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Is it true that the eyes are the window to the soul? To consider this, I suppose one would first have to define (or at least characterize) soul. Because this is my written thought and because I am likely the only one that will read it, I think we will use my definition for soul.

Soul: The aspect of an individual as seen and understood by the individual to be the individual; apart from the body but impacted by the body, apart from the emotions but influenced by the emotions, and apart from the intellect but persuaded by the intellect.

Considered in this regard the soul is either 1) a bladder-like receptacle that collects the unexplainable detritus of life which is then expelled into the void upon the death of the individual, or 2) a bladder-like receptacle initially imbued with meaning and purpose that collects wisdom which is then transformed into Truth upon the death of the individual.

Reconsidering, …perhaps the Truth will show that 1) and 2) are exactly the same. Perhaps as I am living in this existence it is merely a matter of perspective. Perhaps not.

So from my perspective the soul is a place where the individual collects and questions uncertainties, and formulates beliefs that ultimately guide actions that ultimately define the individual. And because we put so much emphasis on individuality and power and importance, this soul definition outmaneuvers all others, and by doing so may perpetuate cycles of selfishness. My body may tell me one thing, my heart may tell me another thing, and my brain yet another; but when it comes to understanding “me” (especially when the body, brain and/or heart disagree) I first gather this information together to determine which bits when coalesced most conform to my soul definition. The soul encourages consistency and provides a measure of comfort and safety. I tend to put more trust in my soul. So in the sense that I see what and how my soul sees, (at least metaphorically) the eyes are indeed a window to the soul.

Research also shows that physically the eyes in various ways do provide clues to one's emotional state. I believe the emotional state revealed by the eyes reflects direction after one's soul has processed and coalesced. So in this literal sense the eyes again are a window to the soul.

So what happens when the eyes are faulty, deficient or malfunctioning? The literal eyes I believe in most cases will work to continue to reflect one's soul direction though defective eyes may throw up some barriers. For example eyeglasses become a window to the window to the soul. But what about metaphorically? What if the soul sees with lazy eye or cloudy eyes or double vision? The literal eyes and the literal interpretation of this faulty definition will feel consistent and sincere to the individual because it emanates from the individual soul; that bladder-like collector of things. It is sounding more and more like I believe the soul to be a scheming, manipulative untrustworthy soul. But if this is what I see, and if what I see is guided by what the soul sees, then how can I trust this? And if the eyes are a window to the soul, but the eyes are being hoodwinked by the soul, how can I trust the eyes of another? I am back to the constancy of uncertainty and questioning; most significantly, questioning my self.

I have had medical procedures that have exposed my brain and my heart. Next week I am seeing an ophthalmologist. Will my soul also see the ophthalmologist? Will the ophthalmologist see my soul? Or will we discover together that I do not have a soul? It is a question that weighs heavy on my…

…soul

This past week at work I have had so many urgent task priorities that I have been unable to process beyond the particular specificity. By definition, to process is to apply a series of actions or steps toward a foreseeable end result or toward a progressive continuation. In the context of the urgent tasks, I have applied a process to attain an end result. In the context of the multiple moving parts, the complementary side-by-side tasks, the cycles, and the flow, progressive continuation has (in this past week) come to a screeching halt. By focusing on the task, I am losing sight of the big picture.

By definition a process is systematic.

To systematize is to step back in order to keep up.

To step back is to assess, prioritize, plan, then act.

Process improvement requires a systematization of the whole; not just of each individual task.

One perspective's whole is another perspective's individual task.

Process improvement results in gains in both efficiency and productivity.

Process improvement must constantly evolve.

Considering this process of nesting processes, it becomes obvious that to better improve an individual task process I must come to a deeper understanding of my overall responsibilities; and to come to this depth of understanding I must also see how the results of my individual tasks and overall responsibilities flow into and intermingle with other incoming contributions; and to improve the process further I must follow this streaming productivity (at least) to where it then 1) flows into a larger, faster-moving stream, or 2) empties into a basin, or 3) (due to other streams flowing into it) becomes a torrent of productivity in which (in all 3 cases) my tasks and responsibilities have melded in so thoroughly as to be unrecognizable.

I could continue this analogy to encourage the torrent---(productivity) and flood control---(efficiency), and to discourage leisurely flow into the calm, placid waters of a still, silent basin---(bureaucracy, status quo, business as usual), and I will to an extent, but I also want to narrow my focus by widening my perspective. I want to begin to differentiate leisurely flow from rapid flow because it appears that many of us mistakenly perceive the complexity of bureaucracy and the busyness of tedium as productivity; (i.e. rapid flow). It is not. I want to follow my flow from its source to its end: Will it be consumed as sustenance contributing to a torrent of productivity? Or will it be swallowed whole by a sea of silent quiescence?

It is difficult to track an individual contribution. Perhaps the key is sustenance. Is my contribution maintaining its individual substantiality as is? Not growing or adding to a greater whole? And then what about the greater whole? Is it then moving on to be consumed as sustenance? Or is it in turn swallowed whole? There are many points along the path where it is simpler for me to keep my head down believing the flurry of activity that surrounds me is a torrent of productivity when in actuality, just around the bend, we may be swallowed whole.

As I am thinking this through I have also come to realize that there are many individuals who would prefer that their individual contribution maintain its individuality and not meld into a greater whole because after all it is all about “me” the individual. It is this mindset that supports, strengthens and perpetuates bureaucracy and business as usual, and it is this mindset that skews reality and keeps us from seeing (or even imagining) what is just around the bend.

Inevitably though, an individual contribution will lose its shape and definition regardless of how it is promoted, and it typically does so just before it goes around that final bend so the individual does not see (or have to admit to him or her self) that “me” inevitably is fused into the greater whole anyway; so at this point many choose to grab hold and ride a different individual contribution and then continue to repeat the process for a lifetime.

Wouldn't it be better to widen one's perspective by narrowing one's focus?

Wouldn't it be better to see beyond me by following a personal individual contribution to its ultimate and inevitable demise that either contributes to a torrent of productivity or drowns in a sea of silence?

Wouldn't it be better if upon my demise I had contributed to more than just the status quo?

Wouldn't it be better to step back in order to keep up?

Have we become the necessity of minutiae? Have we evolved from the actual small and trifling detail to the delusional belief that to surround oneself with a collection of details adds meaning and purpose to inconsequence? What is it about copious complexity that we find so alluring and so all-important? I suppose it keeps us busy; gives us something to do; distracts us from reality.

One might argue that the reality of meaning and purpose is every bit as real as the reality of survival. I would argue that today's reality of meaning and purpose is every bit as individual as yesterday's reality of survival. Because survival of the individual (for many) has become something taken for granted, and because many individuals are unable to wrest their focus from their self, they have shifted their consideration from longevity to relevance, (though the essence of reality has not changed). I would suggest that the individual continue to see survival as the ultimate reality and advance their thinking to work toward survival of the species. Next to that, individual meaning and purpose is inconsequential fluff existing in an alternate and specific reality as created and maintained by the individual.

I understand the difficulty in accepting my personal details, (my perception of me), as inconsequential fluff. But in many ways to embrace this reality is liberating.
…It allows me to see that I am as necessary (or as unnecessary?) as every other individual on this planet; (perhaps not as influential but every bit as necessary).
…It allows me to focus on personally enjoyable details (such as cooking and reading and walking and writing).
…It allows me to think more freely with less regret and less guilt.
…It allows me to work to save the world.
…And though it allows for empathy, encourages kindness, and demands that one respect the autonomy of another, from the perspective of others, my truthfulness often comes across as angry or mean or surly or sad; and I suppose it is all of those things, but it is also real.

I am concerned for the future of Humanity. You should be concerned for the future of Humanity. If we could harness the wasted energy spent on relevance, would it be enough? Or is it already too late?

This brings me to faith. By definition faith is belief that is not based on proof. I have faith that Humanity, in some way, shape or form, will survive. On our current trajectory, my belief appears to be a fairly large leap. But I am evidence, and each day I find an increasing number of examples, of active faith. There are two types of faith. Quiescent faith is seen in those who focus on relevance and/or sit and wait and hope that things will get better; that ‘someone' will figure it out; or that we will be okay, if not in this lifetime then in the next. Active faith (or active hope) is seen in those who focus on survival by listening and reading and learning. Active faith is productively angry and mean and surly and sad and truthful and real. Active faith is purposeful effort that recognizes the pointillist perspective of autonomy and the whole.

For me, faith is not an answer and active faith is merely a start. To those who believe in a better life beyond this one, I cannot disprove your faith and I will not expend energy on a pointless argument. But I can ask that you contribute to the well-being of future generations while we are sharing this plane of existence. I don't believe it is too much to ask that you fit an active faith alongside your faith. I believe it will complement and strengthen your faith and I have the strong impression that this is happening in many evolving enclaves of faith.

I suppose a certain amount of energy spent on personal relevance is unavoidable and even necessary. We are, after all, only human. But the more of that energy one is able to redirect towards active faith, the better our chances for survival.

And in the end, survival is the ultimate reality.

In my new position I am required to ask doctors, who work for a university health care system (that includes hospitals), to fill out evaluations on students working to become doctors. In the most recent eight week period (which ended three weeks ago) this amounted to 307 evaluations sent to 117 different doctors; some sent as many as nine weeks ago. I have followed this (so far) with 654 reminders and I am still missing over 100 evaluations; (107). Overall, this is more than 1 in 3 evaluations so far unreturned.

From the other side I have students expressing frustration over the apparent double standard within a system that requires prompt responses from them yet allows doctors they finished working with 8 or 9 weeks ago to continue their boycott of evaluations. The most vocal complaint I have heard from students is that the lack of timely feedback makes it more difficult for them to focus on areas needing improvement.

Though I suppose I am complaining and I definitely would like to see improvement, I believe this to be the norm; typical prioritization for busy and harried professionals. So with that in mind I would like to think my written thought is less frustration and more seeking understanding so we may improve the process.

I understand it often is a matter of perceived priorities and I know that some of the doctors who are guilty of this heedless procrastination are literally making life-altering and life-saving decisions on a daily basis. But I am also quite certain that they are not doing so every moment of every day. When will a 10 minute block of time to fill out an evaluation become a priority? When the Clerkship Director asks? Or the Faculty Director? Or the Dean? Or the University President? If any of these apply, then why not when I ask?

I believe that for a physician to accept a position in a teaching hospital or health care system is to accept a responsibility to the future of medicine. I understand that in a given moment an evaluation may appear to be a small thing, but it speaks to a much larger mindset, and it has a much greater influence on morale and energy and outlook than what it may appear to, in a given moment.

Finally, and certainly of least importance, I am told I should not take this consistent lack of response personally. And I do not take it home with me or lose sleep over it; (at least not much). I consider it a particularly challenging (and at times a particularly frustrating) aspect of the job, but then I have also always been energized by a difficult challenge. When I see more expedient responses from a Director's request though, it is difficult to not realize that there is less respect for my position, and I am in my position because I am me; and being human, “me” is personal. How can it not be? Still, I agree it is the least important aspect of this plea for more expedient evaluations.

I truly am extremely energized by all of the organizational aspects of this new position, but most particularly I am personally challenged by the not-uncommon and contradictory disregard I see for a responsibility that I am confident every physician in our system takes seriously. I am not going away. I will continue to send reminders, (however many it takes), and I am sure that I will continue to be challenged. I have a great deal of respect for doctors and their profession. They are (from my perspective) performing miracles; but when they are doing so in a teaching environment, (like it or not) that involves filling out student evaluations. Please.

And Thank You.

I originally wrote the above as a template for a slightly more personalized “impassioned and heartfelt plea regarding student evaluations” that I intended to share with the Director, in the active hope that we could then share this with 117 physicians and that my perspective might help us to improve. But when I verbally presented a condensed version of this thought, (focusing mostly on the stats), I received a lukewarm (at best) reaction. After this discussion the Director sent out her standard “ATTENTION NEEDED” email to the 15 or 20 seriously delinquent doctors, and this missive will accomplish what is intended and it will keep me in my place and we will do it all over again in another eight weeks.

The paragraph above reflects my immediate reaction which (because of its immediacy) I am sure is an overreaction. Perhaps the Director will think things through and determine that my perspective and my thoughts are valid and worth sharing. I do believe that our doctors take their responsibility for the future of medicine very seriously, and I am pleased to be in a position to support this endeavor. And yes, I am in my position because I am me, and I do struggle with what I perceive as (perhaps not exactly a lack of respect, but certainly) a recognition and active acknowledgement of my place vs. their place. In this circumstance, in this moment, it feels like we have simply maintained. Whether, (from our varying perspectives), we see it as thinking things through, or prioritizing, or (because I am new to this position) giving it some more time, or avoiding confrontation, or making excuses, or protecting fragile egos, regarding student evaluations it feels like we are merely staying afloat. Long live the Status Quo!

I am confident we will improve. I believe we could (and should) work to improve more quickly.

The other aspect of this circumstance I want to examine is the apparent contradiction between responsibilities taken seriously and tasks not completed. The most obvious (to me) explanation is that some physicians need urgency to act. I could analogize my requests and reminders to the common cold, and the Director's requests to pneumonia, and the doctor's resulting response to their efforts to avoid further complications, and by doing so it lessens the personal sting for me, but it does not optimize student learning. It is apparently difficult for some to see the urgency in evaluation because by the time they are asked for this formal feedback, they have moved on to new students and they have nobody in their face demanding attention.

Assessment and evaluation is a critical piece of every effective teaching-learning model utilized at every level of education. After dealing with an urgency some physicians hand patients off for continued care and follow-up. This is not an option in teaching. The process is not complete without the evaluation, and the physician cannot hand the evaluation off to someone else. The urgency can be found in the future of medicine, and this (teaching – evaluation process) mirrors the earlier contradiction between responsibilities taken seriously and tasks not completed in that “now” is far more urgent than the future. So how do we instill a sense of urgency into our actions for the future, as represented (in this circumstance) by student evaluations? This question reaches far beyond this circumstance.

Phrasing the question as applicable to our current challenges worldwide, with the past on our backs and the present slapping us silly, how do we instill a sense of urgency into our actions for the future?

As a clerkship coordinator unable to obtain a few student evaluations from a few heedless procrastinators without the intervention of a Director, when I consider worldwide challenges, I am discouraged; and more than a bit overwhelmed.

Unless we find a way to disarm the nostalgic yearning for days gone by and to demobilize the crippling bureaucracy and the polarizing politics that dominate today, tomorrow will simply become a more dysfunctional extension of today.

In my personal circumstance, we will improve because I will continue to pound the drum and (though faint right now) it will ultimately become a part of the rhythm and flow of our small community.

In the worldwide circumstance, even though my drum is not the only drum, those with the wealth and power either cannot or will not hear the drums. Regardless, we must continue to pound the drums until they too become a part of the rhythm and flow of our larger community.

But this week, I am the one that feels beaten. This week I am sad. This week I am discouraged. This week I am disappointed. This week I am seeking understanding, and I am asking for understanding.

Please.

And Thank You.

I live in the Land of No-Ever.

How to describe it?

It is not necessarily a where, but at times it is. It is more often a when, and on occasion it is a why. It is not an ever, nor is it a never; unless I am on the cusp of How-When or Why-How. How in No-Ever is brief and rare. An extended moment of How overlapping Why and/or When often results in a fleeting simultaneity of ever and never. This synchronicity is hard to describe, and harder to catch, but you know it when it hits you. This paradoxical concurrence may be coincidence, but I like to imagine it as more. This Whatever feels the closest I will come to a definitive Whatever.

In the Land of No-Ever, hard work is its own reward. At first it has to be, but eventually it becomes itself.

In the Land of No-Ever the intangible becomes far more important than the tangible. To survive in the Land of No-Ever, the imponderable must be pondered, the imperceptible must be perceived, the insensible must be made sense of, the indeterminate must be determined, and the inappreciable must be appreciated.

In the Land of No-Ever, there is only uncertainty. Outside the Land of No-Ever, though there are still many moments of uncertainty, there are also many moments of Whatever; many more for some than for others.

Some inhabitants of the Land of No-Ever pretend so hard that they are a Whoever from Whenever, that they actually create a Wherever for themselves outside of No-Ever; but still only a stone's throw away, and still with considerable uncertainty and relatively few moments of Whatever.

When those of us from inside the Land of No-Ever must transact with an individual or an entity (Whoever) from outside the Land of No-Ever, (be it Wherever or Whenever), we are required to spend considerable effort explaining and justifying. From inside the Land of No-Ever we are frequently expected to apologize and to ask forgiveness from whenever for following whoever's instructions from wherever. And not infrequently, from inside the Land of No-Ever, we must admit to wrongdoing for not following instructions ungiven.

In all the Lands, unrealistic expectations are the norm. Inside the Land of No-Ever many, many unrealistic expectations have become unrealistic requirements. Outside the Land of No-Ever excuses are reasons. Inside the Land of No-Ever reasons are inexcusable.

Those from outside the Land of No-Ever never come to visit; even though they have a multitude of easily accessible and readily available maps and compasses and guidebooks that are full of color photographs depicting the gray reality of the Land of No-Ever.

Inside the Land of No-Ever, we have a plethora of maps and compasses and how-to guides and directions to help us find our way out of the Land of No-Ever, but because they were provided to us by those from outside the Land of No-Ever, they do not work.

From inside the Land of No-Ever it feels like everybody lives outside the Land of No-Ever.

From outside the Land of No-Ever there is no such thing as the Land of No-Ever because there is no Land.

From outside the Land of No-Ever, those of us from inside the Land of No-Ever are seen (in the best light) as unexpected guests, or visiting relatives over-staying their welcome. In other lights we have been slaves, we are prisoners, we are the homeless, we are the underprivileged, we are the outsider, the newcomer, the disparate and the unimportant, we are an unnecessary burden or a necessary evil, but we are most definitely not autonomous inhabitants of an autonomous Land.

From inside the Land of No-Ever, we tend to go along with the assessment above.

From outside the Land of No-Ever, nobody lives in the Land of No-Ever.

I live in the Land of No-Ever.