Episode Transcript
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Speaker 1 (00:00):
Absolutely. I still remember the first person I had to
tell that they had cancer on a biopsy, and how
completely bereft of any skills I felt I had, and
how desperate I was to just model it based on
something I had seen, like in a movie or you know,
it's really grabbing straws. This is Here After, and I'm
(00:26):
your host, Megan Divine, author of the best selling book
It's Okay that You're Not Okay. This week on Hereafter,
Dr runa Audish on compassion in medicine and what it's
really like to listen to others and honestly to listen
to your own self settle in everybody. An excellent conversation
is coming up right after this first break. Before we
(00:53):
get started, one quick note. While we cover a lot
of emotional relational territory in our time here together, show
is not a substitute for skilled support with a licensed
mental health provider or for professional supervision related to your work.
Hey friends, So this week, this week, I would like
(01:14):
to say that I un characteristically gush about my guest.
But in in saying that, I think it's possible that
I might gush about a lot of guests. I don't
know it is true though that I am a bit
obsessed with this week's guest, Dr Renna Odish. She's a
critical care physician, founder of the Clear Program, which is
(01:35):
a narrative based communications training that helps medical staff practice
empathy in critical care, and she's the author of the
book in Shock. I first found her through her essay
The Shape of the Shore, where she writes what it
was really like in those first early months of the
pandemic for medical providers. It's haunting and gorgeous and really
(01:57):
hard to read. Dr is really really an amazing human being.
I mean I feel like I say that a lot.
This is one of the perks of doing the show
is that I get to have conversations with really amazing people.
But Doctor Ottish man who she is no stranger to loss.
In her last year of medical residency, Doctor Outish became
(02:19):
very ill a tumor burst in her abdomen, causing a
massive loss of blood. She was seven months pregnant at
the time. She lost the baby, as well as nearly
losing her own life. And the things that she heard
from her medical teams as she was waiting for surgery
and as she made the long climb back to health
those things she overheard really opened her eyes or maybe
(02:42):
her ears, to the unfeeling, cruel, and often unintentionally dismissive
things that care providers say to and about their patients,
especially when they think their patients can't hear them. That
experience lit something up in her a desire to help
her fellow medical providers learn to communicate with compassion, to
(03:04):
really listen to the patients and the families in the room.
And as you'll hear her say in the show, she
wanted more compassionate communication, not just for patients, but to
help nurses and doctors and surgeons regain some of their
own humanity, their own power that was maybe lost or
ground out of them as part of the medical industrial
(03:25):
machine that we all work in. And her approach to
teaching is just so kind and so generous and so
entirely shame free. Whether you work in the medical professions
or not, I hope that you love her as much
as I do. Now. If you do work in the
medical field and you're still kind of reeling from everything
(03:46):
these last few years have taken from you, please be
sure to listen to this episode. It's a beautiful meditation
on compassion in action for everyone. But if you're one
of those people we called a hero over the last
few years, you're really gonna dig with dr Otis has
to say. All right, on with the show with the
excellent Dr Renna Odish Renna. I am so glad you're here.
(04:12):
Thank you so much for joining me. I know you're
at the library at the hospital right now, so I'm
just I'm just really thrilled that you're here. Thank you.
I'm so happy to be joining you. So I got
kind of lost in all of your writing over the weekend.
I try not to work on weekends, but I started
reading your book towards the end of the week and
I couldn't stop reading it. So thank you for being
such a beautiful and poetic writer. There's there's something, really
(04:37):
I'm going to go with the word luminous. There's something
really lit from within in the way that you right
and the way that you speak. So thank you for that.
Thank you so much. I'm glad that you found it
to be luminous. I love that word. That's a really
good one. So I talked a little bit about your
work and what you do in the introduction, but I
would love to hear your story from you. So, these
(04:59):
days as a physic shen you're focused on the patient
experience and communication styles. But these aren't like those aren't
typical things that a doctor focuses on. So what happened
for you that made you feel like that kind of
focus was important? Yeah. I had sort of two educations,
you know. I went the traditional medical school residency fellowship
(05:20):
route and learned so much beautiful science and just fell
in love with the human body and and all the
different ways that it could fail, and really prided myself
on on helping in those acute situations. I went into
pulmonary and critical care medicine. But because I think the
(05:42):
universe understands irony, on the very last day of my training,
I got critically ill myself and it began really a
ten year odyssey into the patient side of medicine. And
when I got sick, I really got sick. I had
a tumor that was in my liver that ruptured and
(06:05):
it was like an artery bursting. I just lost all
of my blood volume into my abdomen. I was seven
months pregnant at the time, so we lost that baby.
I went into multisystem organ failure. I ended up on
a ventilator. I required massive transfusions, replacing my blood volume
(06:25):
probably three to five times over, and then woke up
in my own I see you, you know, on a
ventilator with my priest preying on my body, and got
to experience medicine from the other side of the bad.
And when I say that there were so many errors
(06:46):
in miscommunication, there was nothing for me to do except
to go into training physicians in compassionate communication after my illness.
I love how you just phrase that like there was
no other option, like you can't experience that, and then
go back to business as usual. That's exactly right. And
(07:08):
it it took time because my first goal when I
came back was I want to be different. I could
see myself in every error. I could see, you know,
if my team said she's trying to die on us,
I was horrified, But then I knew I had said
that two weeks before. And so what was it about
our culture that had us describing our relationships with our
(07:32):
patients in these vectored ways that were very blaming and shaming.
So I went to improve my own communication skills. That
really led me on a path of discovering how we
could be better. Yeah, can you give me another example
of the sort of errors that you experienced. I think
that that can be sort of vaguan esoteric for people.
(07:54):
I bet that the people who have experienced what you
just talked about are like, I know exactly what she means,
But what kind of errors were you experiencing? There were
really so many. So the first thing I remember was
hearing in the operating room them saying she's circling the drain,
(08:15):
and that one it got my attention because it indicated
that they thought I was dying. But also that could
have been the last thing I ever heard, and I
also have said things like that, so again it was
an awareness that we had acculturated to think that that
was okay. Having the team say that I was trying
(08:38):
to die on them felt very blaming. I had a
nurse who was very upset with me for not wanting
to hold the dead baby. She really thought and told
me that all babies deserve to be held by their
mother at least once, and didn't at all take into
(08:58):
account what was right for my healing in that moment.
Um So lots of presumptions we know what's best, lots
of not having a sense of awareness that the words
we say around our patients impact their own belief about
their ability to recover, their own sense of their resilience
(09:21):
and strength and capacity and agency and just a real entitlement. Yeah,
definitely that that I know what's best thing, right, and
like for certain medical decisions, I'm sure you know a
lot more than I do, knowing nothing but that sort
of human connection, that related nous is really where that
(09:43):
that gap is just massive, absolutely, and and that idea
that we we're the holders of medical information maybe, but
the patient is the holder of all of the information
about their body and what they want from their life
and what a good day its like. And until we
ask those things, I think it's impossible to make a
(10:04):
recommendation about what a path a patient should choose. It's
just it's not based in reality. It's just based in
our own judgment. And bridging that gap, as you said,
through conversations that are really generative, is critical. Yeah. I
can hear you know, the health care providers listening to
(10:27):
this thinking like that sounds lovely. I don't have time
for that stuff, right, Like the realities of managed care
and short staffed hospitals and I c U s and
treatment centers like Okay, I'm gonna use marketing terms here,
like how do you sell this idea of compassionate connection
to your patients to medical providers that are barely hanging on? Honestly,
(10:53):
in so many ways, it sells itself because there's really
good evidence that communicating and passionately doesn't actually take longer.
We've all been in situations where we're talking to a
patient and they're just telling us the same thing because
they're not feeling heard. And often that's because there's an
(11:15):
emotional cue that we're missing. There's something that we need
to acknowledge to diffuse the situation, and we're reading the
emotional cues is as wanting a cognitive answer. So it
is actually quite efficient, and that's true across the board,
whether it's emergency medicine, family medicine, surgery. Not only do
(11:36):
the encounters take less time, but the patients are more
likely to adhere to the plan of care that you
co create together. They're likelier to have better health outcomes.
And frankly, that's the space where we have fulfillment. And
so I think we have to redefine our idea of efficiency.
(11:57):
I can get through a clinic visit and five minutes
a patient will have no idea what's wrong with them,
and that's not authentic efficiency, really educating, really building a connection.
You know, it saves time on the back end when
you have to have hard conversations. You know who we're
talking to and they know you, and that's priceless. I
(12:20):
really love what you said in there. There's a book
that maybe you're familiar with called compassion Omics. Yes, I
love that book. My friends wrote it, they did. I
have it on my shelf. I love it. And one
of the things that I love about that book is
they start right out by saying, look, it actually takes you,
on average, ninety seconds more in a patient visit to
(12:40):
treat them like a human being and to hear what's
actually in the room, because there is that reality of
what it's like being a medical provider in the systems
were in, in the time that we're in, and what
the healthcare profession as a whole has endured the last
few years. I think, you know, very often when we
(13:01):
talk about burnout and resilience, it's about putting that burden
of resilience and self care back on the providers who
are already fried, and like, here's what you can do
to make this better and version. So I want to
take a step sort of sideways for a minute and
talk about the experience of doctors and other medical providers
for the last few years, and then we'll weave this
(13:22):
back into how this relates to these compassionate conversations. So
you have an essay that you wrote called The Shape
of the Shore, in which you describe what it was
like working during those really terrifying early days of the
pandemic inside the hospital. Can we talk about that essay
for a minute? Okay? This was one of those ones
where I was like, I just need to keep reading
(13:43):
it and rereading it because it's so evocative and so beautiful.
Can you give me give a little a little summary
of what that essay is about. It's, honestly, probably the
hardest thing I've ever written. I was trying to capture,
as you said, what it was like in those early days,
(14:04):
our uncertainty about how the virus was transmitted, the sense
of isolation and dependency that we all felt, the fear
that we were taking it home to our families, the
mass deaths that we witnessed, and then kind of how
(14:25):
we found our way through those early days, which was
really through pure support, really through sharing our experiences and
identifying in each other the light and the beauty and
the magic that we couldn't see in ourselves. Yeah, and
(14:46):
there there's something about the telling the truth part of
that experience of pure support and really seeing each other
that there's this great section where you're talking about Actually
don't remember if it's in that essay or another one
where you were writing about those early years where you're
talking about, you know, they talked about us as heroes,
and talking about us as heroes meant that they didn't
have to see us, they didn't have to see what
(15:08):
we were struggling with and the ways that we needed
to violate our own morals, our own values, our own
beliefs because of the situation at hand. I've come to
know that people call you a hero when they're going
to force you to betray yourself, and that that is
a signal that you are being sent into a situation
(15:30):
that will not leave you whole. That's such a powerful
way of describing it. I think everybody is so sick
of it, right, like so tired of the pandemic. And
there's just this like, we're through the worst of it.
Worst in air quotes here, but we're through the worst
of it, So bounce back and look at the ways
that you were resilient and let's pay attention to the
task at hand. The sort of speed dating with trauma, right, like,
(15:55):
let's just get it over with quickly. But what you're
talking about is we've really got to talk about what
happened for us in there. And I think healing comes
differently for everyone, and allowing enough intersection points where people
can find their way in, whether that's through therapy, whether
(16:17):
that's through their writing, whether it's through the creation of art,
whether it's through running, which I will never do that option, right,
I hear it works. We just need to acknowledge that
we've been through something and we can either heal and
(16:38):
talk about it or we can bury it. But it
always floats, it will always resurface. Yeah, there's a section
in that essay in the shape of the shore where
you're you're describing like, Okay, so administrative staff realizes that
this is really tough on our physicians, so let's put
them in basically like an encounter group. Yeah, and the
(16:59):
things that you just scribe in there. I was reading
it and I was actually like yelling out loud, like,
how they've survived a bad breakup in the past is
absolutely irrelevant to what they are witnessing on a daily basis.
So I would love to discuss that just for a second,
like this, that sort of well intentioned but wrong approach
(17:22):
to trying to help people survive a violation of their
values and their beliefs. You know, I have a really
deep empathy for anyone trying to do wellness work or
psychological first aid work in the time of a respiratory pandemic.
(17:44):
There is nothing that is going to fix it. Everything
is a band aid except structural change. Right, There are
real structural changes that need to happen to keep people safe.
But what we can do together in a room whom
is just validate each other's experiences. And I think there
(18:04):
was a real disconnect in those early days between the
experience of the people providing the care and the people
who wanted to help us, and in many ways that
was even more isolating. Yeah, it's the wrong tools for
the situation, right, And I see this a lot with
(18:24):
grieving people, especially for folks who have lost children or
my sister was killed by a drunk driver, or these
sorts of losses that we don't like to talk about.
That we apply these tools that work sort of in
normal everyday life, and they're really valuable tools and they're
really helpful. Absolutely the wrong medicine for the situation at hand, exactly.
(18:54):
We've been talking with author and physician Dr Rena Audish.
Let's get back to it. One of the things that
I really love about your work is that you tell
me if I'm phrasing this incorrectly, but I feel like
for you, the medicine at hand is validation and acknowledgment. Yeah,
it's been evolving for me. You know, when I wrote
(19:17):
my book, I really thought that if we could just
be present for each other's suffering, that that would be
a kind of win that we hadn't done that well.
And what the pandemic really taught me is that that's
like the lowest level. Being a bystander to trauma is
(19:40):
basically what that is. You are observing it, you are
apart from it, and there's nothing that's truly healing about it.
And what I hope we can come to is that
we all have different you new experiences, but we can
validate the experiences of others as our own by saying
(20:01):
I might not have had the same material experience that
you did, but I too have felt shame, moral distress, isolation.
I know how you got to where you are because
I've gotten there too, and then have that kind of
resonance between us as humans without invalidating someone's experience, without
(20:22):
being reductive, and saying this is just like a breakup
I had, but really just letting our souls kind of
resonate with each other. I love this. It's actually one
of the quotes that I pulled from your work where
you say bearing witnesses one wrung up from being a
bystander to trauma of just being a spectator. It's not
sufficient and it's not healing. Yeah, there's more to the
assignment here than just saying I see you. I feel
(20:46):
like I feel like we've talked so much over these
last several years about bearing witness and and paying attention
that it's become sort of one of those drive by supports, right, like, yep,
I hear you as this way to like and let
me tell you why you're wrong or why this isn't
you know what you think it is that there is
more there in our ability to actually see the other
(21:09):
and connect with them and serve from that place of
connection and seeing the other as human. But that door
goes both ways, and and I think one of the
things that I really took from looking at your work
with communication skills and training that you're doing is I'm
going to ask you about the work that you're doing
to help doctors understand new community communication styles. But even
(21:33):
before we get there, like, I want to talk a
second about the skills that we need to be better
communicators and better at empathy and better connection. Like as
this thing that you have to do for the other, right,
you have to do this as part of being a provider.
You have to be able to deliver this beautiful, compassionate
care to your patients. But what you're doing in training
(21:56):
physicians in better communication styles is your actually helping them
to feel human again after a pandemic that robbed a
lot of people of their humanity. I'm so glad to
hear you frame it in that way. That's certainly the
hope that when we connect with compassion, that it unlocks
(22:19):
some part of ourselves and there's reciprocity in it, and
we see ourselves as human, and the vulnerability that we
so often try to pretend isn't there is allowed to
be expressed. And those connections, they're the only thing that
will give young physicians longevity or joy and work or
(22:42):
a sense of purpose. And none of the other things
that feel so pressing or urgent that are always calling
for our attention, the emails and the pages and the
phone calls and the mandatory modules for compliance. And see,
none of that's going to fill our bucket the way
a connection with someone you're caring for, who you see
(23:05):
as a fellow human will. I have a friend who
went to med school in her late forties, and as
she was going through the med school experience, like she
lost her hair, she had a whole bunch of like
stress related illnesses, and I remember talking with her about it,
and she said, I swear med school is designed to
(23:25):
beat the humanity out of you. How do you see
the work that you're doing now as counteracting is maybe
the wrong word, but how do you see the work
that you're doing now interact with that med school culture
of check your humanity at the door, don't bring your
human self into the room. We've definitely come a long
(23:46):
way from when I graduated from medical school twenty years ago.
I think that was the culture break people and forced
them to be in human medical education has softened a
bit in the interim, and honestly, they come out really whole.
I'm always amazed how much smarter they are than I
(24:10):
was at that age. They see the community, the role
of health systems and community. They see the role that
racism has played in so many health outcomes. They have
a wider scope of understanding of public health. But what
happens is then they enter the industrial health care system
(24:31):
that is built for efficiency and built for profit. And
that's why I choose to work with new residents, because
that's the point that everything they've learned, all of the
beautiful generative thinking they've done, is liable to go right
out the window because they're going to think, well, that
(24:53):
was school and this is real life, and in real life,
this is how we do things, and there's no more
time for that and was just what they taught us
because that was their agenda. But here in the hospital,
to fit in, I have to do these other things,
the hidden curriculum, and I find if you can get
them right, when they've started to have trouble with these
(25:15):
conversations when they've started to find them challenging, and they
have a little humility about it, but they still have
all their idealism. That's kind of the perfect moment. Yeah,
we want to protect the idealism, Like just see this
work as sort of this buffer, Like let's not let
these new idealistic still human folks get devoured by the machinery. Exactly. Yeah,
(25:41):
I love that. I also feel really hopeful in what
you just said because I've talked to so many physicians
who weren't trained that way during their med school time,
and that they they still need to worry about being
seen as professionals if they cry on the job, if
they're seen as a and being affected by the work,
(26:02):
even if they hide their emotions in front of a
patient or in front of a family. And I think,
you know, one of the things that I think the
pandemic experience has done for the health care industry is
made the humans who do the work a lot less
willing to hold up the old system. Absolutely, because I
(26:22):
think it became very apparent when you know, many places
didn't have adequate personal protective equipment, and we're still sending
in their staff and putting them at risk, and people
were dying that a bad system disadvantages everyone equally. And
so the same way we saw it hurting our patients,
we saw it hurting our providers. And if we figured
(26:46):
out how much we have in common, I think that
sort of combined lobby of professionals and patients could do anything. Yeah,
there's a program that you do now in training these
I just keep seeing this, Sorry everybody, I keep seeing y'all.
A these like little fuzzy chicks that we want to
protect and let grow into like the full expression of
(27:08):
the reasons that you got into this field in general.
So that's where my mind is today, protecting the new chicks.
But your training doctors in these new communication styles really
rooted in empathy and connection and humanity. The program that
you run is called clear So can you tell us
about that program? Yeah, so it really was born out
(27:30):
of Vital Talk, which is a national program, which is
where I went to train after I first got sick,
shaped into a little bit of our Detroit Henry Ford
culture to suit our trainees in their backgrounds. So what
we do is we utilize improvisational actors and they're really
really skilled. So depending on the skill level of the
(27:53):
person who's in the chair or the learner, they can
modulate the experience from one where it's really introductory level,
just delivering serious news to someone who's a little anxious,
all the way up to this father just got a
call that his daughter drowned in the mini pool at daycare,
(28:18):
and you have to tell him, and he is angry
and screaming, and you have to facilitate this conversation. And
you know when I say that, obviously that would be
any physician's worst day to have to tell someone that
their daughter died. But the thought that we used to
do that without training is bananas. So we think of
(28:43):
it just like we think of you know, a lot
of the procedures we do. None of them are the same,
No conversation is the same. But there are signposts you
can look for that you can mark, there's a toolkit
that you can draw off of, and it really creates
an environment that I think no one is hurt, right.
(29:04):
It's an experiential learning and they get to try out
new skills in a safe place with their peers who
give them feedback about what went well. You know, I
saw that when you acknowledge her anxiety, that really the
emotion in the room de escalated and she was able
to hear you differently. And then they walk out with
(29:26):
that awareness and it's like a bodily awareness because it happened.
It's not something we taught them. They had the experience,
and that's really where the magic comes in. Yeah, I
love all of this. I love that it's theater. I
love that we're employing actors. I also love the permission
(29:46):
to experience experiment with that right, because this is this
is really really daunting. I talk about this a lot,
and I teach about this a lot, like really paying
attention and improving your communication skills and listening to what's
be being said and not being said right, address what's
actually unfolding instead of managing what's unfolding. Right. I love
(30:08):
that we're not expecting You're not expecting these providers to
already know how to do this there. I think that
there's just so much sort of pop psychology out there
about like express your needs and have a better conversation,
but they don't really talk about how terrifying that is
and that there are real skills involved in this and
real skills that you can practice in really low stakes situations, right,
(30:32):
you don't want to have to learn this stuff on
the fly and make things up and like feel confident
in it. That's just I think that's way too many barriers. Absolutely.
I still remember the first person I had to tell
that they had cancer on a biopsy, and how completely
bereft of any skills I felt I had, and how
(30:56):
desperate I was to just model it based on something
I had seen, like in a movie, or you know
it's really grabbing straws, or you have a mentor who
did it well and you try to dissect what they do,
but it seems like magic. You can't even see what
the steps are and you don't know how to emulate it.
And the idea that we wouldn't train in communication when
(31:19):
it's so impactful is just banana. It is bananas. I
mean it really truly is that, Like this is as
somebody who has received medical care and who is not
a medical profession other than being a therapist, but like
you just want to be seen, right and giving somebody
(31:41):
who is in a stressful situation or they're anxious about
somebody they care about, or they're anxious about themselves, like
hitting them with a bunch of medical terminology is the
opposite of helpful. But I feel like that's sort of
my role as a provider. I will give medical information
and this and this, but this is really what you're
doing is really running that upside down and again coming
(32:02):
back to like, the medicine is in the connection. The
medicine is in the connection. And the best medicine in
the world doesn't work on the wrong story. So you
better know your patient story. Oh, tell me more about that.
That was beautifully said. The best medicine in the world
doesn't work on the wrong story. What do you mean
by that? That is something that is attributable to somebody.
So I'm going to have to give you his name.
(32:24):
It's j ber Rouge, and he articulated those beautiful words
at a narrative medicine conference. And narrative medicine is another
one of the tools that we use to try to
increase empathy and compassion and that kind of close reading
(32:44):
that you're talking about, that there's what's being said, but
also how it's being said and what's not being said,
and what's between the lines and the words, And it's
something that I find really exciting. Yeah, Narrative medicine is
one of my favorite things ever. I remember back in
my early days, when I was just a tiny wee
(33:05):
baby duckling therapist, I had a book called Poetic Medicine,
which talked about like the importance of story. I think
in the psychotherapy world we often talk about the power
of telling your own story as a way of healing
what's wrong. Right, there's always sort of that transactional piece
to it that, like, you do this in the service
(33:25):
of getting better. I feel like you come at narrative
medicine without that expectation of a happy ending. Is that accurate? Yes,
I rarely have an expectation of a happy ending. I
think just going deeper is all I ever hoped for.
So being allowed to read the story in the room
(33:49):
lets you be more effective and therefore more efficient in
the care that you're trying to deliver. And having a
belief that I have the coldpath city to hold whatever
suffering reveals itself. One of the things that I think
we don't necessarily believe in in medicine is that there
(34:12):
is a value in that that sitting and holding space
for someone else's suffering is valuable. And we worry about
the toll that it will take on us, and and
for me recognizing that often for our patients and families,
just having a safe container for it is the most
(34:35):
meaningful thing that I do, because I can't alter the outcome,
even if I had a magic wand I can't change
someone's death from being death, but I can be present
for it and attend to it and trust that that's
enough in that moment. Yeah, allowing what is true to
(34:55):
be what's true is a really powerful act. In that moment,
I think there's so much speed and so much of
what we do right, Like, Yep, this accident happened, and
this person is dead, and we need you to make
a decision about organ donation, and like just kind of
taking those boxes and chop, chop, chop, because I've got
sixteen patients all in a row waiting for you after
(35:17):
this and feeling like you don't have the time to
take a breath, but also feeling like even if you
had thirty seconds, you have no idea what to do
with that, So you lean on what you know, which
are the facts. Yeah. It's a cloak, right, a shield,
It's something we hide behind. But I've never not done it.
(35:38):
So when I have avoided these hard moments, I've always
regretted it. When I've made myself too busy to be
present intentionally, when I have avoided, I've always felt like
I I robbed myself too. I didn't trust my elf
(36:00):
enough to have that moment, and I've always regretted it. Interesting,
like it makes me think of you know, coming into
the medical profession is a commitment and you kind of
have to take every opportunity for nourishment that you can, right,
And you don't get those moments back, yeah, right, You
(36:21):
don't get those moments back to to be fed in
that way. And I think there's the two pieces of
that as one is seeing that human connection as nourishment
and to adapting your style so that you can be
fed in that way, so that you can help co
create the situations that allow you to make those connections,
so you have fewer regrets about who you are as
(36:44):
a person showing up in this system that is sort
of designed to drill out your humanity. Yeah, preserving your
role as a healer. I think against a system that
would have you just be a therapeutic robot of some sort.
It's not easy, but it's for us as well as
our patients. Yeah, I want to go back to what
(37:06):
you were talking about in the beginning with your experience
and the sorts of things that you heard people say,
like she's circling the drain or she's trying to die
on us. I feel like maybe there's two There's two
different parts of your communications work. One is like taking
the people who are interested in learning how to connect
and how to address what's actually in the room. And
(37:26):
then there's sort of overhauling the internal communications culture. How
do you approach that from a system's perspective and on
an individual perspective to get people to realize that their
words matter and that maybe the things that we say
in the operating room, like you know your people can
hear you. How do you approach that you're speaking to
(37:49):
two really important things. One is accountability. How do we
hold each other accountable to the standards that we would
want for our own care, for our family's care and vulnerability.
And for me, the only way I was able to
to write about the bad things that happened were because
(38:09):
I had been a part of those things myself, and
I knew I wasn't intentionally trying to hurt anyone. It
was just an accepted part of the culture. And so
by pointing out things that had hurt me and being
very vulnerable and going to the nick you nurse and
saying you know, it sort of broke my heart when
(38:32):
you said that, And to be able to have a
conversation that says that ends really with her saying, you know,
I just thought I was advocating for your healing. It
didn't occur to me that there was another way to heal.
I wasn't taking your perspective into account, and I'll do
that in the future with other mothers. I just didn't
know when you realize that everyone who walks into the
(38:56):
hospital comes you're not wanting to hurt anyone and wanting
to do their best, and sometimes they're at their limit
and they don't have the capacity to do their best,
but by and large they want to do what's right.
I think it opens the possibility of having these discussions
and pulling someone aside and saying, you know, it's a
(39:16):
shame that you you phrase things that way in front
of the patient, because I think it left them feeling
like you didn't care. And I know you care, and
I wonder if we could brainstorm differently, how we could
say the same thing but with different words. I love
how kind that is. I love how what a kind
(39:37):
teacher you are. Thank you. Yeah, I think we just
hear so much you did this wrong? Do better and again,
you know, like the medical profession has been through so
much and even of course predating the pandemic, Like the
system was never built for humans, but like there's just
(39:57):
so much pressure to like do better, get better on
fewer resources and kindness inside teaching. We cannot add another
layer of shame to medicine. It's all built on shame.
And so being able to say I hold you an
unconditional positive regard. I believe that you have the values
(40:19):
that make you so wonderful, and in this moment you
didn't express them, and I noticed, and I care about
you too much to let that moment pass. It's a
way of still allowing people to learn without hurting them. Yeah,
that is just beautiful and useful and I love it.
And I love what you just described. Going back to
(40:39):
that nick you nurse, because people really do think that
they are being helpful and they're being advocates, and what
you describe her saying is like, you have to be
curious about what feels like healing to the person you're
talking to, right, you have to be curious about who
they are and what does healing mean to them, and
(41:00):
then help advocate for them to get Like that's where
your advocacy impulse comes in, is how do you advocate
for what feels like healing to the person in need
of healing and not your agenda of what that is.
And there's just there's just so much around what we
think people should do, and really curiosity sounds like the
better medicine there. We have to start with curiosity. Otherwise
(41:23):
we fill in the blanks with everything that we believe
and it's not really healing at all. It's not, and
it just becomes one more thing to sort of um
steamroller over the people in the room, which is again
not why so many people get into the practice of medicine.
They get in because they want to be of service.
And what I love about what you're doing is you
are giving people the tools and the insight to be
(41:45):
able to be of service in the ways they most
want to and maybe haven't been allowed to explore and
sort of a shame free and accepting environment, So thank
you for that. One of the quotes that I pulled
from your work was the work here is to grow
a heart that can hold all of this even now,
And I feel like that's what we've been talking about
(42:06):
from all of these different angles, from being a patient,
from being a family member, from being a provider who
has been in the healthcare industry for a long time
and has been sort of ground down to leave their
humanity behind, to the new folks coming in to how
do we create systems of growth and insight and learning
that don't have shame and badgering at their root. Like
(42:28):
all of these things come together in that in that
line that you wrote, the work here is to grow
a heart that can hold all of it. I mean,
this is the work. It feels like that's what I'm
called to do for myself and whatever little bits of
wisdom I pick up along the way I share because
(42:51):
they think we're all trying to to learn how to
do this. So you've lived through your own life threatening
medical condition, you are on the very front lines of
suffering and death during the pandemic. You continue to teach
communication and connection inside a medical industry that, as we've said,
hasn't always cared about the humans on the floor. Now,
(43:12):
the subtitle of your book is The Redemptive Power of Hope,
so I'm really curious. I guess two questions. One is,
how has your understanding of hope changed since you wrote
the subtitle of that book, and what does hope look
like for you now in this moment in time. As
(43:34):
an intensive care physician, I had a really complicated relationship
with hope. And when I wrote the book, I was
still struggling with this notion that as someone could be
dying and the family might not see it the way
that I did, and it felt like a denial of
everything that I knew, and it felt like we were adversaries.
(43:58):
And slowly, over time, I came to realize that hope
isn't this unfettered optimism. Hope is gritty. Hope is when
you've looked at it and you know there is nothing
and you have one last thing you can keep, and
that's hope. That was hard to come by, truly as
(44:20):
a as an intensive care doctor, but I got there.
And now it's interesting because I'm navigating life as someone
who's newly diagnosed with cancer, and I found that when
I was going through the testing that led to the diagnosis,
there was so much hope around. I hope it's nothing.
(44:43):
I hope that it's benign, and that hope wasn't helpful
to me because it didn't allow me to experience just
what was unfolding, what was true. And what I needed
was a kind of hope that wasn't vectored, that wasn't
hendon on any outcome, just hope as an orientation to
(45:04):
the future, full stop. And that's where I am now.
With hope. It's just an awareness that life is unfolding
and there will be joys and things to look forward to,
and none of it's mappable and none of it's controllable.
It just is available, and that is what hope is
(45:27):
to me. Now, it's interesting you said, you know, hope
sort of lives in the future, or that there is
a future. One of my other guests this year said
that his issue with the word hope is that it
is future related and that his his understanding of hope
now is like I can find the stillness in this moment.
So just I'm really fascinated by everybody's different ideas of
(45:48):
what hope is and where it lives and you know,
going back to what we were talking about with meeting stories,
with curiosity, like, hope is an individual thing and we
and be curious about what does hope look like for
my friend, What does hope look like for this patient
or this family, What does hope look like as a
(46:09):
provider for what I'm living as a as a doctor
or a nurse or a reproductive midwife. You know, like
what allowing there to be curiosity about hope? I guess
as what I hear and what you're talking about that
hope is a is a living thing that shifts and
changes absolutely and lives in the moment just as much
(46:32):
as it lives in the future. Where can you find
joy now? I like the idea of the of hope
in the future too. It's like it's not predictive, it's
not predicated on any specific outcome, but that there is
a moment to come, even if those moments are very
very limited and and prognosis says there's not going to
(46:53):
be you know, very many of these moments left, but
that there is hope and what we can reach for
in those moments that are to come. Yeah, yeah, that's
really beautiful. I really am just such a such a fan.
I'm going to wrap us up because I'll just do
that in my in my you know, um promotion of
this episode, because I think everybody really needs to listen
(47:14):
to you, both consumers of health care but also providers.
It's really just been m such a long road in
such a broken system, and I just I feel like
you bring really useful, actionable tools to help people stay
rooted in their own humanity and deliver the kind of
care that they got into this profession to deliver. It's
(47:37):
just I just really dig you. Thank you, I dig
you right back. Awesome, you so much for highlighting the
power of hope and optimism and curiosity and learning and
it's beautiful. Yeah, I really, I just I feel like
we really can create the networks and the relationships that
(47:59):
so many of us long for if we pay attention
to our words. You know, I kind of I have
to think that way because I'm a writer and because
I'm a speaker, but I really just there is just
such power in narrative medicine, in really hearing the story
and being curious about the story. So thank you so
much for being here. It has been such an honor.
We're going to link to your book. We're gonna link
to the essays that I was obsessed with over the weekend.
(48:23):
But where else can people find you? Especially if somebody
wants to train in the things that you've been talking about,
Like where where can people go? Bask? And you're awesome?
I live on Twitter. I am very happy to here.
I'm like many people, and my website for audis md
dot com has links to all the podcasts and articles
(48:45):
and it's a nice place to be if Twitter is scary,
if you are a Twitter averse to the Twitter universe,
you will find Dr Autish on her website. We're going
to link to all of that stuff over there. Friends,
stay tuned. We will be right back with your questions
to carry with you and more gushing from me about
today's guest. We'll be right back each week. I leave
(49:15):
you with some questions to carry with you until we
meet again. You know what really struck me in today's
conversation was Dr Odish's generosity of spirit, you know what
I mean? Like the way that she talks about leading
with curiosity and kindness, teaching without relying on blame or shame.
That's a really uncommon and amazing approach to communication work.
(49:39):
I mean, communication training is very often and I'm totally
I totally do this sometimes like you're doing everything wrong.
Let me show you why, and dr Otish just doesn't
roll like that. It makes me feel so hopeful for
the medical world and so happy for anybody who has
had the opportunity to work with dr Odish or be
tended by a metal provider who dr Audish has taught.
(50:03):
It really makes me feel hopeful for that world. What
parts of the conversation stuck with you today? What parts
made you think about the ways you communicate and what
you really want from the world around you. Everyone's going
to take something different from today's show, but I do
hope you found something to hold onto. I'd love to
(50:23):
hear what connected with you or for you today. Check
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(50:45):
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(51:28):
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(51:51):
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(52:12):
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