Pushing the river: Boundaries, choices, and life as an academic

A very wise clinical mentor of mine once told me: “You can’t push the river.” At the time, I was trying to work with a family to make change that they needed and recognized, but weren’t ready to make. As I’ve moved down river in my career, that phrase has come to mean many things. As I worked towards my doctorate and later struggled through my postdoctoral fellowship and third masters degree, and a mentor who self-destructed, it meant that I had to ride out the rough patches. Hold on, keep your head down, and see where you came out when the rapids eased up. As I’ve advanced into the professoriate, it’s come to mean something different again- hearkening back to something that I learned back at the beginning of my clinical career- something about boundaries and choices.

As academics, we get a very long line to play with sometimes. There are expectations, parameters, guidelines and rules, but we often get to build our own bridges and do our own thing. As long as we are productive with grants and publications, show up to meetings, hold office hours, and get decent teaching reviews, no one questions how happy we are or whether we love our work. Community engagement, outreach, and things that make your department look good are applauded. Student opportunities created are rewarded with applause in faculty meetings at the beginning and end of the academic year. The problem, though, is that those things are not valued at the same rate. Starting a clinic or doing community outreach is not ‘the big one’ that you hoped for… not unless it leads to external research funding and a publication. Student mentoring is gratifying, especially when you can see the change in the future practice field- when medical students ask about structural barriers to care or social determinants of health, or when pharmacy students automatically start looking up alternatives for expensive medications that could help someone when they meet a family living on the edge, or when social work students get excited about working with the PTs, med students, and nursing students to help migrant farmworkers. Student mentoring, however, is not a plank in the boat that brings you to tenure. It helps- it’s teaching or service, or both, and the connections made are good for clients, students, and for us- boosting our morale as we see the future of our profession being created in the excitement of our students.

So- how do you know when you are pushing the river? What are the signs that you are the only one championing a cause, and how do you decide if it’s worth holding onto a project? This is where that insight about boundaries and choices starts to appear.

Early in a clinical career, we are taught about boundaries: how to find them, where to put them, and how to hold them. We are taught about how to know when you are dealing with countertransference, or just flat out getting your buttons pushed. Academia is not entirely different from a clinical career; we still deal with people who are seeking our help to advance their lives, with families, individuals, and sometimes even with damaged partnerships that we hope to help repair. We seek out opportunities to advance the evidence base about understudied things, to bring that work to communities that can use it, and see it put into practice. So how do we recognize when we’ve become passionate about something that isn’t serving us well? How do we recognize that the passion might be countertransferance- our need to make change in the world? And perhaps most importantly, how do we know when it’s time to ‘cut bait’- to let go of something that has had such promise?

As an early career academic (in that critical first 10 years), I am learning that applause is wonderful, but a project- no matter how much passion you put behind it- cannot be sustained unless someone wants to wade into the water with you. Project sustainability requires buy-in- not just from the actual participants, but also, critically, from peers who will step in and share the burden of your role. If you can’t convince people that it’s worth it, or if the same passion isn’t present among your peers, it may be realistic to consider whether you are driving your passion in the right time and place. Without peers to share the burden, sustainability relies solely on your own ability to keep it up. When the river continues to rise, when the pull of the current that belongs to other projects, other responsibilities, and the constant pull of tenure progress begins to win out, it’s useful to think about boundaries… choices… why those are where they are, and how they were made. Sometimes, no matter how passionate we are about something, we have to remember that we can’t push the river. Sometimes you have to cut bait and trust that the river will take care of itself.

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Building relationships with overseas colleagues

I was invited by my friend and colleague, Dr. Fei Sun, to work with a university in Wuhan, China, in June. I gave a short course (8 lectures) on aging, geriatric clinical skills, and dementia at Huazhong Agricultural University, College of Law & Humanities; I also gave a lecture with Dr. Sun at another nearby university- Huazhong University of Science & Technology, then joined him and esteemed colleague Dr. Nancy Hooyman from the US at an international conference on dementia in Nanjing, China, hosted by the Amity Foundation- a large non-profit, faith-based charity that operates training programs for differently-abled individuals, nursing homes, and dementia caregiving programs across the nation.

I am so pleased to have met so many amazing people. It was truly a fascinating trip- there is so much that is different between the Chinese and American cultures, but there was also a great deal that was the same. Families struggling to plan for caregiving, trying to raise children and care for aging parents, get a proper diagnosis and understand what is happening and what to expect, learning to communicate with adults who are disappearing into a horrible disease that robs them of their memory and their words– these things are the same across all cultural boundaries. We shared experiences, knowledge, and strategies to help our communities, and set the foundation for possible future collaborations in research and practice.

Here is a picture of Fei Sun and me at the Amity Foundation home office in Nanjing:

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Here I am with students and colleagues in Wuhan at HZUA (I met a retired Philosophy Professor and his retired wife- he was turning 101 years old! He said he loved seeing such young enthusiastic college professors!):

Here are a few pictures from the lecture that I did with Dr. Sun for local physicians, psychiatrists, neurologists, researchers, and students at HZAU:

I had the privilege of speaking after Dr. Nancy Hooyman, former Dean of Social Work at University of Washington in the US, and an expert in dementia and caregiving at the 4th Amity International Conference on Senior Service & Training for Elderly Chronic Disease Management conference in Nanjing. Turns out that a colleague from Germany was not able to get his visa at the last minute, so I was asked to do a workshop on behaviors in dementia for practitioners from across China and Mongolia the next day, which of course I was thrilled to do! Our hosts from the Amity Foundation were very kind and we had a wonderful experience at the conference and for the workshop. Dr. Sun and I were interviewed by the regional Jiangsu Province television station for a special on the topic, and we got to do some sightseeing with our hosts!

 

Mentorship

I’ve had the privilege of having both amazing and anti-mentors (yes, it’s a word- ask around!), so it’s both my responsibility and great pleasure to pass on the great mentorship that I’ve had (and never become those things that were harmful!). I have the opportunity to mentor students in a number of ways at UCF, and my students are now graduated and out in the world, so I hope our relationships continue as they grow as colleagues and friends.

Here are a few of the mentoring relationships that I am so proud to have built here, and some of the students that I have the privilege of working with in this phase of their professional development:

The Social Work Healthcare Education And Leadership (HEALS) scholars we’re on our 4th cohort, and every year I get to spend time with extraordinary social work students who are becoming amazing advocates for healthcare and social justice related issues. They visit Tallahassee and Washington D.C. for advocacy trips, and together we have hosted several public forums on healthcare and policy related issues- in particular, one on cultural barriers to care (in partnership with our med school colleagues), and one on aging and healthcare policy (in partnership with our Barry Law School & 9th Circuit court colleagues). Together, we have started some great conversations about important issues in our community!

The Apopka clinic student leadership team and the social work students and colleagues who join the clinic: Three times a year, we work with colleagues in medicine, nursing, PT, pharmacy, and the local Farmworkers Association to open a pop-up clinic that provides outpatient primary care, counseling, and referrals to people in the healthcare desert area of Apopka, FL. Most of our clients (50-150 each time) are uninsured or underinsured, and we increasingly see people who speak Spanish or Creole and are afraid to go to normal healthcare settings out of fear of arrest, even if they are legally present in the state. It’s a rough introduction for some students to the realities of life for those who make a living in low-income jobs/careers such as farmwork or housekeeping, who may not have health insurance, who may or may not have a stable citizenship or immigration status, and who may be living with tremendous stress and fear related to these and other family, health related, or financial pressures. The learning opportunity for students is tremendous, the care provided to patients at the clinic is excellent (and free), and the mentorship opportunities with the students before, during, and after this experience has given me new chances to grow and learn. I am better for having done this, and for having worked with these people.

I have the opportunity to take on a few medical students each year, as they work their way through the Focused Inquiry Research Experience (FIRE) in their first and second year of med school at UCF. Along the way, I’ve also picked up a few med students who just wanted to write together, and it’s been a great privilege to get to know them and support them as they develop into amazing physicians.

My students in social work occasionally get to do service learning or initiate general awesomeness in the community. I’ve worked with Macro classes in producing a health fair for our local homeless population, and the Phi Alpha honor society to raise funds, awareness, and supplies for local organizations. I love my Phi Alpha leadership team and each year, it’s a blast to see what they’ll plan next!

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Those of us who have had career success have gotten where we are with the help of mentors, colleagues, and friends who lift us up, help us see things in new ways, and open doors. It is our responsibility to hold that door open for someone else.

Building relationships

Good research is not very useful unless it manages to get out into the world. The best way for that to happen is through building relationships with community partners and colleagues in the field.

I’ve been working with some colleagues in the Orlando area to adapt well-established evidence-based interventions for dementia caregivers/care partners to better meet the needs of our local folks. We are working on that slow-but-steady shuffle towards that magical “translation” of research- moving it from books into real life practice settings.

Together with colleagues in the northern part of the state, I engaged with the Rosalynn Carter Center for Caregiving to add another tool to our toolbox- the Dealing with Dementia program. This is a whole different approach to CG interventions, but I think it has promise. The 4-hour workshop gives an orientation and practice time in using a giant resource and skills book. This may be the elusive answer to what we can do when the family that we meet lives in an area where there isn’t a referral to make for support or training. Data are being collected now by RCI, and I’ll be doing two public workshops in the next year in Orlando or the surrounding area, so stay tuned!

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