February 26, 2024 • 53 mins
Ever wonder what doctors say about their patients when they think no one can hear?
Dr. Rana Awdish doesn’t have to wonder - as a patient, she overheard a lot of distressing things. Her experience led her to change how medical providers speak about - and to - their patients, spreading compassion through communication (which we know is a mission dear to my heart). Listen in to hear Dr. Awdish’s take on the pressure on healthcare workers, too.
Content note: mention of life-threatening illness, pregnancy loss, medical industry
In this episode we cover:
- The “two educations” of Dr. Awdish - med school and a life threatening illness
- Why miscommunication is such a dangerous medical practice
- Being present is only the first step - validation is where the real healing begins
- Why compassionate communication helps doctors - maybe even more than it helps patients
- The very cool CLEAR program - using trained actors to help doctors & medical providers learn how to connect with patients going through some of the hardest times of their lives
We're re-releasing some of our favorite episodes from the first 3 seasons. This episode was originally recorded in 2022.
Looking for a creative exploration of grief? Check out the best selling Writing Your Grief course here.
About our guest:
Dr. Rana Awdish is a critical care physician operating on the front lines during COVID-19 at Henry Ford Hospital in Detroit, MI. Her own serious illness in 2008 has informed her belief in the power of compassion, sacred listening, and community. As medical director of the Care Experience for the Henry Ford Healthcare System, she is training staff to practice empathy in critical care. Find her at ranaawdishmd.com
About Megan:
Psychotherapist Megan Devine is one of today’s leading experts on grief, from life-altering losses to the everyday grief that we don’t call grief. Get the best-selling book on grief in over a decade, It’s Ok that You’re Not OK, wherever you get books. Find Megan @refugeingrief
Additional resources:
Read Dr. Awdish’s book - In Shock: My journey from death to recovery and the redemptive power of hope
Read “Restoration in the Aftermath” and ”The Shape of the Shore” from Dr. Awdish
Creative Writing as a Medical Instrument - paper by Jay Baruch, cited by Dr. Awdish
Want to talk with Megan directly? Join our patreon community for live monthly Q&A grief clinics: your questions, answered. Want to speak to her privately? Apply for a 1:1 grief consultation here.
Check out Megan’s best-selling books - It’s OK That You're Not OK and How to Carry What Can’t Be Fixed
Books and resources may contain affiliate links.
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
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,
is really grabbing straws.
Speaker 2 (00:24):
This is it's okay that you're not okay, and I'm
your host, Megan Devine. This week on the show, Doctor
Renna Otdish on compassion in medicine and what it really
takes to listen to others and to your own self
settle in everybody. An excellent conversation is coming up right
after this first break before we get started. Two quick notes. One,
(00:51):
this episode is an encore performance. I am on break
working on a giant new project, so we're releasing a
mix of our favorite episodes from the first three seasons
of the show. Some of these conversations you might have
missed in their original seasons, and some shows just truly
deserve multiple listens so that you capture all of the goodness.
(01:12):
Second note, while we cover a lot of emotional, relational
territory and our time here together, this show is not
a substitute for skilled support with a licensemantal health provider
or for professional supervision related to your work. Take what
you learn here, take your thoughts and your reflections out
into your world, and talk about it. Hey, friends, So
(01:35):
this week, this week, I would like to say that
I uncharacteristically gush about my guest. But 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,
doctor Renna Otdish. She's a critical care physician, founder of
(01:57):
the Clear Program, which is 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 hard to read. Doctor Ottish
(02:24):
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 Otdish became very
ill a tumor burst in her abdomen, causing a massive
(02:47):
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 her ears
to the unfeeling, cruel and often unintentionally dismissive things that
(03:11):
care providers say too 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 really listen
to the patients and the families in the room. And
(03:32):
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 machine that
we all work in. And her approach to teaching is
(03:53):
just so kind and so generous and so entirely shame free.
Whether you work in the medical professions are 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 these last few years
have taken from you, please be sure to listen to
(04:13):
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 what doctor Odish has to say. All right,
on with the show with the excellent doctor Renna Otdish.
Renna Otish, I am so glad you're here. Thank you
(04:36):
so much for joining me. I know you're at the
library at the hospital right now, so I'm just really
thrilled that you're here.
Speaker 1 (04:42):
Thank you. I'm so happy to be joining you.
Speaker 2 (04:44):
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
something really I'm going to go with the word luminous.
There's something really lit from within in the way that
(05:05):
you write and the way that you speak. So thank
you for that.
Speaker 1 (05:08):
Thank you so much. I'm glad that you found it
to be luminous. That's a love compliment.
Speaker 2 (05:13):
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 days as a physician,
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
(05:34):
feel like that kind of focus was important? Yeah.
Speaker 1 (05:38):
I had sort of two educations, you know. I went
the traditional medical school residency fellowship route and learned so
much beautiful science and just fell in love with the
human body and all the different ways that it could fail,
and really prided myself on helping in those acute situations.
(06:01):
I went into pulmonary and critical care medicine. But because
I think the 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
(06:23):
got sick. I had a tumor that was in my
liver that ruptured and 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 multi system organ failure.
I ended up on a ventilator. I required massive transfusions,
(06:47):
replacing my blood volume probably three to five times over,
and then woke up in my own icee you you know,
on a ventilator with my priest praying on my body,
and got to experience medicine from the other side of
the bed. And when I say that, there were so
(07:08):
many errors in miscommunication, there was nothing for me to
do except to go into training physicians in compassionate communication
after my illness.
Speaker 2 (07:21):
I love how you just phrased that like there was
no other option, Like you can't experience that and then
go back to business as usual.
Speaker 1 (07:30):
That's exactly right. And 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
(07:55):
with our patients in these vectored ways that were very blaming?
And so I went to improve my own communication skills.
That really led me on a path of discovering how
we could be better.
Speaker 2 (08:09):
Yeah, can you give me another example of the sort
of errors that you experienced? I think that that can
be sort of vague and esoteric for people. 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?
Speaker 1 (08:26):
There were really so many. So the first thing I
remember was hearing in the operating room them saying she's
circling the drain, 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,
(08:48):
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 to die on them, felt very blaming. I
had a nurse who was very upset with me for
(09:09):
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 account what was right for my healing in
that moment. So lots of presumptions we know what's best,
(09:30):
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 and strength and capacity and agency and just a
real entitlement.
Speaker 2 (09:52):
Yeah, definitely 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 relatedness is really where that gap.
Speaker 1 (10:07):
Is just massive, absolutely, 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 looks like. And until we ask those things,
I think it's impossible to make a recommendation about what
(10:29):
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.
Speaker 2 (10:46):
Yeah. I can hear you know, the healthcare providers listening
to 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 ice use and treatment centers.
Like Okay, I'm going to use marketing terms here, like
how do you sell this idea of compassionate connection to
(11:09):
your patients to medical providers that are barely hanging on?
Speaker 1 (11:15):
Honestly, in so many ways, it sells itself because there's
really good evidence that communicating compassionately 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
(11:38):
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 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 they
(11:59):
can owners 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.
(12:20):
I can get through a clinic visit in five minutes,
my 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 you're
talking to and they know you, and that's priceless.
Speaker 2 (12:43):
I really love what you said in there. There's a
book that maybe you're familiar with called Compassionomics. Nice. Yes,
I love that book.
Speaker 1 (12:51):
My friends wrote it, they did.
Speaker 2 (12:53):
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
it takes you, on average ninety seconds more in a
patient visit to 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 we're in, in the time that we're in,
(13:16):
and what the healthcare profession as a whole has endured
the last few years. I think you know, very often
when we talk about burnout and resilience, it's about putting
that burden of resilience and self care back on their
providers who are already fried, and like, here's what you
can do to make this better and version. So I
(13:37):
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 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
(13:58):
the pandemic inside the hospital. Can we talk about that
essay for a minute? Yes, Okay, this was one of
those ones where I was like, I just need to
keep reading it and rereading it because it's so evocative
and so beautiful. Can you give a little all summary of.
Speaker 1 (14:16):
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,
our uncertainty about how the virus was transmitted, the sense
of isolation and dependency that we all felt, the fear
(14:40):
that we were taking it home to our families, the
mass deaths that we witnessed, and then kind of how
we found our way through those early days, which was
really through peer support, really through sharing our experiences and
(15:00):
identifying in each other the light and the beauty and
the magic that we couldn't see in ourselves.
Speaker 2 (15:09):
Yeah, and there's something about the telling the truth part
of that experience of peer support and really seeing each
other that there's this great section where you're talking about
I 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
(15:31):
see what 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.
Speaker 1 (15:40):
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 that will not leave you whole.
Speaker 2 (15:56):
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
(16:16):
speed dating with trauma, right like, 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.
Speaker 1 (16:27):
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 that's through their writing, whether
it's through the creation of art, whether it's through running,
which I will never do that for other people, right
(16:53):
I hear it works. We just need to acknowledge that
we've been through something and we can either a heel
and talk about it or we can bury it. But
it always floats, it will always resurface.
Speaker 2 (17:08):
Yeah, there's a section in that essay in the shape
of the shore where 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 things that you describe 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
(17:31):
is absolutely irrelevant to what they are witnessing on a
daily basis. So I would love to discuss that just
for a second, like that sort of well intentioned but
wrong approach to trying to help people survive a violation
of their values and their beliefs.
Speaker 1 (17:52):
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. There is nothing
that is going to fix it. Everything is a band
(18:12):
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 is just validate
each other's experiences. And I think there was a real
disconnect in those early days between the experience of the
(18:33):
people providing the care and the people who wanted to
help us, and in many ways that was even more isolating.
Speaker 2 (18:42):
Yeah, it's that the wrong tools for the situation, right,
And I see this a lot with 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
(19:05):
the wrong medicine for the situation at hand, exactly. Hey,
before we get back to this week's guest, I want
to talk with you about exploring your losses through writing.
There are lots of grief writing workshops out there with
(19:27):
prompts like tell us about the funeral, that sort of thing.
My thirty day writing your grief course is not like that.
Speaker 1 (19:34):
Them.
Speaker 2 (19:34):
Prompts are deeper, they're more nuanced. They're designed to get
you into your heart and into your own actual story. Now,
writing isn't going to cure anything, but it can help
you hear your own voice, and that is incredibly powerful.
You can read all about the Writing your Grief course
at Refuge in Grief dot com backslash wyg. That is
(19:55):
WYG for Writing your Grief. You can see a sample
prompt from the course and get writing your own words
in minutes. My thirty day Writing your Grief course is
still one of the best things I've ever made for you.
Come join more than ten thousand people who have taken
the Writing your Grief Course refugegrief dot com backslash wyg,
or you can find the link in the show notes.
(20:18):
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.
Speaker 1 (20:31):
Yeah, it's been evolving for me. You know. When I
wrote 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
(20:52):
like the lowest level. Being a bystander to trauma is
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 experiences, but we can validate the
(21:16):
experiences of others as our own by saying 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 being
(21:41):
reductive and saying this is just like a breakup I had,
but really just letting our souls kind of resonate with
each other.
Speaker 2 (21:49):
I love this. It's actually one of the quotes that
I pulled from your work where you say bearing witness
is one wrung up from being a bystander to trauma
of just being a spectator. It's not sufficient and it's
not healing. There's more to the assignment here than just
saying I see you. I feel like I feel like
we've talked so much over these last several years about
bearing witness and paying attention that it's become sort of
(22:12):
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 and
connect with them and serve from that place of connection
and seeing the other as human. But that door goes
(22:35):
both ways. 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 want to
ask you about the work that you're doing to help
doctors understand new community communication styles. But even before we
get there, like, I want to talk a second about
the skills that we need to be better communicators and
(22:58):
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
physicians in better communication styles is you're actually helping them
(23:19):
to feel human again after a pandemic that robbed a
lot of people of their humanity.
Speaker 1 (23:29):
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 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
(23:50):
is allowed to be expressed. And those connections, they're the
only thing that will give young physicians longevity or joy
and work or 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
(24:10):
pages and the phone calls and the mandatory modules for complaints,
and none of that's going to fill our bucket the
way that a connection with someone you're caring for, who
you see as a fellow human will.
Speaker 2 (24:26):
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 beat the humanity out
of you. How do you see the work that you're
(24:47):
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.
Speaker 1 (25:02):
We've definitely come a long way from when I graduated
from medical school twenty years ago. I think that was
the culture break people and force them to be inhuman
Medical education has softened a bit in the interim, and honestly,
they come out really whole. I'm always amazed how much
(25:27):
smarter they are than I 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 that is built for efficiency
(25:52):
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 was school and this is
real life, and in real life, this is how we
(26:15):
do things, and there's no more time for that. And
that 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 conversations, when they've
started to find them challenging, and they have a little
(26:38):
humility about it, but they still have all their idealism,
that's kind of the perfect moment.
Speaker 2 (26:44):
Yeah, we want to protect the idealism, Like you see
this work as sort of this buffer, Like, let's not
let these new idealistic still human folks get devoured by
the machinery.
Speaker 1 (26:58):
Exactly.
Speaker 2 (26:59):
Yeah, 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 still need to worry about being seen
as professionals if they cry on the job, if they're
seen as even being affected by the work, even if
(27:21):
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 healthcare industry is made the humans
who do the work a lot less willing to hold
up the old.
Speaker 1 (27:38):
System, absolutely, because I 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
(27:58):
it hurting our patients saw it hurting our providers. And
if we figured out how much we have in common,
I think that sort of combined lobby of professionals and
patients could do anything.
Speaker 2 (28:13):
Yeah, there's a program that you do now in training
these I just keep seeing this, Sorry, everybody, I keep
seeing y'all, these like little fuzzy chicks that we want
to protect and let grow into the full expression of
the reasons that you got into this field in general.
So that's where my mind is today, protecting the new chicks.
(28:33):
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?
Speaker 1 (28:46):
Yeah, so it really was born out 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 trainee in their backgrounds. So what we do is
we utilize improvisational actors and they're really really skilled. So
(29:09):
depending on the skill level of the 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
(29:32):
daughter drowned in the mini pool at daycare, 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.
(29:53):
But the thought that we used to do that without
training is banana. So we think of 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
(30:14):
can draw off of, and it really creates an environment
that I think no one is hurt, right, 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
(30:35):
when you acknowledged 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 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.
Speaker 2 (30:57):
Yeah, I love all of this. I love that it's theater.
I love that we're employing actors. I also love the
permission 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
(31:18):
being said and not being said right, address what's actually
unfolding instead of managing what's unfolding. Right. I love that
we're not expecting You're not expecting these providers to already
know how to do this. I think 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
(31:39):
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, 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.
Speaker 1 (32:02):
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 is really grabbing straws, or you have a
(32:24):
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 it's so impactful is just bananas.
Speaker 2 (32:42):
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 who is in a stressful situation
or they're anxious about somebody they care about, or they're
(33:03):
anxius 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, but this is really
what you're doing is really turning that upside down and
again coming back to you like the medicine is in
the connection.
Speaker 1 (33:23):
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's story.
Speaker 2 (33:30):
Ooh, 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?
Speaker 1 (33:37):
That is something that is attributable to somebody. So I'm
going to have to give you his name. It's j
Beruche 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
(33:59):
compacts and that kind of close reading 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.
Speaker 2 (34:16):
Yeah, narrative medicine is one of my favorite things ever.
I remember back in my early days, when I was
just a tiny wee 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
(34:37):
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 of getting better. I feel like
you come at narrative medicine without that expectation of a
happy ending. Is that accurate?
Speaker 1 (34:53):
Yes, I rarely have an expectation about happy ending. I
think just going deeper is all I ever hoped for.
Speaker 2 (35:02):
So being allowed to read the story in the room
lets you be more effective and therefore more efficient in
the care that you're trying to deliver.
Speaker 1 (35:14):
And having a belief that I have the capacity to
hold whatever suffering reveals itself. One of the things that
I think we don't necessarily believe in in medicine is
that there is a value in that that sitting and
holding space for someone else's suffering is valuable, and we
(35:40):
worry about the toll that it will take on us,
and for me, recognizing that often for our patients and families,
just having a safe container for it is the most
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 deaf, but I can be present
(36:04):
for it and attend to it and trust that that's
enough in that moment.
Speaker 2 (36:11):
Yeah, allowing what is true to be what's true is
a really powerful act in that moment. I think there's
so much speed in 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 ticking those boxes and chop, chop, chop,
(36:32):
because I've got sixteen patients all in a row waiting
for you after 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. Yeah, with that, so you lean on
what you know, which are the facts.
Speaker 1 (36:49):
Yeah, it's a cloak, right, a shield, It's something we
hide behind. But I've never not done it. 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 robbed
(37:15):
myself too. I didn't trust myself enough to have that moment,
and I've always regretted it.
Speaker 2 (37:23):
Interesting, like it makes me think of, you know, coming
into the medical profession as 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
don't get those moments back to be fed in that way.
(37:43):
And I think there's the two pieces of that as
one is seeing that human connection as nourishment and two
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 regrets about who you are as a person showing
(38:04):
up in this system that is sort of designed to
drill out your humanity.
Speaker 1 (38:08):
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.
Speaker 2 (38:23):
Yeah, I want to go back to what 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 different parts of your
communications work. One is like taking the people who are
interested in learning how to connect and how to address
(38:43):
what's actually in the room. And 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. Yeah, how
(39:05):
do you approach that?
Speaker 1 (39:06):
You're speaking to two really important things? One is accountability.
How do we hold each other accountab bilt 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 write about the bad things
(39:26):
that happened were because 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
(39:46):
nick you nurse and saying you know, it sort of
broke my heart when 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
(40:09):
with other mothers. I just didn't know. When you realize
that everyone who walks into the hospital comes here 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
(40:33):
and saying, you know, it's a shame that 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.
Speaker 2 (40:51):
I love how kind that is. I love how what
a kind teacher you are.
Speaker 1 (40:57):
Thank you.
Speaker 2 (40:58):
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 something the system was never
built for humans, but like there's just so much pressure
to like do better, get better on fewer resources and
(41:21):
kindness inside teaching.
Speaker 1 (41:24):
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 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
(41:44):
moment pass. It's a way of still allowing people to
learn without hurting them.
Speaker 2 (41:51):
Yeah, that is just beautiful and useful and I love
it and I love what you just described. Going back
to 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. Yes, right, you have to be curious
(42:14):
about who they are and what does healing mean to them,
and 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 so much around what we think people
should do, and really curiosity sounds like the better medicine there.
Speaker 1 (42:38):
We have to start with curiosity. Otherwise we fill in
the blanks with everything that we believe and it's not
really healing at all.
Speaker 2 (42:47):
It's not and it just becomes one more thing to
sort of 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 able to be of service in the
ways they most want to and maybe haven't been allowed
(43:09):
to explore in 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 from all of these different angles, from being
a patient, from being a family member, from being a
(43:30):
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 all of these things come together in that line
that you wrote, The work here is to grow a
(43:52):
heart that can hold all of it. I mean, this
is the work.
Speaker 1 (43:56):
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 I think we're all trying
to learn how to do this.
Speaker 2 (44:14):
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, the
subtitle of your book is The Redemptive Power of Hope,
So I'm really curious. I guess two questions. One is,
(44:40):
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.
Speaker 1 (44:52):
As 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 someone could be
dying and the family might not see it the way
that I did, and it felt like a denial of
(45:13):
everything that I knew, and it felt like we were adversaries.
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
(45:34):
that's hope. That was hard to come by, truly 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
(45:57):
was so much hope around. I hope it's nothing. 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 dependent
(46:19):
on any outcome, just hope as an orientation to 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
(46:42):
just is available, and that is what hope is to me. Now.
Speaker 2 (46:46):
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, yeah,
and that 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 what hope is
(47:08):
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 can 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 provider for what
(47:29):
I'm living as a as a doctor or a nurse
or a you know, reproductive midwife. You know, like what
allowing there to be curiosity about hope, I guess is
what I hear in what you're talking about that hope
is a is a living thing that shifts and changes.
Speaker 1 (47:48):
Absolutely and lives in the moment just as much as
it lives in the future. Where can you find joy now?
Speaker 2 (47:55):
Yeah, 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 be
you know, very many of these moments left, but that
there is hope in what we can reach for in
(48:17):
those moments that are to come. 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, promotion of this episode,
because I think everybody really needs to listen to you,
both consumers of healthcare but also providers. It's really just
(48:37):
been 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 just I just really
dig you.
Speaker 1 (48:58):
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.
Speaker 2 (49:10):
Yeah, I really, I just I feel like we really
can create the networks and the relationships that 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
(49:33):
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 going to link to the essays
that I was obsessed with over the weekend. 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?
Speaker 1 (49:50):
I live on Twitter. I am very happy there and
like many people, and my website are not addish. Empt
has links to all the podcasts and articles and it's
a nice place to be if Twitter is scary.
Speaker 2 (50:08):
If you are a Twitter averse to the Twitter universe,
so you will find doctor Otdish 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
(50:34):
you with some questions to carry with you until we
meet again. You know what really struck me in today's
conversation was doctor Otdish'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.
(50:58):
I mean, communication training is very, very often and I'm totally,
I totally do this sometimes like you're doing everything wrong,
let me show you why, and Doctor Odish 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 doctor Otdish or be
tended by a medical provider who doctor Otdish has taught.
(51:21):
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 on too. I'd love
(51:41):
to hear what connected with you or for you today.
Check out Refuge and Grief on Instagram or here after
pod on TikTok to see video clips from the show
and leave your thoughts in the comments on those posts.
That's a great way to tell me how this show
felt for you. Be sure to tag me in your
conversation starting posts on your own on social accounts. If
you want to open a conversation about how we communicate,
(52:03):
use the hashtag here after pod on all of the platforms.
We love to see where this show takes you. Remember
to subscribe and leave a review. Those reviews help more
than you know. If you want to tell us how
today's show felt for you, or you have a request
or a question for upcoming explorations of difficult things, give
(52:24):
us a call at three two three six four three
three seven six ' eight and leave a voicemail. If
you missed it, you can find the number in the
show notes or visit megandivine dot co. If you'd rather
send an email, you can do that too, right on
the website megandivine dot co. We want to hear from you.
I want to hear from you. This show, this world
(52:47):
needs your voice. Together, we can make things better even
when they can't be made right. Want more Hereafter. Grief
education doesn't just belong to end of life issues. As
my dad says, daily life is full of everyday grief
that we don't call grief. Learning how to talk about
all that without cliches or platitudes, or just practice gratitude.
(53:09):
All of that is an important skill for everyone, especially
if you're in a helping profession. Find trainings, professional resources,
and my best selling book, It's Okay that You're Not
Okay at Megandivine dot Co. Hereafter with Megan Divine is
written and produced by me Megan Divine. Executive producer is
Amy Brown. Co produced by Elizabeth Fozzio. Logistical and social
(53:31):
media support from Micah, Edited by Houston Tilley, music provided
by Wave Crush and background noises provided by Luna yelling
at anyone walking by
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,
is really grabbing straws.
Speaker 2 (00:24):
This is it's okay that you're not okay, and I'm
your host, Megan Devine. This week on the show, Doctor
Renna Otdish on compassion in medicine and what it really
takes to listen to others and to your own self
settle in everybody. An excellent conversation is coming up right
after this first break before we get started. Two quick notes. One,
(00:51):
this episode is an encore performance. I am on break
working on a giant new project, so we're releasing a
mix of our favorite episodes from the first three seasons
of the show. Some of these conversations you might have
missed in their original seasons, and some shows just truly
deserve multiple listens so that you capture all of the goodness.
(01:12):
Second note, while we cover a lot of emotional, relational
territory and our time here together, this show is not
a substitute for skilled support with a licensemantal health provider
or for professional supervision related to your work. Take what
you learn here, take your thoughts and your reflections out
into your world, and talk about it. Hey, friends, So
(01:35):
this week, this week, I would like to say that
I uncharacteristically gush about my guest. But 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,
doctor Renna Otdish. She's a critical care physician, founder of
(01:57):
the Clear Program, which is 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 hard to read. Doctor Ottish
(02:24):
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 Otdish became very
ill a tumor burst in her abdomen, causing a massive
(02:47):
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 her ears
to the unfeeling, cruel and often unintentionally dismissive things that
(03:11):
care providers say too 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 really listen
to the patients and the families in the room. And
(03:32):
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 machine that
we all work in. And her approach to teaching is
(03:53):
just so kind and so generous and so entirely shame free.
Whether you work in the medical professions are 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 these last few years
have taken from you, please be sure to listen to
(04:13):
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 what doctor Odish has to say. All right,
on with the show with the excellent doctor Renna Otdish.
Renna Otish, I am so glad you're here. Thank you
(04:36):
so much for joining me. I know you're at the
library at the hospital right now, so I'm just really
thrilled that you're here.
Speaker 1 (04:42):
Thank you. I'm so happy to be joining you.
Speaker 2 (04:44):
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
something really I'm going to go with the word luminous.
There's something really lit from within in the way that
(05:05):
you write and the way that you speak. So thank
you for that.
Speaker 1 (05:08):
Thank you so much. I'm glad that you found it
to be luminous. That's a love compliment.
Speaker 2 (05:13):
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 days as a physician,
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
(05:34):
feel like that kind of focus was important? Yeah.
Speaker 1 (05:38):
I had sort of two educations, you know. I went
the traditional medical school residency fellowship route and learned so
much beautiful science and just fell in love with the
human body and all the different ways that it could fail,
and really prided myself on helping in those acute situations.
(06:01):
I went into pulmonary and critical care medicine. But because
I think the 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
(06:23):
got sick. I had a tumor that was in my
liver that ruptured and 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 multi system organ failure.
I ended up on a ventilator. I required massive transfusions,
(06:47):
replacing my blood volume probably three to five times over,
and then woke up in my own icee you you know,
on a ventilator with my priest praying on my body,
and got to experience medicine from the other side of
the bed. And when I say that, there were so
(07:08):
many errors in miscommunication, there was nothing for me to
do except to go into training physicians in compassionate communication
after my illness.
Speaker 2 (07:21):
I love how you just phrased that like there was
no other option, Like you can't experience that and then
go back to business as usual.
Speaker 1 (07:30):
That's exactly right. And 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
(07:55):
with our patients in these vectored ways that were very blaming?
And so I went to improve my own communication skills.
That really led me on a path of discovering how
we could be better.
Speaker 2 (08:09):
Yeah, can you give me another example of the sort
of errors that you experienced? I think that that can
be sort of vague and esoteric for people. 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?
Speaker 1 (08:26):
There were really so many. So the first thing I
remember was hearing in the operating room them saying she's
circling the drain, 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,
(08:48):
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 to die on them, felt very blaming. I
had a nurse who was very upset with me for
(09:09):
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 account what was right for my healing in
that moment. So lots of presumptions we know what's best,
(09:30):
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 and strength and capacity and agency and just a
real entitlement.
Speaker 2 (09:52):
Yeah, definitely 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 relatedness is really where that gap.
Speaker 1 (10:07):
Is just massive, absolutely, 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 looks like. And until we ask those things,
I think it's impossible to make a recommendation about what
(10:29):
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.
Speaker 2 (10:46):
Yeah. I can hear you know, the healthcare providers listening
to 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 ice use and treatment centers.
Like Okay, I'm going to use marketing terms here, like
how do you sell this idea of compassionate connection to
(11:09):
your patients to medical providers that are barely hanging on?
Speaker 1 (11:15):
Honestly, in so many ways, it sells itself because there's
really good evidence that communicating compassionately 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
(11:38):
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 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 they
(11:59):
can owners 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.
(12:20):
I can get through a clinic visit in five minutes,
my 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 you're
talking to and they know you, and that's priceless.
Speaker 2 (12:43):
I really love what you said in there. There's a
book that maybe you're familiar with called Compassionomics. Nice. Yes,
I love that book.
Speaker 1 (12:51):
My friends wrote it, they did.
Speaker 2 (12:53):
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
it takes you, on average ninety seconds more in a
patient visit to 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 we're in, in the time that we're in,
(13:16):
and what the healthcare profession as a whole has endured
the last few years. I think you know, very often
when we talk about burnout and resilience, it's about putting
that burden of resilience and self care back on their
providers who are already fried, and like, here's what you
can do to make this better and version. So I
(13:37):
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 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
(13:58):
the pandemic inside the hospital. Can we talk about that
essay for a minute? Yes, Okay, this was one of
those ones where I was like, I just need to
keep reading it and rereading it because it's so evocative
and so beautiful. Can you give a little all summary of.
Speaker 1 (14:16):
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,
our uncertainty about how the virus was transmitted, the sense
of isolation and dependency that we all felt, the fear
(14:40):
that we were taking it home to our families, the
mass deaths that we witnessed, and then kind of how
we found our way through those early days, which was
really through peer support, really through sharing our experiences and
(15:00):
identifying in each other the light and the beauty and
the magic that we couldn't see in ourselves.
Speaker 2 (15:09):
Yeah, and there's something about the telling the truth part
of that experience of peer support and really seeing each
other that there's this great section where you're talking about
I 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
(15:31):
see what 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.
Speaker 1 (15:40):
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 that will not leave you whole.
Speaker 2 (15:56):
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
(16:16):
speed dating with trauma, right like, 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.
Speaker 1 (16:27):
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 that's through their writing, whether
it's through the creation of art, whether it's through running,
which I will never do that for other people, right
(16:53):
I hear it works. We just need to acknowledge that
we've been through something and we can either a heel
and talk about it or we can bury it. But
it always floats, it will always resurface.
Speaker 2 (17:08):
Yeah, there's a section in that essay in the shape
of the shore where 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 things that you describe 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
(17:31):
is absolutely irrelevant to what they are witnessing on a
daily basis. So I would love to discuss that just
for a second, like that sort of well intentioned but
wrong approach to trying to help people survive a violation
of their values and their beliefs.
Speaker 1 (17:52):
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. There is nothing
that is going to fix it. Everything is a band
(18:12):
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 is just validate
each other's experiences. And I think there was a real
disconnect in those early days between the experience of the
(18:33):
people providing the care and the people who wanted to
help us, and in many ways that was even more isolating.
Speaker 2 (18:42):
Yeah, it's that the wrong tools for the situation, right,
And I see this a lot with 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
(19:05):
the wrong medicine for the situation at hand, exactly. Hey,
before we get back to this week's guest, I want
to talk with you about exploring your losses through writing.
There are lots of grief writing workshops out there with
(19:27):
prompts like tell us about the funeral, that sort of thing.
My thirty day writing your grief course is not like that.
Speaker 1 (19:34):
Them.
Speaker 2 (19:34):
Prompts are deeper, they're more nuanced. They're designed to get
you into your heart and into your own actual story. Now,
writing isn't going to cure anything, but it can help
you hear your own voice, and that is incredibly powerful.
You can read all about the Writing your Grief course
at Refuge in Grief dot com backslash wyg. That is
(19:55):
WYG for Writing your Grief. You can see a sample
prompt from the course and get writing your own words
in minutes. My thirty day Writing your Grief course is
still one of the best things I've ever made for you.
Come join more than ten thousand people who have taken
the Writing your Grief Course refugegrief dot com backslash wyg,
or you can find the link in the show notes.
(20:18):
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.
Speaker 1 (20:31):
Yeah, it's been evolving for me. You know. When I
wrote 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
(20:52):
like the lowest level. Being a bystander to trauma is
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 experiences, but we can validate the
(21:16):
experiences of others as our own by saying 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 being
(21:41):
reductive and saying this is just like a breakup I had,
but really just letting our souls kind of resonate with
each other.
Speaker 2 (21:49):
I love this. It's actually one of the quotes that
I pulled from your work where you say bearing witness
is one wrung up from being a bystander to trauma
of just being a spectator. It's not sufficient and it's
not healing. There's more to the assignment here than just
saying I see you. I feel like I feel like
we've talked so much over these last several years about
bearing witness and paying attention that it's become sort of
(22:12):
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 and
connect with them and serve from that place of connection
and seeing the other as human. But that door goes
(22:35):
both ways. 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 want to
ask you about the work that you're doing to help
doctors understand new community communication styles. But even before we
get there, like, I want to talk a second about
the skills that we need to be better communicators and
(22:58):
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
physicians in better communication styles is you're actually helping them
(23:19):
to feel human again after a pandemic that robbed a
lot of people of their humanity.
Speaker 1 (23:29):
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 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
(23:50):
is allowed to be expressed. And those connections, they're the
only thing that will give young physicians longevity or joy
and work or 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
(24:10):
pages and the phone calls and the mandatory modules for complaints,
and none of that's going to fill our bucket the
way that a connection with someone you're caring for, who
you see as a fellow human will.
Speaker 2 (24:26):
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 beat the humanity out
of you. How do you see the work that you're
(24:47):
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.
Speaker 1 (25:02):
We've definitely come a long way from when I graduated
from medical school twenty years ago. I think that was
the culture break people and force them to be inhuman
Medical education has softened a bit in the interim, and honestly,
they come out really whole. I'm always amazed how much
(25:27):
smarter they are than I 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 that is built for efficiency
(25:52):
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 was school and this is
real life, and in real life, this is how we
(26:15):
do things, and there's no more time for that. And
that 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 conversations, when they've
started to find them challenging, and they have a little
(26:38):
humility about it, but they still have all their idealism,
that's kind of the perfect moment.
Speaker 2 (26:44):
Yeah, we want to protect the idealism, Like you see
this work as sort of this buffer, Like, let's not
let these new idealistic still human folks get devoured by
the machinery.
Speaker 1 (26:58):
Exactly.
Speaker 2 (26:59):
Yeah, 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 still need to worry about being seen
as professionals if they cry on the job, if they're
seen as even being affected by the work, even if
(27:21):
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 healthcare industry is made the humans
who do the work a lot less willing to hold
up the old.
Speaker 1 (27:38):
System, absolutely, because I 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
(27:58):
it hurting our patients saw it hurting our providers. And
if we figured out how much we have in common,
I think that sort of combined lobby of professionals and
patients could do anything.
Speaker 2 (28:13):
Yeah, there's a program that you do now in training
these I just keep seeing this, Sorry, everybody, I keep
seeing y'all, these like little fuzzy chicks that we want
to protect and let grow into the full expression of
the reasons that you got into this field in general.
So that's where my mind is today, protecting the new chicks.
(28:33):
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?
Speaker 1 (28:46):
Yeah, so it really was born out 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 trainee in their backgrounds. So what we do is
we utilize improvisational actors and they're really really skilled. So
(29:09):
depending on the skill level of the 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
(29:32):
daughter drowned in the mini pool at daycare, 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.
(29:53):
But the thought that we used to do that without
training is banana. So we think of 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
(30:14):
can draw off of, and it really creates an environment
that I think no one is hurt, right, 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
(30:35):
when you acknowledged 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 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.
Speaker 2 (30:57):
Yeah, I love all of this. I love that it's theater.
I love that we're employing actors. I also love the
permission 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
(31:18):
being said and not being said right, address what's actually
unfolding instead of managing what's unfolding. Right. I love that
we're not expecting You're not expecting these providers to already
know how to do this. I think 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
(31:39):
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, 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.
Speaker 1 (32:02):
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 is really grabbing straws, or you have a
(32:24):
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 it's so impactful is just bananas.
Speaker 2 (32:42):
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 who is in a stressful situation
or they're anxious about somebody they care about, or they're
(33:03):
anxius 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, but this is really
what you're doing is really turning that upside down and
again coming back to you like the medicine is in
the connection.
Speaker 1 (33:23):
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's story.
Speaker 2 (33:30):
Ooh, 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?
Speaker 1 (33:37):
That is something that is attributable to somebody. So I'm
going to have to give you his name. It's j
Beruche 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
(33:59):
compacts and that kind of close reading 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.
Speaker 2 (34:16):
Yeah, narrative medicine is one of my favorite things ever.
I remember back in my early days, when I was
just a tiny wee 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
(34:37):
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 of getting better. I feel like
you come at narrative medicine without that expectation of a
happy ending. Is that accurate?
Speaker 1 (34:53):
Yes, I rarely have an expectation about happy ending. I
think just going deeper is all I ever hoped for.
Speaker 2 (35:02):
So being allowed to read the story in the room
lets you be more effective and therefore more efficient in
the care that you're trying to deliver.
Speaker 1 (35:14):
And having a belief that I have the capacity to
hold whatever suffering reveals itself. One of the things that
I think we don't necessarily believe in in medicine is
that there is a value in that that sitting and
holding space for someone else's suffering is valuable, and we
(35:40):
worry about the toll that it will take on us,
and for me, recognizing that often for our patients and families,
just having a safe container for it is the most
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 deaf, but I can be present
(36:04):
for it and attend to it and trust that that's
enough in that moment.
Speaker 2 (36:11):
Yeah, allowing what is true to be what's true is
a really powerful act in that moment. I think there's
so much speed in 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 ticking those boxes and chop, chop, chop,
(36:32):
because I've got sixteen patients all in a row waiting
for you after 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. Yeah, with that, so you lean on
what you know, which are the facts.
Speaker 1 (36:49):
Yeah, it's a cloak, right, a shield, It's something we
hide behind. But I've never not done it. 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 robbed
(37:15):
myself too. I didn't trust myself enough to have that moment,
and I've always regretted it.
Speaker 2 (37:23):
Interesting, like it makes me think of, you know, coming
into the medical profession as 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
don't get those moments back to be fed in that way.
(37:43):
And I think there's the two pieces of that as
one is seeing that human connection as nourishment and two
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 regrets about who you are as a person showing
(38:04):
up in this system that is sort of designed to
drill out your humanity.
Speaker 1 (38:08):
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.
Speaker 2 (38:23):
Yeah, I want to go back to what 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 different parts of your
communications work. One is like taking the people who are
interested in learning how to connect and how to address
(38:43):
what's actually in the room. And 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. Yeah, how
(39:05):
do you approach that?
Speaker 1 (39:06):
You're speaking to two really important things? One is accountability.
How do we hold each other accountab bilt 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 write about the bad things
(39:26):
that happened were because 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
(39:46):
nick you nurse and saying you know, it sort of
broke my heart when 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
(40:09):
with other mothers. I just didn't know. When you realize
that everyone who walks into the hospital comes here 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
(40:33):
and saying, you know, it's a shame that 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.
Speaker 2 (40:51):
I love how kind that is. I love how what
a kind teacher you are.
Speaker 1 (40:57):
Thank you.
Speaker 2 (40:58):
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 something the system was never
built for humans, but like there's just so much pressure
to like do better, get better on fewer resources and
(41:21):
kindness inside teaching.
Speaker 1 (41:24):
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 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
(41:44):
moment pass. It's a way of still allowing people to
learn without hurting them.
Speaker 2 (41:51):
Yeah, that is just beautiful and useful and I love
it and I love what you just described. Going back
to 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. Yes, right, you have to be curious
(42:14):
about who they are and what does healing mean to them,
and 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 so much around what we think people
should do, and really curiosity sounds like the better medicine there.
Speaker 1 (42:38):
We have to start with curiosity. Otherwise we fill in
the blanks with everything that we believe and it's not
really healing at all.
Speaker 2 (42:47):
It's not and it just becomes one more thing to
sort of 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 able to be of service in the
ways they most want to and maybe haven't been allowed
(43:09):
to explore in 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 from all of these different angles, from being
a patient, from being a family member, from being a
(43:30):
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 all of these things come together in that line
that you wrote, The work here is to grow a
(43:52):
heart that can hold all of it. I mean, this
is the work.
Speaker 1 (43:56):
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 I think we're all trying
to learn how to do this.
Speaker 2 (44:14):
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, the
subtitle of your book is The Redemptive Power of Hope,
So I'm really curious. I guess two questions. One is,
(44:40):
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.
Speaker 1 (44:52):
As 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 someone could be
dying and the family might not see it the way
that I did, and it felt like a denial of
(45:13):
everything that I knew, and it felt like we were adversaries.
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
(45:34):
that's hope. That was hard to come by, truly 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
(45:57):
was so much hope around. I hope it's nothing. 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 dependent
(46:19):
on any outcome, just hope as an orientation to 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
(46:42):
just is available, and that is what hope is to me. Now.
Speaker 2 (46:46):
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, yeah,
and that 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 what hope is
(47:08):
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 can 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 provider for what
(47:29):
I'm living as a as a doctor or a nurse
or a you know, reproductive midwife. You know, like what
allowing there to be curiosity about hope, I guess is
what I hear in what you're talking about that hope
is a is a living thing that shifts and changes.
Speaker 1 (47:48):
Absolutely and lives in the moment just as much as
it lives in the future. Where can you find joy now?
Speaker 2 (47:55):
Yeah, 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 be
you know, very many of these moments left, but that
there is hope in what we can reach for in
(48:17):
those moments that are to come. 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, promotion of this episode,
because I think everybody really needs to listen to you,
both consumers of healthcare but also providers. It's really just
(48:37):
been 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 just I just really
dig you.
Speaker 1 (48:58):
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.
Speaker 2 (49:10):
Yeah, I really, I just I feel like we really
can create the networks and the relationships that 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
(49:33):
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 going to link to the essays
that I was obsessed with over the weekend. 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?
Speaker 1 (49:50):
I live on Twitter. I am very happy there and
like many people, and my website are not addish. Empt
has links to all the podcasts and articles and it's
a nice place to be if Twitter is scary.
Speaker 2 (50:08):
If you are a Twitter averse to the Twitter universe,
so you will find doctor Otdish 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
(50:34):
you with some questions to carry with you until we
meet again. You know what really struck me in today's
conversation was doctor Otdish'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.
(50:58):
I mean, communication training is very, very often and I'm totally,
I totally do this sometimes like you're doing everything wrong,
let me show you why, and Doctor Odish 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 doctor Otdish or be
tended by a medical provider who doctor Otdish has taught.
(51:21):
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 on too. I'd love
(51:41):
to hear what connected with you or for you today.
Check out Refuge and Grief on Instagram or here after
pod on TikTok to see video clips from the show
and leave your thoughts in the comments on those posts.
That's a great way to tell me how this show
felt for you. Be sure to tag me in your
conversation starting posts on your own on social accounts. If
you want to open a conversation about how we communicate,
(52:03):
use the hashtag here after pod on all of the platforms.
We love to see where this show takes you. Remember
to subscribe and leave a review. Those reviews help more
than you know. If you want to tell us how
today's show felt for you, or you have a request
or a question for upcoming explorations of difficult things, give
(52:24):
us a call at three two three six four three
three seven six ' eight and leave a voicemail. If
you missed it, you can find the number in the
show notes or visit megandivine dot co. If you'd rather
send an email, you can do that too, right on
the website megandivine dot co. We want to hear from you.
I want to hear from you. This show, this world
(52:47):
needs your voice. Together, we can make things better even
when they can't be made right. Want more Hereafter. Grief
education doesn't just belong to end of life issues. As
my dad says, daily life is full of everyday grief
that we don't call grief. Learning how to talk about
all that without cliches or platitudes, or just practice gratitude.
(53:09):
All of that is an important skill for everyone, especially
if you're in a helping profession. Find trainings, professional resources,
and my best selling book, It's Okay that You're Not
Okay at Megandivine dot Co. Hereafter with Megan Divine is
written and produced by me Megan Divine. Executive producer is
Amy Brown. Co produced by Elizabeth Fozzio. Logistical and social
(53:31):
media support from Micah, Edited by Houston Tilley, music provided
by Wave Crush and background noises provided by Luna yelling
at anyone walking by
Host
Megan Devine
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com