Transcript
Speaker: Everything on the podcast is for entertainment purposes only.
Speaker: Nothing I say is meant to treat or diagnose, or it's not even advice for you to follow.
Speaker: So remember when you're listening to the podcast, I am a doctor.
Speaker: I'm just not your doctor.
Speaker: Welcome to On Call with Dr. Dave.
Speaker: Today we're talking to Nurse Hannah.
Speaker: Nurse Hannah, welcome to the show.
Speaker: Thank you for coming and talking with us tonight.
Speaker: Thank you guys so much for having me.
Speaker: I am really excited to be here.
Speaker: excited to have you we obviously have no podcast without guests we tried it it was boring which is me we didn't have enough to say and so the podcast only works when we have people to talk to so thank you for coming on we're excited to hear your stories from nursing and also you have another outlet as well something else you're working on related to medicine so we want to jump into that as well and we'll probably hit that a little bit more towards the end but let's start out with
Speaker: nursing so we love stories our nursing colleagues have some of the most fun stories you spend so much time with patients as the doctor i sometimes write things i'm in and out now i meet people in clinic but half the time i spend with them they're under anesthesia we're not having great conversations while they're under anesthesia i don't get as much patient interaction as nurses do so i'd love to hear your story so when you thought about your career and you thought about your nursing moments what came to mind
Speaker: My background is in the emergency room, so I have a large number of stories.
Speaker: Emergency nursing is my passion for sure.
Speaker: There are so many wonderful ways that we get to interact with patients and I just don't do well sitting down.
Speaker: I don't sit well, so emergency was the place for me to go because you don't get to sit very often.
Speaker: And so I have stories from death and dying all the way to silly reasons people come to the emergency room.
Speaker: Do you have a preference?
Speaker: We love all of those things.
Speaker: So we want to hear the sad death and dying things because that's the reality of what nursing is sometimes.
Speaker: But also we love the lighthearted chief complaints that are just silly or ridiculous or they came via ambulance for a broken toe.
Speaker: All of those things.
Speaker: Yes.
Speaker: So I will start with one of my favorites and I want to preface by this is in no way to make fun of this client.
Speaker: Right.
Speaker: I think it just highlights how out of touch people are with their bodies.
Speaker: More so than like this client was undereducated and came because they were concerned.
Speaker: So I don't want anyone listening to think that I am kicking aspersions on this person for coming to the emergency room.
Speaker: Because if you're concerned, we want to see you.
Speaker: But
Speaker: A client came and checked in with the chief complaint of bumps on their tongue.
Speaker: And as an emergency nurse, this could be like an allergic reaction.
Speaker: Right.
Speaker: So this is a potential airway involvement.
Speaker: I need to see this person quickly and took vitals.
Speaker: They were fine.
Speaker: They were
Speaker: talking to me, complete sentences, no obvious airway involvement.
Speaker: And so I go and I talk to the provider and this was in our fast track.
Speaker: It was staffed by a mid-level, so a PA or NP, and I don't remember who saw the client.
Speaker: It isn't relevant, but they went in and saw the client and came out and told me that the client's discharge diagnosis was going to be normal exam because
Speaker: the bumps on their tongue were their case buds.
Speaker: And so I just think it highlights that this person who was an adult, probably mid thirties and had apparently never taken the time to look and see what their mouth normally looked like, looked in the mirror and said, oh my gosh, what are these bumps on my tongue?
Speaker: And they went to the emergency room.
Speaker: So I don't think medical professionals do a better job of telling people what is normal for their bodies.
Speaker: I don't know.
Speaker: I will never forget that particular moment because I think it was really eye opening for me.
Speaker: I was a pretty young nurse at the time and I was still under the impression that like most people that come to the emergency room are there for emergencies, which is not the case.
Speaker: it is funny because when you're a kid and at least i remember in elementary school like taking your tongue out and like with a tissue and being like look at the back like look all those things but if you had no if you didn't have that experience when you're a child i don't know if you would ever take it upon yourself to really look back there because it looks like an octopus a little bit your taste buds do look weird
Speaker: That reminds me, I've had people sent to me for normal things.
Speaker: They just noticed as well.
Speaker: Yeah.
Speaker: And even referred for other doctors just because there's normal variants.
Speaker: So just because it looks like this in a lot of people doesn't mean it looks like this at all people.
Speaker: So I've been, I had a patient one time just for their, the little punctum where your tears drain.
Speaker: This patient was sought and went to their primary care doctor.
Speaker: The primary care doctor said, you need to go to the dermatologist.
Speaker: Dermatologist said, ah, that, that looks like it needs a biopsy, but I don't do anything that close to the eye.
Speaker: And then the patient came to me.
Speaker: I'm like, that's normal.
Speaker: That is a completely normal thing.
Speaker: It just looks different than most, but it's, there's nothing wrong with it.
Speaker: And she said, I went to three doctors to figure this out.
Speaker: I said, sweet girl.
Speaker: There's a reason why we're all trained differently.
Speaker: I love also when little kids come in, sometimes we get consults for little kids cause they get double vision.
Speaker: It's, oh no, what's happening?
Speaker: It's just the kids paying attention the first time that they look at their thumb, everything's double behind and they look away, their thumb is doubled.
Speaker: So they're just learning that their eyes work, but they don't know what to say.
Speaker: And then they talk to their parents and they explain they're seeing double.
Speaker: The parents freak out.
Speaker: They run to the hospital or to the eye doctor.
Speaker: You are so observant.
Speaker: Good for you.
Speaker: Most people don't really pay attention.
Speaker: That is great.
Speaker: It's just, we learn about our bodies and sometimes we need a medical professional to help us learn about our bodies.
Speaker: Yeah, I do.
Speaker: And it is interesting that you brought up that there are doctors that don't know what normal variants look like.
Speaker: And I think that's something that when a patient is embarrassed that we can explain that not every normal looks the same and it's okay that you didn't know that this was normal.
Speaker: Cause I think there is a lot of like embarrassment when you get discharged from the emergency room with a normal visit form when you expected something to be wrong.
Speaker: And even like you said, just education, learning.
Speaker: But I even got a notification the other day inviting me to a course about, it was more for dermatologists, but I get some things because I take care of some skin things on the face.
Speaker: But it was how things look different on people with brown or black skin.
Speaker: And so, so many rashes and diseases, we have these things and we say, oh, this is the classic thing for a Lyme disease.
Speaker: This, they like, it's a bullseye rash and it's here's a picture of that on somebody with pigment in their skin and it doesn't look the same.
Speaker: So a lot of things go misdiagnosed because even as doctors and nurses and providers, we don't know what the normal variant is.
Speaker: We're just used to what we're used to seeing.
Speaker: And almost every picture in textbooks are of Caucasian white skinned patients.
Speaker: And so that's what we think of normal when that doesn't represent the patients we're seeing.
Speaker: heck, when you try to go buy foundation for your face, like makeup for your face, there's so many colors.
Speaker: There's so many colors.
Speaker: And so it's all normal.
Speaker: It's all normal.
Speaker: It's just so many variants.
Speaker: And so I can imagine that to assume that everybody knows every variant at every time is probably pretty, it's a tall order.
Speaker: Yeah.
Speaker: So pretty far aside from just bumps on the tongue, but I'm trying to give it, trying to give that guy a little grace to 30.
Speaker: Hopefully you've seen your tongue.
Speaker: We all, we all learn things at different times.
Speaker: So that's fine.
Speaker: Yeah.
Speaker: It's interesting that you said that because that was actually gonna be my next story was the first time I saw chicken pox on a black patient.
Speaker: because the textbooks are all white skin because it's easier to see a rash that way.
Speaker: And it took us an embarrassingly long time to realize that it was chicken pox.
Speaker: He got the right diagnosis, but I was embarrassed with myself that I didn't realize that it was chicken pox.
Speaker: And it spurred me to say, I need to do better about this.
Speaker: Are you guys familiar with the medical student who is drawing illustrations of these things on like black and brown skin so that we have these illustrations in textbooks?
Speaker: Yeah, I saw that on I don't know if it's Instagram or not, but also that email that I was mentioning about going to that conference.
Speaker: He was one of the people I think was involved with that.
Speaker: And so he was going to be there and some of his drawings were highlighted on the email.
Speaker: I got so.
Speaker: Yeah, just.
Speaker: We need to know, we need to know what normal looks like.
Speaker: And normal is not what we see in the textbooks.
Speaker: Like most medical studies are done on college age people in college most of the time.
Speaker: And so it's a study of people in college that age.
Speaker: And we just extrapolate that to the general population.
Speaker: And we're learning more and more that most of the studies probably don't hold up in a general population or other people.
Speaker: We're examining a very weird, small group of people.
Speaker: Mm-hmm.
Speaker: and that's what medical literature is based off of and so it's becoming much more expansive and when you're like at peak health there's nothing else wrong with you at all when you're in college and you want 40 to eat lunch yeah yes and exactly you want to get paid for a study and so you enroll yourself because you're dead broke and but you'll never be healthier in your days and so as like a middle-aged woman to look at studies that were done on mostly probably mostly male college age
Speaker: kids, does it really the study show?
Speaker: What does the study show?
Speaker: And on who, I guess that's the good questions.
Speaker: Right.
Speaker: The questions that we need to ask every time we read a medical study, who paid for it?
Speaker: Who is this done on?
Speaker: And is this going to be repeated?
Speaker: Is it repeatable?
Speaker: There's been some great studies that nobody's able to repeat the findings.
Speaker: So that's why anytime somebody says, oh, a study, I'm like, hold off.
Speaker: Like I like to quote studies too, but usually it's a meta-analysis, even for meta-analysis for our guests that don't do literature, just looking at all the studies and then they weed out all the ones that basically were done poorly.
Speaker: And then they try to come up with all the ones that were done right, that you could compare.
Speaker: And then they come up with a consensus statement as much as they can.
Speaker: And even for recently for dry eye and like in the ophthalmology world, they determined that no actual treatment for dry eye has good data to says it works.
Speaker: That says it works from the over the counter artificial tears to the warm compresses, to the medications that are formulated specifically for dry eye that costs a whole lot of money.
Speaker: When they looked at the actual evidence, they said we can do better.
Speaker: but some of these people you treat people with these and people sometimes get relief and then you keep using them but some people don't and maybe it's because they're that's not right for them we haven't studied in their type of that type of person yeah yeah we're going on so many tangents today usually a little bit more linear but that's all right
Speaker: Yeah, as someone who does research, a nurse researcher is something I do a little bit on the side as part of my faculty things that I have to do.
Speaker: The other thing I would add is statistics can say anything.
Speaker: You can make any numbers, anything you want if you pick the right statistic.
Speaker: And so I love it when people say statistics show and I say, which statistics?
Speaker: I think it was caution to people listening of if you are reading evidence, then you need to know, is it good evidence?
Speaker: I have heard from, I don't know, somebody who I heard it from quoted to Einstein.
Speaker: I'm gonna have to double check this, but the saying goes, there's lies and there's damn lies and then there's statistics.
Speaker: Yeah, which is why good studies, they choose how they're going to analyze the data and what statistics they're going to use before they do any of the actual research.
Speaker: Because once you've done it, you can be biased and you can choose the thing that's going to work best.
Speaker: And so the best done research, you actually lay that all out in front so you're not cherry picking the data.
Speaker: But we're all full of our own biases and mistakes.
Speaker: And that's why it needs to be repeatable.
Speaker: Right.
Speaker: Repeated and repeatable.
Speaker: Yes.
Speaker: Let's go back to the ER though.
Speaker: What's happening in the ER?
Speaker: Yes.
Speaker: Do you want to hear about one of the first mistakes I ever made?
Speaker: I do.
Speaker: I think we need to be more honest with our mistakes in medicine because we all make them, but we all pretend like we don't.
Speaker: And then we do a disservice to ourselves, colleagues, and patients when we don't just mention our mistakes out front.
Speaker: Yes, I actually want to do a presentation at some point about the three biggest mistakes I made as a new nurse or something because they're very common, right?
Speaker: And I still have vivid memories of this, but I was in my first couple shifts off of orientation.
Speaker: And so I knew
Speaker: So I was caring for this client and he was thankfully in a room that was close to the nurses station.
Speaker: And I don't remember what he presented for, but I was in his room and he looked at me and made eye contact and I looked at the monitor and it was VTAC.
Speaker: And I've, which is ventricular tachycardia in case anyone who's listening doesn't know.
Speaker: Art going crazy at a, it's not compatible with life.
Speaker: Yes.
Speaker: Long-term not compatible with life.
Speaker: Now this was VTAC with a pulse because he was looking at me and talking to me, but we all know that doesn't last forever.
Speaker: Um, eventually ventricular tachycardia will become polseless and then that's incompatible with life.
Speaker: And I stood there staring at the monitor.
Speaker: thinking, what do I do?
Speaker: What do I do with this patient who is like literally dying in front of my eyes?
Speaker: And thankfully the charge nurse could see the monitor from where she was sitting.
Speaker: And she said, what are you doing?
Speaker: And she crowded the crash cart and ran into the room and just gave me this look of,
Speaker: What the heck?
Speaker: And she took over and I snapped into that gear.
Speaker: But one of my very biggest mistakes was just inaction.
Speaker: I didn't know exactly where to start.
Speaker: And so I did nothing.
Speaker: I didn't call for help.
Speaker: I didn't take his vital, which is like stage one in the unearthing process is assess.
Speaker: Didn't do that.
Speaker: I just stood there paralyzed because I knew that this was bad, but I didn't know where to go from there.
Speaker: And it's so embarrassing.
Speaker: I'm shaking even just thinking about it because it could have gone so wrong.
Speaker: He ended up being okay.
Speaker: But just, it was awful.
Speaker: It was awful.
Speaker: I did not do a good job.
Speaker: And that's why we train.
Speaker: And that's why there's not just one person.
Speaker: It's just...
Speaker: We, you don't always make the right call the first time.
Speaker: And then the next time you walked in a room and somebody needed help right away, you probably pushed the code button and took vitals right away.
Speaker: And it's part of the learning process.
Speaker: There's fright, flight, fight, and freeze.
Speaker: When we're overwhelmed.
Speaker: I actually had a patient went in VTAC for three days straight.
Speaker: He was in the cardiac ICU.
Speaker: I did rotation the cardiac ICU in medical school and he could talk the whole time and we kept trying to shock him into a good rhythm every once in a while.
Speaker: And so it's so not multiple attempts, but he was hemodynamically stable, good blood pressure, good pulse.
Speaker: And we're like, how are you alive?
Speaker: How are you talking to us?
Speaker: But he just never actually,
Speaker: did that bad and then eventually they got the right the cardiologist got the right dose of medicines and we did the shocking we tried medical therapy and three days straight i have no idea how that's even possible but he eventually got a good medication and got a good rhythm and left the hospital just fine but you never know it's crazy i also think it's a good lesson for life like you can study all you want but until you do
Speaker: you're never going to be proficient.
Speaker: So you can see a lot of people that know, yeah, a lot of things, especially about like nutrition or moving their body or working out or whatever.
Speaker: But until you actually get in the gym and do those things, they're only half as good for you, maybe even less.
Speaker: So it was just, and also the first time you do something, you're probably not going to be great at it.
Speaker: That's just the breaks.
Speaker: You have to be brave enough to be bad at something before you can be good at that thing.
Speaker: So yeah,
Speaker: everybody's first time is not going to be their proudest probably in anything new that they try so good on you for getting in the arena because it's better than just studying the whole time you know
Speaker: Yeah, I think it is a lessons learned.
Speaker: I always tell my students, cause I teach the scary nurse is the one who can't ask for help.
Speaker: The one who thinks, and that goes for like medical trainees as well.
Speaker: If you think everything you're wrong and you're the one who's going to hurt someone and then keep your trainees close.
Speaker: It's really close to you because they're going to have that moment with something.
Speaker: Even if they were the best student in their class, they're going to have that one moment where they don't know what to do.
Speaker: And then we, as the more experienced providers have to step in and help with that.
Speaker: So I'm so grateful that I worked with amazing team that was able to catch that with me because otherwise I wouldn't know what would have happened, but I've the VPAC for three days.
Speaker: I don't even know how he had any cardiac output.
Speaker: That's amazing.
Speaker: I have no idea.
Speaker: Like it was just, you'd watch the monitor and everybody in the hospital came by to see that guy at least once.
Speaker: So I'm sure most, it's probably like a hundred doctors and nurses out there right now, they could tell the story of that guy because just endless parade, people coming on service, off service, every medical student, every resident on service, and just other doctors in the hospital just came by and be like, huh?
Speaker: And just look at the monitor, be like, and you feel fine.
Speaker: He says, yes, I feel fine for the thousandth time.
Speaker: I feel okay.
Speaker: He felt like he was in a human zoo.
Speaker: Until you shock me, that hurts.
Speaker: We gave him medication because at that point it wasn't emergent.
Speaker: The first time it was emergent, we just shocked him.
Speaker: And then after that, we would give him some sedating meds, try to make him calm.
Speaker: And then, but he still said it was horrible to get shocked while you're fully aware.
Speaker: Most people get shocked and they are not aware of what's happening.
Speaker: This guy was awake when he got shocked and not an enjoyable experience for his, for his reports.
Speaker: I was about to sign up for that.
Speaker: No, I've done that a couple of times and they usually yell pretty loud.
Speaker: Doesn't seem fun.
Speaker: No.
Speaker: Now you said also there's the sad stories from nursing too.
Speaker: I don't know if we're ready to move on to the sad stories, but you should share at least one or two of the sad stories.
Speaker: Yeah.
Speaker: I think one of the ones that will always stick with me is the first time I watched someone die because that's not something that people who don't work in medicine do right on a regular basis, at least not in our country.
Speaker: And so I knew that
Speaker: I was a nurse and people are going to die.
Speaker: But up until that point, and I think that was within my first year, but it wasn't right away.
Speaker: I had cared for people who later died, but I didn't see any of them.
Speaker: It was just like a really weird out of body experience to watch the monitor and watch the client.
Speaker: And thankfully the client was not in any pain.
Speaker: They were unconscious.
Speaker: So that would have been, it was a good first experience as far as watching people die go, which is a horrible thing to say, but there are worse ways to watch someone die.
Speaker: And we just watched the monitor and their heart isn't beating anymore.
Speaker: it was another moment where I was like, okay, what do I do now?
Speaker: Like now I, there, my whole job is to keep people alive.
Speaker: This client's no longer alive.
Speaker: What do I do?
Speaker: And it's a little mini existential crisis in that moment.
Speaker: And thankfully, again, my team stepped in and helped me do it was my first postmortem care.
Speaker: Right.
Speaker: So help me do the, when do we take out the tubes?
Speaker: Let's clean up their face because they had vomited and let's, how do we prepare them for the family?
Speaker: How do we help the family?
Speaker: Which is a skill in and of itself that I am definitely not an expert in.
Speaker: I remember feeling weird that it wasn't like really sad.
Speaker: Does that make sense?
Speaker: I didn't really know the client.
Speaker: It wasn't in the emergency room.
Speaker: We don't care for people for days and build up a relationship.
Speaker: And I felt weird that I didn't have a more visceral reaction to watching the client die.
Speaker: I wasn't happy about it, but it was not the experience I expected it to be.
Speaker: I think that's where a lot of it gets us into trouble is we have these expectations.
Speaker: We imagine what it might be like or what people tell us it's going to be like.
Speaker: And so our expectations are so rarely correct.
Speaker: And then you're in that moment and you just say, oh, this isn't how I'm supposed to feel.
Speaker: And I think we just cut off what we actually are feeling.
Speaker: I remember the first time feeling so confident when I was gonna go to the cadaver lab in high school.
Speaker: I'm gonna be a doctor someday, I'm going like anatomy and doing great, I'm loving the course.
Speaker: And then we went down to the university to look at the cadaver.
Speaker: I'm like, I'm excited, this is gonna be fun.
Speaker: And then they took the drapes off and the eyes were open.
Speaker: my brain was like no i don't want that like i was not picturing that and so that threw me and then i spent thousands of hours with cadavers through medical school and in residency and fellowship and training but my expectations yeah i was speaking with daughter of a friend who i've known her for a while and she has since graduated high school gone off to college and talking about the process of
Speaker: Growing up, living on your own, going to college and in this conversation, I remember thinking back when I was younger, man, being an adult is not what I thought it was going to be.
Speaker: Like life is not what I expected it to be when I was 18 as opposed to 25, as opposed to 30.
Speaker: It's just, yeah, your expectations are constantly.
Speaker: Not true.
Speaker: Life rarely meets you where your expectations are set because when it does, we tend to raise them again and, or expected more different.
Speaker: I don't know why we're so capable and able to do that, but yeah, the skill of putting aside expectations is
Speaker: in life, I think it's a lifelong lesson I have yet to grasp.
Speaker: Now thinking about that moment though, do you still feel weird that you didn't feel sad or have you just come to say, that's okay that I didn't feel sad in that moment?
Speaker: I actually feel sad or thinking about it now.
Speaker: I think it was more like a coping mechanism.
Speaker: Yeah.
Speaker: I know that I have other patients, right?
Speaker: Like I'm gonna have to leave this room and go care for the client next door.
Speaker: That's vomiting.
Speaker: And I can't let myself be like super sad right now.
Speaker: And, but at the time I wasn't ready for
Speaker: that i didn't expect to have that coping mechanism and so it felt disjointed yeah i'm not supposed to like this is supposed to hit harder and right yeah and it's okay if it does too like my first death i did cpr on the patient and i was hands-on chest compressions and then they called it and everything else kept moving and i needed it to stop i needed people to stop and acknowledge that their life had passed and everybody just
Speaker: went to the next room, did the thing, people came in, cleaned, and I was just overwhelmed, just sitting there not knowing what to do.
Speaker: But I've seen the opposite too, where people just take it and then they feel it later.
Speaker: I think it doesn't matter so much in that moment, as long as you're able to honestly look at it at some point.
Speaker: And it's okay if you look at it at some point.
Speaker: I'm okay with this, as long as that's okay, but it's okay to be a year later.
Speaker: That was sad.
Speaker: It just, I don't think it needs to like ever be shut off or it's just a finalized memory and it's just, is what it is.
Speaker: I think it's always fine to go back and look at it through fresh eyes.
Speaker: We've heard that several times of people saying I didn't process that in the moment.
Speaker: I wasn't allowed to, I didn't the nature of the job, the nature of the care of the other patients, obviously things are very demanding of you in the moment, but eventually to be able to sit and be like, okay, I'm going to really think about this.
Speaker: How do I feel about it and think through it and pushing that off rarely for too long, really does us good, but it's a common theme we've heard.
Speaker: That might lead us a little bit into some of the other stuff we wanted to talk to you about is how do you go through something like that and then come home and show up as a spouse, show up as a parent?
Speaker: How do you keep that moment, all those moments and process it and not just bottle it up, but still be a whole person in your relationships outside of the hospital?
Speaker: Yeah, so I think one of the things is that's why we debrief.
Speaker: Right.
Speaker: So if there's an especially traumatic death, we should be debriefing.
Speaker: And this was not, thankfully, a traumatic death, but there have been really traumatic death, like when it's children.
Speaker: or other cases that they give you some that like moral injury feeling we should hold ourselves to the standard that we don't just move on immediately that we do find a time to debrief ideally before we go home so that we don't take it home to our families and there are lots of tools for that if anyone's listening who wants to
Speaker: speak up about debriefing where you work, there's lots of tools for that.
Speaker: I think another thing is I found that for me, the things that I took home ended up being the little things, not the big things.
Speaker: Because I felt like the big things were an expected part of the job.
Speaker: Like I knew that clients were going to die, right?
Speaker: But it was the little things of, I forgot to get that patient a blanket.
Speaker: And they're always going to remember me as the nurse that didn't do what she said she was going to do.
Speaker: And that's what kept me awake at night actually.
Speaker: Oh my gosh, that patient wanted water and I was too busy giving medications in the next room.
Speaker: And then I went home and I forgot to tell the next nurse that patient wanted water and they're sitting in there so thirsty.
Speaker: And it was those little moments that we have the opportunity to meet our patients expectations and I didn't meet them that really
Speaker: eat up at me actually.
Speaker: Cause usually in the big moments, I felt like most of the time I provided good care, but it was the small things that, that it's easy to forget the things that aren't lifesaving, but each of those things matters to that patient.
Speaker: And so I always felt like I had let them down a little bit that I would have forgotten that thing, even though maybe I was like giving life saving medications in the next room, but to that patient, they don't know that.
Speaker: All they know is that I didn't come back when I said I would come back.
Speaker: No, I definitely understand that.
Speaker: I was going to bed on Monday night and feeling bad about not calling a patient.
Speaker: I was in surgery all day and I got labs and I know this mother is concerned about the lab work for her son and that she called multiple times and the labs weren't back yet.
Speaker: And I got the lab report in between surgeries and I said, I don't want to put this off.
Speaker: I know she's waiting.
Speaker: So I did a nice text.
Speaker: I told her all the lab values.
Speaker: I told her what it meant.
Speaker: and that there was no change from our plan and I was going to see them back and I'd sent that text and so it said everything I needed to say but most of the time I would have called the patient with that and so I still felt guilty and I thought should I have called it's too late to call now it's 10 p.m.
Speaker: she'll think I'm insane she has the information it's okay but that's what was going through my brain as I'm trying to sleep is
Speaker: I usually call people for that, but I didn't because I wanted her to get information right away and I didn't have time for a call in between surgeries.
Speaker: And that's what I'm stuck with when I'm trying to sleep.
Speaker: It's interesting because these little things that you're describing, they inform, see if I can say this right.
Speaker: They're more likely to inform an opinion you have about yourself
Speaker: More than the big traumas.
Speaker: So like you're saying, oh, I'm the person that is forgetful that I didn't show up for that patient when it was so easy to show up for that patient.
Speaker: When it's something big that happens, I did everything that I could, but it's these little things.
Speaker: Oh, I could have done better with minimal effort.
Speaker: And it erodes at this, I'm a good person.
Speaker: narrative as maybe more of a more of an opportunity to do that than the big things would and you get so many of those over time and you can see how people just get like I can't do this anymore it's it's really sad yeah and I think it's something that
Speaker: I don't know that patients have an understanding that like this is what keeps us up at night.
Speaker: I never want to let a patient down, even if it's something as small as you wanted ice and I forgot to get you ice.
Speaker: And I think that
Speaker: It's really easy for patients to see how hectic the hospital is and to think that, oh, they just don't care.
Speaker: And I desperately want them to know that I do care.
Speaker: And it feels like those are opportunities to show them that you care.
Speaker: And then when you can't do that, or you forget, then it feels, oh, I really missed that opportunity to show that patient that I really do care about what they would need.
Speaker: And then other than.
Speaker: doing that at work, like debriefing.
Speaker: When you come home, is that something you do with your spouse?
Speaker: What else do you do in your relationship to help that function?
Speaker: The things that really helped me, I think, are the time in the car on the way home or I worked at one place where I was close enough to walk and that was an amazing break.
Speaker: That would be helpful, yeah.
Speaker: Walking home with my music and my ears, that was really helpful because
Speaker: the break of being out in nature between building one and building two felt like a clean cut.
Speaker: But the time in the car, I try to make sure that I'm using that wisely.
Speaker: Most of the time for me, that's music.
Speaker: Either I need music that's going to hype me up or I need music that's going to provide me peace because the day was so rough.
Speaker: And I think for
Speaker: any clinician who is struggling to make the break between work and home finding the thing that is a good demarcation and for me that's car time so i i can get in the car i can take off my stethoscope and now i'm no longer nurse hannah right now i can
Speaker: turn on my music and remember who I am as a person because this is my like unique musical taste that my husband hates and that's the time I get to listen to it right when he's not in the car and then I get home and leaving the car now I'm putting on my wife and mom hat right and the easiest days to come home are actually usually the days that wear that have been the hardest because they make me the most grateful to come home
Speaker: when something really traumatic happened, you come home and you're like, I really want to hug my kids tight tonight because today was so hard.
Speaker: And so those days actually, I think for me personally were easier to make that switch because I was just so grateful to be able to make it.
Speaker: Yeah, I think there is something powerful in what you're saying about some sort of ritual, either the walk or the music.
Speaker: There's a rock star.
Speaker: I can't remember who it is.
Speaker: People can probably look it up.
Speaker: But recently on a podcast basically told people that after a big show, he needs to do something to ground himself back into reality before he goes home.
Speaker: He says, if I go home with this energy, I'm not a good father or a husband.
Speaker: And so after the show, he will spend a different amount of time, but he will clean a toilet or pick up trash or take down like some of the parking cones.
Speaker: If he does something mundane and then does it there, he is able to switch and then he can go home as himself and not the rock star.
Speaker: And so it doesn't necessarily have to be at that venue, I think, but he does something before he gets home.
Speaker: So he shows up who he is.
Speaker: And I think sometimes too in medicine, we are the decision makers.
Speaker: We are the people keeping people alive.
Speaker: We are whatever we are, we're the rock star in what we're doing in our day-to-day job.
Speaker: And
Speaker: We can't be that person when we come home.
Speaker: And so having something that says I am switching off, changing my mindset, listening to my music, reading something, an audio book.
Speaker: I do think other than like the big things that work where you have the meeting about the death or you talk to people, just something small where you are intentionally grounding yourself.
Speaker: And I think the intentionality matters so that this is something I am doing to then show up better.
Speaker: And I do it on the way to work as well.
Speaker: So I do the switch both ways, right?
Speaker: So my walk to or cart time to work is where I am preparing myself intentionally for work.
Speaker: So I think it does work both ways because it's hectic.
Speaker: You get the kids ready for school and you drop them off and I'm still in like mom mode and I think they forgot their sweater and are they going to have enough to eat at lunch?
Speaker: And so then I have to intentionally swap into the
Speaker: work mode or I'm not going to be the best caregiver that I can be when I step into the hospital that day.
Speaker: Yeah, there's a surgery center that has this elevator.
Speaker: It's only one flight.
Speaker: I almost never would take the elevator for one flight.
Speaker: I'm a big fan of take the stairs.
Speaker: It's healthy.
Speaker: But for some reason, at this one center, part of my routine and just becoming the surgeon that's about to walk in the OR as I go up the elevator and I take some deep breaths on the way up and it's a mind shift.
Speaker: And then I walk out of that elevator.
Speaker: I'm
Speaker: Here, I'm ready to go.
Speaker: And every time I'm about to hit that button for the elevator, I'm like, why are you taking the elevator?
Speaker: You're taking the stairs.
Speaker: And I'm just like, no, this little moment is important.
Speaker: That little 10 seconds where I'm not walking, I'm not just getting up the stairs, I'm just writing, and it's just this kind of phase shift for me.
Speaker: Plus, you get the drama of the elevator doors opening, and there you are, ready to operate, right?
Speaker: It opens in mostly an empty lobby.
Speaker: It's all just internal.
Speaker: There's no fanfare when those doors open.
Speaker: Yeah.
Speaker: It's not like the medical show is where it opens straight into the OR and you have to pre-scrub somehow.
Speaker: You start playing your own theme music in your AirPod when the doors open.
Speaker: Fantastic.
Speaker: No, but I think it's important to have some sort of separation and as much as you can, I can't turn it off all the time.
Speaker: I have to be available for patients as a surgeon.
Speaker: I have to be on call, so I can't always turn off the surgeon and the doctor, but I try to keep it as separate as possible from what I've been with the kids.
Speaker: But I can't keep it separate from you.
Speaker: I dragged into the medical podcast.
Speaker: So here we are.
Speaker: And here we are for you.
Speaker: Tell us about this product that you've worked on here, this and the evolution of it.
Speaker: I'm very curious.
Speaker: Yes.
Speaker: A little bit of background.
Speaker: I'm married to a physician and we are
Speaker: doing residency number two right now.
Speaker: So in residency number one, I looked around and I saw a lot of our friends were really struggling in their relationships and their marriages.
Speaker: And
Speaker: I said, something is off here.
Speaker: There's a gap here that is not being filled.
Speaker: And I'm sure you know that residency causes high rates of burnout and your partner just isn't who they were two years ago and it's not their fault, but there are going back to expectations, repeated times where expectations are not met for one reason or another.
Speaker: And so I actually started just writing a blog about how
Speaker: I saw ways to fill that gap.
Speaker: How do we communicate with our spouses when our spouses are burned out?
Speaker: How do we set expectations that are my, my three keys for expectations are that they need to be reasonable.
Speaker: They need to be well communicated and in medicine, they have to be flexible because some days you're on call.
Speaker: Some days you're not, some days you're in clinic, some days you're in the OR all day.
Speaker: And so you can't have the same expectations every day.
Speaker: Like people with a normal nine to five can.
Speaker: reasonable, communicated, and flexible.
Speaker: And things like, how do I find community when I moved for med school and then I moved for residency and then I moved for fellowship and then I moved for my attending job?
Speaker: And so it's harder to make those deep connections.
Speaker: And the more I did this, the more I realized that this was really something I was passionate about.
Speaker: And I ended up being on the Married to Doctors podcast in its early stages.
Speaker: And I got a phone call and the guy on the other end said, hey, Laura gave me your phone number and I want you to make this a course.
Speaker: And I was like, not even on my radar.
Speaker: I was planning to make a book one day.
Speaker: Of course, seems like a lot of work, but we talked about it and I ended up writing an entire course based on the blog that I had been working on.
Speaker: And so now I have that and it's called residency proof your marriage.
Speaker: And I obviously named it while I was in residency with I wasn't, my husband was, can't take any credit for that.
Speaker: It's a tag team.
Speaker: It's a partnership.
Speaker: If you're married or with somebody through residency, it's something you're doing together.
Speaker: It's a team sport.
Speaker: Yeah, so we actually got married pre med school.
Speaker: So I have been through all of it, all the phases, med school residency attending and now residency again.
Speaker: And so I have that course and it is really more of a passion project than it is a product.
Speaker: I would say, obviously, if I could make money off of it, that would be amazing.
Speaker: But the more important thing to me is if it can help someone, because I do think there's a lot of loneliness
Speaker: in the medical career and i don't know if you guys have seen there's actually like a surgeon general call to action about loneliness for the medical family and i i have the solution but i do i have this course and i am it is for sale but i'm also currently
Speaker: Because of the Surgeon General's call to action, I am offering it for free to any medical training programs who want it.
Speaker: So if any of your listeners are listening and they are in medical training, either med school or residency, and they want to take this as a free resource for resident or medical school illness, I will give it to them.
Speaker: I would love to do that because I think that we can't just continue to stand by and let this
Speaker: loneliness epidemic increase.
Speaker: And if that's the least I can do, then I want to do that.
Speaker: So people can absolutely buy it.
Speaker: But most medical students and residents don't have disposable income to do that.
Speaker: And so I think we need to now put the call to the training programs of it's partially their responsibility to make sure their residents are well.
Speaker: And part of resident wellness is making sure that they are well supported at home.
Speaker: Yeah, I definitely agree.
Speaker: Residency fellowship, difficult.
Speaker: The funny thing about is the, when you hear the Surger General talk about, he's talking about loneliness of the actual medical trainee, but just like married residents are just as lonely and married resident spouses are just as lonely.
Speaker: Just because you happen to be married during residency does not mean you're not lonely.
Speaker: And it's the nature of the beast that it just wants to pull you apart.
Speaker: And unless you're actively really engaged in staying together, it is a high possibility that you will end up a different place than you start, which is not, not what anybody wants.
Speaker: Nobody wants to gets married.
Speaker: then for it to end later that's not what we get into it for i think it's an incredible resource and i wish we would have had it or something like it because i expectations man expectations are not bad just poorly communicated expectations it's not expectations it's covert expectations those killers
Speaker: Yeah.
Speaker: So as a professor, which is what I do full-time now, I liken it to you're grading your spouse on a rubric that you didn't show them ahead of time.
Speaker: So how are they going to get, how are they going to give you, right?
Speaker: How are they going to meet the expectations of this rubric if they don't know what you're grading them on?
Speaker: And you're setting them up for failure and then you're going to get resentful and that's going to spiral.
Speaker: And that's just not sustainable.
Speaker: And we can't have the same expectations for our spouses in training that our friends have of their banker spouses or her spouses.
Speaker: It's just a different ballgame.
Speaker: And I think if we can accept that, it'll get us a long way.
Speaker: And the problem is what we're hearing, at least on our side, is that I just see so much bashing, like negativity about health care in general and working in health care.
Speaker: And the solution to this problem is not just don't go into health care because I don't know about you, but I'm only getting older and I'm going to need people to care for me when I get older.
Speaker: So highlighting that health care is.
Speaker: An amazing place to be, but it does require work on the backend for your relationships, for them to come along.
Speaker: Because if you're not happy at work, you're not going to be happy at home and the burnout just gets worse and worse.
Speaker: So it's, it's a very big piece of a puzzle that we ignore completely when we're talking about Dr. Burnout is home life and relationships.
Speaker: If we go back to our conversation too about how we get trained on what is told to us is normal.
Speaker: And in medicine, we don't have great examples of good relationships.
Speaker: It's not something that's talked about or that residencies talk about.
Speaker: I was never sat down as a resident saying, this is going to be the stress on your relationship and these are the tools that we have to support you.
Speaker: And you look at what's normal and what's normal is you work all the time.
Speaker: You'd never take time off.
Speaker: You, you get resentful of residents that do take some time off because it puts more workload on you and it just spirals.
Speaker: And so we're talking about normal skin, normal studies.
Speaker: And we look at medicine and these relationships are not normal.
Speaker: We don't know what normal is.
Speaker: And so the expectations are just hard to meet because nobody knows what it's supposed to be.
Speaker: And so I think we need to have these tools, sit down, medicine's a great place to be and your relationship can survive.
Speaker: But if you're gonna tell somebody, hey, to become a doctor and to get through residency, you need to divorce your wife right now.
Speaker: nobody would say okay great yeah sign me up but a lot of us end up losing our loved ones because of the training and so we need to start from the beginning and say this is something i'm choosing to do i want to be a doctor or a nurse or in medicine but i'm still wanting to keep my relationship and so getting a course like yours and knowing
Speaker: something about it before you go into it talking about it setting expectations i know when we had dr jennifer finlayson five she had a good conversation about if both of you choose this chosen suffering is how she phrased it is much different than imposed suffering but you can't choose it unless you know what it entails so and you don't know everything is a new resident because nobody tells you
Speaker: You know, you just hear about divorces, you hear about this or that, but it's this person's fault and this person's fault.
Speaker: So I think without a course, you're just figuring things out.
Speaker: So I like that you've established something, you have a course, it's written out, it's something you can get ahold of, and then you can go in with your head up and know what to be working on.
Speaker: Yeah, I think the ideal time is fourth year, if possible, of medical school.
Speaker: Usually students have a lot of time, but
Speaker: Because the medical training process is so rigorous, we were very careful to tailor the course to that.
Speaker: So it is evergreen, so once you have access, you don't lose access, and self-paced, so you can do it all in one weekend if you say, I just need to get it done.
Speaker: Or if you just don't have a lot of time, the videos are very short.
Speaker: Most of them are less than 10 minutes.
Speaker: and then there's a worksheet that takes maybe 15.
Speaker: You could do one a month if that's all you have time for.
Speaker: And so it's really hopefully a tool that can be molded into any of the medical training lifestyles no matter how busy they are because
Speaker: it was made with that in mind, as opposed to maybe some other marital tools, which are excellent, but don't have the understanding that you can't just take four Saturdays a month to go to a class because we work four Saturdays a month.
Speaker: Yeah.
Speaker: We don't have Saturdays off all the time.
Speaker: Totally.
Speaker: Yeah, but fourth year, like you said, that's a great opportunity, either prior to medical school, when maybe you have a little bit more time, if you've gotten yourself admitted to a school, you've been accepted, that's the path you're going and you're going with somebody.
Speaker: I don't even know if you need to be in a relationship to have this information.
Speaker: Yeah, but that's a good time before medical school or fourth year.
Speaker: I had time to take a medical Spanish course in fourth year.
Speaker: You have some time fourth year once you've matched or done what you need to.
Speaker: So it's kind of the last time you had a little glimpse of time.
Speaker: Use it wisely.
Speaker: You've got time on planes flying to residency interviews.
Speaker: There's little, there's teeny tiny little things in there.
Speaker: Life hack it.
Speaker: Yes.
Speaker: But yeah, I think even if...
Speaker: People don't buy my course, at least they can know expectations, right?
Speaker: Reasonable, well communicated, flexible.
Speaker: That's the key.
Speaker: That's the key.
Speaker: Thank you so much for coming on.
Speaker: Thank you for sharing your stories and also for sharing your hope for residency relationships.
Speaker: So I love that you have a passion for that because it's definitely needed and most people never find the time or know how to put it together.
Speaker: So thank you for doing that for us.
Speaker: I appreciate that.
Speaker: It was definitely a labor of love.
Speaker: But a labor nonetheless.
Speaker: Oh yes.
Speaker: So if you do have some extra funds and you do use the course free of charge and then you'd find it useful, then I would say gift it forward.
Speaker: Yeah.
Speaker: Gift, but give her some money for the effort that she put into it.
Speaker: So it was very sweet of you to offer for free, but if you have the means, please purchase it to help her with all the things she's working on.
Speaker: I appreciate that.
Speaker: I think the pay it forward is a great, a great method, right?
Speaker: Yeah.
Speaker: If you use it and find it useful, then maybe you can buy it for someone else.
Speaker: Yeah.
Speaker: Yeah.
Speaker: She's a genius.
Speaker: I've got a few, I've got a few up my sleeve.
Speaker: Thank you so much.
Speaker: I hope you have a wonderful evening and thank you for being on the podcast.
Speaker: Hi, this is Dr. Dave.
Speaker: Thank you so much for listening to this week's episode.
Speaker: Please rate review and share this episode so that we can continue to get you more stories in the future.
