Something to Push Against

It is natural to seek out the roadblock, the check-point, the official approval gate: someone whose job it is to green light your idea, give you your next gig, say yes.

The search for something to push against, a hurdle to overcome, is also a chance to hide: to take small steps, to describe nothing more than the bit that could get an OK within the confines of how things work today.

At its worst, seeking out a “yes” can even  be a clever, acceptable way of being OK with a “no.” It’s a way to hide, to shift blame, to take on too little, to search for a wall to point to that we couldn’t break through.

“They wouldn’t let me do this” is often just another form of “I was afraid to see what would happen if I tried to pull this off without someone else’s cover.”

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Being Mortal by Atul Gawande

I’ve been a big fan of Atul Gawande ever since I read Complications, which is still one of my favorite books. Gawande is a surgeon at Brigham and Women’s Hospital in Boston, a professor at Harvard Medical School and the Harvard School of Public Health.  He’s also an acclaimed writer who welcomes his reader into his personal exploration of the assumptions he brought in to his surgical practice and where those assumptions have fallen short.  I enjoy Gawande’s skills as a writer and an observer, and I deeply respect his capacity for introspection, honest self-critique, and his willingness to take on medical orthodoxy even when (especially when) it’s uncomfortable.

Complications hooked me from the first page and helped me understand surgery, and the fallibility of surgeons, in a new way. I also devoured The Checklist Manifesto, which, while not nearly as enthralling as Complications, was so overwhelmingly useful that I couldn’t put it down. It explains, among other things, why they ask you seemingly stupid questions before operations (“which leg are we operating on today?” answer: because when they don’t ask this they often end up amputating or reconstructing the wrong legs) and why commercial flying is safer than driving (hint: checklists!).

I downloaded a free sample of Atul Gawande’s newest book, Being Mortal: Medicine and What Matters Most in the End, weeks ago, but I’d hesitated to start it because, on some level, I wanted to shy away from the topic. Who wants to read a book about end of life care?  Then last week a friend told me how profoundly the book had changed his thinking, and that I had to read it. I started reading it on Friday and I’d finished it by Sunday.

Being Mortal confronts head-on a reality that we all will face: how we manage dying and death, for ourselves and our loved ones. No, it’s not a fun topic, but it is a singularly universal topic, and I’m convinced that without reading this book we will not face death well.

The basic premise of the book is that, in the West, where families have become nuclear (rather than extended), illness, dying and death have been turned over to medical professionals and to end-of-life facilities, both of which are designed to treat illness and prioritize safety rather than care for people. This is why more than 85% of people in the US died in hospitals, not at home, in the 1990s; why we sign on for third-line chemotherapy treatments that have miniscule chances of success and very likely to worsen quality of life; and why we are surprised to learn that high-quality hospice care not only increases the quality of life, it often ends up extending life as well.

In summarizing his findings, Gawande argues:

I am leery of suggesting the idea that endings are controllable. No one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is we are not helpless either. Courage is the strength to recognize both realities. We have room to act, to shape our stories, though as time goes on it is within narrower and narrower confines. A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.

The story gets very personal at times, as Gawande weaves in the details of his own father’s illness and death.  He shares the excruciating choices that his father, his mother, and he had to make in the years following the discovery of his father’s rare spinal cancer; the important conversations they all had while navigating the nearly impossible decisions of whether and when to operate, and what sort of care to get in service of his fathers’ well-being and his father’s health in the years leading up to his death.

The book is both moving and overwhelmingly practical. It presents stories and facts and analysis and also gives us the tools to manage our own confrontation with serious illness and death. Most powerful, to me, are Gawande’s guidelines for the conversations we need to have when someone is very sick and near death. They must follow, in Gawande’s estimation, a clear path:

Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

These questions are powerful because they put the sick and dying person back in the driver’s seat, not just as someone making choices from an array of medical interventions – interventions that are, customarily, described incorrectly (doctors consistently overestimate the likelihood of success and consistently underplay risks to patients) – but as someone who knows best what they value in their own lives. It is these conversations that empower real choices and ensure self-determination even in the midst of declining physical and mental well-being.

The book is both sobering and empowering, giving us the tools to confront some of our most challenging moments with dignity. Gawande concludes with a simple reframing: “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.”

I’ll be evangelizing this book for a while, to anyone who will listen – not because it’s a fun read or a good one, but because it’s real and because we are failing ourselves and our loved ones by handing over some of the most important decisions in our lives to professionals who are neither trained nor equipped to answer them without us.

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There really is green grass under the snow

No matter how many feet deep you have to dig to find it.

Not just metaphorically. Actual green grass, just waiting there for the spring.

Helps to remember that every now and again.

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People like us

A few years into my job as a fundraiser, one of the things I grew to hate was being sent lists of rich people. What, exactly, was I supposed to do with them? Of course, by definition the people who can give a lot of money are the people who have a lot of money, but that qualifier alone means next to nothing.

As Seth keeps reminding us, our work is to find our tribe, people who share a worldview, and to communicate to them that “people like us do things like this.”

WSJ_people like us

This Wall Street Journal ad nails it for me. While the WSJ no doubt has all the obvious data you’d hope they have – about income levels and geography and demographics and and and – about their readers, the ad boils everything down to:

People who don’t have time to read the Wall Street Journal make time to read the Wall Street Journal.

(will.i.am – producer, entrepreneur, philanthropist)

People like us – busy, successful, top of the heap enough that we now wear multiple hats – believe that the WSJ helps keep us where we are, believe that it is our access to this kind of content allows us to continue to be the thing we are so proud to be.

It’s specific and aspirational for the group that people who identify with that worldview, people for whom that story resonates.

What is your group? What is their worldview? What story do they want to be a part of?

(Want to learn more?  Sign up here.)

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Getting Fundraising Right

It’s so easy to end up telling this story:

This is who we are.

This is what we do.

This is why we do it well.

This is what we need.

Can you help?

When we should be telling this one:

This is how the world looks today.

This is how it could look tomorrow.

This is why this matters.

This is proof that we have what it takes to get from here to there.

Let’s make this happen together.

In the first approach, full of good intentions, we make the classic mistake of focusing on, and talking about, ourselves. Good students to the end, we promise you that we’ll do a good job if you’ll just (please!) trust us with your support. It is, literally, self-centered.

Instead, our opportunity is to pull ourselves out of the center of the story, to paint a bigger picture of the world as it could be, and describe how we can partner to make a change.

As good and as important as our work is, we are not the protagonists in this story.  We are the enablers of the change.

(Bonus: Pixar’s 22 Rules for Storytelling, visualized, via Swissmiss. It includes #7, “Come up with your ending before your figure out your middle.  Seriously.  Endings are hard, get yours working up front.”  For our purposes, let’s remember that the ending cannot just be “So, can you fund us?”)

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Good Society in India

I’m in India this week, and today I had the pleasure, and challenge, of facilitating a selection of “Good Society” readings with the Acumen India Fellows.

The opportunity to take a step back and be reminded of the words and deeds of the great thinkers and activists throughout history is a rare one, and I thought I’d share some of my favorite excerpts from these readings.

While these excerpts lose some of their richness when taken out of context, I hope they serve to remind you, as they do me, of the great thinkers we have in our corner as we work to build a future of greater rights and dignity for all.

 

Universal Declaration of Human Rights (1948) (link)

“Preamble. Whereas recognition of the inherent dignity and the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.”

“Article 1. All human beings are born free and equal in dignity and rights.”

“Article 6. Everyone has the right to recognition everywhere as a person before the law”

 

Letter From Birmingham City Jail (1963) by Dr. Martin Luther King Jr (link)

“I am in Birmingham because injustice is here…Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny.”

“History is the long and tragic story of the fact that privileged groups seldom give up their privileges voluntarily.”

“I am coming to feel that the people of ill will have used time much more effectively than the people of good will. We will have to repent in this generation not merely for the vitriolic words and actions of the bad people, but for the appalling silence of the good people. We must come to see that human progress never rolls in on wheels of inevitability. It comes through the tireless efforts and persistent work of men willing to be co-workers with God, and without this hard work time itself becomes an ally of the forces of social stagnation.”

 

The Republic, (390 BC) Plato (link)

“He who is to be a really good and noble guardian of the State will require to unite in himself philosophy and sprit and swiftness and strength.”

 

The Social Contract (1762), Jean Jacques Rousseau (link)

“Man is born free; and everywhere he is in chains.

“The problem [in creating the Social Contract] is to find a form of association which will defend and protect with the whole common force the person and goods of each associate, and in which each, while uniting himself with all, may still obey himself alone, and remain as free as before… [To do so] Each of us puts his person and all his power in common under the supreme direction of the general will, and, in our corporate capacity, we receive each member as an indivisible part of the whole.”

 

Development as Freedom, Amartya Sen (link)

“The usefulness of wealth lies in the things that it allows us to do – the substantive freedoms it helps us to achieve. But this relation is neither exclusive (since there are significant influences on our lives other than wealth) nor uniform (since the impact of wealth on our lives varies with other influences.”

“Expanding the freedoms that we have reason to value not only makes our lives richer and more unfettered, but also allows us to be fuller social persons, exercising our own volitions and interacting with – and influencing – the world in which we live.”

 

The University and the Leadership Factor in Nigerian Politics (1988), Chinua Achebe (link)

“Leadership is a sacred trust, like the priesthood in civilized, humane religions. No one gets into it lightly or unadvisedly, because it demands qualities of mind and discipline of body and will far beyond the need of the ordinary citizen. Anybody who offers himself or herself or is offered to society for leadership must be aware of the unusually high demands of the role and should, if any doubt whatsoever, firmly refuse the prompting.”

 

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Your Point of View

If you’ve made the decision to put your own stories – blogs, videos, articles, poetry, spoken word, email campaigns, multimedia, whatever – into the world, there are two different kinds of gaps you can fill.

You can be on the lookout for untold stories and uncover them, becoming, over time, great at picking stories worth telling, the kind of information you’re able to uncover and the narrative that brings us along, engages us, and, hopefully, pushes us to act. This is what Serial was all about (except for the action bit).

Or, you can decide that the project you’re actually engaged in is to share your own point of view.  In this kind of project, you still tell stories but these stories serve as springboards to explore, elaborate upon and illustrate your point of view.

In both cases your job is to engage us, to connect with us, and, yes, to seduce us just a little bit. In both cases, we expect you to hone your craft. In both cases, you have the power to change us.

But because it’s so easy to underestimate ourselves, because we so often convince ourselves we have nothing to say, because we imagine that someday (someday!) we will have wisdom to share…we wait.

Because the act of deciding we have something to say feels a little too proud (“who am I to think that I can….?”), a little too exposed (“what if try and it turns out I don’t actually have anything worth saying?!”), a little too much like it’s the kind of things other people do (“they’re just good at that sort of thing…”), we put off starting. And we put it off some more. And some more. Until we prove to ourselves that we were right all along – we really don’t have a point of view worth sharing.

But that’s just not true. The dirty little secret is that the only way to become, tomorrow or the next day or maybe 10 years from now, someone who has something to say is to start to share our truth today.

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