Underneath My Wonder Woman Cape

My sister and I were talking the other day and she confided in me that as her body tiptoes into menopause she is experiencing a seesaw of emotions which makes her feel weak. "One minute I'm up, the next I'm down. You are such a rock" she tells me, "you always have been". We both know that is not true, but I rarely let the outside world know of my internal and private struggles. (Unless of course, you read my blog) Friends, family, and co-workers know the smiling "see the world with all of it's bright colors" Kristen.  


When my sister told me she feels like crying all of the time, how she just wants to sleep, and she has been gaining weight, I told her she should talk to her doctor because it sounded to me like she was experiencing signs of depression. Even as I said those words, feelings of being a hypocrite crept upon me. The voice in my head shouted "What about YOU?!?!" Who me? I can handle my issues on my own... I always have. "Except for the time you took a handful of sleeping pills and your friend had to put his fingers down your throat to make you puke them up" the voice reminds me. "That was a very long time ago" I think, as I bury that memory down deep.  


One of my former employees sent me an email after reading one of my blog posts that said "what makes you a great leader that people respect is that you aren't afraid to share raw emotions to help the meaning of what we do sink in." I guess in my own way, I believe if I put myself out there and share what I have gone through or what I am going through, it will give someone else the strength to share their own stories or get the help they need. The way I find my way through the world is by writing it all out and bearing my soul in the process. So... In the spirit of being a good leader, better sister, and just plain real, here is the side of Kristen that hides under the Wonder Woman cape.


Most days, I am absolutely fine and the person you see is really me and I am happy. But there are days, sometimes weeks, that old memories bubble up to the rim of my already full life. Days that I fight back tears and have absolutely no desire to interact with others, eat, talk, exercise, or just BE. Not that I feel like hurting myself or anyone else, but times when I just want to stop the world and get off for a while. Times when my mind feels so cloudy that I actually avoid trips to my doctor because she knows me well enough to see through my facade, and I don't want anyone, not even her, to think I am not the person they think they know. Sometimes those feelings are brought on by "trigger events" like birthdays of someone I loved who has passed on or the anniversary of their death. Other times it is related to my work. Not the stress of my work, because I manage that pretty well, but the subject of the work itself. For instance, when we started our alcohol screening initiative I was reminded on a daily basis of the day I lost my best friend to an alcohol related car accident. The loss I felt after his death and other circumstances in my life with my family pushed me in to a world of true depression so dark that I thought I would be better off leaving it. Thankfully, a friend intervened. 


Recently we have been working on Domestic Violence screening so I felt inspired to share my personal story as a domestic violence survivor through my blog(s). Because of my DV blog someone reached out to me to help their friend and, while I'm extremely grateful that I could help, it conjured up emotions that I had disassociated myself from for some time and it sent me in to grey days. I was recently asked to join the Domestic Violence committee at work and at the first meeting my friend said wanted me to share my personal story with the group. I literally felt like I was about to have a panic attack because though I have had private conversations about my past, I have never been asked to vocalize my experience in front of a group.  I was so grateful that we ran out of time and that part was skipped, at least for that meeting. I know I want to use that chapter of my life to help educate others  so I will have to find a way to cope with the overwhelming emotions that come from bringing those skeletons out of my closet. Baby steps though.


Now the focus is on Depression Screening and there is a voice inside me screaming "Yes... we need to find THESE people who need our help" and a quieter voice saying,"but, whatever you do, don't screen me because I'm just fine." Right?


From a young age I used writing and music to deal with and share my emotions. If I was upset about something, I would write a poem or a story and slip it under my mom's bedroom door and we would talk about it on the way to school. One of my first poems was called "A Point of View of a Spider" as a plea to get my mom to stop killing spiders, but growing up in a pretty dysfunctional family - my teenage years introduced darker topics like "On the Edge of Suicide". My mom freaked when I slipped that one under her door. I remember the drive to school that morning and this expression on her face that was a mix of irritation, concern, and panic all mixed together. She looked at me and said "Do I need to worry about this?" "Nope... I'm good" was all I said, even though I wasn't. Music has also been a huge part of my life. I grew up around music because my dad's band would use our house to practice. There are times when I can't find the right words to express my thoughts, so I lose myself in music until the words come along. The one that helped carry me through my teenage years and the death of my friend Robbie was "Lord is it Mine?" by Supertramp. I would slip my cassette in to my yellow sony walkman and go down to the park where I would climb a tree and hide from the world.

These past couple years, while as amazing as it is to be in the role I am in at work, have come with many challenges.  There are times when work, family, home, being adult (with bills to pay), and dealing with fibromyalgia can get to be a bit overwhelming.  This song "Swim" by Jack's Mannequin has helped me pull through the difficult times by reminding me of the reasons I do what I do and who I do it for.  Occasionally, you're going to get caught up in turbulent seas and the only thing you can so is just "swim".  

When I put on my work clothes, it is like I'm putting on a different me. The person with all those fears, doubts, and worries gets pushed aside and the strong, confident Kristen takes her place. The one that always responds "great" when someone asks how I am or cracks a joke to make someone else smile. However, Wonder Woman Kristen knows that there is a different person quietly hiding under that flowing cape waiting to surface and lately I've been thinking that, "Yes... some people can handle most things on their own, but perhaps it takes an even stronger person to ask for help when it's just too much". Feeling sad or down occasionally is normal. Depression isn't and shouldn't have to be. We should all just take off our super capes and let the world see us for who we are and allow others to help us paddle through life together.


Wondering if you or someone you love is suffering from symptoms of depression, use this  Interactive Tool: Are You Depressed?

If you think you have a medical or psychiatric emergency, call 911 or go to the nearest hospital. 

Steps You Can Take To Feel Better

Want to know what songs I use to work through my gray days? Check out my iTunes Playlist - Hold On

I See You

I see you... Sitting on the exam room table
Bare back exposed through an undersized gown
Hands twisting together in nervous anticipation
The person I've come to know through ups and downs
I see you... grey hair speckled through shades of black
Skin pale and freckled... wrinkles slowly staking their claim
You have been my patient for so many years now
I've grown to welcome the sight of your name


I see you with your list in your lap
The latest of ailments to set in
I know these pains are more than just aging
How your heart still aches from loosing him
I saw the brave act you put on for my nurse
But I'm grateful you drop down your guard with me
I ask how you are and see tears swell in your eyes
Though your voice whispers "fine"... You know I can see


I hand you a Kleenex and sit quietly... Waiting
Allowing this moment of release you so desperately need
"Sometimes it's just so hard" you say softly
Wounds so very deep; but they never bleed
I take your hand and ask how I can make things better
You stare at my hand on yours and say "you just did"
A simple gesture they didn't cover in medical school
That I learned from my mom when I was a kid


I see you... Not just a patient but a person
And though at times I admit I've forgotten
I know compassion is the first medicine I must offer
Before any other medical healing can begin
I am grateful that you still confide in me
You are a reminder of why I do what I do
And if you continue to trust in me
I promise... I will always see you

The Theme of the Week is "Collaboration"

Northern California KP visits Southern California to share innovations

In a meeting a couple weeks ago one of our doctors told me she didn't think we should share information with one of our sister regions."I don't like xxx person in that region" she said adamantly, "and I don't think we should partner with her. She will just steal our ideas and take credit for them." So I gently reminded her that we always share our work openly and freely because, in the end, it isn't about who gets credit, it's about improving the lives of our patients and our communities. When you think about it, Kaiser Permanente exists because of a collaboration that began over 60 years ago between Henry Kaiser and Sidney Garfield. That journey continues today because of internal collaboration within our three entities (Hospital, Health Plan, and the Medical Group) who have come together to build a partnership all aimed towards one vision and goal - Providing high-quality affordable care. 

Interestingly enough, the work theme for the past couple weeks for me has been all about collaboration.  Starting with a meeting with our Southern California Complete Care Leaders where we shared ideas for improving care for patients with rare diseases, diabetes, asthma,  etc. The meeting opened with our Southern California Medical Director over Quality and Clinical Analysis and our Foundation Hospital Senior Vice President for Quality and Patient Care Services Patti Harvey who spoke of their appreciation towards this group for coming together to improve outcomes, to improve quality, and improve lives.  The collaboration theme was echoed by our Southern California Permanente Medical Group Business Leader, Judy White, who spoke about replacing the competition that we have with each other across service areas to a culture of collaboration to improve care for all patients.   

Three days later I met with consultants from Community Partners to go over our plans to deploy our Proactive Encounter program in surrounding community clinics throughout Los Angeles area... work sponsored by our Kaiser Permanente Community Benefits grant program. This work aims to improve the quality of care delivered to patients across our communities by teaching clinics quality improvement strategies, implementing standard workflows, and sharing clinical guidelines. When I was approached by our Community Benefits team last year about the idea of sharing and deploying Proactive Office Encounter (POE) across our community clinic partners I didn't need any persuading to get me on board. "Count me in!" was my ecstatic response.

Wednesday we spent almost two hours on a conference call with Northern California KP explaining how we developed and implemented a Proactive Encounter program for our Obstetric patients that provides prompts in our EHR to remind staff to stage orders for providers so based on what each individual patient needs according to gestational age. If depression screening hasn't been completed, labs are missing, or a RH- patient hasn't had Rhogam given by her 28th week a care gap will remind the staff to place the order. Sharing strategies, programming logic, technologies, and thought processes helps us deliver outstanding care to both the mother and child.

My last call today was with a group of physician leaders from our Colorado region who were in the process of rolling their version of Proactive Care out to their specialties and shoring up the work already accomplished in primary care with a Successful Opportunity Report much like what we use in Southern California to monitor the effectiveness of our Proactive Care program by measuring how often patients came in to our health care system with a care gap and whether that gap was closed within 30 days. I shared with them some of our strategies for engaging specialties and how we used the report to identify areas for improvement and celebrate successes. After the call, I had a side conversation with one of their project leads who had more questions of her own. She thanked me for taking the time to talk with her offline. What they don't get is that this is one of my greatest joys... Sharing successful practices to improve the patient care experience. 

I'm grateful every day that I work for an organization that allows open collaboration. Together we save lives... one patient at a time.


"Every day is Collaboration Day when you have friends on Twitter and other social media platforms" KA