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At the height of the war in Iraq and Afghanistan, I had the opportunity to escort a number of celebrities, “suits” (politicians) and “stars” (generals/admirals) when they visited the wounded, ill and injured soldiers in the Army hospital where I was the chief medical officer. On one such occasion I had the privilege of accompanying the late Senator John McCain on a visit to present a purple heart medal.

He came out of the car with a gruff, all-business demeanor that continued as we walked to the conference room and I briefed him on the soldier and his family. His face transformed into a warm smile as he walked into the room.

The family was from a small town in the south.
“Isn’t there a famous BBQ place there?” the senator asked, and mentioned the restaurant by name.
The family was dumbfounded.
“How did you know that?” they asked him.
“Remember the campaign for president,” he replied with a grin. “I ate a lot of BBQ.”
He instantly connected with the soldier and his family as he entered into their story.

The American poet Muriel Rukeyser wrote, “The universe is made of stories, not of atoms.” The older I get the more I find myself enamored with my own story and its associated yarns, (my wife knows them all by heart), and the more my autobiography seems to become my most oft referenced book. I am as facile with the first person singular as anyone. It is something I am very aware of and so am sensitive to it when I notice it in others.

It is also something I have watched successful, respected leaders intentionally avoid. I have come to the conclusion that they are able to do it by actively engaging and entering into others’ stories. In practical terms it means being present, paying attention and being intentional. It is often driven by the art of the second question:

“How are things going?” you ask a subordinate on executive rounds.
“Fine.”
“What do you mean by ‘fine?’”

Rather than using another’s comment as an excuse to open the pages of my autobiography and drag another unwilling victim into its pages and personal lessons, through careful, thoughtful, open-ended questions, eye contact and engaged body language (leaning forward, mirroring their facial expressions with my own) I am invited into their narrative and become a part of their story.

It doesn’t take much. More than thirty years ago, I remember running into a senior nurse who was visiting the hospital where I worked. I had met her only once previously a few years earlier when I was still in training . She remembered our meeting and in fact greeted me by name. With just a brief encounter in a hospital hallway she became part of my life’s story; a model of the kind of leader I hoped to become.

At home with my wife and children, this should mean the practice of “Your day goes first” when we gather after work and school. My mother was so good at this when I was a boy that I grew up thinking that my story, my day was more important than anyone’s. It has been a hard habit to break. When I was a college freshman, I distinctly remember a mentor requesting of me after several of our one-on-one meetings, “Why don’t you ask me how I’m doing; how my week has been?”

I am aware that I have been woefully inadequate at this practice. A decade ago, at yet another dinner where I was talking about the particulars of my 40-mile, 60-minute commute, one of my teenage daughters said without looking up from her meal, “You know Dad, no one really cares about this.”

The story goes that Winston Churchill’s mother Lady Jennie Jerome Churchill dined in the same week with two of the greatest leaders in England at the time, Benjamin Disraeli and William Gladstone. A journalist asked her impression of the two men and she replied, “When I left the dining room after sitting next to Gladstone, I thought he was the cleverest man in England. But when I sat next to Disraeli I left feeling that I was the cleverest woman.”

Apparently, Disraeli wanted to learn all he could about Lady Churchill; he asked her a series of questions and avoided my own tendency to relate everything back to my own story. It is a practice that can be learned – with attention and intention.

I walked Senator McCain back to his car after he made his purple heart presentation. As we reached the curb, I told him that I had recently read his book, “Character is Destiny.”
“Really?” He looked up and made eye contact.
I told him that my favorite chapter was his story from a Christmas morning when he was a prisoner of war at the Hua Lo prison in Hanoi.
“Christmas at Hua Lo…” his voice trailed off and he looked past me; briefly focused elsewhere. I continued to look into his eyes. He glanced at me again, smiled, turned a moment later and climbed into his car.

I remember standing for a few seconds after he drove away savoring the privilege of having shared the story of one of America’s greatest heroes with him, even briefly.

Then as now I was reminded that the privilege of entering another’s story requires the willingness to leave my own. It is an honor even for a moment, and over time I have become convinced that,“Life is measured in moments like these” (Maggie Stiefvater).

Chuck Callahan Henry V 4.3 – Lead from the Front   https://henryv43.com/

“Do not reap to the very edges of your field…” (Leviticus 23:22)

I came across this Old Testament reference during an early stint in hospital leadership a decade or so ago. Then as now I occasionally vexed my wife by splitting hairs around the subtle difference between saying “It’s too much” when considering the weight of family, work and calendar stress and saying “It’s a lot.” One makes the challenges sound insurmountable, while the other leaves the possibility that we could still squeeze a few more things into the schedule. (Hence the vexation.)

My reflex is to go with “It’s a lot” rather than “it’s too much,” but there is no question that there are “too much” times in life; times when we need to take a tactical pause and figure out what needs to change.

Thirty years ago I hiked the Grand Canyon wearing boots that were too small (very painful on a continual downhill slope). After about twelve hours I reached the point along Bright Angel Creek that I told my friend I couldn’t go another step. It was a first for me. The first time in memory where I had reached a limit to what I was physically and mentally able to do. We camped just off the trail that night before heading back the next morning. Staring up at the stars on that cloudless night I thought a lot about margins and edges.

At the time, I was leaving general pediatrics, relocating my family across the country, entering into a fellowship in pediatric pulmonology, and I had already started plans to simultaneously get a masters degree in health administration from Temple University.

That night I resolved that it would all probably be too much. And the next day on the trail when we struck up a conversation with other hikers who just happened to be students in Temple’s MHA program, I bit my tongue and didn’t tell them that I’d soon be joining them. (Some things you just can’t make up.) I let the idea go. It was a fortunate decision. The fellowship was more rigorous than I had imagined, my father declined rapidly and died from cancer in that three year window, and we had the surprise birth of our first set of twins. I am thankful for the persuasive influence of those too-small boots.

The passage in Leviticus further explains why the corners of one’s field should be left unharvested: “Leave them for the poor and for the foreigner residing among you.” The harvest and gleanings at the edges of the field were for the needy in Biblical times. And they represent a primary reason for leaving margins in our own lives as leaders. We cannot always anticipate who will need us; when we will need to be present and available for others particularly for family members who often have the most difficult time “getting on our schedules.” Early in parenting I abandoned the idea of thinking that I could schedule quality time with our kids. Instead I learned that we need to just “Be there,” echoing lion-tamer Gunther Gabel-Williams advice to his son about climbing into a lion cage. I wish I had been there more.

We also need to leave a little at the edge for ourselves. Like the too-small boots in the Grand Canyon episode, there will be times when “a lot” becomes “too much,” the schedule becomes too tight and we will need to recover. Better to have those times of rest, hobby or relaxation anticipated and scheduled than to have to cancel or shuffle other things to find the time to squeeze them in.

The margins are for others and for self.
They won’t be available to either if we reap to the edge of our field.

Chuck Callahan Henry V 4.3 – Lead from the Front   https://henryv43.com/

The U.S. Public Health Service (PHS) was established more than 200 years ago to support national efforts to assure the health of the American population. Before the advent of the antibiotic era in the first half of the last century, health was largely defined as the control of infectious diseases and accident prevention. Public health policy comprised efforts to confine contagion, prevent epidemics and promote practices that improved public safety.

The availability of antibiotics and widespread vaccination campaigns of the last century diminished the potential of infectious diseases to shorten life expectancy. Since then, Americans have lived longer. And with longer lives we are more likely to suffer the long-term consequences of increasingly common chronic diseases such as hypertension, heart disease, cancer and diabetes. Our Western diet, use of tobacco, and exposure to environmental insults that have resulted from industrialization have increased the prevalence and deleterious impact of these diseases.

In recent years American healthcare providers are awakening to the idea that health is more than the absence of disease. Dr. Lester Breslow was one of the most influential proponents of public health in the United States over the past century. In his nearly 70-year career, he described the evolution of the public health from merely disease and accident prevention to the idea of active health promotion. A career researcher, he demonstrated the importance of simple practices such as getting adequate sleep, exercise, and nutrition, moderating alcohol consumption and maintaining weight within recommended parameters to reduce the impact of chronic disease, increase longevity, and improve overall health.

However, there is a tension between the lifestyle health benefits championed by Breslow and the factors that prevent large sectors of our nation from realizing them. We increasingly recognize the potential adverse effect social determinants have on individual and population health in our communities—factors that include income below the poverty level, inadequate housing, lack of education, low literacy, unavailable transportation, and dangerous environmental conditions. Much work remains to be done. But there are too few to do the work. Continue reading →

Despite all of our efforts over the past decades to build medical homes for our patients and families and to connect them to their new homes, people still choose emergency rooms (ERs) for ambulatory care.

As an example, in a study utilizing the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Hospital Discharge Survey (NHDS) to assess hospital-associated healthcare between 1996 and 2010 in the US, the number of ER visits increased by 44%, resulting in an average 48% of contacts (comparing hospital outpatient departments, emergency departments, and ambulatory surgery sites).

In this study the rise was significantly greater in African-American populations, Medicare and Medicaid recipients and in women, emphasizing the important use of ERs by traditionally vulnerable, urban populations (Marcozzi et al. Intern; Int J Health Serv. 2018;48:267-288). In Baltimore City there were 52 ER visits/1000 patients per month and 28/1000/month in the State of Maryland as a whole in 2018 (CRISP). Earlier studies using the ecology of health care model suggested a generalized rate of 13/1000 ER visits per month for the US population (Green et al. NEJM 2001;344:2021-2025). It seems that people are choosing ERs more often. Continue reading →