3 Weeks Into A Laddership Circle For Doctors
--Devendra Tayade
8 minute read
Feb 10, 2018

Last Spring, I participated in a 6-week Laddership Circle with many inspired project initiators. I was inspired by the quality, depth, caliber, and tremendous value of many forms that emerged in that space. Lara eloquently described the experience. The dedication was so rich amongst volunteers and fellows alike -- for instance, a member of our circle was traveling one week, and still dialed into our call at 2AM in the local time of the city he was in!

Fueled by that inspiration, I wanted to bring that spirit into the doctors I work with at Aravind Eye Hospital -- and with much excitement, we are now midway through a Doctors Laddership Circle -- with both doctors from various branches of our specific eye hospital in India, as well as a few who've been holding questions of healing and transformation in the U.S.

After three weeks together, lots of interesting themes are surfacing. In our most recent call on the theme of "Holding Space," for instance, here's a few questions we collectively explored:

1. Can Healthcare Hold Space for Impermanence?
Interestingly, death emerged very prominently this week. One of us had a family member pass away. Several of us face death regularly in the hospitals where we work. Perhaps as a doctor, holding space often means having difficult conversations with patients and their families, on the impermanence of their conditions, and of life. Balaji remembered a quote by Steve Jobs, "Death is a destination we share. No one has ever escaped it." Similarly, Bill poignantly offered, "Every birth has a death associated with it. The older I get, the more intimate I get with the reality of death... the more we deal with uncertainty, the easier it is to take on the ‘uninvited guests’ who are going to show up at our door." To that end, Shalini zoomed out to the training ground of healthcare: "We need to learn how to hold space and listen and design systems around impermanence. In med school these days, we're given this 19th century education -- how to give antibiotics, how to give surgery, how to give healthcare ... There needs to be an evolution in how medicine is taught and practiced." "How do we design for impermanence?" Audrey recalled, referencing 7 questions that ServiceSpace has recently been holding. As doctors and health workers, how and when do we 'hold space' to accept rather than 'fix' these greater unknowns?

2. When do we Heal vs. Cure?
Building on impermanence, Radha recalled a stunning piece from Brother David Steinl-Rast, on Letting Meaning Flow Into Purpose, and wondered, "When all purpose seemingly goes to an end, is there meaning in life? I see many patients suffering from dementia, who can’t find meaning in anything around them. How do you hold that patient?" Annamalai noted that beyond those graver situations, the small things in front of us -- like simply "making them comfortable is also a part of the holding space". Once, two older patients had to get surgery in a field beyond Annamalai's expertise. They still came and asked his advise. "Even if I didn’t have the knowledge of the other surgeries that they had to undergo, just a few compassionate words made them feel happy and reassuring," he observed.

3. Can Trust Fuel Systems?
One of the readings this week described a company that implemented designs based in trust for its employees. There was no clock-in, clock-out time, no set vacation days, and people determine their own salaries. Many institutions would ideally love to run like this, Lavanya commented, but they "fear that freedom given to people might be misused, hence the code of conduct has to be written most of the times." Yet at her eye hospital, she notices that patients trust the doctors and doctors trust that patients will be given the best treatment possible. What conditions must be in place to instill a culture of deep trust?

Pavi referenced mirror neurons -- which, research posits, viscerally enable us to feel each others' emotions. Applying that to systems, Ochsner Health Systems (and the Ritz Carlton) experimented with the 10/5 Way: staff members smile or make eye contact when the come 10 feet away from anyone. At 5 feet, they must say, "hello". While it raises questions of authenticity, as Thich Nhat Hanh says, "Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy." When a whole system of staff practice this, one can't deny how the culture of a place transforms and tilts towards greater collaboration. Haripriya recalled a surgery conducted this week that encountered unexpected complications, yet the patient, patient's family, and hospital staff, all handed it with remarkable calm and collaborative support. This took place in a relatively new branch of the eye hospital, and while their specialty of eye surgery is quite strong there, the other systems are not as established yet. It was a remarkable lesson in how we can plan as much as we can, and sometimes all we really can do is drop into the emergence -- and perhaps unlock other forms of value in the process.

4. Can Simply Listening Heal?
"If you listen long enough, everything holds value." Bill reminded us of this quote from Pavi's husband, Viral. While out for pizza this week, there was a mistake in Lavanya's order. She decided to inform the server of this mishap, not so much to complain, but just so they were aware. Expecting an angry or indifferent response, to her surprise, the server genuinely listened and swiftly apologized, offering a new pizza with extra starter at no charge. At such an encounter, the next day, Lavanya wrote a thank-you card delivered it to the kind staff person, which was received with wide smiles. Hard to quantify what value emerges from such disarming exchanges, but we all smiled at their elevated spirit that undoubtedly ripples out in invisible ways.

"Why is it that listening can be a healing act?" Pavi posed. On a patient-doctor level, Radha recalled an unforgettable impression a nurse left her when she was a patient and the nurse's sensitive demeanor offered just the right words to carry her out of a devastating experience. Then, Venu blew us away with a powerful story of shifting towards the patient perspective, when a close family member had a brain aneurysm, and they were not sure she was going to make it. In a surreal role reversal, he asked what he himself has been asked as a doctor (but that had never hit home before): "If she was your family member, what would you do?" With compassionate simplicity, the radiologist gave an answer which, beyond the decision made, acknowledged him as a human being at that vulnerable point: "Just the act of him pausing and reflecting, was not about the specific treatment that he did – it was just that he held us. And that was the healing that we needed to get past that dark moment."

With so much stirring to the surface, Audrey joked, "Wow, what a stilling call. You can really feel that we've all been really practicing and exploring what it means to 'hold space' this week!" :)

Bill concluded our circle with an excerpt of a poem by Celtic poet, John O'Donohue, from his book, To Bless The Space Between Us:
May my mind come alive today
To the invisible geography
That invites me to new frontiers,
To break the dead shell of yesterdays,
To risk being disturbed and changed.

May I have the courage today
To live the life that I would love,
To postpone my dream no longer,
But do at last what I came here for
And waste my heart on fear no more.


"That's a call to emergence!" Bill decisively concluded, with a twinkle in his eye. :)

On that note, we are look forward to diving into questions of Money & Wealth next week!

More About The Doctors Laddership Fellows:

Annamalai Odayappan, in his own words, says –“Do not work for money. When sufficient efforts are put, money you deserve comes automatically”. While saying so he reflects and feels he needs to scale in different forms of capita especially social and spiritual capital. Through Laddership Circle he would like to explore other forms of capital and deep dive to see how he can improve as a human.

Balaji Velayutham believes in the teachings of Swami Vivekananda and asks for courage to accept failures and keep moving out of his comfort zone. A table tennis player when he is not rendering duties as an Ophthalmologist, Balaji wants to develop Aravind Centre for Innovation so that more people can get eye care.

Haripriya Aravind, it has been said, is like poetry in action in the operating room. One of the best surgeons at Aravind, Dr. Haripriya strongly believe in the value of spirituality. As part of leadership team of the recently started Aravind Chennai hospital, she feels responsible for building the culture of empathy and trust and would like to explore ways to do so during Laddership Circle.

Lavanya KC, a vitreo-retinal surgeon, is grateful for all the learning she has had through her patients and wants to do something for them. She draws inspiration from the ordinary and holds trust as a value very close to her heart. Those who have seen her can definitely say that she doesn’t just treats her patients but adores them.

Radha Ivaturi's overflowing heart of service touches so many around her. Her sincerity of personal practices -- such as a 44-day meditation challenge! -- coupled with keen attentive care in her practice of hospital medicine, she is witness to striking moments of the human spirit. A mother, gardener, and volunteer, she is often witness to disarming micro-moments of beauty in the world around her.

Shalini Sahai serves as a pediatric doctor, a mother, friend, and maker of meaning. In her own words, she reflects, "Each day as I see patients in the clinic, I'm humbly grateful for the ability to serve in any small way. I try to bring my complete presence to every encounter I have, giving all my attention to that moment knowing that some times just the act of active listening is healing for the other."

Venu Julapalli is on a journey of amplifying humanity in healthcare. Specializing in Gastroenterology, he has "engaged in the best of what traditional allopathic medicine can offer and lamented the vast flatland of unconscious healthcare." Along with his brother, he's diving into "Health 3.0," with visions to "build a health care procedure center that runs sustainably on the principles of a gift ecology. One through which we bring our unique skillsets to bear, while inspired and owned by the community."

In addition, five of us have teamed up to volunteer with the circle -- Deep Medicine doctor-author, Bill Stewart; organizational facilitator, Larry Hulbert; illustrious author-filmmaker-poet Pavi; Audrey and I. It's a real privilege to explore the possibilities and tune into the collective emergence!

Posted by Devendra Tayade on Feb 10, 2018

2 Past Reflections