Dr. Vater: How to SMILE through Challenges

Episode 15 November 30, 2020 00:48:37
Dr.
More Happiness Less Suffering
Dr. Vater: How to SMILE through Challenges
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Show Notes

Laura B. Vater, MD, MPH is a Hematology/Oncology Fellow at Indiana University School of Medicine.

Influenced by her mom, an Internal Medicine physician, and dad, a safety engineer and community leader, she developed an early interest in medicine and care for humanity. Throughout her medical training, Laura has remained interested in preventive health, the vital role of communication and humanism in medicine, and promotion of clinician health.  

In 2017, she developed a tool to help patients and clinicians simplify and prioritize health (the SMILE Scale). This tool is being used in schools and clinics in the U.S. and England.

Laura enjoys hiking, reading, and spending time with her husband, daughter, and dog.

Connect with Cayce & Monisha on Instagram or the web:

IG @mhlspodcast
IG @caycehowe
IG @monishavasa

www.mhlspodcast.com

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Episode Transcript

Speaker 0 00:00:00 Welcome to the more happiness, less suffering podcast. I'm Casey Howe, senior meditation and Dharma teacher for insight LA and I'm dr. Monisha Basa psychiatrist in our little podcasting studio in orange County, California. We bring wisdom from the couch and the cushion to your real life questions and struggles. So grab a cup of tea and join us. We're so glad you're Speaker 1 00:00:23 Yeah. Speaker 0 00:00:26 Welcome back to the more happiness, less suffering podcast as always. We are so grateful to have you with us and, uh, for all of you to join us, um, today we are thrilled to announce our guests. Uh, we have dr. Laura Valter with us. And, um, let me tell you a little bit about dr. <inaudible>. Um, dr. Vada and I actually met through Instagram. Uh, one of the positive sides of social media of course, is just connecting with amazing people that we wouldn't have necessarily connected with otherwise. And, uh, dr. <inaudible> is actually a hematology oncology fellow at Indiana university. And for those of you who may not be familiar with the terminology, a fellow is somebody. So what that means is that dr. <inaudible> completed her internal medicine residency and is now doing additional training, um, in hematology and oncology, which, um, is essentially blood and cancer related disorders. And so she is training essentially to become a cancer specialist and, uh, dr. Potter and I connected, um, out of a shared interest and passion for, um, mental health in general, um, humanism and medicine, physician wellness, uh, and also creativity. Dr. <inaudible> is a writer. Um, and she'll be sharing a little bit more about the creative side of her life as well, and she's also a mother. So, um, we connected on all those accounts. And so we feel really honored to have you with us today. Speaker 1 00:02:09 Thank you so much for having me Moe nation Casey. I'm so grateful to be here. Speaker 0 00:02:14 Yeah, sure. Thank you. Thank you. So maybe let's just begin as we usually do when we have our guests, like, we'd love to just hear a little bit more, you know, just kind of about you, like where you grew up and, you know, maybe your path to medicine and, you know, maybe what drew you specifically to hematology and oncology in particular? Speaker 1 00:02:36 Sure. So my parents are both from a small town in Minnesota called Hibbing, Minnesota. They were high school sweethearts met there and they, um, my dad is an engineer and works for 3m. And because of that, we moved around a little bit when I was a kid from Minnesota, kind of through the Midwest. And then we came to Indiana and my mom kind of had this moment in her mid thirties. She said, I don't want to go to med school. She a med tech for many years. And then she, and she had three children and she said, no, I want to be a clinician. I want to see patients and I'm going to go to medical school. And so because of that, my family essentially kind of transplanted to this very small town in Indiana. And my mom went to medical school for the next four years and then did her residency training. Speaker 1 00:03:22 And I essentially finished the rest of my childhood in this very rural part of Indiana. And, um, subsequently I did my, um, my college education at Notre Dame. And then I, you know, my husband and I met there, we moved to Pittsburgh for a period of time, or my husband's found that I pulled him back to Indiana for medical school and residency and fellowship. Then, you know, I'm very, I'm rooted to this place now because of my family. And, um, of course it's not the most exotic place, but I think there's some something, you know, being grounded and being surrounded by people who you care deeply about, um, there's such a distance. And so for that reason, I'm now kind of a, the nearly lifelong Hoosier, um, because of my mom, you know, and, um, uh, so that is kind of my background and, um, in terms of why I chose oncology, but we had a very close family friend who was actually my volleyball coach in this small town in Indiana, since I was a kid, she was diagnosed with metastatic colon cancer in her forties. Speaker 1 00:04:25 At this point in time, she was already, you know, coming over to our house for Thanksgiving. You're just very close family, friends. And when she had this diagnosis, I was in high school, she knew I was interested in medicine and that was partially no big reason that my mom kind of brought me to the hospital and took me on rounds and took them to the nursing home, took me to her patients' home. Right. My mom was the primary care physician. And so I had this very, um, early experience in medicine. And then this close friend was diagnosed with a terrible illness. And she said, no, her name is Kim. And she said, you're interested in medicine. I want you to observe my surgery. If you'd like to watch her surgeries in the, or I went to chemotherapy with her. Um, and she survived from this diagnosis for four years. Speaker 1 00:05:11 And then she, um, unfortunately she passed away when I was a sophomore in college. So during some of my really formative years of my life, this close, this close friend of mine, right. Um, got to at least be with her parts of her illness journey and that, you know, very, very formative for me in those early years. And I think so it's been a combination of things since that time that has drawn me back to medicine and into oncology. And that's just kind of everything, my interactions with patients now, and throughout my training, I've just confirmed that this is, this is the field that I want to be in because I can support a person and help them navigate. So she's difficult, difficult part of their lives. And I think there's such a gift to be a person that these, each patient, as a person with a story and, um, getting to be someone that almost shepherd them with, um, and through that with them, no matter the outcome of that has been something that has been incredibly meaningful to me in my life. And I'm three months into my fellowship. Um, and so far that has been just continually true that this work brings me so much being difficult. You know, it's very difficult in many ways, but it's, it's very meaningful. Speaker 0 00:06:27 Beautiful. Yeah. Yeah. Thank you for sharing that with us. And, you know, we know it's like the stressors associated with, you know, a medical training and education and, you know, going through all these stages that you discussed, you know, medical school, residency fellowship, um, certainly bring about so many mental and emotional challenges. And, um, of course, hematology and oncology in particular is an especially, um, trying or, you know, potentially stressful field. Um, and it sounds like for you, you know, staying connected to that sense of meaning and purpose is maybe one way that you, that you navigate that. Speaker 1 00:07:13 Absolutely. I feel like during my intern year, you're an intern at your first year, right out of medical school. And you are so cognitively overwhelmed by the amount of knowledge you don't know. And so it could be hard to connect with your patients and it can be hard to connect with your purpose. And I really felt like that during my intern year where I just felt like I was, I had all these lists, these lists of tasks that I had to check off all the documentation and all of these things, but I really wasn't seeing my peers. I was seeing my patients that I was with them for such a period of brief period of time. And I was up in my head for a lot of that thinking about what tests do I need to order and imaging studies and what's, what am I going to choose for that plan that sometimes I was just missing and I was just completely missing out on that moment of this is a human being in front of me that I can connect with. Speaker 1 00:08:03 And not only is that protective for me as a clinician to connect with my patients, it's protective for my patients, right. There's so much benefit that I have found throughout the subsequent years of my training. And if I just pause, if I sit down, if I truly just set aside all distractions as much as possible and just be in that moment with my patient. And it may only be for a few minutes for the time that we're allotted, but there there's so much meaning that comes with that connection with my patients and learning something about them beyond their illness beyond, beyond just being a patient. And I feel like that has, that has carried me through my residency training, especially on some really, really difficult stretches. And I absolutely agree that that has been, um, the things that I've learned in my training. I think connecting with my patients, seeing them as human beings and caring about them that has helped me to stay connected to this work and want to come every day and keep doing this work even when it's hard. Speaker 2 00:09:04 Wonderful. Yeah. And, and maybe you could speak a little bit to your own process of, uh, a little bit more about being with your own stress and whatnot. That, that comes up. We spoke a little bit before we jumped on a about meditation and you're mentioning how meditation has assisted you, uh, personally. So maybe you could speak to that for a moment. Speaker 1 00:09:32 Yeah. So I really didn't have at least what I could recognize as anxiety much before medical school, but I can, didn't really know what at the time is that slowly started to creep in during my early years of medical school, but there became a point kind of mid part of medical school where I was having panic attacks. And I didn't really know what it was at the time, but I, I could not be in a large group of people without being on. If I was in, uh, an auditorium, for example, I had to be on the outside seat because I was so afraid that my heart would start racing and I would have this impending sense of doom and that I was going to pass out dry. You know, I had all these fears of, you know, I find if I can't escape, if I can't separate, not only am I going to be embarrassed, but you know, I, I just couldn't, I couldn't stand it. Speaker 1 00:10:24 Right. So I developed kind of a claustrophobia and a little bit of that, this kind of specific social anxiety related to crowds of people being embarrassed. And none of this was founded in rational thought. I'd never think of pies and, you know, passed out in a group of people I never been at this was, it was a daily thing, or I would just be contacted Kartik. I would start sweating and then I'd have to leave, you know? And, um, it was extremely distressing and I didn't know enough at the time to really understand and dive through, but I, you know, thankfully thank goodness for psychiatrists and psychologists and wise people, right? Even in learning this things in my patients, I started recognizing the symptoms in myself that this was not normal, that while a lot of medical students experience what I was experiencing, we didn't talk about it. Speaker 1 00:11:13 And I, you know, I, I didn't really know what to do with this because it was relatively new and it kind of creeped up on me and I didn't really talk to anyone about it. I just like most medical students, we, we try to find solutions on our own and we do it often in silence. And so of course I was reading about anxiety and I was learning about Gabba, which is one of the neurochemicals, that's an inhibitory neurons neurochemical, right. I was getting really cerebral about this turning thinking that, wow, there's this benefit of this thing called meditation? What is that increases Gabba and increases a sense of calmness. It shows yield benefit and human beings. I had anxiety what is said frightened. So I started, I think I came to meditation from a really fully role research, cognitive perspective. Right. And, um, so I, I, you know, I haven't asked and I just started teaching myself how to meditate through the bets. Speaker 1 00:12:10 And I would say that it, within a matter of probably a month, it cut my anxiety and benefit that it provided in my life where I could sit in an auditorium and listen to a lecture from start to finish where I, if I felt what meditation can do to me, I could feel how I was feeling, and I could acknowledge that, but I could also watch it pass. And it was just this acceptance of who I was and what I was feeling right. Instead of having to act on it. And I think that was, that was still powerful in my life because I had been an athlete. I had had all of this physical training. Right. But I had never learned or heard anywhere that maybe training your mind could be a beneficial thing. So my personal life meditation has been something that has, I truly see it as a survival mechanism for me to continue to do the work that I can do without my anxiety creeping up. Right. I think there's so many things that can triggering bite in medical training. There's competition, there's sleep deprivation. There is no all sorts of all sorts of trauma and secondary trauma that you witnessed. And I think meditation has been such a gift to me. And I'm so grateful that I found it when I did. Speaker 2 00:13:32 Yeah. Grateful that you did too, you know, cause it's like you're helping so many people and if you're not, you know, centered and, and at ease, it's really hard to transfer that that over. Um, and I think, you know, Monisha and I, we talk about this all the time of like, where is the training about this? And, you know, dr. Vasa is very committed to helping out medical students and whatnot and, um, you know, assisting in, in these ways. And I going back to school, like, where's the, I call it like the thought one Oh one class, cause like our thoughts are so powerful. Thoughts, emotions and body sensations are incredibly powerful. Um, the three ways we process our external reality, it internally it's just those three things. And, and yet, even though the, the, the most powerful things that we, that we, um, experience, we don't know how to work with them. Speaker 2 00:14:28 Like, it's the same thing with, you know, police officers not getting any emotional deescalation training or something it's like, these are, these are so important. And, and it's wonderful that we do have the science now. Um, and so we can see those things that are, that are happening in, in the brain of the FMRs and, and, you know, et cetera that we can see this. So, um, but that's wonderful that you were able to really try that on. I just want to say that, um, to, to make sure that just to, to normalize that meditation is difficult in the beginning, uh, for one and, um, and that it works. If we stick with it, it is difficult. Sometimes people say, Oh, Casey, you know, thanks for teaching me that meditation. I tried it, it didn't work. And I'm like, okay, cool, let let's work with it. Speaker 2 00:15:20 So, um, how long do you meditate for it? They're like, Oh man. At least five minutes. And I was like, okay, five minutes. How many times do you try it out? They're like, Oh, like twice. I'm like, yeah, we gotta, we've gotta stick with it, you know? Um, but, um, but that's really good, good, good for you to do, really stick with it and, and, and really, really try it on. And especially in those difficult situations, when you have anxiety that's really difficult to do. Um, so that's, that's awesome that you, that you did that. Speaker 1 00:15:55 Thank you. And I applaud you for, um, just for teaching meditation and mindfulness for both of these reporters and encouraging people to stick with us and sharing with them that it takes time. And that, you know, for me, when I might say to myself, I don't have time to do this in a couple of days passed and I don't meditate. I can actually feel my anxiety to increase again. And so for me, it's a very clear pattern of the benefit that meditation helps in my life. Yeah. Speaker 0 00:16:23 Yeah, definitely. And yeah, I really appreciate you sharing your story because as we know, you know, and kind of the culture of medical training, you know, a lot of us don't necessarily talk about our own, you know, mental health and emotional struggles. And I feel like it's something that's really important to speak up about because it just normalizes the conversation around mental health, um, broadly speaking. And I also think that it, of course helps us to empathize with our patients as well. Um, but you know, I, I also appreciate what you're saying about how you first started it almost as like a cognitive exercise. You know, it's like, I think that everybody kind of has their doorway or their entry point, um, that may be, makes them curious or willing to try whether it's, you know, meditation or therapy or whatever it is. Um, and so I think, you know, the, the fact is that you sort of found a window of opportunity or an entry point that allowed you to feel comfortable trying it. And then maybe through your, then your direct experience felt like you could stay with it because you saw the direct benefit for yourself. Speaker 1 00:17:38 Yes. And I think it's something that we don't talk about enough in medical training, because not only is it going to help you feel better, it's in connect with your patients that are pretty well, it will help you perform better. Really felt that, you know, there have been moments where I am standing at the head of my patient's bed. Their alarm is blaring. I have to take a tube through the, into their trachea. Right. And everyone is looking to me, right. I'm standing at the head of the bed of this critically ill patient. And I, you know, you are in the spotlight and you have to perform and to be able to regulate your emotions, right. There are times when I'm standing there and I can, I know that my heart is racing and I start to become very anxious. And then I'm able to just put myself into a deep breathing pattern and right away it centers me and it allows me to perform. And I think that has been so beneficial to me. And I'm sure I'm not the only one who has experienced that anxiety being in that position or not. I'm not the only one that will experience that. And having, having a, a pattern and knowing that you can regulate your thinking and, and your, you know, even your, you know, your sympathetic nervous system, it's such a gift to that. Really. We really don't talk about enough. Speaker 0 00:18:53 Yeah. I think that's the benefit of the daily practice when the stakes are lower so that you can then, you know, apply those same skills and tools when the stakes are higher, you know? Um, so, so it sounds like, you know, meditation is really a part of your self-care. Um, could you maybe share with us just in general, sort of what your self-care looks like? I mean, you're obviously busy as a fellow. I know you're a mom as well. You also have a dog, you know, so you have many moving parts to your, to your life. How do you, how do you take care of yourself in the midst of all of this and kind of keep all those, all those balls in the air? Speaker 1 00:19:35 Yeah. Um, I had played that being in my field, um, from medical school kind of your third year, all the way through fellowship, every single month of your life, it changes. So it can be really hard. You go from being on one rotation to the next and your schedules change all the time. And so it can be really hard to be anchored to a routine. And I'm sure that there are other people that are, you know, that they're listening that have maybe have, have similar, you know, um, changes in their life. And I think that's one of the hardest things about medical training is that you just feel so transient all the time for them from one location to the next, and it's hard to get into any routine. And so I try to be really realistic about what's possible. And so every morning I wake up and I go into my office where I have a yoga mat just out on the floor and I just do some gentle stretching and some deep breathing. Speaker 1 00:20:26 And that's typically the moment where I do, um, a face devotional and then I do, um, a meditation. And usually that meditation is only about, um, so it's not like I have time in the morning to meditate for an hour, even if I wish that I could. And then, you know, I make myself a cup of tea and I get ready for my, and sometimes that sometimes that moment in the morning, it can, you know, that whole thing can be done in 15 or 20 minutes, if I'm really on a bunch of sleep deprived, right. Because I'm on call or things like that. But every day I just try to start it in the same way. It's not perfect. And it changes that community that, that helps kind of anchor myself. And then, um, in terms of, um, other things I do for myself. So I can't always exercise every day and they're in a routine way because of my schedule. Speaker 1 00:21:18 But if I, you know, if I need to, then I'll do take 20 minutes during the day and just do the stairs at the hospital. I'm on call and my scrubs all, you know, do something in my call room. If I have more time, I will go for a walk or run outside. Right. I try to integrate some type of activity into my day, even if it's only an extra 10 or 15 minutes based on what I can do. Um, I also think it's really important. Something else we don't talk about enough is just getting enough sleep at least seven hours of sleep and trying to get quality sleep. So it was trying to go to bed relatively at the same time each night and waking up about the same time each morning and limiting distractions and bright lights and flashing screens, you know, places where you sleep. Speaker 1 00:22:03 I think that's something that, you know, unfortunately in medical training, I'm still asked to stay awake for 30 hours at a time. And, um, when I am not getting enough sleep, I absolutely feel my anxiety increasing my, um, I think there are, if you have the ability to sleep, that you should make that a priority in your life. Um, other things I do for myself. So, um, I eat mostly plants. You know, I know that when you and I have talked about this before, but I know mostly trans. And I try when I have time, maybe on a single day of the week, I create, you know, foods that I'm going to bring with me for the rest of the week. And I think that's something that's also very centering, you know, knowing that even if my day is busy, even if I'm eating at my desk, that I have something that going to nourish me and comfort me at the same time during my lunch break. Speaker 1 00:22:52 Um, I think another thing we don't talk about enough is just having strong relationships. We know, you know, Harvard has studied this for at least 60 years and the, you know, the study of the Harvard study of adult development, that social connection is essential for your health. That if you are social, socially isolated, meaning you don't have someone you can count on. If you're in crisis, if you know financial crisis, we would go through something traumatic, right? Having a few people that you can rely upon. And them that is just as bad for your blood pressure to be socially isolated as having, I'm sorry, just as bad for your health as having high blood pressure or smoking, if you're socially isolated. And so that's something else that I've learned throughout my medical training, that even when you're busy, even when so much else is going on, or you have ambitious goals, fostering your relationships, taking time for the people in your life that are a part of your life, laughing with them, you know, pouring into their lives. Speaker 1 00:23:50 That is so that's really, I see as like a key component to your health. And during my, um, during my residency training, I created kind of this mnemonic to help me remember these kind of five key pillars for my health. And I call it the smile score. And so F it just reminds me to get enough sleep and move my body, even if it's only for 15, 20 minutes, ideally more, um, but move my body every day. The, I stands for inhale and exhale. So for me, this is my, um, self reminder to, to meditate. And L is love and connect and foster, my relationships in the E is eat to nourish. So eating mostly whole foods that are grown in the ground that are going to nourish my body. So everyday I just mentally check in with myself. Did I, my prioritizing my health in this field where I am still focused on the health of others, right. Just reminding myself that my health matters too, and that my health is interconnected with my patient's health than I am. Well, I'm going to do a better job at caring for them. And so just having those reminders that centered me each day to remind me to do my best, to take care of myself as well. Speaker 2 00:24:58 Beautiful. Yeah. I like to say we, we can't give what we, what we don't have, you know, that's really, really hard, like taking more money out of the bank, you know? Um, yeah. You know, I think it's so important that we all have, self-awareness like self-awareness is, is so incredible and, you know, listening to you and all those things that you've listed, um, has taken so much self-awareness to see what you need, you know, so just cause you just listed a ton of things and they they're all so important and so crucial, but it just shows how much, um, commitment that you have, uh, to yourself and, and temperament all these things and, um, all the work that you put in and in, in, in discovering and then maintaining, you know, sustaining that this practice, um, it's really wonderful to have that self-awareness mixed in with compassion for ourselves. Speaker 2 00:26:01 Like, Hey, I don't want to suffer. Like part of it is like the self-awareness of like, Hey, I'm not doing well. And then the compassion to like, and I'm going to do something about it, which, which just takes love. I mean, it's like really cliche of like this self-love or when we be say self-care, it's like, you know, a lot of times we'll really care for others. You know? Like, look sounds like 99% of your day, um, and a hundred percent it could be, I've just taken care of others. Um, and then what about you, you know, what about taking care of herself? So yeah, just kudos on such beautiful, um, things that you've mentioned and by the way, um, Laura is going to share her Instagram later, I assume. And she has a post on the smile acronym, um, on there. And, and so, yeah, so if you didn't catch that, um, yeah, you could revisit it, but I love that acronym. Those are so important. This pillars, you know, of, of daily health. Yeah. Speaker 1 00:27:08 I'm just giving yourself grace. So if you know, you, you reach a point where you're not prioritizing your health, just saying, you know, today is a new day to start over and I don't have to be perfect, but, you know, just with the goal of reminding yourself that your health matters too. And in healthcare, we have this privilege of, um, being many patients who have kind of lived their lives without taking care of their health. And, um, and you see so much unnecessary suffering with things that could be not, of course not everything can be prevented, but many things can be prevented. And I think that is a continual reminder to me too, that there are so many, that prevention is so key and can prove and can prevent so much suffering moving forward. Speaker 0 00:27:55 Yeah. A couple of things that you said really stood out to me, like I think what you said about how our own health is related to the health of our patients. I think that's so true on so many levels. Um, you know, that when we take good care of our own mental and emotional and physical and spiritual health, you know, that translates into how we care for others, um, in both direct and indirect ways. Um, and I think, yeah, sometimes even if patients aren't explicitly aware of, of those practices, I think on many sort of energetic levels, they can, they can feel that from us. You know? So I love that you're modeling this, um, you know, essentially you're practicing what you're preaching to your patients as well. Um, and also just your emphasis on kind of small steps, you know, that it doesn't, it could just be 10 minutes in the morning. Speaker 0 00:28:51 It doesn't have to be sometimes I think when we think of self care, it almost becomes an additional sort of performative thing that we try to do or, or we get kind of self-critical about it, you know, like, Oh, I didn't do X, Y, and Z exactly in the way that I wanted to. And so, you know what you said about just that even small steps count and, and really looking at the big picture and giving yourself grace when you're not able to necessarily get it all in exactly the way that you want to, that it still matters. Speaker 1 00:29:24 Right. It's so funny. You know, we see so much of this, you know, even the morning routine and then to have all of these components, these 15 things put into one, one morning and you're thinking, you know, do these people have jobs? Do they have, do they have other responsibilities? I can't, you know, and I think, I think being realistic is really the only way that her, myself and my medical training, that I've been able to be sustainable. And I add, I have ways, but if I have extra time, you know, so if I have a little extra time at work, I always take my computer with me. I do journaling. I work on my creative projects if I have time in the evenings. And I usually do, especially if it's warm, we go for a walk and that's very centering to me. You know, I write, I write more in the evenings. I read, I have these other practices that if I have time, I can pick them up. But I also know that that's not possible every day, but at least have one thing every day for at least 15 or 20 minutes that I know that's going to ground me. And I think that's really helpful when the rest of my world feels very chaotic. Yeah, Speaker 0 00:30:26 Yeah, absolutely. Absolutely. And so important, you know, as Casey mentioned, those self-awareness, you know, practices being critical in terms of knowing when we need that grounding. Um, especially in these times when everything really feels so upside down. Um, but yeah, maybe tell us a little bit more about your creativity. You know, I know one of the things that kind of connected us as our shared love of writing and narrative medicine, and that's, you know, a big part of both of what, you know, what we both share on social media. Um, so yeah. Tell us a little bit about kind of your creative practices and what that looks like for you. Speaker 1 00:31:06 Yes. I, first of all, I love your book out. It is I pick that out sometimes in the evenings and just read a poem or two beautiful KCI I'm looking forward to, um, you know, reading some of the things that you share with your poetry. Well, I think that, I think there is a gift in reflection and a gift in journaling, but, um, for me has really helped me see my patients with people and learn their stories and reflect on my patient care more than just from a scientific, um, um, problem-solving type of perspective. And that's really what writing has done for me. So I started and then it also helps me to cope with what I witnessed now. I, um, was pregnant with the third year medical student, my husband and I, um, I know I started medical school a little bit later than most. Speaker 1 00:31:58 And, um, we decided we wanted to start a family. And so I was pregnant as a third year medical student. And, um, I was on my OB GYN rotation when there was a woman who had a miscarriage, um, around the same baby was about 22 weeks. And I was about 22 weeks pregnant and she had to deliver her child. Right. And I watched her hold her baby, you know, that has to hide. And there's just so many emotions and so much trauma in that encounter that I did not know what to do with it. And you know, that is, I started, I am sure that I journaled a little bit or that, but that was really when I started writing. And I really just started writing down the emotions and the things that I experienced that I couldn't get anywhere else. And so I think money me, some of your audience might have heard the term learn that's medicine or parallel charting, or maybe not, but it's the idea that, you know, we're seeing patients as people and there are going to be emotions that are evoked in our encounters. Speaker 1 00:33:05 They're entangled in our lives with other people, and that cannot go in the medical record, but it needs to go somewhere. And so through this process for many, many years, it was just me journaling, my thoughts as I was going through medical training. Um, and then it has become much more than that. It has become, um, sharing some of my patients stories in a way that is respectful to of course, protecting their identity in the details of the story, um, and also advocating for them. And so most of what I've written now, or are kind of SES in the narrative medicine realm, and I am working on any of your time on this earlier, I'm working on a larger project. That's been an idea, um, that has been ongoing for about three and a half years. And that's something that I'm just kind of slowly, um, in the therapeutic way, just writing and learning how to write with and something that I know as you go through writers and there's something so therapeutic and sitting with my thoughts that slows me down from the chaos of some day, it helps me process what I've experienced helps me to see my patients experience being, and it connects me and inkers me to my own reality. Speaker 1 00:34:17 And for that reason, writing has been only the greatest gift that I have really discovered in the last, as it was yourself. Speaker 0 00:34:26 Yeah, that's fantastic. Um, you brought up so many good points there, but really it strikes me, you know, one of the things that I talk about with the med students and residents that I work with, you know, from a physician health, um, standpoint, is reeling allow it really allowing ourselves to actually be changed by these encounters that we have with our patients. Um, I think sometimes in medicine, especially earlier on in our careers, we're so afraid to open up emotionally and to actually be, um, impacted and moved and affected by the stories that we take in. And almost like we feel like we have to choose between being present and empathic or being sort of clinically competent and an objective, you know, it's sort of this false dichotomy. And, um, and so, you know, I really think that what you're describing about journaling and really kind of taking in our patients as people with stories and taking in how that affects them and how that changes them, but also how their story changes you, you know, and really using as a way to integrate that and understand that I think is so powerful and important. Speaker 0 00:35:42 And, um, I think it's part of how we maintain our, our compassion and our humanity in this, in this work is, you know, recognizing that we're changed, the patient has changed, you know, by one another. And also by kind of the shared experience of, of walking through, through illness together. Yeah. I was telling Casey, you know, before we got on, I was sharing with him a little bit about you. And I mentioned to him that one of your posts that resonated with me the most was, um, maybe, maybe I don't know, a month ago, or so you, you wrote about sort of the act of pronouncing a patient, um, as deceased and how to go about doing that and in a compassionate and empathic way. Um, and you know, I really appreciated sort of the, just the presence of mind and the presence of heart and the compassion that you, you brought in writing about that, that process. And, you know, we were talking about how in, in medical school, we never learned about this. You know, we never learned this part, but it's, it's so important to, to recognize how we can bring ourselves into these moments and to not be afraid of that. Speaker 1 00:36:59 Um, and I keep to bring it back to, you know, mindfulness and being present. I think we should strive to be present in all aspects of our patient care. And that includes having compassion in death and recognizing that there are other people, other family members that will benefit from our, you know, how we treat their loved one in, in life and in depth. And there's something, um, like you said, there's something missing in medical education where we learn how to treat a patient that is deceased based on how we treat our cadavers. Right. And then, you know, and, you know, I won't get into the details, but there are some traumatizing aspects of that. And then medical school for me now that I've reflected back on that personally, and kind of having to self, teach myself how to bring compassion back into my practice, right. I I'm to the point where I have mastered some aspects of my medical education, still working to regain some of the empathy that gets trained out of us when medical school, no, we know that medical students are less empathetic when they end their training and then they begin and there's something that is held profoundly wrong. And I think many insightful people such as yourself and Neesha are working to correct. I think we have to continue this dialogue. Speaker 0 00:38:26 Yeah, absolutely. And we were just talking about a study that had been done. I think Casey, you were telling me about, um, medical students who gone through mindfulness-based stress reduction, um, and something about how they were more compassionate by the end of that, that eight week course, you know, um, to the point, what was it that they were more likely to, Speaker 2 00:38:48 To give up their seat to our person with a broken leg or on crutches? Yeah, so they were in a waiting room and all the seats were taken. And so the other control group, you know, hadn't come from, um, the MBSR group or course, and, and yeah, they were, I forget how many percent tile, like more likely to give up their seat and, and mind you too, this was a, not like mindful self-compassion class. It was a mindfulness one. So of course a loving kindness and compassion aspect. So in those course are, um, implicit, right. Um, there are some explicit examples of them that training that we do, but they're very small. They're like literally one, one class, you know? Um, so yeah, just, just mindfulness, um, really starts to connect us with compassion because we actually see our own suffering. So, you know, when we look at mindfulness in this way, is that when we're just aware of ourselves, when we can connect to our own suffering, uh, compassion can spontaneously arise because we're like, Oh, damn, like, look at me like, Oh my gosh, I'm really suffering. That means, and I don't look at, you know, they might not know it's like invisible. I have tons of anxiety or I'm depressed today. And, and you know what, my, my coworker, she looks great, but maybe she's not maybe like, I'm not, you know? Um, and so, yeah, there's then there's that, that, that connected and that, uh, connectivity starts to arise for, for self and others, you know? Speaker 0 00:40:29 Yeah. And I, I made that point when he told me that story, that I was like, gosh, it's kind of sad that in a way, you know, medical students that we have to, I guess, still reconnect with that part of ourselves, but it's, it's true that as you said, I mean, to some extent it does get trained out of us almost as a survival mechanism or strategy or, or self-protective, um, mechanism. And, and yet I think because that's one of the reasons that many of us go into medicine to begin with reconnecting with that compassion on some level, um, is perhaps one of the main things that's going to keep us sustainable in, in this work longterm, you know, so it's, it's just a really, it's like we, we lose it and then we have to find it again or find a way to actively cultivate it again. Um, if we're to, if we're to sort of stay in this, in this work. Speaker 1 00:41:26 Yeah. That's really, that's really profound. Thank you for sharing that with me. I think that there is, you know, I've seen in myself, my current compassion fatigue, which means that you hire a compassionate person, but that, you know, that compassion fade with either a long period of time. Or for me, I would see myself on a 30 hour call and the first admission I would have, I would be sitting in present and, you know, taking care of them and really intentional way. And then as my sleep would decline, and that's my stress that increased and the number of tasks would increase. I would see you see your own, you can feel your own, self-compassion your own compassion for others, you know, decline. And I think having mindfulness and being able to check in with yourself and check in with your emotions is a really big thing. And, um, being able to give yourself the mechanisms to kind of reset, reset to your kind of your, your physiology is a really powerful thing. Um, especially when we really stressful days. And it allows you to be more intentional with how you, how you feel about your day. Speaker 0 00:42:33 Yeah, absolutely. Absolutely. Yeah. Thank you. Yeah. I feel like we could continue talking for so long. I think we're going to have to find a way to have you come back and for us to continue the conversation. Um, but you know, for our listeners, uh, how can they, how can they find you, what's the best way for our audience to find your writing and just all the beautiful things that you share more information about the smile score as well. Speaker 1 00:43:00 I have a number of things in the works. So I think the best way that I'm probably most active on Instagram, I'm also on Twitter, but less active on Instagram because the ad doc, Laura Baader, just one word. Um, and I also have a website, um, you know, links on my Instagram or <inaudible> dot com and I'm as I write and publish things. And I'm trying to update that. Um, and I've got more information about the smile for a pair as well, and you can reach out to me anytime and you can, you know, give me an email for either of those platforms and, um, we'd love to connect. Speaker 0 00:43:38 Perfect. Yeah. Thank you so much. Yeah. We really appreciate your time. And all of the, you know, all of the beautiful suggestions that you shared with us and all that you shared about your own own journey. Um, I would definitely encourage all of our listeners to follow dr. <inaudible>. She's one of my favorites on Instagram and, um, always just share such wonderful information Speaker 2 00:44:00 And thank you so much. So insightful and yeah, just wonderful. And it's dr. Vada with, with a V V as in Victor, a T E R. Yeah. Um, yeah, so yeah, we, we usually end with a short meditation, so yeah, we're going to do the same today and dr. Vada, if you could join us. Um, cool. Um, yeah, if you were operating large equipment, her driving really fast and a car and just allow these, these words to just kind of land where you are, but if you could join us in, in meditation, that would be great. And coming into a nice posture and that is alert, but at ease and what's coming up for me today is just the word gentle gentleness. There is so much in the talk today that had to do with tenderness, softening the edges, which just hearing those words, gentleness like tenderness softening, I've seen what happens in the body, the mind or heart, Nan, what would it feel like if you were gentle with yourself in this moment? Speaker 3 00:46:05 <inaudible> Speaker 2 00:46:28 Yeah. And what about meeting the moment itself with gentleness? Speaker 3 00:46:33 <inaudible>, Speaker 2 00:46:40 What's sort of happening internally in the moment, thoughts and emotions, and anything externally that may be floating through your awareness, Speaker 3 00:47:24 Meeting it all, but 10 on this, Speaker 2 00:47:58 And then just wishing that all beans can meet themselves in their Citrix situations, which Antinous may all beings everywhere with that exception, Speaker 3 00:48:16 I'll be happy and free from suffering.

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