Tuesday, February 12, 2013

Why I write: Only hope can carry us aloft

It has been two years since I left my job as CEO of a hospital, and I have had many opportunities to reflect upon what I learned during my nine-year tenure there as well as during this period afterward.  It was a privilege to serve in that role, working with so many well-intentioned people, both on the staff and among the governing bodies and the hospital’s supporters in the community.  As someone who had had no exposure to the health care world, it was also a revelation to me to see how difficult it was to consistently offer high-quality, patient-centered care.  I learned, too, how much harm is inadvertently caused by the way work is organized in hospitals and how ill-suited professional training programs are in enabling clinicians to engage in process improvement.  I also made my share of mistakes, one of which in particular received a great deal of public attention, punishment from my Board of Directors, and apologies from me to them, the hospital staff, and even to you, my loyal readers.

Upon leaving BIDMC, I decided I would devote this next period of my life to reflecting on what I had learned, trying to consolidate the lessons, and then offering myself to other hospitals and communities to pass along things that might be helpful to them.  Almost immediately, I was challenged by some people with doubts.  Shortly after publishing my book Goal Play!, one reporter asked: 

I’m sure you know, there are some people out there who feel like you lost the ability to write a book about leadership and management because of this failure in leadership in this incident when you were at Beth Israel. How much credibility do you think you still have as someone who can talk about leadership and management?

I responded by saying:

Well, if you lose the ability to talk about leadership because you make a mistake, even a big mistake, then there aren’t going to be many people who can talk about leadership. I think the sign of any good leader — or, for that matter, any person — who wants to improve is [that] you acknowledge your mistakes and you see if there are lessons to be drawn from them and, in the case of this book, perhaps teach other people from that experience and go on. 

That was easy enough to say, but the proof of the pudding would be how I was actually received as I wrote the book and this blog and traveled the globe telling stories and offering advice. On that front, so far so good, and I am grateful to my readers here, to those who have sent me kind notes about the book, and to other folks for their respectful attention, engagement, and encouragement.

Nonetheless, I make no claims to bringing the level of eloquence and persuasion that might be possible.  I am inspired, though, by  these remarks made by E. B. White (in absentia) upon receiving the National Medal for Literature in December 1971.  If I ever become as good a writer and presenter as he, I shall die happy.  Meanwhile, I keep at it, trying not to be discouraged at the degree of harm caused by well intentioned people in the health care field and my inability to motivate, teach, and help as much as I would like.

The Egg Is All 

Ten years ago they pulled the railroad out from under me, and this almost severed my connection with New York. Then sixteen months ago, I met with a motor accident, and this made the highway a problem for me. As for the skies, I quit using the flying machines in 1929 after the pilot of one of them, blinded by snow, handed the chart to me and asked me to find the Cleveland airport.

The world of letters sometimes seems as remote or inaccessible to me these days as the City of New York, and it would be foolhardy of me to comment at length on that wonderful, untidy and seductive world. I drifted into it a long time ago with no preparation other than an abiding itch. I fell in love with the sound of an early typewriter and have been stuck with it ever since. I believed then, as I do now, in the goodness of the published word: it seemed to contain an essential goodness, like the smell of leaf mold. Being a medalist at last, I can now speak of the "corpus" of my work--the word has a splendid sound. But glancing at the skimpy accomplishments of recent years, I find the "cadaver of my work" a more fitting phrase.

I have always felt that the first duty of a writer was to ascend--to make flights, carrying others along if he could manage it. To do this takes courage, even a certain conceit. My favorite aeronaut was not a writer at all, he was Dr. Piccard, the balloonist, who once, in an experimental moment, made an ascension borne aloft by two thousand small balloons, hoping that the Law of Probability would serve him well and that when he reached the rarefied air of the stratosphere some (but not all) of the balloons would burst and thus lower him gently to earth. But when the doctor reached the heights to which he had aspired, he whipped out a pistol and killed about a dozen of the balloons. He descended in flames, and the papers reported that when he jumped from the basket he was choked with laughter. Flights of this sort are the dream of every good writer: the ascent, the surrender to Probability, finally the flaming denouement, wracked with laughter--or with tears.

Today, with so much of earth damaged and endangered, with so much of life dispiriting or joyless, a writer's courage can easily fail him. I feel this daily. In the face of so much bad news, how does one sustain one's belief? Jacques Cousteau tells us that the sea is dying; he has been down there and seen its agony. If the sea dies, so will Man die. Many tell us that the cities are dying; and if the cities die, it will be the same as Man's own death. Seemingly, the ultimate triumph of our chemistry is to produce a bird's egg with a shell so thin it collapses under the weight of incubation, and there is no hatch, no young birds to carry on the tradition of flight and song. "Egg is all," quote Dr. Alexis Romanoff, the embryologist, who spent his life examining the egg. Can this truly be the triumph of our chemistry--to destroy all by destroying the egg?

But despair is no good--for the writer, for anyone. Only hope can carry us aloft, can keep us afloat. Only hope, and a certain faith that the incredible structure that has been fashioned by this most strange and ingenious of all the mammals cannot end in ruin and disaster. This faith is a writer's faith, for writing itself is an act of faith, nothing else. And it must be the writer, above all others, who keeps it alive--choked with laughter, or with pain.


Marilyn said...

Nicely written, Paul. When my husband, Jim, was diagnosed with a terminal disease that eventually claimed his life, I really learned about Hope. One cannot live without hope nor wants to. There is no such thing as "false hope", only hope. It can take many forms, not only for a cure. There is hope to see a child graduate, hope to visit with an old friend, hope to see another sunrise. Finally, there is hope to be without pain, without fear. But rather, hope to to be lovingly and peacefully delivered.

Deanna Bland Hiott PhD, MSN, RN said...

I appreciate the wisdom with which you answered the reporter. I love the eloquence of E. B. White but Marilyn your comment was perhaps the most beautiful expression about hope that I have ever encountered. Bless you.

Marilyn said...

Thanks, Deanna. I am also a long-time nurse. But, I didn't really understand the absolute necessity of Hope for life and the ability to tolerate suffering until my husband and I needed it to survive.

The worst thing a surgeon ever did to us was to offer no Hope (over the phone on a Friday evening, no less!). It actually caused pain and harm and, I believe, may have shortened my husband's life.

Richard said...

From Facebook:

Paul - thank you. Thank you for your continued contributions and leadership and thank you for modeling that which is easy to speak to, and yet seemingly so challenging to live. The reality that human beings make mistakes, regardless of role and title, and that the real lessons, real progress, comes from the uncomfortable, messy, brave, healing space that is living your values. Thanks for leading Paul.

Peter said...

From Facebook:

Paul, you have always inspired me and the fact that you could founder on your journey (their judgment, not mine) and then press on, inspires me still. Thank you for your journey and for sharing E.B. White.

Anonymous said...

Paul, when I first 'met' you through this blog several years ago, as a jaded female doc I was pretty cynical about hospital CEO's. You changed that, in a hurry.
Keep doing exactly what you're doing. You are valuable, and needed.

nonlocal MD

Unknown said...

I worked as a VP of Communications for a hospital CEO. I used to bring him your blog to read - encouraging him to put his fingers to the keys. He was, in his own way, a very good leader. Yet, he was terrified of his board, public critique, etc. His paranoia led to his demise as the leader of the hospital and he left in disgrace and publicly blamed for the hospital's frailties, which exist 6 years later, and just as frail. My point is his genius was only apparent to a few of us - his inability or unwillingness to share his vision and inspiration benefited no one, and in the end, was one big waste of a very good mind. I don't believe we pay our hospital CEOs to be wallflowers or to not take risks. It becomes a slippery slope and some get caught up in escape shoots not of their making, or of their making. In any case, I still talk about Paul's blog and how extraordinary it is for a leader to simply speak on technical issues, life issues, and to always do so with hope and vision. That is personal leadership, and we all benefit by it.

SK said...

We all make mistakes, but hopefully the world around us is forgiving and will allow us the opportunity to move on with life.