Wellness Discussions with Dr Cassie Ferguson

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Chris (00:38):
Welcome to pulse check, Wisconsin.

(01:20):
Good morning, good evening, goodafternoon.
This is Dr.
Ford from PulseCheck Wisconsin.
And I wanted to wish you all avery happy new year, we are
wrapping up the holiday seasonAnd new year, new PulseCheck
Wisconsin episode for everyoneout there.
This episode, I wanted to coverthe topic of wellness,
specifically wellness for all ofour healthcare professionals,

(01:40):
but for everyone out there inthe pulse check audience, this
episode, we were very fortunateto have with us Dr.
Cassie Ferguson, who is apediatric ER doctor, and she
specializes in wellness for notonly healthcare professionals,
but also for our medical schooltrainees, now with that being
said, Although this is a newyear, in looking back at the

(02:03):
previous year, we unfortunatelysaw a tragedy that happened in
Madison, Wisconsin.
My home institution ofUniversity of Wisconsin was
affected, and University ofWisconsin hospital staff and
faculty participated in the careof those victims.
If you guys want to go back onthe YouTube channel and I'll

(02:25):
post it here as well Just alittle excerpt.
We did a video myself and someof the alumni throughout the
country As well as some stateofficials including the governor
and lieutenant governorrepresentative Francesca Hong
who represents the area at thestate assembly level came out

(02:47):
and gave some words ofencouragement to the healthcare
providers that took care of thevictims of this mass shooting.
During our politics of publichealth.
Episode with Dr.
Megan Schultz, as well asrepresentative Deb Andraca.
We talked about the groups thatare most vulnerable and that is

(03:07):
our pediatric demographic.
And so, you know, I won't go inand rehash a lot of the things
that we discussed in thatepisode, but feel free to go
back.
And unfortunately we got to keepworking towards our goal of
reducing the amount of schoolshootings that we see, or
reducing the amount of massshootings that we see in this
country.
But I wanted to extend mysentiments still to University

(03:31):
of Wisconsin Hospital, to theentire Madison community, as
well as to all those affected bythat shooting.
So again, To introduce Dr.
Cassie Ferguson, she is aprofessor of pediatrics.
She's previously served in theroles of quality improvement and
patient safety.
As a lot of you remember fromour first season, she was
paramount in putting togetherour health scholars pathway.

(03:53):
And that program again is to,Encourage and to get more
matriculants from the communityinto medicine in hopes of giving
back to the community.
And so I wanted to bring her onto talk about some of her
experiences as well as talkabout some of the next steps now
in order to help push theenvelope and to help create open
dialogues, dealing withcommunity issues, dealing with

(04:14):
community building, mentalhealth treatment for healthcare
professionals as well as How wereduce stigmatization about
Mental health treatment.
that being said is myDistinguished pleasure to
introduce my friend.
Dr.
Cassie Ferguson

(04:57):
Okay.
Well, again, thanks for beingwith us here today.
I gave an intro at the verybegiNning, talking about all the
amazing things that you're doingboth in the city of Milwaukee
and at Children's and just forthe state of Wisconsin.
But if you could, could you giveus a little bit of your
background and tell us, whatinspired you to pursue this
amazing career in medicine?

Cassie (05:16):
Sure.
Absolutely.
I'm actually a Milwaukeetransplant.
I grew up in Oakland, Californiawhich it's, you know, there's
certainly some similaritiesbetween Oakland and Milwaukee
and really strong positive waysin some ways that aren't as
positive, but I loved growing upin the Bay area.
I think it had a lot to do withhow I approach both my career

(05:38):
and my personal life.
But my dad was an architect.
My mom.
I think you could best describeher as a social justice
advocate.
She's done a lot of work in manydifferent areas but I think that
sort of best captures what it isshe did.
So there was really no one in myfamily, whether it was my
immediate family or extendedfamily, who was in medicine or
in health care at all.
I think growing up, I at onepoint wanted to be a chef

(06:01):
designer an elementary schoolteacher all over the map.
I think what was important wasthat my parents, no matter what
I had decided that I was goingto do that week or that month or
that year, were always verysupportive of what I wanted to
do.
My mom's main rule was thatwhatever I chose, I had to be
the best at that thing, or atleast, you know, attempt to be

(06:23):
the best thing.
So I certainly still hold thatmaximum really, really close to
my heart.
And I also saw how my parentslived their lives, and I
realized that to live in, or towork and live in service of
other people was probably themost satisfying way to live.
So then I went off to UCLA, andin my third year, I went to do

(06:46):
an externship at the HealthPolicy Research Center at George
Washington University.
Mm hmm.
At the time, I thought that Iwanted to do something along the
lines of public health orepidemiology, and I spent, I
mean, honestly, I really wentbecause my best friend was
going.
I wanted to, to spend threemonths in Washington, D.

(07:07):
C., and while I was there, I dida, I did work on really looking
at infant mortality ratesbetween black mothers, Latino
mothers and white mothers.
And specifically because I wasin Washington, D.
C.
I had a lot of interaction withwomen who had moved from El
Salvador, Central America,mostly And I had the opportunity

(07:31):
to really spend time in a lot ofclinics talking to people who
cared for women who were, youknow, having families.
And I learned a lot about how wewere, as a country, failing
mothers.
But it really stood out to methat we were failing black

(07:51):
mothers in particular.
And that there was no socialsupport, there was no network of
support.
And as a result, you know,infants were dying and I really
learned during that time that Ididn't want to be studying these
women from afar.
I wanted to be taking care ofthem directly.
And so I got home one day when Iwas still in D.

(08:14):
C.
and I wrote all the classes.
I was a psychology major at thetime, and I wrote all the
classes that I would have totake to go to med school,
realized that that would mean anextra year in college.
And so that's what I did.
I You know, I, I took an extrayear and then another year to
apply and work, make some money,and then Off I went to

(08:36):
Wisconsin, which was a state Ihad never visited nor, at the
time, could probably reliablypick out on a map since
Californians are so, we're veryCalifornia centric.
That's a problem.
That's fair.
Yeah.
So, and here I am.

Chris (08:54):
Awesome.
Well, you know, what a amazingjourney and, you know, the
selfless journey to a lot of, alot of folks that we have on,
have a similar pathway throughmedicine or pathway through
whatever work that they're doinghere.
We had a couple of folks on fromVotE R that had a similar
journey through, you know,started out as a teacher and
then went to advocacy and getmore information, get more hands

(09:18):
on experience with thatpopulation.
And so one of the things that Icommend you for doing is to take
that step back, especiallyrerouting your career and
saying, okay, this is what Iwant to do.
And the steps that I need totake in order to not only.
Help the situation but identifyit in that first person stance
and the work that you do now aswell It also is a testimony to

(09:39):
it because currently you're inpediatric er over at children's,
correct?

Cassie (09:44):
Yes, I Did my residency training in pediatrics and my
fellowship training in pediatricemergency medicine in denver,
colorado And then came back tomilwaukee in 2010 and i've been
at children's ever since

Chris (09:58):
And, and, you know, a lot of, a lot of that, what you said
in the beginning, we, it mirrorsto what my mom said as well, you
know, the fact that whateveryou're going to do, you got to
be good at it.
Right.
And so you hear that over andover again with pediatric
emergency providers, as well ason the adult side too.
We have all these things that,that, that we're interested in
and kind of focusing it in, butthe recurrent theme is to help

(10:20):
people.
And so that's the, that's thegood part about it.

Cassie (10:24):
Yeah, I think, you know, I enjoy being that sort of that
adage, the you know, Jack of alltrades, master of none.
I don't, I don't mind notknowing, you know, so much about
so many things, but I really.
Love the fact that I can walkinto almost any room, get a
sense for what the family needs,what the patient needs pretty

(10:47):
quickly, and then be able todraw on resources, whether
they're my own, you know, or mycolleagues or a social workers
or a nurses and.
And put together, you know, aplan for the patient.
And I think that's what's soincredible about emergency
medicine is that, you know, wereally we really understand that

(11:07):
it takes a whole bunch of peopleto take care of other human
beings.
So.

Chris (11:14):
You know, exactly.
And especially another one ofthe hats that you wear is that
you are co director for thehealth equity scholars program
that we had on last season aswell.
So very much commend you forthat.
But one of the things that isvery consistent in programs like
that and that program in generalis to take in, To account the
entirety of the patient too.

(11:35):
I feel like emergency medicineis very unique in that respect
and that we are sort of thegatekeepers of the hospital,
right?
So it's the only place where youhave patients that come off of
the street and then they becomea patient, right?
And all that that goes into youknow, that, that presentation
and, and, and considering Thosefactors when you're considering
next steps to disposition aswell as how to treat this

(11:56):
patient.
And also, you know, what's thesafest way for them to go home?
What is the most realistic wayfor them to pursue treatment or
even have access to thattreatment?

Cassie (12:05):
Yeah, I think that that is you know, and perhaps this
came, I remained a psychologymajor when I was in college and
always found it reallyinteresting to, you know, to
understand, to sort of have theskills or the tools to be able
to try and unlock What peopleneed in any given situation, and
I think that that is, it'shonestly what drove me to be a

(12:31):
part of the health equityscholars program, because this
idea that we cannot care forother people without a holistic
understanding of what it is thatwe need.
need, which entails, you know,really understanding their
strengths and what they'rebringing to any situation.
And, and I think we forget thatin patients, particularly when

(12:53):
we're seeing them at their mostvulnerable is this idea that,
you know, there are whole peopleoutside of our emergency
department and you know, theyhave whole lives that have
nothing to do with us and we'rereally just there for a sliver
of time.
And so how do we be, you know,how do we take into account
Everything about them in thatvery small, you know, period of

(13:16):
time that, that we are, arethere to help.
And I, I really, I see that as achallenge, but the most
interesting part of, of our job.

Chris (13:25):
Yeah.
And, and not only patients, oneof the things that you also have
specialized in is, is leadingfocus on the well being of
physicians and medical studentsin your career.
What led you to focus on that?
I know you said you had abackground in psychology, but
what other things kind of ledyou to focus in that, in that
pathway?

Cassie (13:45):
You know, so when I, when I started as an attending
physician, I had just leftfellowship in Denver and coming
back to Milwaukee.
And you know, there's that firstcouple years when you are
suddenly, you know, a real livedoctor.
And, you know, You know, I, Itook some time to really
understand what it is I wantedto do with the part of my life

(14:07):
that wasn't clinical you know,as an academic physician.
And what I was drawn toimmediately was really the area
of quality improvement andpatient safety.
I was both, like, fascinated andcompletely terrified that, you
know, You know, we had all ofthis knowledge, all of this
information about how to bestcare for patients.

(14:29):
And yet, you know, in somecases, less than half of our
patients were actually receivingthat.
That treatment and, and that's,you know, across the board, not
just pediatrics, but in adultmedicine as well.
And that it felt like a waste.
It felt like we had thisopportunity, you know, we've
been spending millions andmillions of dollars to try and,

(14:49):
you know, into to research intowhat would best serve our
patients and really throughthrough an ignorance of, of what
it meant to, you know, Get thosetreatments to the bedside and
into patients homes We werereally wasting all of that money
and so I Kind of dove into payinto quality improvement right

(15:12):
away both into doing projectsfocused on Patients with chronic
illnesses who were had to cometo the emergency department
frequently because of They'reillness, so patients with
diabetes, for example, who wouldpresent with diabetic
ketoacidosis our patients withsickle cell anemia who are
presenting a pain crises andrecognizing that they spent

(15:35):
hours.
in our emergency department andhow, how could we better care
for them and ensure that theyare getting the treatments that
they, that they should begetting.
So that's how it, that's how Istarted my career.
And, and one of them, I would Itaught this program called the
quality improvement and patientsafety pathway, which was really

(15:56):
meant to teach student medicalstudents who were interested in
quality improvement.
sort of help them learn moreabout it.
And I had a group of facultymembers advising me, and one of
those faculty members, who's apediatric critical care doctor,
handed me this paper.
This was back in, I think, 2015or so, handed me this paper, and
it was something, it was calledFinding Joy and Meaning in the

(16:18):
Workplace.
And it was written by this thisinstitute called the Lucian Leap
Institute, which was a patientsafety institute.
And it was the first time I hadever read something that sort of
took the Health care workersperspective into consideration
when they were talking aboutpatient safety and the bottom
line was, we, if we are notsafe, if we don't feel safe as

(16:40):
providers as clinicians wecannot provide safe care to
patients and that was sort ofjust opened my eyes to this.
This whole other aspect ofquality improvement that I felt
we hadn't really, you know,really explored as a profession.
And so, right then, that year, Istarted to teach our quality

(17:06):
improvement students, burnoutspecifically.
And I had I had someone PaulaDavis who was a lawyer and
became a, an expert in, inburnout and resilience.
And she and I started somethingcalled the MCW resilience
project.
And we just put together acurriculum for those students

(17:27):
and it was pretty basic at thetime, but that was how I got
started.

Chris (17:32):
Yeah.
And you brought up a couple ofgood points there, especially
the impact of burnout.
And I feel like that's not onlyunique to our specialty but you
see it in, in, in healthcare.
You see it, you know, kind ofthroughout, you know, any other
professional careers forphysicians specifically, could
you talk a little bit about, youknow, what burnout is and the
consequences for burnout forboth Not only physicians, but

(17:55):
medical students, bothprofessionally and personally,
especially as we're starting tosee more and more mental health
crises and healthcareprofessionals, unfortunately, in
recent years.

Cassie (18:04):
Oh, absolutely.
So I think, you know, beforedigging into the consequences of
burnout, I think it's reallyimportant to highlight and to
make it very clear that burnoutis an occupational phenomenon.
This is not you know, we don'tsee burnout outside of the
workplace.
And it's, it's really a group ofsymptoms that result from

(18:26):
chronic workplace stress.
It.
Thank you.
It didn't appear for a long timein, in the medical, like, in the
list of our diagnoses, it didn'tappear.
It was really describedthroughout the decades, really
from the 1970s just in, in theworkplace in general, it wasn't
specific to medicine and, but wehave sort of co opted the term

(18:49):
in medicine and, and in someways we use it as sort of a
catch all for, for unwellnessand in medicine.
And I want to make it clearthat.
That this is what I, when Ithink of burnout, really that,
that sort of trifecta ofemotional exhaustion and
cynicism and sort of a sense ofthat you've lost the ability to
do what it is you want to do.

(19:11):
When I think of that, I thinkof.
Really that, that while theremay be ways that, that we can
manage it as, as healthcareworkers, really, it's not within
our power to eradicate it.
And physicians and physiciansand training you know, I think
are sort of are made to feel asif they have more power over

(19:33):
their level of burnout than theyreally do.
So so that being said, I think,you know, their burnout can
lead.
To a lot of you know, mental andphysical distress that could,
you know, that then sort of sitsoutside of of the definition of
burnout.
Things like substance abusedepression anxiety disorders,

(19:55):
suicidality, you know, I want tomake it, you know, really
abundantly clear that thosedon't sit under the umbrella of,
of burnout.
They are a direct result ofburnout.
In some cases of of chronicworkplace stress, and there are
study.
I mean, you can find just aboutany study linking burnout to any

(20:17):
workplace.
You know, any type of badoutcome that you can imagine.
So, you know, I've mentionedsome that are really
individually, like depressionand anxiety and suicidality.
But there are also aconsiderable number of studies
that link that link burnout and.
In medical professionals,specifically physicians to

(20:37):
things like worse, you know,worse quality of care physicians
who are burned out are morelikely to report having made
serious medical errors.
It's linked to decreased patientsatisfaction, decreased clinical
productivity.
Lapses in professional behaviordecreases in empathy.
And then students who are burnedout.

(20:59):
And again, you know, linked tothe structure an organization
medical school they're morelikely to also have lapses in
their professional behavior.
There's studies that shows thatstudents who are burned out are
more likely to cheat, forexample, on on exams.
And because of that, you know,that group of, of consequences,

(21:21):
it certainly impacts patientcare.
But when we think about how itimpacts the entire system, the
other thing we have to thinkabout is turnover.
So physicians who are burned outare more likely to leave
medicine early retire earlychange jobs.
And so there's, I saw anestimation that burnout costs

(21:42):
the medical or the healthcaresystem almost 5 billion a year
because of, you know, increasedturnover.
And then, and physiciansreducing their work hours
because.
You know, they, they really needthe time to recover.

Chris (21:58):
And I like one of the things that you said there too,
in that I feel, especially, youknow, in the last 10, 15 years,
especially since I've been inmedicine, you, you see this
shift at least in theory thatphysicians have control over
this and that, you know, we, wehave the keys to the car, to the
vehicle, essentially of drivingburnout or not.

(22:19):
And so, you know, there are somemethods that have been
introduced, you know, their,their wellness, you know,
retreats and things like that tokind of identify it.
But I, I, I think that it's agift and a curse in some
respects, right?
Because at the same time, A lotof things that burn physicians
out, and I can speak for some ofour partners, and I feel like
every medical professional,especially any of us that have

(22:41):
practiced through the pandemic,have felt it at one point or the
other.
You, you can see things that areoccurring in the healthcare
system that are causing burnout,right?
So like if you don't have accessto, you know, the medications
that you need, if you don't haveaccess to even the rooms, you
know, the physical space to seeyour patients, you feel as
though you're not, you know,Providing the adequate care to

(23:02):
your patients that you couldotherwise do if those things
were remedy, right?
and to a certain extent a lot ofthose things are outside of you
know, The the control of thephysicians in in the moment,
right?
And a lot of has to do with youknow things, you know at a
legislative level things at ayou know Insurance level at a
private equity level all thosethings are playing a role in it

(23:25):
but you know, I I appreciatethat you brought that up because
this is something that A lot of,you know, amongst us
professionally, we all talkabout and identifying it is a,
is a key point, but there areother things that are going into
it that, that may not be withinthe purview of us controlling as
physicians, but it is good toknow and good to see those signs
in yourself.

Cassie (23:47):
Yeah, and I think you know, the, the problem that I
see that's happened, and, and Ido, I absolutely appreciate that
health care systems, hospitals,medical institutions are trying
to take some responsibility forthis.
The well being of theiremployees of their staff, but

(24:11):
the bottom line is they are notthey were not designed.
They were not set up to takecare of us in that way.
Right?
So, like, wellness retreats ormindfulness modules, meditation,
yoga, all those things that, youknow, sort of are creeping into
our our hospitals and ourclinics.

(24:32):
That's just not what.
What that's not what they'regood at,

Chris (24:37):
but what

Cassie (24:38):
they could be good at.
Is everything else that you justmentioned, right?
They could be good at really andthey should be at looking at the
underlying drivers of burnout,specifically, meaning the
occupational hazards that weencounter every day.
The fact that our administrativeburden is you know, You know, so

(24:59):
high the fact that as you pointout, there's a tremendous amount
of moral distress that weencounter because our values and
how we want to take care ofpatients don't seem to be lining
up with the resources that wereprovided in our clinical
workspaces and, you know, fromthat standpoint, that, you know,

(25:21):
I, that there's not a one sizefits all and in, in that and in
my section.
So in our, section of emergencymedicine, what makes me well
from an occupational standpointis not what makes my colleagues
in anesthesia well.
And, you know, I learned thatwhen I was the professional

(25:42):
health committee chair atChildren's for several years,
and one of the things that Ilearned When I started was to
talk to every single section inthe Department of Pediatrics and
then all the pediatric divisionsof our colleagues in the, on the
adult side.
And, you know, something like,for example, Epic most.

(26:03):
Most sections I spoke with had alot of problems with Epic,
right?
It's usability, the amount oftime that they spent at home
charting on patients.
But then you go and you talk toAnesthesia and they were like,
this is the best thing thatwe've ever had.
This makes my life a thousandtimes easier, right?
Cause it was, it was designedreally well for them.

(26:25):
And so, you know, if, ifhospitals are going to say, Set
aside resources and time to makechanges.
structural changes that wouldimpact burnout.
Not only do they have torecognize that that's their
lane.
They also have to understandthat it's local and that entail,

(26:45):
you know, it's hard to have toput all of that on a chief
wellness officer, right?
Who's responsible for theentire.
healthcare system.
You, that, that responsibilityreally should be diffused
throughout the organization.
And those people at the locallevel should be empowered to
make the changes that they needto make in order to change the

(27:08):
working environments of theirpeople.

Chris (27:11):
Yeah.
And for, for some of our youngerlisteners, we have a lot of
medical students that listen tothe program as well.
People who are pursuing careersin medicine, et cetera.
What are some of the signs?
You talked a little bit aboutit, but just, I feel that
identifying it in the beginningand identifying those signs in
yourself are, are things thatcould be very helpful in terms

(27:33):
of, you know, riveting yoursituation.
Either it be, as you saidbefore, a career change or
learning how to you know,improve those measures within
your own discipline.
What are some of the signs andsymptoms of burnout that you
normally will teach

Cassie (27:48):
sure.
So, you know, I, it'sinteresting because I talk less
and less about burnout with mystudents.
And and more and more about itwith physicians, but because it,
you know, it's, it looks sodifferent in medical school than
it does in the clinical space.
But for medical students, I, youknow, there's, there's the three

(28:10):
main components of burnout.
The first is emotionalexhaustion.
And that is really You know, Italk about that in terms of when
you are presented with aproblem, maybe you go and you're
talking with a standardizedpatient and you cannot, you
can't muster the, the sort ofthe interest or the compassion

(28:34):
or the empathy for the personsitting across from you because
you just, it's just, The well isdry.
You just

Chris (28:41):
can't

Cassie (28:41):
pull it from someone.
You're sort of going through themotions.
It's almost mechanical.
You know, that's one of those,those sort of telltale signs of
emotional exhaustion that Iadvise students to pay attention
to and whether the underlyingreason for that is burnout or,
or something else.
It's, it's good.
It's good to recognize whenthat's happening.

(29:04):
The second component is cynicismwhich, You know, I think
emergency medicine physicianssort of reliance and

Chris (29:13):
I was going to say, and that's another, that's another
very specialty specific thingto, but

Cassie (29:19):
I happen to really thrive it with sarcasm and a
little bit of cynicism, becauseI think, you know, when we're
not using it as a defensemechanism humor can really sort
of boost all of our, you know,Moods, but that being said if
you really feel like you Like,it's not worth it that nothing,

(29:41):
no matter what you do, nothing'sgoing to change.
You know, and in students thatcan feel like it doesn't matter
how hard I study.
It doesn't matter how many hoursI spend, you know, studying for
step one or for this exam.
Like, it, it won't matter in theend.
I'm, I'm not going to do as wellas I want to.
And then the loss is the, thelast is really sort of a loss of

(30:01):
personal efficacy.
What's interesting to me is thatboth in medical students and in
physicians, this is really thelast, sort of the last sign of
burnout.
It's almost like you, Not asmany people reach that point,
and I think it's because we aresort of a group of people who

(30:23):
really have at least to convinceourselves that what we're doing
like, that we can, we can do it,that we have that, that if we
really just put in enough time,it will be fine, but, but when
that, when that gets lost, whenyou feel as if that you are not
going to be able to help Someonein front of you that you are not
going to be able to, to reallybe the kind of physician that

(30:44):
you want to be that's sort ofthe final nail in the coffin.
As they say, it's really ittends to happen in that order
and emotional exhaustion tendsto be the most commonly seen
symptom in both medical studentsand physicians.

Chris (30:59):
Yeah, and like you said, I think a lot of it, too, is
based on our culture, right?
And so, especially in medicine,we have this delayed
gratification.
A lot of us who have beenworking at this for years, it
starts in undergrad.
For some people, it startsbefore that.
It starts in high school.
You know, you're on this pathwayof achieving this goal of being
a physician, or being a PA, orbeing whatever, a healthcare

(31:22):
professional, and it'll bebetter when.
Right.
So everything is bad now, butit'll be better when I get to
residency.
Everything is bad in residency.
It'll be better when I become,you know, a fellow, et cetera,
et cetera.
It goes into your career.
And on the whole, if you'restarting to feel those stages
and like Cassie said, which weget to that, to that tertiary

(31:42):
stage there, then you're at thatposition where it, no matter
what, you know, your outlook onthings are remaining the same.
And so I think it's reallyimportant and very prudent,
especially as a group ofindividuals who are caring for
other people who are dependingon our empathy, who are
depending on us, bringing thebest part of us, or the, you
know, the best version of us towork in order to care for them.

(32:05):
It's very important to care foryourself in those situations
first before it spins out ofcontrol.
Yeah,

Cassie (32:13):
I think that it's a hard thing to talk about with
students and physicians, too,because, you know, the response
is, and this makes sense islike, well, what control do I
have over over these conditions?
Right?
And and students in particular,I think just feeling at the
mercy of the structure ofmedical education the amount of

(32:35):
work.
Yeah.
The amount of studying that'srequired to get through medical
school doesn't, it doesn't feellike you have any say over that
whatsoever.
And, you know, in, in largepart, you don't.
And

Chris (32:49):
even recognizing

Cassie (32:50):
that and saying, okay, Yeah, there are what do I have
control over and and what isoutside of my control so I can
let go of that and really focuson the things that land and
under my control and focusing onthose.
And, you know, 1 of those thingsthat I talk about frequently is
just pausing.
It's, you know, 1 of the mostpowerful tools we have is, rest

(33:15):
and recovery and and that ideaof pausing and, and this is
something that carries over intothe clinical space as well.
You know, we are always.
Going, going, going, and werarely give ourselves permission
to stop and to just kind oftake, take inventory of what's

(33:36):
going on emotionally for us and,and naming those emotions and
and, and then choosing ourbehavior based on, on what we're
feeling.
And I think that when we getdeep into burnout.
We neglect to pause, and ouremotions drive our behavior

(33:57):
because we're not recognizingthem.
We're not we're not realizingthat we're angry, for example.
We're not realizing that, thatwe're in grief.
And, and so they just drive howwe act in the world.
And that never, that doesn't endwell for students or physicians.

Chris (34:19):
Yeah.
Well, Kathy, I'll tell you, you,you, you are one of my heroes
and have, have been for quitesome time.
I remember I rotated through thepeds er back when I was a
medical student, and I believethat's right when you first
started.
And so, you know, I I, I havealways you know, been in awe of
how you manage some of thesethings.
And in addition, how, how youteach and are able to carry that

(34:40):
message through to, you know,your colleagues as well as.
Some students coming up, butcould you share with us how you
personally manage stress andmaintain, you know, your well
being throughout your career?

Cassie (34:53):
Yeah so I think there, I had a turning point as many of
us did in 2020 in the pandemic.
And you know, when I, and I'vehad the opportunity to sort of
look back and reflect on whatthat period of time has been
like.
Look like and meant for me.
And, and I think that that wasas much as I had really been

(35:16):
talking about and teaching aboutwellbeing, I don't know that I
truly understood exactly what Iwas talking about until I had
the opportunity to go throughthe pandemic with, with the rest
of the world.
And, you know, I remembersitting in my living room and we
were actually listening to theschool board discussion and and

(35:38):
our And listening to them talkabout how well, you know, the
kids were gonna be out of schoolfor two weeks.
And I was like, that'sunimaginable.
What am I going to do with mykids for two whole weeks?
Right.
And, and then as the realitykind of set in, not only was I,
you know, trying to figure outhow I was going to.

(36:00):
I had, you know, three kids andthe youngest of whom was in the
1st grade at the time, how I wasgoing to manage school at home
and then was going, you know,thinking about, well, I'm now
I'm also going into theemergency department where we
were facing things like we, wedidn't have a 95.

(36:24):
we didn't have gowns.
We didn't have well, we didn'treally have anything, but we
didn't have any idea what it wasto take care of a patient with
coven what that meant as far asour risk, what it meant to the
risk that I was bringing home tomy family.
But my, my initial.
instincts and what kicked inwas, like, okay, well, you know,

(36:44):
my kids are going to, they'regoing to get online and they're
going to learn how to writefrom, like, the New York Times
and they're gonna they're gonnado, we're going to do yoga
together at lunchtime and we'regoing to take nature walks.
And, you know, I I was gonnalearn to make, Sourdough bread,
all the things that I was like,okay, well, if I, you know, if I
don't have control over this,then I'm going to take just

(37:07):
Matt, I'm going to take controlover everything else in my life.
And, and I, you know, because mynatural way of dealing with
things, and I think a lot ofours who are in the medical
profession is to over function.
That is our response when we arepresented with a challenge.
How do I do?
Not only what's necessary, butlike 10 times that and and

(37:33):
that's what i've learned Is is away, you know, it's as a result
of practice Of beingperfectionist.
It's also sort of arm helps usarmor up against feeling
vulnerable, right?
So if if we're just workingworking working we can't ever
stop and and understand how howvulnerable we feel And so I kept

(37:56):
I kept that up for about twomonths And then I suddenly well,
not suddenly, but I startedwaking up at like three in the
morning and every day it wouldbe three.
I would roll over and look at myclock.
It was 3 a.
m.
and I couldn't fall back asleep.
So I would get up and I wouldstart, you know, doing
something, working, doingsomething related to the kids

(38:19):
school.
And this went on for a couple ofmonths every single, every
single morning.
I started having, like, feelingmy heart race, like where
there's a point where I couldn'tcatch my breath.
I would cry on my way to work.
I would cry on my way home fromwork.
I would get really upset when,like, if my husband would make

(38:41):
very sensible suggestions, like,you know, you don't need to
sleep at the hospital.
Like, just come home, changeyour scrub, you know, like, You
can stay here.
I would get just incensed likehe didn't understand what I was
having to deal with and, and andI did all of that.
And this was what I think wasthe biggest takeaway is I was
experiencing all of that alone.

(39:04):
I didn't tell anybody else.
I didn't tell my family.
I didn't tell, you know, mysister, who's a confidant of
mine.
I didn't tell my best friends.
And it wasn't until I.
Broke down in front of one of myfriends who luckily also happens
to be a psychiatrist and shesaid, okay Here's what you're

(39:24):
gonna do.
You're gonna call your primarycare doctor You're gonna get on
a zoom visit with her and you'regonna tell her that you would
like some Lexapro and that'swhat I did and I started Lexapro
in May of that year and Itdidn't it didn't take away
every, you know, it didn't wipeeverything away You But it meant

(39:46):
that I slept, it meant that Istopped having headaches, it
meant that I stopped, you know,having heart palpitations, and
it at least gave me sort of thatpause, right, that, that just
that, the ability to rest andrecover when I needed to, and
it, I think that that, thebiggest shift that happened was

(40:09):
that I now reach out when I'mhurting, like, even if it's just
to like text a friend and justbe like, hey, okay.
This horrible thing happened atthe hospital.
I don't really know what to donext.
Or to say, hey, can we go get acup of coffee?
And so I have this very thisvery specific way.
Like, when I am.

(40:30):
When I notice I'm not doingwell, I, I try and name the
feeling like, is it exhaustion?
Is it grief?
Is it anger?
I sort of, this is going tosound crazy, but I welcome those
emotions into the fold.
Sometimes I name them.
So like I have this particularvoice in my head that's very
critical, that sort of, youknow, it's like, Oh, you're not

(40:53):
doing as well as you should.
You should be doing these 20other things.
And I named that voice ReeseWitherspoon for a variety of
reasons.
So I'll say, you know, like,okay, there's Reese Witherspoon.
I'll give myself some compassionfor those feelings.
And then, then I'll just try andcheck off the easy things,
right?
Am I thirsty?
Sometimes I just need a glass ofwater.
You know, am I hungry?

(41:14):
Do I need to get outside?
And if it's more than that, ifit's truly overwhelmed, then I
will stop.
And I, as I said, I will reachout to people.
And I think that that has been.
A game changer and it's thatsense of interdependence and
interconnectedness and, youknow, and that real feeling that

(41:35):
we are all sort of entangledwith one another.
And that that makes us so muchstronger.
That has been key to my.
You know, staying well, or atleast recognizing when I'm not
well and being able to recover.

Chris (41:54):
Yeah.
And, you know, thank you forsharing that because I feel like
a lot of us, especially inmedicine, but you know, just,
just in modern society, we tryto push off those feelings,
right?
Especially, you know, in themedical field, we're told to
just continue to push and takecare of your patients and move
the meat and emergency medicine,right?
That's, that's, that's the adageto just kind of get patients to

(42:15):
their disposition.
Yeah.
But to take that time to, firstoff, like you said, identify the
feeling and then secondly, namethe feeling and then try to
figure out a way, you know, howyou're going to not only accept
that, but also move forward.
Those are things that, that we,we typically don't do especially
if you have any other strains,you know, both personally in

(42:36):
your family and financially fora lot of folks too.
And I feel like the, one of thesilver linings out of the
pandemic was to.
Provide that silence for aminute, right?
Like we had so much that we weredealing with in the moment and a
lot of that was unknown as well.
We didn't know what we were upagainst and we didn't know sort
of the social strains and theeconomic strains that it would
have, but it provided that timefor us to look further into

(43:01):
that, right, to, to build ouremotional IQ to say, you know,
this is something that I'mfeeling and that's okay.
Right.
It's okay to seek thattreatment.
It's okay to take a step backand not care for everyone, but
care for yourself as well.
And without doing that, youknow, it would, the, the symptom
is manifest and it can turndangerous, especially in the
medical field, as we've seen inthe, in the most recent years,

(43:23):
we've seen a number of folks whounfortunately have been at their
time of crisis that, you know,have committed suicide or, you
know, have turned to substanceabuse, et cetera, et cetera.
And so, you know, naming thatgoes a long way in preventing
those those outcomes and it'sprudent for us to do so as the
stakes are very high and, and,and you need to know that about
yourself.

Cassie (43:44):
Yeah, absolutely.
And I you know, I, I think thatone of the things that that we
don't teach medical students, I,I don't think that anyone really
learns this, honestly, and nomatter what profession or career
or job they have you know, we,In medicine, we're, we're

(44:05):
witness to suffering like thatis, it's really sort of the
central part of our job and, andperhaps more in, in emergency
medicine than, than otherfields, but it doesn't matter,
you know, we are we're witnessto all sorts of, of pain and
suffering and whether it's ourown or Or our patients or

(44:29):
friends or colleagues orwhoever, we're not really taught
the impact that that can haveshort and long term.
And we're certainly not taughtwhat to do with it.
And one of the things that hasstuck with me, there is a
meditation teacher.
Named Ram Dass.

(44:50):
He died a couple years ago, buthe, he has this he, he says, he
says this a lot and, andbasically he said that we have,
as a species, as human beings,we have a natural aversion to
suffering.
Right.
And, and that our tendency is totry and distance ourself from

(45:14):
it.
And in many ways, the pandemicmade it impossible to do that.
It's suffering.
We were steeped in it.
And and I think it sort ofshowed where the cracks were in
our profession in particulararound.

(45:34):
Well being because you know ineven in a perfect system, even
if our health care systemDecided tomorrow that they were
going to implement everyStructural and organizational
change that we needed in orderto you know Support health care
professionals.
The fact of the matter is is youand I would still show up
tomorrow and we would still bewitness to you know to Telling

(46:01):
somebody that they have leukemiato being a child try and die by
suicide to seeing kids drown,right?
So we see just enormous pain inour job, and that's not going to
go away, even if our hospitalchanges all of its policies to

(46:22):
support our well being.
And if we don't develop theskills to sit with that
suffering and, and reallymetabolize it, as opposed to
like, Use all of our skills topush it away and to maintain our
distance from it.
We're going to be, you know, wereally are going to be consumed

(46:43):
by it.
And, and that's like, when wechew it, when, Instead of
sitting with it, we do thingslike try and numb ourselves,
right?
So we that's why we havesubstance abuse issues.
You know, we, we try andcompartmentalize it away.
And.
Those types of responses arewhat got me to where I got in,

(47:09):
in 2020.
That's right.
I literally was sort of consumedby it because I wasn't
responding to it and not able tosort of see it for what it was.
And those are really the skillsthat I think that I feel a
responsibility to teach tostudents and to physicians who
never learned them as students.

(47:29):
And, and that's where I feellike I can make.
A difference, right?
I mean, that's where I feel likewe have, we have a locus of
control there.
We have leverage there.
Again, we may not be able toforce the hospital to make
changes, but, but we can reallywork on how we sit with
suffering.

Chris (47:49):
And, you know, I wholeheartedly agree with you on
that.
And just to get back to some ofthe other things that you're
doing too, you recently wrote amanuscript on, you know,
outlining some of the principlesof medical student wellbeing.
But as we discussed before thistoo, I feel like this message
should be.
Brought out to everyone.

(48:10):
I feel like this this could haveapplicability for everyone in
every walk of life, and you'recurrently working on on that
manuscript as well toEncapsulate everyone else too
Can you give us an overview ofsome of the key themes and some
of the key messages in your bookand that message that?
You're that you're that you'regiving out.

Cassie (48:27):
Yeah.
Well, and it it really startswith that The central premise is
that all of us, like all humanbeings are a witness to
suffering and that we don'treally deal with the fallout of
what, of what all thatwitnessing does to us as well
as, as well as we could.

(48:48):
Mostly because, as I said, wetend to find suffering aversive
You know, a recent story came tomind when I was thinking about,
you know about what this meansand what this actually looks
like in the practice ofmedicine.
And, you know, I took care of alittle boy who had gone to a
friend's pool party, and by thetime other parents had noticed

(49:09):
that he was gone, he was, he hadbeen at the bottom of the pool
for several minutes.
And EMS was able to get a pulseback before they brought him to
our trauma bay, but he wasreally sick and I was the one
who was responsible for tellinghis father you know, his dad who
had just dropped him off at thisparty hours before perfectly
happy, perfectly healthy.

(49:30):
And I was responsible for sortof deciding how much truth was
merciful, right?
Like this idea that, you know, Ididn't think that his son would
ever leave the hospital and, andI, And I had to tell him
something along those lines.
And so all of us are constantlyreminded of how fragile life is.

(49:52):
I mean, I, at the, I had a son,I have a son who's the same age
as, as his son.
And, and it seemed natural towant to turn away from that
pain, to completely avoid it.
Completely avoid talking aboutit.
And so that the attendance orreally sitting with it is so it
feels so counterintuitivebecause we think that we're
going to be swallowed up by itand.

(50:14):
You know, what Ram Dass said wasthat when we do that, then we
be, then we're really at themercy of suffering.
So the book is really about howwe keep our hearts open amidst
suffering from how we bear theunbearable.
And I tell it obviously throughmy lens as a physician, but also

(50:37):
as, you know, a daughter and amother and a wife and a friend.
And And I tell, I really talkabout the skills that we need in
order to be present withsuffering through stories.
So certainly my own stories thatI have from medical training
and, and medical practice.

(50:57):
And then my colleagues Iinterviewed many medical
students for the book.
Who told me their stories andreally sort of use that, that
framework to talk about andintroduce specific, very
specific strategies and skillsthat we can kind of

(51:20):
operationalize what it means tosit with suffering, right?
That's.
That sounds really great.
Sounds very poetic but what doesthat actually look like in
everyday practice?
Like what does that look like inall of our lives and how do we
actually make that happen?
And so that's, that's reallywhat the book is focused on.

Chris (51:39):
Awesome.
So where, where can ourlisteners, I know that you're
currently in the process ofworking on it, but where, where
will they eventually be able tofind your book and how can they
learn more about your work?

Cassie (51:51):
So right now I'm in the process of editing, so it could
be.
This is the first time I'vewritten a book, so I am not sure
when the time will come.
My hope is, you know, sometimelate next year, but it will be
widely available, is my hope.
Right now I do write onSubstack, so I have a Substack

(52:13):
account, which I'm happy toshare with you for, it's under
Cassie Cron Ferguson, and that,I really use that as sort of
just a, A holding space forstories that I that are in my
head that I want to get out onpaper, some of which will, you
know, appear in various formsin, in the book itself.
And some of which are just sortof musings that I, you know,

(52:35):
just want to get on paper.
But that's probably the bestway.
And then, you know, certainly asfar as.
You know, other things that I doat MCW as you mentioned, the
thing that I'm most involvedwith and is closest to my heart
are the health equity scholarsand the health equity scholars
program.
And that program can be, youknow, information about that

(52:55):
program can be found on MCW'swebsite.

Chris (52:59):
Awesome.
Well, definitely link all thattoo.
I know the health equityscholars program is already
linked to the website, but we'lldefinitely link your sub stack
and some of the articles thatyou've done in the past and some
of the amazing work that you'vedone.
And I want to thank you so muchfor coming out and sharing your
thoughts.
This is very valuable for.
Not only our medical students,but for all of our listeners I
feel like wellness and, andespecially, you know, building

(53:20):
up our emotional intelligence,talking to ourselves through
some of the issues that we'regoing to, and actually allowing
ourselves to feel those feelingswill go a long way in terms of
healing us as, as a whole personand then going forward.
But with that being said, do youhave any final thoughts or any
final messages that you wouldlike to share with our audience?

Cassie (53:40):
Hmm, no, I think, you know, I, I want to say.
Thank you to you too.
I, I feel like so oftenphysicians stories aren't told
and that the more that we canmake the lay public, you know

(54:02):
aware of what it is, you know,we do every day and the kinds of
situations we find ourselves in,you know, I think one of the
things that's been hardest And Ithink it's really been difficult
for physicians and medicalstudents well being recently and
post pandemic is sort of this,you know, the politicalization

(54:24):
of, and I said that word wrong,but making,

Chris (54:29):
making

Cassie (54:30):
vaccines, for example, making science political and
That I think has been reallyhard for those of us who are
doing this every day towithstand and to feel as if, you
know, we are really seen forwhat it is we're trying to do,
which is, you know, Tocompassionately care for other

(54:51):
people and, and everybody, youknow and so I think, you know,
you putting yourself out thereon this podcast and, and pulling
in voices of physicians andpeople who are really connected
with the healthcare system is apowerful part of changing that
narrative and, and really makingit clear that, you know, That we

(55:14):
are all interconnected, and weall rely on one another so
intimately that that to, to sortof to view health care through
that lens will be.
It hurts.
It hurts us.
So I appreciate you doing whatyou're doing and thank you for

(55:36):
having me on.

Chris (55:37):
Absolutely.
Well, thank you so much, Cassie.
I appreciate it.
And best of luck with everythingyou do and I'm sure I'll be in
touch with you.
Hopefully it'll help out in anyway that I can with the scholars
program as well.

Cassie (55:47):
Absolutely.
Thank you.

Chris (55:49):
All right.
Thank you.
Very special.
Thanks to Dr.
Ferguson for coming out andspeaking with us.
We're very much looking forwardto seeing all the things that
she's going to continue to dowith the health equity scholars
program, as well as all thethings that she's going to do
with healthcare providerwellness.
I want to thank you all forcoming out and listening again,

(56:11):
as always, we're very muchlooking forward to the new year
we're going to have some greatepisodes on the horizon.
We're going to have some thingsthat we're going to be doing
with the show as well.
So looking forward to unveilingthat and to have you all
involved as you always have beensince the beginning of the show.
So feel free to continue toreach out, continue to ask

(56:32):
questions and to provide yourinsights so we can tailor this
to how you all want.
This is a community show.
We're looking forward to usingthis show as we have been in the
past to help improve the issuesas we see it in our communities,
as well as to help create agrounds for discussion of these
topics.

(56:52):
Tune in, in the upcoming weeks,we've got another great episode
on horizon.
And with that being said, asalways take care of yourselves,
take care of each other.
And if you need me.
Come and see me.