My survival secret: more from the other side of hell

On the evening of Sunday, March 23, I was wandering around campus, looking for a place to eat before class. I knew where everything was, but I still felt lost. Over the course of the semester, I had made a habit of carrying food and books with me wherever I went, but all of the spaces that allowed for both eating and studying were occupied. I had planned to do work with my extra time, but instead I spent at least half an hour trekking all over, scouting spaces. Eventually I gave up, settling onto an antique bench in an empty hallway. I spread my assortment of packaged foods over the deteriorating fern-colored velvet cushion. I stared at it for a few minutes. Upstairs, a chamber choir had started rehearsal. The music came drifting faintly down the stairwell. I felt so, so alone. I reached for my phone. I opened the Facebook app. I scrolled through my news feed. I saw a beautiful tribute that Nicole wrote to her brother.

That’s when the breakdown came.

See, aside from the losses Nicole already wrote about, we also lost two colleagues in the first few months of 2014. This was on top of the dear friend and role model that she mentioned, who we had also had the joy to work with for many years. What’s more, I suddenly lost a business I had had for almost seven years in January. Meanwhile, I was writing a thesis and working full-time. I commuted to campus four nights a week, and I ate almost all of my meals in my office, in my car, or in a public space on campus. And financially, I was completely strapped.

The first four months of 2014 were unequivocally the hardest months of my life.

Yet, here we are. I made it through the semester. I wrote an eight-month thesis in three months, and did a damn solid job. Nothing blew up at work. I stayed healthy. I didn’t even catch a cold from the undergrads.

But how?

You’ve probably heard about the importance of having an emergency fund. I have a small one. It grants an invaluable degree of peace of mind. But a financial emergency fund isn’t the only kind of fund you need. I didn’t realize it when I set out this semester, but I also kept an emergency fund for time. That is what really got me through, and it’s a practice I intend to continue.

You might remember that I had developed a pretty intense schedule for the semester – 9am – 10pm on weekdays, and 10am – 1opm on weekends. This was designed to include a cushion, and I used every bit of it. I also set some serious limitations on outside demands on my time. Fridays were my only “free” nights that could be used for social events (with very few exceptions). I probably used a third of them to catch up on cable TV teen dramas on while doing my laundry, and another third for big-batch cooking. I got really, really good at saying no.

All of those time blocks and limitations created an expanse of time specifically for studying – more than I theoretically needed. The trick was not letting that excess time fill up. Here’s why: I spent a ton of time studying and writing, but I spent more time trying to study and write. If you’re going through something (and you’re human, so you’re probably going through something), then you never know when you’ll actually be able to do the work. Sometimes this is due to outside influences, and sometimes it’s our own brains. We can’t predict when we’ll be able to focus, or which days we’ll be brilliant and which days we’ll be kind of dumb. Having that extra space in my schedule meant that I was able to grieve when I needed to grieve and work when I was able to work, without falling too far behind. When I had a mini-breakdown, I didn’t make it worse by feeling guilty for not working. When I slipped a little behind after another blow, I just caught up the next week. And so it went.

That’s my secret: space.  I made other kinds of space, too – emotional space, physical space, intellectual space – but by far, the most important kind was time space (not to be confused with the space-time continuum). As Nicole wrote, “badasses know that every single thing that comes their way is survivable.” It’s true, but you’ve probably heard that you need to breathe to survive.

Going through a rough time? Make the space. Breathe. You’ve got this.

Who do you think you are?

“So you’re a writer, then.”

Five words, spoken to me six months ago, by one total stranger. A simple observation that’s been nagging me ever since.

Nag, nag, nag.

Let’s back up a little. First of all, I’m a little jealous of people with straightforward job titles that need zero explanation. Salespeople, accountants, web designers, scientists, and so on – I’m talking to you. Public health is messy, and most people don’t even know what the field is. What’s more, my title makes absolutely no sense to people who don’t know the field well. I know, I know – this is not a problem exclusive to public health. I’ve come to adapt my explanation to my audience, drawing out the most relatable aspects of my blended position. At a tech event? I play up what I do on the web. At a do-gooder event? I talk about social determinants. If the tailored approach isn’t an option, I mention the field and the specific disease area I work in. Most of the people I come across at happy hours are just looking for points of similarity, so that usually does it.  But not this one fateful December evening.

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Busy Season: Notes from the depths of scheduling hell

We public health workers are busy people.  Most of us don’t just work from nine to five, even if those are our scheduled hours.  Even when we’re not on the clock, we’re learning, hanging out in Twitter chats, reading blogs, going to public health book clubs, or informing some poor, unexpecting strangers at happy hour about alarming STD rates in their city.  We’re not in the highest-paid of fields, so many of us wind up with side gigs.  We work in a culture that places a heavy emphasis on continuing education and advanced degrees, so a lot of us wind up taking classes while working.  Given that we’re humans, we’re also trying to build and maintain friendships with families, friends, and partners.  And maybe have some fun every once in a while.

Did I mention that we’re busy people?

That being said, we all have times that are busier than others.  I’m going through one of those times myself.  It’s probably the busiest I’ve ever been, so I’m going to share how I’m getting through it in hopes that it proves useful for your own busy seasons.  I’m not, however, going to lecture you on self-care.  After all, you know what they say about people in glass houses.

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You, too, can screw up in front of tons of people!

We’ve talked about why you need to take risks, and we’ve gone over how you might mess up.  The next step is to convince your supervisor or funder or whoever lets you do what you do.  This is not How to Win Friends and Influence People, although that’s a great book and you should read it if you haven’t already.  This post is also not a conversation guide.  Consider this more of a list of pre-requisites for public health risk-taking.  Without further ado:

1. Establish a track record of taking responsibility.  Everyone answers to someone, and the people you answer to don’t want to get stuck taking crap for things that you did.  I am quite sure that they’re already taking crap for a lot of other things they didn’t do.  If you have a tendency to assign blame for your mistakes to other people, then no one in their right mind will let you do anything new.  If possible, attach your name to the work you produce.  That way, complaints (and any accolades) go to you.  Take responsibility for the negatives, and share credit for the positives.

The people you answer to also want to know that you follow through on the projects you start, or they’re not interested.  You may be familiar with this concept in the form of conversations you had with a parent when you were a kid, or conversations you’re having with your own kids now.  They tend to start with the kids asking for a puppy and end with the adults pointing out that they’d wind up taking care of it themselves.  Especially if the kid has a track record of goldfish neglect.  Take care of your work-goldfish or no one will let you do anything.

2. Know that you will screw up.  Possibly royally.  The thing about taking risks is that, much of the time, your screw-ups become a lot more visible.  You will be embarrassed and worry about your professional reputation.  You’ll think you looked stupid in front of a ton of people, and maybe you did.  At least it will help you develop a sense of scale for your mistakes.  Make a their/they’re error in a guest blog post* where you’re meeting a new audience for the first time?  At least you didn’t accidentally send them all a flyer of an angry possum.

Please note that this does not mean that you should be careless.  It does mean that you have to accept that even you are not perfect.  It also means that you have to learn the difference between attention to detail and crippling perfectionism.   (Perfectionism is just a fear of failure anyway, and you’re over that now, right?)

3. Own your mistakes.  Anything else looks defensive or shady.  I don’t get to blame the two people who missed the their/they’re error in that guest blog, because I’m the one who typed it.  I’m the person that got so excited about open enrollment on the Marketplace that I forgot basic English grammar.  (I really don’t know how that happened, since we’re all really anal retentive about that kind of thing.)  The point is, you’ll find that people don’t get nearly as upset about your mistakes as long as you admit to them.  If you’ve ever had any kind of relationship with other humans, you’ve probably had at least one argument centered around this idea.

4. Do what you can to make it right. If it’s a typo, fix it.  If you caused an actual problem, try to make it right with the understanding that you might not be able to fix it.  That’s slightly easier in business where you can compensate with replacement, discounted, or free products/services.  In public health, you might only be able to listen and adjust your course.  Do what you can.

5.  Rinse and repeat.  If you own your screw-ups and try to make them right, then you get to cycle back to step #1.  People will let you take more risks.  You’ll get to mess up in front of a bigger and bigger audience in bigger and bigger ways.  Congratulations!

*Don’t bother looking for it – it’s not there anymore.  I saw it within a couple hours and had it fixed immediately.

The Angry Possum Incident: a risk-taking fail

Last time we met, I implored you to take a damn risk already.  This statement is all well and good for me, while I sit safely away from the consequences of your potential failures.  But I can assure you, I’ve made my fair share of mistakes too.  Possibly more than my fair share.  I’m encouraging you to take some calculated risks anyway.

Here’s a story for you.  Five years ago, the organization I work for had a pretty limited online presence.  One of my favorite projects has been the challenging work of expanding that presence with exactly zero extra budget.  (I really mean that – I love leveraging limited resources, which makes me a great fit for the non-profit world as well as a stellar shopping buddy.)  A little over two years ago, I managed to convince the necessary people that our organization should start an email newsletter.  It sounds small, but it was a bit of a perceived risk for us.  By providing extra information to a wider audience, rather than having our audience come to us, we were opening ourselves up to more public criticism.  Yet, we valued (and continue to value) transparency, and wanted to act in accordance with that.

I was grateful and excited when I got the approval to move forward.  With a great deal of enthusiasm, I drafted a template for our very first newsletter and sent it around the office.  After everyone agreed on the look, I filled it with some content on recent happenings in the organization and sent it around again.  I had two people proofread it.  I sent it to our email list.  Then, I got up and walked away.  If you’ve ever sent a marketing email and obsessively hit “refresh” on the analytics, you’ll understand why I left my desk.

Upon my return, I was pleased to see a high open rate and tons of clickthroughs.  Success!  I noticed that our readers were clicking on one link in particular – what was supposed to be a link to a post on our organization’s blog.  And then I realized that the link didn’t look familiar.  In fact, it was a link to an image.  More specifically, it was a link to this image.

Angry Possum

Scariest cat in the world.

I’ll let you guess what came out of my mouth next.  (Hint: It was very creative and would not be welcome language around the Thanksgiving dinner table.)  It was a minor mistake, but it was a pretty mortifying one for my kickoff newsletter.  What a first impression.  I resisted the urge to crawl under my desk, freaked out to a few friends on Gchat (they all laughed at both me and the possum), sent another email with “updated links,” and carried on with my day.

This was hardly my greatest professional failure, but it’s indicative of the types of mistakes you make when you’re trying new things.  I learned a lot from the Angry Possum Incident.  I learned that multitasking while copying links is not a great idea.  I learned that you have to specify if you want your proofreaders to double-check your links.  I learned that a LOT of people will click on a link to a blog post, find an angry possum in its place, and not bother to tell you about it – so you have to pay attention to your stuff even after it’s been disseminated.  And with all this learning, I got to start something new.  Over two years after the Incident, the newsletter is a popular endeavor.  The public criticism we were concerned about never happened.  Nobody talks about the possum, and the readers get surprisingly jazzed about a relatively dry newsletter on a pretty specific topic.  Why?  Because no one else is doing it.

This all points back to my original request that you take a damn risk already.  You might look stupid sometimes, but you’ll learn things that no one would think to tell you about.  You’ll get smarter faster.  You’ll set yourself apart from the other guys.  And you’ll get to feel like a badass.

Next up, I’ll tell you how to convince people to let you take those risks.  Catch you on the flip side.

Take a damn risk already.

The time has come to try to get in trouble.  Just a little bit.  By all means, go on collecting your data and hitting your targets, but stop keeping your head down all the time.  Be a badass and try something new.  Use whatever leeway you’ve got to do small things that are different and bold and a little risky.  Build some credibility with your little wins.  Then go a bit bigger with it.  Why?  Tired, mediocre junk bullshit doesn’t change anything.  You do want to change things, don’t you?  Otherwise you’d probably be reading a paper newsletter called Status Quo Public Health, written in Microsoft Works.

Of course, the system isn’t set up as a friend of innovation.  Federal, state, and local governments are set up to favor existing providers and previously funded programs.  Public grants come with hefty reporting requirements, and tend to go toward evidence-based interventions – even if they’re based on small studies from twenty years ago.  Foundation grants come with their own restrictions and motivations.  This means that we all wind up spending a lot of time just trying to function within some pretty inflexible parameters.  But my point stands:  You have to find a way to do some things differently from your peers.  You have to be willing to be risky.  It’s the only thing that will keep you competitive as the funding continues to melt away.

Right now, you might be thinking about how you don’t have time or resources to waste on things that might not work.  I hear you.  But listen:  there is waste, and then there is risk.  Somewhere along the line, we started to mix them up, but they’re not the same thing at all.  Waste is often dressed up as “but that’s the way we’ve always done it.”  Waste is neutral colors, safe language, and talking about the weather.  Risk, on the other hand, is loud and boisterous.  Risk is probably wearing a big, crazy hat and cracking sex jokes.  You might love it or you might hate it, but it definitely makes an impression.  Waste fades into the background.  Risk stands up and gets noticed.  Waste is safe.  Risk isn’t.  Waste gets you nowhere.  Risk might get you somewhere.

We happen to be pretty comfortable with waste in public programs.  We are way less comfortable with risk.  This a problem for most humans, but it’s a problem that public health can no longer afford to have.  It’s impacting our ability to do our jobs well in an environment where we’re increasingly competing for attention.  What are you so afraid of, anyway?  That your little program will get called out on a national level like those Obamacare keg stand ads from Colorado?  You should be so lucky.*

Target Audience

No it’s not. Knock it off.

Here’s the thing.  I can promise you that someone will always think that you are wasting money.  It’s a natural consequence of almost everyone having to pay taxes, whether they like it or not.  If you are trying to please everyone, then you are serving no one.  This is an idea that is accepted by smart businesspeople, but foreign to the public sector.  Trust me – if no one is complaining about your program, then no one knows you’re there.  (If you don’t believe me, go to a public meeting on something.  Anything.)  We can’t serve every person with every dollar that we spend.  So stop trying.  

Instead, try to serve a smaller number of people really well.  You can do that by thinking about the people you’ve had a positive impact on already, and figure out what they need.  (Here’s a hint: it might not be what they think it is.  They might say they need a meal, but what they might really need is both a meal and to know that someone cares enough about them to give them a meal.)  What could you do that they wouldn’t be able to shut up about?  How can you do something just crazy enough to get noticed, but not so nuts that you lose your funding?  Figure those things out, and then do them.  Build something different.  If it works, the funding will follow.  Oh, and you might really help some people along the way.

TL;DR:  Take a damn risk already.

And then do it again.

*For the record, I’m not a huge fan of those ads.  That being said, I’m not their target audience so my opinion doesn’t mean jack.  Plus, I appreciate the ballsy approach.  Props to the Colorado Consumer Health Initiative and ProgressNow Colorado for getting people talking nationwide with practically no budget.

Public Health Happy Hour on November 26!

Has the internet failed to sate your thirst for extensive public health discussion?  Join some of Philly’s finest public health professionals, students, and aficionados for real-life, in-person happy hour.  Both of the badasses behind this blog will be there, and so will an assortment of very interesting people.  Come for the beer, and stay for the epidemiology jokes.

Here are the details:
Public Health Happy Hour
Perch Pub, 1345 Locust Street (Broad & Locust), Philadelphia
Tuesday, November 26 at 5:30 p.m.

Be there or be chi-square!

Healthcare for Geeks: A Discussion from BarCamp Philly

On Saturday, I attended a fantastic annual event known as BarCamp Philly.  If you’re not familiar, it’s an “unconference” – a conference with a user-generated schedule packed with a wide variety of user-generated content. BarCamp tends to be more techy/web-oriented, but the topics extend to all areas of life, from transportation to food to raising geeky kids.  If you weren’t there this year, I’d keep an eye out for info on next year’s.  The unconference is a pretty brilliant format.  Setting the schedule the morning of the event breeds excitement and community and even brand-new ideas for talks.  (If you’re thinking we could use that kind of energy in public health, I’m with you.  More on that in a future post.)

After a midweek shower epiphany, I decided to use a small part of my BarCamp time to host a discussion on the Affordable Care Act’s impact on the tech community.  My session was sleepily and unsexily titled “Healthcare for Geeks,” and would focus on  insurance for freelancers, start-ups, and entrepreneurs.  I came with a small stack of paper handouts (quaint, I know), but mostly I came with questions.

We started the session off with a review of some figures.  We talked briefly about the subsidies and cost-sharing that are available to people without employer-provided coverage making between 100% and 400% of the federal poverty level ($11,490 – $45,960 for individuals, $23,550 – $94,200 for a family of four).  We also talked about the premiums on the health insurance marketplace (which range from $147-$357/month for a 27 year old in southeastern PA).  At the time, I had an Excel spreadsheet with the rates; since Saturday afternoon, I’ve learned about a fantastic marketplace premium aggregator site that covers 34 states.  (Note: the aggregator site recommends contacting the insurance companies directly to sign up for a plan, but subsidies are only available when signing up through the Marketplace.)   Given that information, our group was able to get into the meat of the discussion.

Americans have long been accustomed to the idea that a good job is worth having for the health insurance alone.  I personally know dozens of people that have successful part-time businesses, but have never been able to quit their day jobs because they needed insurance.  At the same time, widely-available insurance doesn’t mean free healthcare.  My main question for Philly’s tech community was this:  In a field that skews toward relatively young, healthy, well-resourced men – a demographic that doesn’t tend to access preventative care, and might have been more comfortable living without insurance than other groups – will the Affordable Care Act help or stifle innovation?  And will the new healthcare options reduce barriers to entry to the field for women, parents, people with pre-existing conditions, and other groups that would have been more averse to walking away from insurance?

I wish I could say that we came up with all the answers in that Wharton classroom.  We didn’t.  But our twenty-five(ish) participants seemed hopeful… in the long run.  People are excited about the idea of freelancing full-time or starting new businesses while still having access to health insurance.  But in the here and now?  Almost everyone is confused at best, and many people are scared.

Frankly, I was disappointed.  Not in the conversation (honestly I was excited that anyone showed up and thrilled that they wanted to talk), but by the lack of information.  Here were a group of smart people who are incredibly good at The Internet, and even they hadn’t been able to find the information they needed about their health insurance options.  (An aside: props to us all for not lapsing into a 45-minute healthcare.gov vent session.)  If these very capable people don’t know that health insurance companies have to spend 80% of premiums on actual healthcare, then who does?  And how will we ever get this information out to anyone but health policy wonks?

This adventure in bringing public health discussions to BarCamp Philly is something that the CDC might call “non-traditional methods of stakeholder engagement.”  But to steal another CDC term, it’s hardly a scalable approach (meaning that it’s not the type of thing that can be done on a big enough scale to reach a good number of people).  We will never have enough public health workers willing to spend their days off having conversations about the ACA with seemingly random groups of people, at least not enough to make a large-scale difference.  Yet we know from our discussion that the new availability of insurance could create some serious opportunity for creativity and innovation – something that we could surely use.

So, I’m going to turn to you, creative and intelligent reader.  Clearly what we’re doing isn’t working.  (See: our very first post on Badass Public Health.)  What tools do we need to reach people that don’t talk about health policy for fun?  How do we separate fact from fiction?  Where do we go from here?  And where do we start?

On vulnerability

I promise you that this is not some kind of bait-and-switch.  We brought you to a blog about being badass, and now I’m going to start talking about feelings.

Fun fact:  Badasses have feelings too.

Before we get started, you should watch Brene Brown’s TEDx talk on vulnerability.  Maybe watch it again if you’ve already seen it.  I’ve watched it at least half a dozen times.  It’s worth the 20-minute investment.

Now on to what on earth vulnerability has to do with public health.  As public health professionals, we know that this is hard, and often thankless, work.  There’s the prevention side, where we do everything we can to make sure that some thing (disease, violence, behavior) doesn’t happen, but we can’t see the thing that never occurs.  There’s the administrative side, where we wallow in paperwork that doesn’t seem to actually help anyone.  There’s the client side, where we still can’t figure out if we’re doing any good.  And there’s the bullshit side.  That’s the one where someone has some kind of meltdown, you find out your program will probably get cut (either by a FT position or entirely), and then your supervisor calls you in because you forgot the cover sheet on your TPS reports, and really, who even cares anymore.  So, as Brene Brown would say, you have a couple of beers and a banana nut muffin.  And you numb, because that’s the only way you can wake up and do it again tomorrow.

I’m not about to tell you that you should never check out and have a drink or binge-watch Scandal or whatever does it for you.  We have to numb at least some of the time, because we have to cope.  But in constant numbing, we lose our connection to other people.  If we lose the connection, we lose the purpose.

In a previous post, Nicole talked about the importance of being a real person.  This isn’t just important because it helps us to reach our target audiences.  It’s important because it allows us to be ourselves and live in alignment with our values.  It’s important because it makes us happy.  And it requires a hell of a lot of courage.  That’s pretty badass.

But this whole vulnerability thing goes further than that.  It’s not just about us.  We can’t get better at what we do if we don’t talk about our shortcomings and our programs’ shortcomings instead of putting everything on those social determinants of health we get so excited about.  We have got to stop being so defensive, and think critically about our work.  We need to have conversations that go beyond ascribing every frustration to “burnout.”  Honestly, how often do you hear public health professionals talking about how they can do their jobs better?  And how does that compare to the amount of time spent worrying about things completely out of our control?

Listen, I’m not saying that you don’t have a right to be stressed.  I am saying that we could all do a little bit better by acknowledging that things suck sometimes and letting the frustrations wash over us.  It’s the only way we can come out swinging on the other side.

In future posts, we’ll talk about what exactly vulnerability looks like in the public health workplace.  In the meantime, let’s find out what happens when people stop being polite afraid, and start getting real.

Badass public health, now in your ears

A couple of weeks ago, I sat down with Teagan Keating for the first episode of her new public health podcast, Action Phase.  It was a fun interview, if I do say so myself.  Teagan provided me with a lovely cup of tea from faraway lands (Nepal, maybe?) before we settled in to talk about community planning, sex, coding, why condoms won’t stop the HIV epidemic, and my opinions on how to fix pretty much everything.  Spoiler alert: I also reference an upcoming post I’m (still) writing on vulnerability.  It’s going to be a whole series now.  Buckle your seatbelts.

Visit the Action Phase website to listen to the podcast, and leave her a nice comment while you’re over there.  And maybe follow her on Twitter, too.