Radical listening book

When I stepped off the bus, I was initially startled by the peace and tranquility. Five hours earlier, I had been squeezing past baby strollers and bewildered tourists scanning large Times Square fold-out maps at New York Citys Port Authority Bus Terminal the largest and busiest bus depot in the United States. From bawling babies and squabbling squatters, the chaos and commotion had clogged up my pores and deadened my senses.

By contrast, my destination in a secluded part of western Massachusetts could not have been more differentor idyllic. Walking down a rolling hill, I noticed Canadian geese drifting lazily above a serenely still lake. My tense facial muscles softened at the sight of hiking trails and meditation gardens. In the midst of this serene landscape was the Kripalu Center for Yoga and Health, named after Swami Kripalu and devoted to mindful practice. And it is here where I decided to leave work and pandemonium! behind for four days in order to learn about radical listening.

Months ago, I had learned about a workshop, Radical Listening for Healers, taught by faculty from Columbias Narrative Medicine program. The latter describes radical listening as a first step toward healing the destructive divides that afflict our country. This intensive workshop brought together individuals from diverse backgrounds: healthcare, psychology, politics, literature and social justice.

So, what does any of this have to do with medicine? Turns out that the MOST critical skill taught on Day 1 of medical school is NOT pathology or pharmacology. Its listening. In fact, seasoned attending physicians frequently remind medical students: If you obtain a thorough history, the patient has already given you the diagnosis. Sure, we can fill in the gaps with a physical exam and diagnostic tests [labs, imaging]. But if we truly listened, by being fully present, then the diagnosis has already been revealed.

And yet in spite this KEY message about listening, upon their first meeting, doctors interrupt the patient in the first *15* seconds. When I asked Dr. Rita Charon, founder of Columbias Narrative Medicine program, why this workshop was so important now, she said, Because health care has veered away from the patient. By teaching doctors and nurses and social workers sophisticated ways to bring attention to patients experiences of health and illness, medicine centers its care on what really matterseach patients singular and complex life.

Im also aware that doctors often dont take good care of their health. Burnout rates are at record rates: high levels of substance use, anxiety, divorce and lack of job satisfaction. Suicide, particularly among female doctors, has been alarming: in the past two months in New York City alone, a 4th-year medical student and a resident physician both female died by suicide. A sense of isolation and despair is often associated with suicide, among all professionals, as sadly evidenced by the recent suicides of fashion mogul, Kate Spade, and celebrity chef, Anthony Bourdain.

I experienced so many profound learning moments during the retreat. Let me share five lessons that most resonated with me:

1. I am rarely fully present. Am I really listening to my patients? Among the electronic medical record, billing, typing notes and answering pages HARDLY! In small groups, we did a close read of an essay, facilitated by a faculty member who asked us questions about our interpretation of the writing, how it made us feel, and the writers intent. Then we were given a prompt [e.g. my first day] followed by five minutes to write. Close read of any art [poetry, painting] helps develop our capacity to be present. It reminded me to pay closer attention to the tiny details of my patients stories; what theyre saying and NOT saying; their body language.
2. I need to replace judgement with curiosity. Renowned psychologist and author, Carol Gilligan, led a session about replacing the strong temptation to judge opinions that we find distasteful if not disgusting with curiosity. In todays politically-, culturally- and racially-divided society, this is not easy! One participant started a small-group discussion with this revelation: My brother-in-law is a white supremacist. Hed respond, Do you want to be in a relationship or be right? But theres judgement in the question. Judgement is terribly easy in my line of work where patients are injecting themselves with heroin and cycling in and out of jail. But replacing judgement [what youre doing is illegal, youre hurting your family] with curiosity [tell me more, what do you enjoy about using?], enables my patients to be more engaged and trusting.
3. The importance of Crossing the Bridge. Faculty facilitator and couples psychiatrist, Paul Browde, led a powerful exercise between two participants friends for over 20 years in crossing the bridge to visit the others neighborhood. In order to be fully present, the visitor must leave all of his past experiences behind. After the host shares details about her neighborhood, the visitor asks I heard you say, Am I with you? and Tell me more. This exercise taught me that truly listening to someone patient, relative, friend with disparate views and/or experiences allows me to understand and empathize with him/her. And it takes time and effort.
   Woman doing yoga meditation on mountain, French [+] [-]Alps. [Photo by: BSIP/UIG via Getty Images]
4. The power of mindful practice never ceases to amaze me. Throughout the 4-day workshop, we had multiple opportunities to participate in Kripalus meditation and yoga classes. I joined a Divine Sleep Yoga Nidra class which was designed to improve sleep, by again, being present. I also hiked to the meditation garden in the woods where I sat quietly, closed my eyes, breathed in the crisp air and just focused on the present. The pressures of my hectic New York life congested subways, phone bills, patients medications, nurses questions melted away.

1. Creative arts can heal. One of my favorite small-group exercises involved partnering with someone, hearing her story for 15 minutes, then recreating the story through a collage. Sitting around a table with fellow grown adults, cutting out pictures from magazines, pasting and coloring with Crayola crayons brought back memories of unadulterated kindergarten joy! My veins were surging no longer with cortisol-tainted blood but rather artistic-infused juices. I learned that, sometimes, its easier to express an emotion or experience through a drawing, poem or music. Other participants found the idea of another person telling their story comforting and safe, because they listened with pure intention.

Suffice to say, my fellow participants and new friends were also deeply moved by this workshop. Some testimonials: Gregory Goodale, JD, PhD, a political communications professor: How do I navigate conversations among students who share VERY opposing views? I learned that creative arts can cement storytelling. Im going to take this back to my students.

Kate Kennedy, manager of healthcare marketing strategy: This workshop provided a powerful opportunity to slow down from everyday activities and stresses, and learn to truly focus on being open and curious and connect with people.

But not all is ideal. As one participant noted, coming here is a privilege that many of my clients cannot afford. The financial costs registration, accommodations, travel are not insignificant [ranging from several hundreds to over a thousand dollars]. Time off from professional and personal responsibilities is also a luxury few can afford.

By the end of the workshop, it became quite clear that the things I learned transcended clinical medicine. I am confident that these tools will enhance my relationships with my relatives [including a homophobic cousin]; help me recognize gender bias; and navigate todays contentious political discourse. Replacing judgement with curiosity is a good starting point.