From the Forest

Rather extraordinarily, trees talk. They form communities of sorts, communicating via their roots, excreting chemicals from their leaves, and sending messages out on fungi, like a below-ground mycelial dial-up. They warn each other of dangers, remember things, and respect each other’s personal space. A recent swathe of dendrographic writing has opened our human eyes and alerted our ears to these conversations. Richard Powers, in his magnificent Booker short-listed novel The Overstory, says, “A forest knows things. They wire themselves up underground. There are brains down there, ones our own brains aren’t shaped to see. Root plasticity, solving problems and making decisions. Fungal synapses. What else do you want to call it? Link enough trees together, and a forest grows aware.” 

Trees are our common ancestor – we only parted ways with them a billion and a half years ago, and we share a quarter of their genes. It’s not a bad thing to learn from your elders, even if they’re old and gnarly. 

But why discuss trees? Why hark to an inconsequential arboreal metaphor, when the urgency is to figure out how we, in medicine, can do better as a community?

I have so few answers. I am honoured to write a blogpost for NoWEM, but I don’t have solutions for the rot that sometimes festers within our medical workforce. How do we improve culture? How can we work alongside each other, with respect for every member of the team; not only of other genders, but other colours, sexuality, countries of birth, ideologies?

I am involved in teaching the Fellowship candidates at my institution. I’ve done this for over a decade, and it has given me great pleasure and our candidates a reasonably robust level of success. It’s kind of symbiotic; mycorrhizal if you’ll forgive me extending the metaphor just a little bit past its bedtime. But not long ago I was asked to justify the time I dedicate to the teaching. What were my outcomes? What was the secret to the success of these cohorts? What were the measurables?

Measurables. There’s an untidy word. It makes me itch. Measurables in medicine is an entirely different blogpost, saved for another day. On the other hand, I don’t have a ready answer. The only one I’ve got, and it sounds lame every time I say it, is love. The ultimate unmeasurable. Daniel Coyle has written a brilliant book, called ‘The Culture Code’. In it he dissects what goes into making great cultures, productive teams, cohesive and prosperous communities. It’s a fantastic read – I recommend it with all my heart. In my naivety I thought love would figure highly. Sure, it gets a mention, but to achieve deep and powerful connections within groups – of any sort; business models, problem-solvers, basketball teams, military squadrons – you need a few other ingredients. Essentially, you need the signals of belonging. Signals that say ‘you belong’, ‘I trust you’, ‘I believe in you’, ‘we have high standards here, and you fit right in’, ‘we can work together to make sure you reach these standards’, ‘we share a future’. It’s possible they are simply some of the seeds of love. They are certainly elements we can share with our coworkers and juniors and colleagues. You belong. You are safe with me. We are safe together, because we belong in this community. In this forest. It’s tough out there, and we will support each other. 

So it’s back to signals. Trees signal each other. Signals are the smallest things, like chemicals wafting through the woods, on breezes, among maples, and oaks, and eucalypts and birches. An action, a word, a pattern of behaviour. They are there continuously, like a habit. And in medicine, amongst us Johnny-come-lately bipeds, we can extend it even further. To everybody in healthcare. We all belong together – we have a common aim and purpose. To care for the sick, to promote health, and you are safe with me while you go about it. It’s worth a try, to say it, to believe it. Express it when you first arrive at work, in what you say and your non-verbal cues. It’s a harsh environment, and sometimes it feels like survival mode, but we’re in it as one. I believe it is the smallest of actions, a thousand tiny deeds, endeavours as light as molecules, that make up a culture.

So, no answers. No lessons. Only what is worth attempting, in the hope we can do better than we’ve done in the past.

Richard Powers says it better than I ever could: “Love is a tree with branches in forever with roots in eternity and a trunk nowhere at all”.

  • Dr Michelle Johnston, for NoWEM

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