 2014, I was charmed by the “Bush notion” of networking – or, what I thought it was. At first, "Bush Networking" seemed like a frantic activity symbolized by the BushCon event at the Guthrie Theater, which gave me a headache the first year. Yes, I saw many people I knew and even more that I wanted to know, but I wondered if I could find the time to do all of that connecting, even if I used that “totally awesome” BushCon app. I spoke with several people at the conference who had the same reaction: if networking involved trying to learn the names of 100 people in one day, we were doomed to failure.
But as I began my program, I took my time connecting with the most appropriate people I could find. Once I connected, I tried to work those relationships so that I might be involved in more learning activities. In the process, I learned that real networking isn’t about collecting names or glad-handing strangers: it is about finding your tribe wherever they may be.
My tribal connections around Narrative Medicine began in New York at Columbia University, where I discovered people who were like distant cousins: they had some of my DNA in that they loved literature and medicine, but not enough to be called brothers or sisters. Out of necessity, or habit, some of those I met at Columbia lived in a highly academic world and were less interested in the use of Narrative Medicine to change the world than in the theory and practice as it applied to physicians. At first, I wasn’t sure I understood the difference but later, as I attended my first Columbia seminar, I could see that few attendees wanted to make Narrative Medicine a product of the community. Still, I made solid connections there with the head of the department and with Dr. Rita Charon, the Founder of the program. Without their gracious mentoring, I would be unable to teach with confidence.
So, put a pin in New York City as the place where one of my primary connections occurred.
Next, I worked with Atum Azzahir at the Cultural Wellness Center, who seemed like a mother to me. She not only saw the value of narrative medicine, she encouraged community residents to learn about it through me and gave me my first opportunity to promote my program. While working with her – which I could not have done without the financial support of the Bush Grant – I met an extraordinary number of community residents who were passionately exploring community health and the meaning of personal stories. These are people who are struggling for their very existence in South Minneapolis and who have an intuitive understanding that their personal health is directly tied to the health of the community.
I had never worked in the black community in Minneapolis on healthcare related topics before; but, in doing so, I made deep connections with grassroots health activists who understood the role of personal stories as they impact health. What they didn’t yet comprehend was the emerging field of Narrative Medicine and how it could help community residents shape their own health through narrative engagement.
The Cultural Wellness Center is engaged in a major health improvement program with Allina Health and I was asked to serve on the Community Resources Board for its Backyard Initiative. There I made substantial contacts with people from the University of Minnesota’s School of Public Health, where I discovered a certain kind of insularity hostile to those who were not homegrown experts on public health and, I believe, politics. Some of these people met with me and claimed fascination with Narrative Medicine, but ultimately, they were happy to be ensconced in an academic bubble of their own making, impervious to the probes of outsiders. Once again, as at Columbia, I discovered that academia can be its own punishment.
Through the Cultural Wellness Center connection, I met Stella Whitney-West of NorthPoint Health, a titan in healthcare management whose administrative leadership and progressive vision have helped reshape the health of North Minneapolis. I spoke with members of their physician team about the various possible uses of Narrative approaches to health for physicians and patients.
At that point, my network within the city and in New York seemed to be growing. But I had no idea how limited it was or how large it could become.
Once I met Dr. Jon Pryor at HCMC, I met and became friends with leaders of that organization that are continuing to be important. I met Dr. Mark Linzer, head of Internal Medicine and chair of the Center for the Provider and Patient Experience (CPPE); Dr. Meghan Walsh, Chief Academics Officer; Dr. Scott Wordelmann, head of Ambulatory Care; Dr. William Heegaard, Chief Operating Officer of HCMC; and Walter Chesley, VP, Human Resources. I did not know any of these people before but each of them has guided me, in one way or another, toward reaching the goal of establishing Narrative Medicine within this community and region.
Once I was hired as Resident Fellow of HCMC in June 2015, I began to meet dozens of directors and managers who are involved in the business of patient care and hospital administration. I also began teaching interns and residents, staff and providers, what I have learned about the relationship between literature/art and medicine/science. Everywhere I went, the response to Narrative Medicine was positive.
I heard young physicians say, “This is exactly what I need to stay engaged in medicine,” because the heavy load they carry as new practitioners forces them to focus on the science involved in healthcare, not the humanistic side. Yet, makes both practitioner and patient human brings them together to promote healing. Since the purpose of narrative medicine is to illuminate that which is often hidden, thus increasing understanding between those who are sick and those whose job it is to diagnose and treat illness, many physicians embraced it. Plus, there is very little time available to reflect on the meaning of medical practice; this lack of time is not going to change. But medical education can and will change to build more reflective time into the physician’s practice. Not only does the patient benefit from the reflective physician; so does the physician and her/his family.
Early on, perhaps in September 2015, I was sent to Northwestern University in Chicago to learn Qualitative research in preparation for an exciting new grant possibility. Hennepin was applying for a Robert Wood Johnson Foundation grant to compare U.S. treatment for heart failure and COPD patients with similar patients from the Netherlands. I attended my first meeting of an ad hoc group of healthcare improvement specialists in July and, as I recall it, my head literally spun from a complete lack of knowledge of the terms used in that meeting. Healthcare improvement has its own jargon, even more obtuse from some asked of hospital jargon, and I struggled for three months to keep up. Meanwhile, I learned more about qualitative research from Julie Johnson, Ph.D., who became a mentor to me. Along with Julie, I met Brita Roy, a fantastic researcher and physician at Yale University, who is a Robert Wood Johnson Foundation Scholar.
I learned that my brain is not quite as nimble as it used to be because I had more trouble understanding improvement science than I expected. Actually, I’m not sure I fully understand it now, but I do know that medicine is badly in need of improvement. We spend more money per capita than any other nation on healthcare, yet our results are often not as good as those of other western nations.
Less than halfway through my first year at Hennepin, the program leaders of the Hennepin Health Foundation asked me to write a play about mental illness. The play was supposed to be performed at the Light Up The Night Gala to help raise money for Hennepin’s Psychiatric Services programs. But because the head of the Foundation left before the gala took place, I did not receive the writing assignment until late in October. Therefore, I spent 3 days in a hotel writing the play. The play was loosely based on interviews I conducted with some psychiatric patients and their families.
I completely underestimated the impact the play would have on our executive team and our employees. We sponsored 8 performances of the show over a period of 6 months, and we are still hearing from employees who want to see the show again. Why? Because the show, reflected the stark realities many patients face when trying to come to grips with their illness. Although we used the music of the Beach Boys and the Beatles, the play has a hard edge to it that is derived from an “in-your-face” presentation of the truth.
I learned once again that one way to advance an agenda is to innovate beyond what is expected. When the opportunity to create a new play came my way, I didn’t think about how much work it would take, whether it would be successful, or the impact on my regular work activities. I jumped at the chance to use the arts to help spread the message about narrative approaches to medicine, and it succeeded beyond my expectations. The work with Mixed Blood Theater in producing the play and with the Foundation, broadened my network even more so that I am now engaged in planning new artistic experiences for the hospital.
But the greatest networking experience I’ve had in the last two years came from my research connections here at HCMC. As a member of a new research grant team, I traveled to the Netherlands and met 8 new people – all of whom are part of my tribe – who will probably remain friends of mine for years. These scientists and researcher are looking at ways to improve the co-production of healthcare services. Many have spent their entire lives doing so. Yet, they were enthralled with narrative medicine and responded with enthusiasm to the narrative session I led as part of our qualitative research review. I promoted them to write first-person narratives about the patients they met during our visit and some of the responses were deeply personal – a little overwhelming, actually. One of the researchers wrote about how her encounter with the patient led her to reflect on her husband’s sudden disability and her sense of loss. Another wrote that he wished he had been more courageous in dealing with the Dutch healthcare system as a patient advocate. These reflections will be part of our ongoing learning network on Facebook and elsewhere.
I’ve learned, at a macro level, that the support of an organization like the Bush Foundation is a once-in-a-lifetime boost that can put the achievement of your dreams well within reach. At the same time, the money to support the dream does not make the dream come true. Communicating my dream to others through networking and finding one’s tribe added dimensionality to whatever vision I might have begun with. My goal was to make narrative medicine a viable practice in the Twin Cities healthcare community. Seldom does a day go by that I don’t hear or read about others who are contemplating ways to incorporate narrative practices into local and regional medicine.
Finally, I have learned that self-care is far more important than I thought it would be. I’ve seen this demonstrated at the hospital in the lives of burned out physicians. I’ve noted that as I get older, I need to remain physically active so that I have the energy to complete the challenge I’ve set before myself of changing the perception of narrative health’s value. Although I still have work to do in this regard, I believe the Foundation’s investment in me and my idea has already paid off and will continue to do so in the coming decade.