April 16, 2020 • 38 mins
The heaviest burden of Covid-19 has fallen on the shoulders of medical staff, first responders and others who care for the sick and vulnerable. These people are saving lives, while putting their own health and mental wellbeing at risk.
Several doctors and nurses have written asking for advice on the small ways they can make their daily lives a little easier to bear. So we asked cardiologist and wellbeing expert Dr Michael Rocha to explain the ways he's preparing for shifts on a Covid ward.
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Episode Transcript
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Speaker 1 (00:15):
Pushkin. Welcome to a special set of episodes of The
Happiness Lab. The now global spread of coronavirus is affecting
all of us. This disease has brought a host of medical, economic,
and political problems, but it's also given us a ton
of uncertainty and anxiety, which are beginning to have an
(00:36):
enormous negative impact on our collective While being but whenever
I'm confused or fearful, I remember that looking for answers
in evidence based science is always the best way to go,
and that's where I'm hoping this podcast can help. I
often get emails from listeners asking for specific advice, but
(00:57):
one of the ones I received recently really struck me.
It was from the director of a hospital emergency department,
someone who had spent the last few weeks on their
front lines fighting COVID nineteen. Talked about the fear and
anxiety so many healthcare workers were facing right now, and
asked if I could devote a special episode to helping
medical staff and first responders with some science based tips
(01:19):
specifically designed to protect their well being during this crisis.
Like many of you, I've been wondering what I could
do to help the brave folks who are working on
the front lines of this crisis. But I also didn't
want to give such advice lightly, and so while I
desperately wanted to help, I also wanted to make sure
that I understood what those heroes were really going through.
So I put out a call to a number of
(01:40):
my long time doctor friends, a science buddy from college
who's now a leading oncologist, and my best friend from
elementary school who's now a board certified family physician. I
asked them to share the specific challenges they were facing
and what questions they and their teams had about how
to protect their mental health during this crisis. And then
I put out a call to someone who I knew
(02:00):
would do a great job walking me through all these questions,
doctor Michael Rocha. Doctor Rocha or Mike as I know him,
is a successful ideologist, but I know Mike in a
different capacity. We went to high school together back in
my hometown of New Bedford, Massachusetts. Since graduating, Mike's gone
on to become one of my town's heroes. He founded
(02:22):
a group called the New Bedford Wellness Initiative, which provides
free resources to our community about happiness and healthy living
In doing so, he's basically retrained as a wellness expert
and one that really practices what he preaches. He lost
over eighty pounds through healthy diet and exercise, He meditates regularly,
and he practices many many of the tips that I
(02:42):
talk about in this podcast. But the reason I really
wanted to talk to Mike for this episode is that
he and his medical group have also been on the
front line tackling COVID nineteen, and like many specialists, he's
been asked to help out beyond his own area of
expertise in order to best treat coronavirus patients. Since I
knew Mike was dealing with these challenges directly, I thought
(03:04):
he'd be the perfect sounding board for some of the
tips I wanted to share. I called him home in
his study to record our conversation. All right, so you
can start it? Got it? Yeah? It says continue here.
I'll just hit continue, right, that's all. Yeah, that's your work.
Here we go. Yeah, So I wanted to start at
the beginning because we like you and I actually met
in high school. I think that that's right. I wanted
(03:27):
you to start with just give me a sense, just
on the ground just really generally, like, what is it
feeling like to be someone who's in healthcare right now?
The feel is is that it's trying to ride a
roller coaster because the information is coming in incredibly quickly.
We in medicine are seeing, you know, one study that's
positive and then the next study that's not so positive.
(03:48):
Things keep changing, and also in certain places right now,
there is a very high anxiety as a cardiologist that
you know, two months ago, I would never thought that
I was going to be in a situation that, you know,
going into a patient's room is potentially going to be
something that I was going to have to wear a
gown and you know, a mask and an advisor and gloves,
and so there's a lot of anxiety around that. I mean,
(04:10):
it sounds like just the normal care that you would
normally give, which was this kind of like normal and routine.
It potentially even could be deadly now, I mean, not
even to take an extreme position. Yeah, I have a
friend of mine, I have someone I trained with that
was in the front lines of New York and she's
been admitted to the hospital down there for about ten days.
She's doing better, but you know, she's my age. So
(04:31):
you know that's actually for doctors, especially younger doctors. It
has really caused us to pause because we're young, we're healthy.
It's not something we would actually expect to have to
deal with. And so I want to walk through some
of the things that the science of happiness can help
with in this incredibly scary time. You know, we sadly
there are major structural problems in terms of the amount
of PP access and what hospitals and administrations are doing,
(04:54):
like you know, as a podcast to us, I can't
help with those, but I think there are certain things
we can help with in terms of making sure that
physicians and first responders are protecting their mental health. And
so I wanted to dig into some of the stuff
that you just talked about. First. Give me a sense
of the kinds of emotions that positions and first responders
are going through right now. I mean, one of them
that I hear a lot in my emails is anger
that just like you know, this is an awful angering situation. Yeah,
(05:17):
I think that there's no doubt that there's a lot
of anger out there. And I think that if people
get caught in that situation where they're angry, they're not
actually able to be most effective. But the sense that
we don't feel protected in the United States is a
big thing for people and it's understandable to be upset
about that because we should be prepared better than what
(05:38):
we are. And I think that there is a lot
of disappointment. Let's just leave it at that that, you know,
certain people or organizations that could have made changes and
could have prevented the potential risk didn't, And I think
that that emotion rises up and affects the way people
are feeling these days, especially docs and nurses. And then
(05:59):
I think another emotion we already talked about it a
little bit is fear. I mean, talk about the ways
fear is playing out among first responders right now. People are,
you know, breaking down, they're crying, they're afraid. You know, again,
we have to take that extra pause, you know. I
actually had a situation the other day where I needed
to call nine one one on a patient that was unresponsive,
(06:22):
and I had to make sure that I told them
upfront that there was a concern that that person may
actually have COVID, and that causes everybody to kind of
sit there and go like, oh my god, right, you
know again, I think there's a fear amongst cardiologists that
we you know, it's really hard to tell whether the
patient actually has a COVID manifestation on an EKG or
their presentation, or they're actually really having a heart attack.
(06:44):
So now we're kind of like second guessing ourselves because
if we take somebody to the calf lab to put
in an emergent stent and they actually don't have a blockage,
well then we just exposed potentially six people to an infection.
And that's anxiety for folking because we know that COVID
can affect the heart, and you know, we hear, we
keep hearing over and over again how it affects the
(07:05):
respiratory of the lungs, but it can affect almost every
organ system. Seems like you're not just afraid for your
own health and safety. There's a real fear for first
responders bringing this home to their family, to their kids,
to people that they care about, right right, Absolutely, you
know it's caused a lot of isolation. So you could
be walking around your house with your family and your
(07:26):
concern is that, well, I could have COVID. I don't
know yet. I don't have symptoms I certainly don't want
to give it to my family, And I think that
a lot of people in healthcare first responders are actually
taking extra measures when they come home at night and
they maybe in in their own room, or actually some
people in healthcare are going and staying in hotels to
stay away from their families. That's a tough one, and
(07:47):
so I want to talk about strategies that can come
from the science for how you and other healthcare professionals
can regulate some of these emotions. I mean, I think
maybe the first thing to say is that obviously all
these emotions, the fear and the anger are completely justified,
Like it's awful that you're in these situations and you're
really facing a threat that's like incredibly real, and so
it makes sense to be afraid. The problem, I think
(08:08):
is know for doctors, it's also not good to be
angry and afraid, like it feels yucky and it affects
your decision making. And so if there was something that
could be done to regulate those emotions, it seems like
it would be a smart thing to do. The story
I'm always reminded of when I hear tales of healthcare
workers who are facing this stuff. Is this Buddha's story
about the second arrow. I don't know if we've talked
about that before, but you know, this is this idea.
(08:30):
You know, Buddha's telling his followers the story of you know,
if you get hit with an arrow, you know, is
that really bad? And the followers say, yeah, that's terrible.
It's like, well, if you get with a second arrow
and a third arrow, is that worse? And the followers say, yeah,
that's worse. And Buddha goes on to say that, you know,
the first arrow is the circumstances in life. That's like
the actual bad things that are happening. You can't control those,
but in some sense you can try to control the
(08:50):
second arrow, which is your response to those horrible circumstances.
And I feel like in healthcare now, it's not an
arrow like you all are getting shot with like AK
forty seven, like you know, like the first arrow is
much bigger than like a regular arrow. But I think
there's still there's still a world where there are strategies
that could be useful to regulate these emotion and so
I think it's really important. And you know, one that
(09:11):
I've been talking with a lot of folks about is
just this ability to kind of regulate the threat response
generally like in the body, like what folks can do
to sort of shut off there or at least kind
of calm down your sympathetic nervous system a little bit.
And so can you give me a two seconds on
like the sympathetic nervous system and just like fight or
flight response. I mean I could do it too. You're
(09:31):
the doctor. So yeah, so the fight or flight response
is you know, I deal with that quite a bit,
and you know, honestly, it means actually, I can't tell
you how often that comes up in cardiology, where you know,
your blood pressure goes up, your heart starts to race,
you know, again, you start taking blood away from various
(09:53):
peripheral types of otteries. So it's really again that heightened
sense of awareness. Hopefully, though, that's only a very brief response,
and you don't want to be in that that mode
for a long period of time because it's very detrimental. Right.
You know, you may be able to do that quickly
and it may save your life, but if you're doing
that the whole time, it's not saving your life. It's
(10:15):
usually going to hurt you. And the beauty is that
even though for the most part, we can't really take
much action on our autonomic nervous system other than like
removing the threats that are out there, which you know,
obviously if we could do that with COVID nineteen we would.
But the beauty is there is one way that we
can kind of chill out our sympathetic nervous system, and
that is through our breath. You know, the action of
kind of taking you know, a couple deep breaths, you know,
(10:36):
especially deep belly breaths where you're going really slow and
breathing not into your chest, into your belly. That can
actually activate the parasympathetic nervous system. And the act of
doing that, we know, can regulate again these emotions that
the catecholamine system are signaling, like you know, that fight response,
which is all this anger and those kinds of emotions,
or even the fleeting response, which is the fear and
(10:56):
the anxiety and that panic. Just the act of taking
those deep breaths can really make a difference. Do you
think that's something that kind of doctors and the trenches
could potentially use in this time? Yeah? I think you
know that that type of breathing is very important, and
in fact, patients in the office where you know, again
they come in their blood pressures up, the heart maybe racing,
and I will go through that. Sometimes you can bring
(11:17):
the blood pressure down by just twenty points that way,
So you know, again, activating the vagal nerve and the
parasitic sympathetic nervous system can be one of our best
allies to combat the increased adrenaline and the fight or
flight response, which I think is important. I mean, it's
ironic that you say that you do it with your patients,
but I feel like doctors need to do it with
each other now, and healthcare professionals need to do it
(11:39):
for themselves. I have a daily meditation practice, so I
absolutely and I didn't always have that, and I probably
would say that it's been more over the last five
or six years. It's absolutely critical, and it's really made
a huge difference in how I'm able to approach things,
and not just in medicine, in all aspects of life.
So I want to dig into a second thing that
(12:00):
I hear a lot from medical professionals right now, which
is how hard it is for them to get self
care and all these different domains. So I'm thinking about,
you know, their sleeve, like them eating right and all
these things. So talk through what you're kind of seeing
among your colleagues, like in terms of how hard it's
been to engage with self care during this battle. I'll
just give it for instance, in terms of nursing. For example,
(12:21):
you know, some of the nurses that are on these
COVID units are actually in full regalia or the full
personal protective equipment, and just by having that on makes
it really hard to take a break. So you know,
you've got people that maybe doing your entire eight to
twelve hours shift on their feet with really not even
eating well or drinking well. And if you're in that
(12:44):
situation for eight straight hours at that kind of intensity,
you've basically got your fight or flight response on the
whole time, unless you have some adaptive mechanisms to be helpful.
And then the other thing is is that, no doubt,
when you're faced with these kind of traumas, trying to
wind down at night and trying to find the ability
to kind of be able to decompress to sleep is
(13:05):
a big problem. And then you know, if people are
working longer shifts and not get out till late. You know,
there's sleep is being reduced. You basically you sleep, you
go to work, and you know, there's not a lot
of time for people to be necessarily exercising or you know,
again meditating for an extended period of time. So this
schedule that is forcing people into is really not one
(13:28):
that's conducive to self care. And so I guess, you know,
from my science of happiness perspective, that advice would be
that people just need to make some of these things
non negotiable, you know, especially sleep and rest, exercise, you know,
healthy eating. I mean, these are the things that we
need to double down on when our mental health is
in jeopardy. I mean, they're also the things we need
to double down on when our immune system, you know,
(13:49):
needs a little rev up too. Right, So this is
exactly the time when healthcare workers need to protect their
immune system with all these different practices, and they're not
doing that. And so what would it look like on
the front lines to really make these things non negotiable
right now? That's a real challenge because you know, we
don't have reinforcements or actually currently asking doctors and people
(14:10):
that have been out of medicine or maybe you've been retired.
We're asking for volunteers to fill in, so we're really
out of place where you know, it's it's survival mode unfortunately,
and you know, you can't be in growth mode when
you're in survival mode. And that's that's the real challenge.
I mean, one of the reasons I was excited to
have you on the show is I feel like you've
been really good at practicing what you preach eating during
(14:31):
tough time. So eventually folks are going to come home
from these long shifts, like what can they do ahead
of time to prioritize sleep? I think simple things like
you know, staying off the internet when you get home,
you know, positive sleep habits like you know, putting the
phone away, you know, and trying to get to bed.
Maybe even healthy eating like not eating a huge crazy
meal or drinking. Like what does it look like in
(14:51):
your own life to prioritize some of these things? Yeah, no,
I actually I usually eat pretty healthy, but over the
last four weeks, I don't think that I could eat
much healthier. I have been like ridiculous every day. It's
been regimented, and you know, lots of fruits and vegetables,
and not some beans and lots of water, and and
I have really, I've really tried to actually mentally prepare
(15:13):
and physically prepare in such a way that's really important.
So eating healthy is not just good for our physical wellbeing,
but we do know that it's good for your mental wellbeing.
So if you're coming home and eating, you know, sugary
snacks or having a bunch of drinks, it's first of all,
those things are going to interrupt your sleep. You're not
going to sleep well, you're not going to feel any better,
and you won't be prepared. So you know, again, I
(15:35):
personally really believe that the work that I did beforehand
to get me in the space to be able to
eat healthy in regiment that has been important sleep by
making sure that you know seven hours and you know,
trying to balance all those things is always still a
challenge because again, next week, some of those things may
not be completely in my hands. But I'm going to
have to do the best I can within those circumstances
(15:56):
of what I've prepared to do. I love two things
that you said there I think are so important. One
is this idea that you know, even if the system
is against us, there's still a lot of things that
we can control. You know, there's still a lot of
agency that you can take over what you're putting into
your body, over how you're going to bed and when
you're going to bed. But I also like that there's
some self compassion there, right, Like you said, you're going
to do the best you can, and it might not
(16:18):
be as good as it was before. But even those
baby steps that healthcare workers can take right now, even
though you know, increasing your sleep by fifteen minutes, or
you know, grabbing a piece of fruit instead of a
candy bar, like those small changes are actually going to
have a big difference on your health but also on
your mental health right now. And so these baby steps
can be so important. Yeah, I've also and this happened.
(16:38):
I've done this before. In various weeks that get busy,
I make sure that I exercise. I'll do a four
or seven minute workout. I make sure I walk as
much as I possibly can, you know, and that and
that can be a good way to distress coming home
after work. You know, maybe my workout in the morning
isn't as long, maybe my meditation and practice is cut
a little bit in half, or some of the stretching
(16:59):
that I do. Instead of doing you thirty seconds to
jump in jacks, I'll do ten. But trying to make
sure that I still maintain that because that actually has
made a big difference for me in the past when
I been in situations where I've had to alter the
way I do things in order to fit the time
the timeframe. So in addition to the issues with finding
ways to prioritize self care, I think we also have
(17:20):
to just recognize that healthcare workers, especially healthcare workers who
are on the front lines of this virus, are seeing
an incredible amount of suffering. I mean, healthcare workers obviously
face life or death situations in some cases all the time,
but in some ways it's different now. So I want
you to talk a little bit through the differences and
the way that suffering is kind of affecting people psychologically.
It's the difference between drinking from the FATA and drinking
(17:42):
from the from the fire hydrant. Right now, you know,
as you can see what's happened in New York, and
I have friends of mine down there, and the overall
volume of suffering is on a level that we've never
had to see, you know, I've heard stories and you know,
very heart wrenching things. You know that it was really
sad for me to see that the er doctor in
New Jersey actually passed away from this. You know my
(18:05):
experience when I was a resident in the a Medical
Intensive United a very very busy tertiary care hospital at Tufts.
You know, we would see lots of sick people, but
it was always even on your worst night, it was kind.
You could still get through it. It was manageable. It
wasn't enjoyable because you were dealing with some sick people
and unfortunately, people die in those settings. But I think
(18:26):
that the volume is so high that it's just so
loud out there in terms of, you know, the suffering
that's going on. I mean, we can even hear it,
you know here in New Haven, and friends of mine
in New York they say, you know, it's all you
can hear the sirens, right, you know, and that's what
we're hearing. And it's scary. I can't imagine what it's
like to be on the other side of those sirens
and be dealing with those people when they're coming in.
(18:48):
And so, I mean, the good news though, is I
think the science really gives us a clear thing that
we can do about that point, in particular, the sort
of dealing with other people suffering, and it comes from
a form of meditation. I know, like you're a big
practitioner of meditation, but the particular kind of meditation I
think can be really powerful right now for dealing with
that kind of suffering is a form of meditation known
as loving kindness. So this is a kind of meditation
(19:10):
we've talked a little bit about before on the podcast,
but it's a form of meditation where rather than just
focus on your breath, you try to pay attention to
what it feels like to experience compassion, and you do
that through a set of different mantras. You think about
people in your life and you wish them health. You say,
may you be healthy, may you be safe, and you
kind of just like watch your body in terms of
what it feels when you're doing that. And what the
(19:32):
data suggests is that that kind of meditation can bump
up your emotion of compassion. But in doing so, it
does this incredible thing where rather than see other people
suffering in this awful way, where you're kind of taking
on their suffering and feeling it yourself, you actually get
a motivation like almost like a call to arms when
you see people suffering in these contexts like compassion can
(19:52):
actually build in a motivation to take action. And the
amazing thing is research from folks like Tanya Singer suggest
that this practice of loving kindness meditation can reduce burnout,
particularly in healthcare professionals, because those are the folks that
you know, if you're just paying attention to other people
suffering day in and day out, it can really you out.
And the way that you're talking about and so do
you think that that's the kind of practice that you know,
(20:13):
if more healthcare professionals knew about it, they could kind
of squeeze in. I mean, this is the kind of
thing you can do two to three minutes a day
or maybe even in between patients when you walk out
of the room. You know, you might not be able
to take your mask off and take a break and
you know, grab something to eat, but you actually can
sit there and watch your breath and kind of feel compassion.
Is that is that something that people could reasonably add
in in this time? I do? I think they can.
(20:34):
I actually I've kind of adapted my own way of
doing I do a gratitude meditation and then I kind
of close it out with may all people be free
from suffering, So I kind of I roll all of
that together, and it does. It makes a huge difference
for me. I do that every day. You know. I
do think that with the practice it could be very
helpful for people, and I agree it does. It does
(20:55):
have a very profound effect to be able to think
about that. And I think that the gratitude meditation for
me has been very important because it really causes me
to go back and look at all aspects of my life.
And it also helps me to realize that we're not
alone out there in this and that I kind of
think that this is almost our you know, as people
face these challenges of World War one, World War two,
(21:16):
these kind of uncertain times at such an intensity level.
I really found a little about about my grandfathers, who
both of them served a World War two, because this
is the kind of event in our lives that it
is called us to step up in a way that's
very different. Yeah, And I love that strategy for beating
burnout because I mean it does a couple of things.
One is, you know, if you think about folks who've
(21:37):
been through things like this before and made it through
like that. That gives you confidence that you can do
the same thing right. It's almost like seeing your own
resilience in the mirror, which is really profound. But also
I think gratitude can be a complete like medicine for
the other things we're talking about earlier, things like anger
and so on. You know, if you're experiencing the things
in your life that are a blessing or the people
(21:58):
around you who are doing great things, it can kind
of curb the anger at parts of the system that
could be really problematic. Again, not to say that anger
is not justified. I think it completely is. It's just
not functional. So anything we can to kind of curb
it is really helpful. So we focused a little bit
on the emotions that people are facing in healthcare right now,
and also how to deal with some of the suffering
you're experiencing and some strategies you can use for that.
(22:20):
When we get back from the break, I think we'll
talk about the even harder things, like the existential part
of this challenge of you know, doctors actually facing their
own death and what they can do to deal with
that challenge. In the best way possible, and so the
Happiness Lab will be right back. So, Mike, I wanted
(22:41):
to focus in on a different struggle that I hear
a lot of healthcare professionals facing, which is kind of
more of a personal one, which is, it seems like
a lot of healthcare professionals are kind of beating themselves
up right now about a lot of different things, Like
it's from this kind of survivor's guilt to folks who
are feeling like, you know, they're they're they're working long
hours and they're not there for their kids. It seems
(23:01):
like a lot of the folks I talk to are
just kind of not giving themselves a compassion they need
right now. Do you see that as a problem among
europe colleagues too. Hopefully medicine changes after this in some ways,
because in general, you know, we've kind of always been
trained to be like, you suck it up and you know,
just do your job kind of thing. But there's a
(23:22):
lot of data out there that you know, about fifty
percent of doctors before this happened, we're burnt out, and
that's just doctors in practice, So you know, we're actually
a group of people that you're One of our biggest
challenges is self compassion for doctors, the ideas we're supposed
to be able to use technology keep everybody alive, and
that that's not going to be possible right now, because
(23:43):
you know, we don't have control. And I think some
of this loss of control in a situation where it's
just so much that's happening, is really negatively affecting people.
And I do think that people are beating themselves up
out there. I do see that that's a real concern
and something that's going to throughout this crisis is going
to play itself out with a lot of people and
(24:03):
struggling to cope with those things, which I think is
unfortunate generally because healthcare workers are complete heroes right now
and it's awful to feel like they're beating themselves up.
It's also just bad in terms of their competence on
the job, because of course, if you're second guessing yourself,
if you're kind of feeling bad about things, that's going
to be a challenge for the kind of care you're giving,
because that doesn't lend itself well to good decision making.
(24:25):
If you're kind of constantly second guessing in your head,
but again here I think the science of happiness can
help a little bit because there are lots of techniques
that folks can use, practices that you can use daily
to improve self compassion, which I think can be really powerful.
One of those practices is just a variant on the
loving kindness meditation that we talked about before. And so
(24:46):
a typical loving kindness practice is that you're giving compassion
to all the folks out there, you know, a compassion
for the world or compassion for the people around you.
But at one step in that process, you're supposed to
take a pause and give compassion to yourself. You're supposed
to say, may I be happy, may I be safe,
and so on. And what's funny is that that part
of the process it affects people differently. Like some people
(25:07):
find that one really easy, and they tend to do
that and first because it's so easy in their meditation
to get started with giving compassion to themselves. But you know,
for me and maybe for other folks, it's kind of
hard to say that you should be happy, that you
should be safe, to kind of put yourself in the
priority list. But my sense is that it's a technique
that could be really powerful for your physicians right now
is to not just be worried about the suffering of
(25:29):
everyone else, but just to be making sure that they're
giving themselves some compassion and giving themselves the benefit of
the doubt generally, but especially during this really challenging time. Yeah. Absolutely,
because you can't pour from an empty cup. I used
to be my own worst critic. By far, there's nobody,
there's nobody even close to second. But what I realize
is when i'd stop bopping myself in the face, that
(25:50):
actually I was more effective. And I think that, you know,
one of the things is is that it's not about
just working harder, it's working smarter and being more compassionate.
Because the truth is, when you're in a situation where
you're just like you said, you're going to lock up
and you're not going to be able to take care
of those around you, you also will be in situation
that you're not able to be connected to your family
(26:12):
because you're just you're just so isolating yourself if you
can't be compassionate to yourself, so not only just at work,
but also at home. The other way clinicians can help
with self compassion is to remind their colleagues to have
some self compassion too. I think this is another time
where you know, reminding your colleagues that you're grateful for them,
reminding them that they're doing a good job. Like those
(26:32):
kinds of things can help. If there's someone on your
team who's having a really hard time with self compassion,
expressing gratitude, doing these nice things can really help them
during this really scary time. That's actually something that I've
seen that's really been remarkable over the last couple of weeks,
is to see people's ability to reach out to one
another and be supportive. You know. Interestingly, each doctor thinks
(26:55):
they know more than the other doctor. But actually what
we've realized now is that we all have to pool
our resources. That never was true, but that's kind of
how we've been trained, which makes it a problem. We
now have to collaborate in a way that we've never
done before. And I can tell you that it's happened,
you know, even even if it's not a phone call.
But you know, I greatly appreciate when I get text
messages from friends of mine that just say, hey, how
(27:16):
are you doing, and randomly and just showing up. It's
just it's being present. I wanted to save the question
that I'm getting that I've struggled with the most from
healthcare workers, which is what the science of happiness says
about kind of these real existential crises that I think
doctors are facing right now. A lot of people, especially
doctors in New York who I'm hearing from, you know,
(27:36):
they're really afraid of dying because they're seeing young people
that they're taking care of die all the time. Talk
about the impact that kind of seeing death so closely
has had on physicians and the way it's affecting them
in terms of their performance and in terms of their
mental health. Yeah, so in healthcare, we usually deal with
people that are older, and you know, when you start
(27:58):
to realize the people that you may be taking care
of the younger, you have this kind of transference that
you could put yourself in that bed sort of speak.
We've never really had to face that. You know, we
all in some ways think way off in the future.
You know, twenty five years from now, I'm going to
be in a situation where you know, I may need
to face death or face illness in a way. But
(28:19):
actually that that really caused me over the last couple
of weeks to rethink that, hey, you know, there is
a possibility that I could actually get get sick, and
that has permeated throughout the profession that everybody's asking themselves
the same question. And you know, again, we have doctors
that are actually falling into not just the younger doctors,
but we have doctors in their sixties seventies that you know, again,
(28:42):
we know based on age that people are at higher
risk for complications. So truth is is that you know,
still if a younger, if a younger physician, the chances
of getting really sick are still very low. And I
think that people we still realize the data. The data
says that we're still going to be mostly okay, but
not everybody. That's just a matter of percentages, right, you know,
(29:05):
you just don't want to be the unlucky person. But
we do know that we've asked some of our colleagues
that are older to continue to practice and put themselves
at risk, realizing that their risk may be higher. There's
also doctors and physicians out there and in nurses and
healthcare that actually have underlying chronic diseases. But now there's
a huge concern to say, well, what happens if I
(29:26):
get sick. And I think that it's really caused a
lot of people to relook and say, you know, this
profession is a calling. There there is um you know,
to be a doctor is, or to be in healthcare
to care for other people. It's beyond a job. And
I've never looked at it that way. And it is
(29:48):
showing up in ways that you know when people need
you to be there. And I think that at this point,
even physicians that I think that you know may have
higher risk of having a complication, I can tell you
that they almost universally are saying that they're going to
show up in the face of danger. And that's courage, right,
you show up, You show up even though you know
(30:11):
you may be in danger. That's courage. And we usually
have equated that with our police officers, with our firefighters
or our soldiers. But this is really the first time
that we've really had to answer that calling in a
way that in the face of danger, and people are
doing it, and they're doing it in such a way
that is really powerful and is really going to bring
(30:33):
physicians across the world together at a time that it's necessary.
And I've said this before. You know, doctors largely have
kind of gone to work and done their job and
work really hard for their patients, but we haven't really
been great advocating for the things that really need to
change out there. And I think that this is actually
going to really solidify doctors as a voice that's going
(30:57):
to need to be heard from now on. And I
I love your answer to that question because I think
that what the science suggests is that you're doing exactly
the right thing to do when you're facing a big
existential crisis, which is to double down on the things
that you find important, that you find meaningful, that give
you purpose in life. And it's a strategy that I
think doctors can use right now to kind of face
(31:19):
this existential threat with some dignity right to see, you know,
this is the reason that you jumped into this, because
you are courageous, because it mattered a lot, because you
know it was a calling, and so I think it
can be really powerful to kind of look at it
from that perspective, to realize that you know, that's what
this is about. And I love the idea that you
know that doctors are realizing that they might even have
more of a voice than they thought before. Right the
(31:41):
idea that when we get out of this mess now,
doctors will maybe have a voice to fix the things
in their professions that we're going wrong, or kind of
make things better for the next generation of doctors. All
those deep, meaningful things are the kinds of things that
psychologically speaking, get you through an existential crisis. So the
more that doctors can double down on those big picture
things right now, I think all the better. Another cool
thing I saw when I was looking more about the
(32:02):
work on you know, people who work in palliative care
and see a lot of suffering and see a lot
of death, is that it turns out that the act
of ing death in your profession actually has in some
cases can have a strong benefit to your mental health
because what it does is it allows you to have
this greater appreciation for a life. So nurses who work
in palliative care report that they've gotten so many benefits
(32:23):
out of this because they savor their own life so
much more, and they don't take things for granted in
a way that they say they did before they started
working in that. And so I wonder if again, in
the midst of all this suffering, there might be a
real benefit to the people who are in the trenches
right now, one that you might not see now, but
after you get out of this, it will cause you
to look at life in a completely different way. And
(32:44):
that kind of appreciation is pretty rare. You know, we
should all have that kind of appreciation, but we don't.
And so the opportunity to see that so closely might
bring a powerful mental health benefit that healthcare workers don't
expect in the years to come. Yeah, I agree with that.
I think that it's really important for us to be
able to think about that. And I've meditated that. I
(33:05):
had that meditation before. Just imagine that today, your last day.
And I think that what it does is it really
puts things in perspective that you start to put what's
really important in your life together. And I do think
that this has caused us all to hit the pause button.
You know, we've taken our environment for granted, We've taken
(33:27):
people for granted, right, you know, we've really placed unfortunately
certain times, we've put you know, money or technology in
front of people. That hurts. That hurts as a physician
to see that certain certain populations are going to be
more vulnerable with this. But I do think that you're
taking stock of all the things and all the blessings
and all the things that really matter is going to
(33:50):
make a big difference afterwards. And I do think the
world be kinder and more mindful after this happens, not
during There is going to be great suffering, and so
you know, I think that the world will change, no doubt.
It's been great that you've been able to see these
deep benefits into get meaning out of these things. But
I just wanted to add one strategy for any of
(34:10):
our healthcare workers or first responders who are really struggling
with how to do that. And this comes from a
scientist that we interviewed during the first season of our podcast,
Jamie Pennebaker, and he does a lot of work on
the power of journaling for allowing you to kind of
get to these self transcendent emotions. And so what he's
found is that just the act of taking time to
sit down and talk about your write down about your situation,
(34:30):
write down what you're feeling, it can kind of get
you to that that bigger picture, to kind of see
the big purpose in it, to see that these things
are you're calling and to see where you're getting your courage,
or even just to take a kind of more future
perspective on things. It can allow you to make sense
of these things that feel really out of control. So
if you're listening out there and you need a good
technique to get to the point that Mike has so
(34:50):
well through his meditation practice and all the work that
he's done, you know, just sitting down to scribble it
down and journal it can be really powerful, And that
can be a great technique to add into a routine
or even as a ritual at the end of the day.
You know, scribbling down your feelings is a great thing
to do even before maybe you go to bed, because
you can kind of get it out on paper and
let your brain process to something else that you can
fall asleep too. But I wanted to end with asking
(35:12):
you know, this isn't an awful crisis and people really
are suffering in you know, as I said when we
started in my metaphor about the second arrow, I think
it's not a first arrow that our physicians are getting
hit with right now. It's like an AK forty seven.
But do you think that through the through some of
these interventions, we can make it a little bit better. Again,
not perfect, but but these are things that physicians can
(35:33):
do to improve things at least a little bit during
this challenging time. Yeah. Absolutely. My friend George Mumford, who
is I spoke with a week ago, who is a
meditation and mindfulness specialist, you know, he is the concept
of the eye of the hurricane. And you know, I
think that that's the important thing. Can you be the
calm within the storm? You know, ultimately, you know the
(35:56):
storm is going to be there and there is no
way to wish this away. But it is our ability
to stay calm and peaceful despite the things that are happening.
And also actually you have to be comfortable being uncomfortable,
and also you have to allow yourself to not be
perfect on all of those things, because I think that
you know, it's not about pushing emotions away, It's about
(36:18):
sometimes it's just sitting there with that. You know. I was,
I was out for a walk the other day and
there was a certain amount of sadness that just kind
of came up out of the blue, and I just sat,
I just was there with it. I let it go,
and then eventually it passed away, you know, it just
moved and you know, one of the things is is
our emotions don't always stay. They're fleeting. You know, we're
not happy forever, we're not sad forever. We're not feelful,
(36:40):
we're not angry. You know, if we stay with those
things and we realize that it's just an emotion and
realize that it too will pass, that it's for me,
that's made a big difference for me, and I think
that that will help me in the in the coming
weeks despite whatever whatever storm is going to come, this
will pass. That's awesome, and I think it's it's powerful
because again, there's not much we have control over in
(37:03):
this situation, but we do have control over how we
react to it. There's a lot of work in science
that suggests that what you resist persists. You know, if
you try to push away your fear or push away
your anger, push away your emotion, it's just going to
come back to hit you. So just say this is
the way this is, and it's yucky, but you know,
freaking out and fighting it isn't going to help. Let
(37:23):
me just get through what I need to get through
in as healthy a way as possible. And so, Mike,
thank you for helping our listeners get through what they
need to get through in as healthy a way as possible,
which I really appreciate. And thanks so much for coming
on the podcast. Oh thanks for asking me. I'm really
I appreciate the opportunity to speak with you, but also,
you know, to share what's going on, because I think
it's important for people to realize that it is a
(37:46):
unique physician and healthcare to be sitting where we are
that we've never faced. I wanted to end this episode
by expressing my gratitude to all the medical professionals and
first responders out there. Thank you so much for your
bravery and service, and I really hope you heard some
tips that might help you in this fight. And if
you're not on the front lines but you still want
to help, there are lots of things you can do.
(38:09):
You can start a campaign to get hospitals more life
saving protective equipment. You could consider donating blood, which I'm
told is running really low right now. Or you could
even see if your local hospitals are accepting food donations
for their tired workers. But the biggest thing you can
do is just stay home, which will help flatten the
curve and keep everyone, including our healthcare heroes Safe. The
(38:32):
Happiness Lab is co written and produced by Ryan Delly.
This episode was mixed and mastered by Evan Viola and
our original music was by Zachary Silver. Extra extra special
thanks to the medical professionals who helped me with this episode,
especially doctor Sanjay chevek Romani, doctor Tanya Fik and doctor
Amy Commander. As usual, deep gratitude goes to Ben Davis
(38:54):
as well as the rest of the Pushkin team.
Pushkin. Welcome to a special set of episodes of The
Happiness Lab. The now global spread of coronavirus is affecting
all of us. This disease has brought a host of medical, economic,
and political problems, but it's also given us a ton
of uncertainty and anxiety, which are beginning to have an
(00:36):
enormous negative impact on our collective While being but whenever
I'm confused or fearful, I remember that looking for answers
in evidence based science is always the best way to go,
and that's where I'm hoping this podcast can help. I
often get emails from listeners asking for specific advice, but
(00:57):
one of the ones I received recently really struck me.
It was from the director of a hospital emergency department,
someone who had spent the last few weeks on their
front lines fighting COVID nineteen. Talked about the fear and
anxiety so many healthcare workers were facing right now, and
asked if I could devote a special episode to helping
medical staff and first responders with some science based tips
(01:19):
specifically designed to protect their well being during this crisis.
Like many of you, I've been wondering what I could
do to help the brave folks who are working on
the front lines of this crisis. But I also didn't
want to give such advice lightly, and so while I
desperately wanted to help, I also wanted to make sure
that I understood what those heroes were really going through.
So I put out a call to a number of
(01:40):
my long time doctor friends, a science buddy from college
who's now a leading oncologist, and my best friend from
elementary school who's now a board certified family physician. I
asked them to share the specific challenges they were facing
and what questions they and their teams had about how
to protect their mental health during this crisis. And then
I put out a call to someone who I knew
(02:00):
would do a great job walking me through all these questions,
doctor Michael Rocha. Doctor Rocha or Mike as I know him,
is a successful ideologist, but I know Mike in a
different capacity. We went to high school together back in
my hometown of New Bedford, Massachusetts. Since graduating, Mike's gone
on to become one of my town's heroes. He founded
(02:22):
a group called the New Bedford Wellness Initiative, which provides
free resources to our community about happiness and healthy living
In doing so, he's basically retrained as a wellness expert
and one that really practices what he preaches. He lost
over eighty pounds through healthy diet and exercise, He meditates regularly,
and he practices many many of the tips that I
(02:42):
talk about in this podcast. But the reason I really
wanted to talk to Mike for this episode is that
he and his medical group have also been on the
front line tackling COVID nineteen, and like many specialists, he's
been asked to help out beyond his own area of
expertise in order to best treat coronavirus patients. Since I
knew Mike was dealing with these challenges directly, I thought
(03:04):
he'd be the perfect sounding board for some of the
tips I wanted to share. I called him home in
his study to record our conversation. All right, so you
can start it? Got it? Yeah? It says continue here.
I'll just hit continue, right, that's all. Yeah, that's your work.
Here we go. Yeah, So I wanted to start at
the beginning because we like you and I actually met
in high school. I think that that's right. I wanted
(03:27):
you to start with just give me a sense, just
on the ground just really generally, like, what is it
feeling like to be someone who's in healthcare right now?
The feel is is that it's trying to ride a
roller coaster because the information is coming in incredibly quickly.
We in medicine are seeing, you know, one study that's
positive and then the next study that's not so positive.
(03:48):
Things keep changing, and also in certain places right now,
there is a very high anxiety as a cardiologist that
you know, two months ago, I would never thought that
I was going to be in a situation that, you know,
going into a patient's room is potentially going to be
something that I was going to have to wear a
gown and you know, a mask and an advisor and gloves,
and so there's a lot of anxiety around that. I mean,
(04:10):
it sounds like just the normal care that you would
normally give, which was this kind of like normal and routine.
It potentially even could be deadly now, I mean, not
even to take an extreme position. Yeah, I have a
friend of mine, I have someone I trained with that
was in the front lines of New York and she's
been admitted to the hospital down there for about ten days.
She's doing better, but you know, she's my age. So
(04:31):
you know that's actually for doctors, especially younger doctors. It
has really caused us to pause because we're young, we're healthy.
It's not something we would actually expect to have to
deal with. And so I want to walk through some
of the things that the science of happiness can help
with in this incredibly scary time. You know, we sadly
there are major structural problems in terms of the amount
of PP access and what hospitals and administrations are doing,
(04:54):
like you know, as a podcast to us, I can't
help with those, but I think there are certain things
we can help with in terms of making sure that
physicians and first responders are protecting their mental health. And
so I wanted to dig into some of the stuff
that you just talked about. First. Give me a sense
of the kinds of emotions that positions and first responders
are going through right now. I mean, one of them
that I hear a lot in my emails is anger
that just like you know, this is an awful angering situation. Yeah,
(05:17):
I think that there's no doubt that there's a lot
of anger out there. And I think that if people
get caught in that situation where they're angry, they're not
actually able to be most effective. But the sense that
we don't feel protected in the United States is a
big thing for people and it's understandable to be upset
about that because we should be prepared better than what
(05:38):
we are. And I think that there is a lot
of disappointment. Let's just leave it at that that, you know,
certain people or organizations that could have made changes and
could have prevented the potential risk didn't, And I think
that that emotion rises up and affects the way people
are feeling these days, especially docs and nurses. And then
(05:59):
I think another emotion we already talked about it a
little bit is fear. I mean, talk about the ways
fear is playing out among first responders right now. People are,
you know, breaking down, they're crying, they're afraid. You know, again,
we have to take that extra pause, you know. I
actually had a situation the other day where I needed
to call nine one one on a patient that was unresponsive,
(06:22):
and I had to make sure that I told them
upfront that there was a concern that that person may
actually have COVID, and that causes everybody to kind of
sit there and go like, oh my god, right, you
know again, I think there's a fear amongst cardiologists that
we you know, it's really hard to tell whether the
patient actually has a COVID manifestation on an EKG or
their presentation, or they're actually really having a heart attack.
(06:44):
So now we're kind of like second guessing ourselves because
if we take somebody to the calf lab to put
in an emergent stent and they actually don't have a blockage,
well then we just exposed potentially six people to an infection.
And that's anxiety for folking because we know that COVID
can affect the heart, and you know, we hear, we
keep hearing over and over again how it affects the
(07:05):
respiratory of the lungs, but it can affect almost every
organ system. Seems like you're not just afraid for your
own health and safety. There's a real fear for first
responders bringing this home to their family, to their kids,
to people that they care about, right right, Absolutely, you
know it's caused a lot of isolation. So you could
be walking around your house with your family and your
(07:26):
concern is that, well, I could have COVID. I don't
know yet. I don't have symptoms I certainly don't want
to give it to my family, And I think that
a lot of people in healthcare first responders are actually
taking extra measures when they come home at night and
they maybe in in their own room, or actually some
people in healthcare are going and staying in hotels to
stay away from their families. That's a tough one, and
(07:47):
so I want to talk about strategies that can come
from the science for how you and other healthcare professionals
can regulate some of these emotions. I mean, I think
maybe the first thing to say is that obviously all
these emotions, the fear and the anger are completely justified,
Like it's awful that you're in these situations and you're
really facing a threat that's like incredibly real, and so
it makes sense to be afraid. The problem, I think
(08:08):
is know for doctors, it's also not good to be
angry and afraid, like it feels yucky and it affects
your decision making. And so if there was something that
could be done to regulate those emotions, it seems like
it would be a smart thing to do. The story
I'm always reminded of when I hear tales of healthcare
workers who are facing this stuff. Is this Buddha's story
about the second arrow. I don't know if we've talked
about that before, but you know, this is this idea.
(08:30):
You know, Buddha's telling his followers the story of you know,
if you get hit with an arrow, you know, is
that really bad? And the followers say, yeah, that's terrible.
It's like, well, if you get with a second arrow
and a third arrow, is that worse? And the followers say, yeah,
that's worse. And Buddha goes on to say that, you know,
the first arrow is the circumstances in life. That's like
the actual bad things that are happening. You can't control those,
but in some sense you can try to control the
(08:50):
second arrow, which is your response to those horrible circumstances.
And I feel like in healthcare now, it's not an
arrow like you all are getting shot with like AK
forty seven, like you know, like the first arrow is
much bigger than like a regular arrow. But I think
there's still there's still a world where there are strategies
that could be useful to regulate these emotion and so
I think it's really important. And you know, one that
(09:11):
I've been talking with a lot of folks about is
just this ability to kind of regulate the threat response
generally like in the body, like what folks can do
to sort of shut off there or at least kind
of calm down your sympathetic nervous system a little bit.
And so can you give me a two seconds on
like the sympathetic nervous system and just like fight or
flight response. I mean I could do it too. You're
(09:31):
the doctor. So yeah, so the fight or flight response
is you know, I deal with that quite a bit,
and you know, honestly, it means actually, I can't tell
you how often that comes up in cardiology, where you know,
your blood pressure goes up, your heart starts to race,
you know, again, you start taking blood away from various
(09:53):
peripheral types of otteries. So it's really again that heightened
sense of awareness. Hopefully, though, that's only a very brief response,
and you don't want to be in that that mode
for a long period of time because it's very detrimental. Right.
You know, you may be able to do that quickly
and it may save your life, but if you're doing
that the whole time, it's not saving your life. It's
(10:15):
usually going to hurt you. And the beauty is that
even though for the most part, we can't really take
much action on our autonomic nervous system other than like
removing the threats that are out there, which you know,
obviously if we could do that with COVID nineteen we would.
But the beauty is there is one way that we
can kind of chill out our sympathetic nervous system, and
that is through our breath. You know, the action of
kind of taking you know, a couple deep breaths, you know,
(10:36):
especially deep belly breaths where you're going really slow and
breathing not into your chest, into your belly. That can
actually activate the parasympathetic nervous system. And the act of
doing that, we know, can regulate again these emotions that
the catecholamine system are signaling, like you know, that fight response,
which is all this anger and those kinds of emotions,
or even the fleeting response, which is the fear and
(10:56):
the anxiety and that panic. Just the act of taking
those deep breaths can really make a difference. Do you
think that's something that kind of doctors and the trenches
could potentially use in this time? Yeah? I think you
know that that type of breathing is very important, and
in fact, patients in the office where you know, again
they come in their blood pressures up, the heart maybe racing,
and I will go through that. Sometimes you can bring
(11:17):
the blood pressure down by just twenty points that way,
So you know, again, activating the vagal nerve and the
parasitic sympathetic nervous system can be one of our best
allies to combat the increased adrenaline and the fight or
flight response, which I think is important. I mean, it's
ironic that you say that you do it with your patients,
but I feel like doctors need to do it with
each other now, and healthcare professionals need to do it
(11:39):
for themselves. I have a daily meditation practice, so I
absolutely and I didn't always have that, and I probably
would say that it's been more over the last five
or six years. It's absolutely critical, and it's really made
a huge difference in how I'm able to approach things,
and not just in medicine, in all aspects of life.
So I want to dig into a second thing that
(12:00):
I hear a lot from medical professionals right now, which
is how hard it is for them to get self
care and all these different domains. So I'm thinking about,
you know, their sleeve, like them eating right and all
these things. So talk through what you're kind of seeing
among your colleagues, like in terms of how hard it's
been to engage with self care during this battle. I'll
just give it for instance, in terms of nursing. For example,
(12:21):
you know, some of the nurses that are on these
COVID units are actually in full regalia or the full
personal protective equipment, and just by having that on makes
it really hard to take a break. So you know,
you've got people that maybe doing your entire eight to
twelve hours shift on their feet with really not even
eating well or drinking well. And if you're in that
(12:44):
situation for eight straight hours at that kind of intensity,
you've basically got your fight or flight response on the
whole time, unless you have some adaptive mechanisms to be helpful.
And then the other thing is is that, no doubt,
when you're faced with these kind of traumas, trying to
wind down at night and trying to find the ability
to kind of be able to decompress to sleep is
(13:05):
a big problem. And then you know, if people are
working longer shifts and not get out till late. You know,
there's sleep is being reduced. You basically you sleep, you
go to work, and you know, there's not a lot
of time for people to be necessarily exercising or you know,
again meditating for an extended period of time. So this
schedule that is forcing people into is really not one
(13:28):
that's conducive to self care. And so I guess, you know,
from my science of happiness perspective, that advice would be
that people just need to make some of these things
non negotiable, you know, especially sleep and rest, exercise, you know,
healthy eating. I mean, these are the things that we
need to double down on when our mental health is
in jeopardy. I mean, they're also the things we need
to double down on when our immune system, you know,
(13:49):
needs a little rev up too. Right, So this is
exactly the time when healthcare workers need to protect their
immune system with all these different practices, and they're not
doing that. And so what would it look like on
the front lines to really make these things non negotiable
right now? That's a real challenge because you know, we
don't have reinforcements or actually currently asking doctors and people
(14:10):
that have been out of medicine or maybe you've been retired.
We're asking for volunteers to fill in, so we're really
out of place where you know, it's it's survival mode unfortunately,
and you know, you can't be in growth mode when
you're in survival mode. And that's that's the real challenge.
I mean, one of the reasons I was excited to
have you on the show is I feel like you've
been really good at practicing what you preach eating during
(14:31):
tough time. So eventually folks are going to come home
from these long shifts, like what can they do ahead
of time to prioritize sleep? I think simple things like
you know, staying off the internet when you get home,
you know, positive sleep habits like you know, putting the
phone away, you know, and trying to get to bed.
Maybe even healthy eating like not eating a huge crazy
meal or drinking. Like what does it look like in
(14:51):
your own life to prioritize some of these things? Yeah, no,
I actually I usually eat pretty healthy, but over the
last four weeks, I don't think that I could eat
much healthier. I have been like ridiculous every day. It's
been regimented, and you know, lots of fruits and vegetables,
and not some beans and lots of water, and and
I have really, I've really tried to actually mentally prepare
(15:13):
and physically prepare in such a way that's really important.
So eating healthy is not just good for our physical wellbeing,
but we do know that it's good for your mental wellbeing.
So if you're coming home and eating, you know, sugary
snacks or having a bunch of drinks, it's first of all,
those things are going to interrupt your sleep. You're not
going to sleep well, you're not going to feel any better,
and you won't be prepared. So you know, again, I
(15:35):
personally really believe that the work that I did beforehand
to get me in the space to be able to
eat healthy in regiment that has been important sleep by
making sure that you know seven hours and you know,
trying to balance all those things is always still a
challenge because again, next week, some of those things may
not be completely in my hands. But I'm going to
have to do the best I can within those circumstances
(15:56):
of what I've prepared to do. I love two things
that you said there I think are so important. One
is this idea that you know, even if the system
is against us, there's still a lot of things that
we can control. You know, there's still a lot of
agency that you can take over what you're putting into
your body, over how you're going to bed and when
you're going to bed. But I also like that there's
some self compassion there, right, Like you said, you're going
to do the best you can, and it might not
(16:18):
be as good as it was before. But even those
baby steps that healthcare workers can take right now, even
though you know, increasing your sleep by fifteen minutes, or
you know, grabbing a piece of fruit instead of a
candy bar, like those small changes are actually going to
have a big difference on your health but also on
your mental health right now. And so these baby steps
can be so important. Yeah, I've also and this happened.
(16:38):
I've done this before. In various weeks that get busy,
I make sure that I exercise. I'll do a four
or seven minute workout. I make sure I walk as
much as I possibly can, you know, and that and
that can be a good way to distress coming home
after work. You know, maybe my workout in the morning
isn't as long, maybe my meditation and practice is cut
a little bit in half, or some of the stretching
(16:59):
that I do. Instead of doing you thirty seconds to
jump in jacks, I'll do ten. But trying to make
sure that I still maintain that because that actually has
made a big difference for me in the past when
I been in situations where I've had to alter the
way I do things in order to fit the time
the timeframe. So in addition to the issues with finding
ways to prioritize self care, I think we also have
(17:20):
to just recognize that healthcare workers, especially healthcare workers who
are on the front lines of this virus, are seeing
an incredible amount of suffering. I mean, healthcare workers obviously
face life or death situations in some cases all the time,
but in some ways it's different now. So I want
you to talk a little bit through the differences and
the way that suffering is kind of affecting people psychologically.
It's the difference between drinking from the FATA and drinking
(17:42):
from the from the fire hydrant. Right now, you know,
as you can see what's happened in New York, and
I have friends of mine down there, and the overall
volume of suffering is on a level that we've never
had to see, you know, I've heard stories and you know,
very heart wrenching things. You know that it was really
sad for me to see that the er doctor in
New Jersey actually passed away from this. You know my
(18:05):
experience when I was a resident in the a Medical
Intensive United a very very busy tertiary care hospital at Tufts.
You know, we would see lots of sick people, but
it was always even on your worst night, it was kind.
You could still get through it. It was manageable. It
wasn't enjoyable because you were dealing with some sick people
and unfortunately, people die in those settings. But I think
(18:26):
that the volume is so high that it's just so
loud out there in terms of, you know, the suffering
that's going on. I mean, we can even hear it,
you know here in New Haven, and friends of mine
in New York they say, you know, it's all you
can hear the sirens, right, you know, and that's what
we're hearing. And it's scary. I can't imagine what it's
like to be on the other side of those sirens
and be dealing with those people when they're coming in.
(18:48):
And so, I mean, the good news though, is I
think the science really gives us a clear thing that
we can do about that point, in particular, the sort
of dealing with other people suffering, and it comes from
a form of meditation. I know, like you're a big
practitioner of meditation, but the particular kind of meditation I
think can be really powerful right now for dealing with
that kind of suffering is a form of meditation known
as loving kindness. So this is a kind of meditation
(19:10):
we've talked a little bit about before on the podcast,
but it's a form of meditation where rather than just
focus on your breath, you try to pay attention to
what it feels like to experience compassion, and you do
that through a set of different mantras. You think about
people in your life and you wish them health. You say,
may you be healthy, may you be safe, and you
kind of just like watch your body in terms of
what it feels when you're doing that. And what the
(19:32):
data suggests is that that kind of meditation can bump
up your emotion of compassion. But in doing so, it
does this incredible thing where rather than see other people
suffering in this awful way, where you're kind of taking
on their suffering and feeling it yourself, you actually get
a motivation like almost like a call to arms when
you see people suffering in these contexts like compassion can
(19:52):
actually build in a motivation to take action. And the
amazing thing is research from folks like Tanya Singer suggest
that this practice of loving kindness meditation can reduce burnout,
particularly in healthcare professionals, because those are the folks that
you know, if you're just paying attention to other people
suffering day in and day out, it can really you out.
And the way that you're talking about and so do
you think that that's the kind of practice that you know,
(20:13):
if more healthcare professionals knew about it, they could kind
of squeeze in. I mean, this is the kind of
thing you can do two to three minutes a day
or maybe even in between patients when you walk out
of the room. You know, you might not be able
to take your mask off and take a break and
you know, grab something to eat, but you actually can
sit there and watch your breath and kind of feel compassion.
Is that is that something that people could reasonably add
in in this time? I do? I think they can.
(20:34):
I actually I've kind of adapted my own way of
doing I do a gratitude meditation and then I kind
of close it out with may all people be free
from suffering, So I kind of I roll all of
that together, and it does. It makes a huge difference
for me. I do that every day. You know. I
do think that with the practice it could be very
helpful for people, and I agree it does. It does
(20:55):
have a very profound effect to be able to think
about that. And I think that the gratitude meditation for
me has been very important because it really causes me
to go back and look at all aspects of my life.
And it also helps me to realize that we're not
alone out there in this and that I kind of
think that this is almost our you know, as people
face these challenges of World War one, World War two,
(21:16):
these kind of uncertain times at such an intensity level.
I really found a little about about my grandfathers, who
both of them served a World War two, because this
is the kind of event in our lives that it
is called us to step up in a way that's
very different. Yeah, And I love that strategy for beating
burnout because I mean it does a couple of things.
One is, you know, if you think about folks who've
(21:37):
been through things like this before and made it through
like that. That gives you confidence that you can do
the same thing right. It's almost like seeing your own
resilience in the mirror, which is really profound. But also
I think gratitude can be a complete like medicine for
the other things we're talking about earlier, things like anger
and so on. You know, if you're experiencing the things
in your life that are a blessing or the people
(21:58):
around you who are doing great things, it can kind
of curb the anger at parts of the system that
could be really problematic. Again, not to say that anger
is not justified. I think it completely is. It's just
not functional. So anything we can to kind of curb
it is really helpful. So we focused a little bit
on the emotions that people are facing in healthcare right now,
and also how to deal with some of the suffering
you're experiencing and some strategies you can use for that.
(22:20):
When we get back from the break, I think we'll
talk about the even harder things, like the existential part
of this challenge of you know, doctors actually facing their
own death and what they can do to deal with
that challenge. In the best way possible, and so the
Happiness Lab will be right back. So, Mike, I wanted
(22:41):
to focus in on a different struggle that I hear
a lot of healthcare professionals facing, which is kind of
more of a personal one, which is, it seems like
a lot of healthcare professionals are kind of beating themselves
up right now about a lot of different things, Like
it's from this kind of survivor's guilt to folks who
are feeling like, you know, they're they're they're working long
hours and they're not there for their kids. It seems
(23:01):
like a lot of the folks I talk to are
just kind of not giving themselves a compassion they need
right now. Do you see that as a problem among
europe colleagues too. Hopefully medicine changes after this in some ways,
because in general, you know, we've kind of always been
trained to be like, you suck it up and you know,
just do your job kind of thing. But there's a
(23:22):
lot of data out there that you know, about fifty
percent of doctors before this happened, we're burnt out, and
that's just doctors in practice, So you know, we're actually
a group of people that you're One of our biggest
challenges is self compassion for doctors, the ideas we're supposed
to be able to use technology keep everybody alive, and
that that's not going to be possible right now, because
(23:43):
you know, we don't have control. And I think some
of this loss of control in a situation where it's
just so much that's happening, is really negatively affecting people.
And I do think that people are beating themselves up
out there. I do see that that's a real concern
and something that's going to throughout this crisis is going
to play itself out with a lot of people and
(24:03):
struggling to cope with those things, which I think is
unfortunate generally because healthcare workers are complete heroes right now
and it's awful to feel like they're beating themselves up.
It's also just bad in terms of their competence on
the job, because of course, if you're second guessing yourself,
if you're kind of feeling bad about things, that's going
to be a challenge for the kind of care you're giving,
because that doesn't lend itself well to good decision making.
(24:25):
If you're kind of constantly second guessing in your head,
but again here I think the science of happiness can
help a little bit because there are lots of techniques
that folks can use, practices that you can use daily
to improve self compassion, which I think can be really powerful.
One of those practices is just a variant on the
loving kindness meditation that we talked about before. And so
(24:46):
a typical loving kindness practice is that you're giving compassion
to all the folks out there, you know, a compassion
for the world or compassion for the people around you.
But at one step in that process, you're supposed to
take a pause and give compassion to yourself. You're supposed
to say, may I be happy, may I be safe,
and so on. And what's funny is that that part
of the process it affects people differently. Like some people
(25:07):
find that one really easy, and they tend to do
that and first because it's so easy in their meditation
to get started with giving compassion to themselves. But you know,
for me and maybe for other folks, it's kind of
hard to say that you should be happy, that you
should be safe, to kind of put yourself in the
priority list. But my sense is that it's a technique
that could be really powerful for your physicians right now
is to not just be worried about the suffering of
(25:29):
everyone else, but just to be making sure that they're
giving themselves some compassion and giving themselves the benefit of
the doubt generally, but especially during this really challenging time. Yeah. Absolutely,
because you can't pour from an empty cup. I used
to be my own worst critic. By far, there's nobody,
there's nobody even close to second. But what I realize
is when i'd stop bopping myself in the face, that
(25:50):
actually I was more effective. And I think that, you know,
one of the things is is that it's not about
just working harder, it's working smarter and being more compassionate.
Because the truth is, when you're in a situation where
you're just like you said, you're going to lock up
and you're not going to be able to take care
of those around you, you also will be in situation
that you're not able to be connected to your family
(26:12):
because you're just you're just so isolating yourself if you
can't be compassionate to yourself, so not only just at work,
but also at home. The other way clinicians can help
with self compassion is to remind their colleagues to have
some self compassion too. I think this is another time
where you know, reminding your colleagues that you're grateful for them,
reminding them that they're doing a good job. Like those
(26:32):
kinds of things can help. If there's someone on your
team who's having a really hard time with self compassion,
expressing gratitude, doing these nice things can really help them
during this really scary time. That's actually something that I've
seen that's really been remarkable over the last couple of weeks,
is to see people's ability to reach out to one
another and be supportive. You know. Interestingly, each doctor thinks
(26:55):
they know more than the other doctor. But actually what
we've realized now is that we all have to pool
our resources. That never was true, but that's kind of
how we've been trained, which makes it a problem. We
now have to collaborate in a way that we've never
done before. And I can tell you that it's happened,
you know, even even if it's not a phone call.
But you know, I greatly appreciate when I get text
messages from friends of mine that just say, hey, how
(27:16):
are you doing, and randomly and just showing up. It's
just it's being present. I wanted to save the question
that I'm getting that I've struggled with the most from
healthcare workers, which is what the science of happiness says
about kind of these real existential crises that I think
doctors are facing right now. A lot of people, especially
doctors in New York who I'm hearing from, you know,
(27:36):
they're really afraid of dying because they're seeing young people
that they're taking care of die all the time. Talk
about the impact that kind of seeing death so closely
has had on physicians and the way it's affecting them
in terms of their performance and in terms of their
mental health. Yeah, so in healthcare, we usually deal with
people that are older, and you know, when you start
(27:58):
to realize the people that you may be taking care
of the younger, you have this kind of transference that
you could put yourself in that bed sort of speak.
We've never really had to face that. You know, we
all in some ways think way off in the future.
You know, twenty five years from now, I'm going to
be in a situation where you know, I may need
to face death or face illness in a way. But
(28:19):
actually that that really caused me over the last couple
of weeks to rethink that, hey, you know, there is
a possibility that I could actually get get sick, and
that has permeated throughout the profession that everybody's asking themselves
the same question. And you know, again, we have doctors
that are actually falling into not just the younger doctors,
but we have doctors in their sixties seventies that you know, again,
(28:42):
we know based on age that people are at higher
risk for complications. So truth is is that you know,
still if a younger, if a younger physician, the chances
of getting really sick are still very low. And I
think that people we still realize the data. The data
says that we're still going to be mostly okay, but
not everybody. That's just a matter of percentages, right, you know,
(29:05):
you just don't want to be the unlucky person. But
we do know that we've asked some of our colleagues
that are older to continue to practice and put themselves
at risk, realizing that their risk may be higher. There's
also doctors and physicians out there and in nurses and
healthcare that actually have underlying chronic diseases. But now there's
a huge concern to say, well, what happens if I
(29:26):
get sick. And I think that it's really caused a
lot of people to relook and say, you know, this
profession is a calling. There there is um you know,
to be a doctor is, or to be in healthcare
to care for other people. It's beyond a job. And
I've never looked at it that way. And it is
(29:48):
showing up in ways that you know when people need
you to be there. And I think that at this point,
even physicians that I think that you know may have
higher risk of having a complication, I can tell you
that they almost universally are saying that they're going to
show up in the face of danger. And that's courage, right,
you show up, You show up even though you know
(30:11):
you may be in danger. That's courage. And we usually
have equated that with our police officers, with our firefighters
or our soldiers. But this is really the first time
that we've really had to answer that calling in a
way that in the face of danger, and people are
doing it, and they're doing it in such a way
that is really powerful and is really going to bring
(30:33):
physicians across the world together at a time that it's necessary.
And I've said this before. You know, doctors largely have
kind of gone to work and done their job and
work really hard for their patients, but we haven't really
been great advocating for the things that really need to
change out there. And I think that this is actually
going to really solidify doctors as a voice that's going
(30:57):
to need to be heard from now on. And I
I love your answer to that question because I think
that what the science suggests is that you're doing exactly
the right thing to do when you're facing a big
existential crisis, which is to double down on the things
that you find important, that you find meaningful, that give
you purpose in life. And it's a strategy that I
think doctors can use right now to kind of face
(31:19):
this existential threat with some dignity right to see, you know,
this is the reason that you jumped into this, because
you are courageous, because it mattered a lot, because you
know it was a calling, and so I think it
can be really powerful to kind of look at it
from that perspective, to realize that you know, that's what
this is about. And I love the idea that you
know that doctors are realizing that they might even have
more of a voice than they thought before. Right the
(31:41):
idea that when we get out of this mess now,
doctors will maybe have a voice to fix the things
in their professions that we're going wrong, or kind of
make things better for the next generation of doctors. All
those deep, meaningful things are the kinds of things that
psychologically speaking, get you through an existential crisis. So the
more that doctors can double down on those big picture
things right now, I think all the better. Another cool
thing I saw when I was looking more about the
(32:02):
work on you know, people who work in palliative care
and see a lot of suffering and see a lot
of death, is that it turns out that the act
of ing death in your profession actually has in some
cases can have a strong benefit to your mental health
because what it does is it allows you to have
this greater appreciation for a life. So nurses who work
in palliative care report that they've gotten so many benefits
(32:23):
out of this because they savor their own life so
much more, and they don't take things for granted in
a way that they say they did before they started
working in that. And so I wonder if again, in
the midst of all this suffering, there might be a
real benefit to the people who are in the trenches
right now, one that you might not see now, but
after you get out of this, it will cause you
to look at life in a completely different way. And
(32:44):
that kind of appreciation is pretty rare. You know, we
should all have that kind of appreciation, but we don't.
And so the opportunity to see that so closely might
bring a powerful mental health benefit that healthcare workers don't
expect in the years to come. Yeah, I agree with that.
I think that it's really important for us to be
able to think about that. And I've meditated that. I
(33:05):
had that meditation before. Just imagine that today, your last day.
And I think that what it does is it really
puts things in perspective that you start to put what's
really important in your life together. And I do think
that this has caused us all to hit the pause button.
You know, we've taken our environment for granted, We've taken
(33:27):
people for granted, right, you know, we've really placed unfortunately
certain times, we've put you know, money or technology in
front of people. That hurts. That hurts as a physician
to see that certain certain populations are going to be
more vulnerable with this. But I do think that you're
taking stock of all the things and all the blessings
and all the things that really matter is going to
(33:50):
make a big difference afterwards. And I do think the
world be kinder and more mindful after this happens, not
during There is going to be great suffering, and so
you know, I think that the world will change, no doubt.
It's been great that you've been able to see these
deep benefits into get meaning out of these things. But
I just wanted to add one strategy for any of
(34:10):
our healthcare workers or first responders who are really struggling
with how to do that. And this comes from a
scientist that we interviewed during the first season of our podcast,
Jamie Pennebaker, and he does a lot of work on
the power of journaling for allowing you to kind of
get to these self transcendent emotions. And so what he's
found is that just the act of taking time to
sit down and talk about your write down about your situation,
(34:30):
write down what you're feeling, it can kind of get
you to that that bigger picture, to kind of see
the big purpose in it, to see that these things
are you're calling and to see where you're getting your courage,
or even just to take a kind of more future
perspective on things. It can allow you to make sense
of these things that feel really out of control. So
if you're listening out there and you need a good
technique to get to the point that Mike has so
(34:50):
well through his meditation practice and all the work that
he's done, you know, just sitting down to scribble it
down and journal it can be really powerful, And that
can be a great technique to add into a routine
or even as a ritual at the end of the day.
You know, scribbling down your feelings is a great thing
to do even before maybe you go to bed, because
you can kind of get it out on paper and
let your brain process to something else that you can
fall asleep too. But I wanted to end with asking
(35:12):
you know, this isn't an awful crisis and people really
are suffering in you know, as I said when we
started in my metaphor about the second arrow, I think
it's not a first arrow that our physicians are getting
hit with right now. It's like an AK forty seven.
But do you think that through the through some of
these interventions, we can make it a little bit better. Again,
not perfect, but but these are things that physicians can
(35:33):
do to improve things at least a little bit during
this challenging time. Yeah. Absolutely. My friend George Mumford, who
is I spoke with a week ago, who is a
meditation and mindfulness specialist, you know, he is the concept
of the eye of the hurricane. And you know, I
think that that's the important thing. Can you be the
calm within the storm? You know, ultimately, you know the
(35:56):
storm is going to be there and there is no
way to wish this away. But it is our ability
to stay calm and peaceful despite the things that are happening.
And also actually you have to be comfortable being uncomfortable,
and also you have to allow yourself to not be
perfect on all of those things, because I think that
you know, it's not about pushing emotions away, It's about
(36:18):
sometimes it's just sitting there with that. You know. I was,
I was out for a walk the other day and
there was a certain amount of sadness that just kind
of came up out of the blue, and I just sat,
I just was there with it. I let it go,
and then eventually it passed away, you know, it just
moved and you know, one of the things is is
our emotions don't always stay. They're fleeting. You know, we're
not happy forever, we're not sad forever. We're not feelful,
(36:40):
we're not angry. You know, if we stay with those
things and we realize that it's just an emotion and
realize that it too will pass, that it's for me,
that's made a big difference for me, and I think
that that will help me in the in the coming
weeks despite whatever whatever storm is going to come, this
will pass. That's awesome, and I think it's it's powerful
because again, there's not much we have control over in
(37:03):
this situation, but we do have control over how we
react to it. There's a lot of work in science
that suggests that what you resist persists. You know, if
you try to push away your fear or push away
your anger, push away your emotion, it's just going to
come back to hit you. So just say this is
the way this is, and it's yucky, but you know,
freaking out and fighting it isn't going to help. Let
(37:23):
me just get through what I need to get through
in as healthy a way as possible. And so, Mike,
thank you for helping our listeners get through what they
need to get through in as healthy a way as possible,
which I really appreciate. And thanks so much for coming
on the podcast. Oh thanks for asking me. I'm really
I appreciate the opportunity to speak with you, but also,
you know, to share what's going on, because I think
it's important for people to realize that it is a
(37:46):
unique physician and healthcare to be sitting where we are
that we've never faced. I wanted to end this episode
by expressing my gratitude to all the medical professionals and
first responders out there. Thank you so much for your
bravery and service, and I really hope you heard some
tips that might help you in this fight. And if
you're not on the front lines but you still want
to help, there are lots of things you can do.
(38:09):
You can start a campaign to get hospitals more life
saving protective equipment. You could consider donating blood, which I'm
told is running really low right now. Or you could
even see if your local hospitals are accepting food donations
for their tired workers. But the biggest thing you can
do is just stay home, which will help flatten the
curve and keep everyone, including our healthcare heroes Safe. The
(38:32):
Happiness Lab is co written and produced by Ryan Delly.
This episode was mixed and mastered by Evan Viola and
our original music was by Zachary Silver. Extra extra special
thanks to the medical professionals who helped me with this episode,
especially doctor Sanjay chevek Romani, doctor Tanya Fik and doctor
Amy Commander. As usual, deep gratitude goes to Ben Davis
(38:54):
as well as the rest of the Pushkin team.
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