0:00

This is it's okay that you're not okay, and I'm

0:02

your host, Megan Divine. This

0:04

week, if you are a burned

0:06

out healthcare worker or you know someone

0:08

who is, you need to listen

0:11

to this episode. If you're a

0:13

therapist or another healthcare worker, like,

0:15

how do you keep showing up to do the work when the

0:17

work itself is breaking you into

0:19

a million little pieces? This

0:22

is such a big issue, and it's honestly something we

0:24

don't talk about enough. This

0:26

is another episode friends where we

0:28

speak directly into the

0:30

abyss. This week

0:32

special guest and burnout tour guide

0:35

doctor Jesse Gold. And since

0:37

that long time ago when Jesse and I first recorded

0:39

this conversation, I want to make sure that I note

0:42

she's released a new book. It is called

0:44

how Do You Feel? We will link

0:47

to that book in the show notes, but be sure to check

0:49

it out. Stay tuned, everybody, We're

0:51

going to be right back after this first break before

1:01

we get started. Two quick notes. One, this

1:03

episode is an encore performance.

1:06

I am on break working on a giant new project,

1:08

so we're releasing a mix of our favorite episodes

1:10

from the first three seasons of the show.

1:13

This episode is from season one in

1:15

which I answered listener questions, sometimes

1:17

on my own, sometimes with a guest. So

1:20

if you want more of these Q and A style

1:22

episodes, you can find the entire collection

1:24

from season one wherever you get your podcasts.

1:28

Second note, while we cover a lot

1:30

of emotional relational territory in our time

1:32

here together, this show is not a substitute

1:35

for skilled support for the license mental health provider,

1:37

or for professional supervision related to your

1:39

work. I really want you to take what you

1:41

learn here, take your thoughts and your reflections

1:44

out into your own world, and

1:46

talk about it all. Hey,

1:51

friends, So one of the main goals

1:53

of this show is to give voice to what's really

1:55

going on inside the healthcare

1:58

field. We're always talking

2:00

about the importance of mental health and reaching out

2:02

for help, but the helpers are human too.

2:05

In an industry that prizes stoic detachment

2:07

as a form of high achievement, being

2:10

a real human being with feelings and limitations

2:12

is seen as a liability a lot of the time.

2:15

That's especially true in the hospital setting,

2:17

where the fast paced and demanding workload

2:19

can make even the most committed helper feel

2:21

like they have to sacrifice themselves on the altar

2:24

of the bottom line.

2:27

Doctor Jesse Gold is an assistant professor in

2:29

the Department of Psychiatry at Washington University

2:31

School of Medicine in Saint Louis. She's

2:33

a nationally recognized expert on health

2:36

care worker mental health, and burnout, particularly

2:38

during the pandemic. She writes

2:40

regularly for the popular press about mental health,

2:42

stigma, and medical training. That

2:45

is a giant mouthful of professional street

2:47

cred, all of which to say that doctor

2:49

Gold knows her stuff when it comes

2:51

to mental health challenges facing the health care industry

2:54

itself. Doctor Gold

2:56

isn't afraid to speak into that complex, messy,

2:59

very very human sea of being called to care

3:01

for people while at the same time feeling

3:03

like you're falling apart. JESSI,

3:05

my friends, welcome to the show.

3:07

Thanks for having me.

3:08

So I want to open with something that you wrote in Forbes

3:10

magazine last year. You wrote, quote,

3:13

here's something we don't say out loud as healthcare

3:15

professionals enough. We have reactions,

3:18

feelings and emotional responses. We

3:20

feel angry and depressed and anxious.

3:23

We have worries about what's going on in the world right now

3:25

and how it affects our patients. We also

3:27

have feelings about what we see and experience

3:29

on a shift, and those feelings often catch us

3:31

off guard. Our emotions are suppressed

3:34

and held inside because we are supposed to be stoic

3:36

caregivers. So

3:38

that mouthful just as

3:40

the starting point. What do you see

3:43

as one of the main issues unfolding

3:45

for healthcare workers right now?

3:47

I mean that whole mouthful is mostly

3:49

a way to say that we're told

3:52

and taught not to feel.

3:53

Really, it's the way to survive, it's

3:56

the way to deal with what we see day to day,

3:58

and it ends up being away that we then get

4:00

burnt out and said in a bigger way

4:02

because we push down a lot of feelings and we

4:05

push down our reactions and it

4:07

just becomes not a space we feel safe

4:09

being in. And then it's kind

4:11

of all compounds until it's much worse. And I

4:13

think that's a big problem with healthcare

4:15

in general. But right now, with everything

4:18

that's been going on in the pandemic and everything

4:20

that people have been exposed to, and

4:22

how different the workspace has been. You

4:24

know, it depends on what phase of the pandemic, but

4:27

certainly like more risk to yourself

4:29

or your family, different lacks of resources

4:32

in different ways because of staffing or

4:34

even just simply like resources like beds.

4:37

I think, much more death than

4:39

usual on a day to day in

4:41

what you're seeing, and so you have this

4:43

additional compounded hard

4:46

workplace on a baseline mental

4:48

health situation that's not ever

4:50

really been great for healthcare workers. And

4:52

so it's kind of a perfect storm in a lot

4:54

of ways. And the feelings part is a big part

4:56

of it, because we just don't have a culture that

4:59

talks about any of it, and so

5:01

you feel really alone and that makes it a lot

5:03

worse.

5:03

Yeah, I think it's just it's such a hot

5:06

mess, right It was a hot mess

5:08

before the pandemic. Like

5:10

the none of these things we see erupting right

5:12

now, they're not new. It's like we had

5:15

a system that was

5:17

already broken, was already fractured

5:19

in part because of what you were just mentioning,

5:21

like this culture of stoicism,

5:25

this idea that having human

5:27

emotions is somehow unprofessional.

5:29

Yeah, I mean, I think in a lot of ways,

5:31

a hot mess is a decent way of describing

5:34

it. And it's like an extra hot mess now,

5:36

I suppose, But I think, you know, I've heard someone

5:38

say that the fault lines are what

5:40

you see through COVID, which

5:42

is like these things that have been brewing under

5:44

the surface but just get much more exposed

5:47

with all of the additional stressors of

5:49

COVID, And I think this is definitely one

5:51

of them.

5:52

And our culture and healthcare

5:54

is horrible.

5:55

I mean, we've lived in a

5:57

group where you know, you're prioritizing

6:00

sleeping, not eating, like really

6:02

prioritizing the other person, you know,

6:05

the patient over yourself. There's a

6:07

lot of conversation around like if

6:09

you show emotion in a patient room,

6:11

like are you taking away from what that patient

6:14

is experiencing? So you spend

6:16

a lot of time trying to learn not to react

6:18

to things or that it's normal to go from

6:21

a person dying in one room to a conversation

6:23

about like eating or something

6:25

kind of just generic in another.

6:27

And that's just what you do.

6:28

And it's a weird culture and not

6:31

a culture we talk enough about how weird it

6:33

is either, and that makes it hard.

6:35

Yeah, I think that's a really interesting

6:37

point you bring up about, Like even

6:39

if there wasn't this sort of professional

6:42

training cultural model of the

6:44

stoic attending, right, like you

6:46

don't want to take away from the person in the room

6:48

by showing your humanity because then it's like, oh

6:51

crap, like now we're talking about me. We don't want

6:53

to hijack the situation in the room. But I think

6:55

one of the things that's really happened is we've made

6:58

that an either or situation and stuf

7:00

of a continuum. You are completely

7:02

impenetrable, which doesn't do so great

7:04

for your clients and patients anyway. Or

7:07

to use hot mess again, you're a hot mess and you're taking

7:09

away from what's in the room at the time. And

7:12

I think having these conversations is how we create

7:14

that middle ground of how do we be

7:16

full humans showing up to do this work with

7:19

the boundaries and the ethics that are in place for

7:21

us, but also not at the cost of our

7:24

own humanity and our own relationships and our own.

7:26

Lives for sure.

7:28

And I think in a lot of ways, if you ask patients

7:31

like they would be okay if you showed

7:33

emotion. It's different to show emotion

7:35

over something that requires emotion and

7:37

would be an empathetic gesture to show

7:39

emotion than it is to just be emotional all

7:42

the time and not make it like

7:44

a space that feels safe for patients to

7:46

talk at all. Right, that's very different, and

7:48

I think we worry that once

7:50

you like tip over, you're all

7:52

the way over, and it's just really not

7:54

like that. And I think a lot of times I've

7:56

heard from people where their doctor has like actually

7:59

cried with them or sat with them through something

8:01

that it's been a really meaningful experience.

8:04

But if you take that from the doctor side, they'd

8:06

be like, why would I ever do that? That's horrible, Like nobody

8:08

would like that. That's not something I'm allowed

8:10

to do. So it's a very different perspective

8:13

on what we want or what we think we're

8:15

supposed to be doing.

8:16

It's interesting that you brought up that, like basically

8:18

the if I start crying, I'll never be able to stop

8:21

thing in the medical world as

8:23

well. I mean, I hear this a lot with people who

8:25

are having a really hard time navigating

8:28

super challenging life things. They're like, I can't start

8:30

crying because I'll never be able to stop. And that is

8:32

such a product of our emotion

8:35

a verse culture as a wider

8:38

social culture, and also again in the medical

8:40

industry. So this actually sets us up

8:42

really well. For the first listener question that

8:44

I wanted to get into, if you're ready,

8:47

sure, I actually asked my audience

8:49

for questions. I told them all you were coming on the show.

8:51

I wanted to get a lot of questions from people

8:54

really working on the front lines, and I can tell you that, like,

8:56

question after question after question after question

8:58

was basically asking the same thing, how

9:01

do I handle my own grief, knowing how I

9:03

have to show up day after day and take care of

9:05

other people. For some of the people who sent

9:07

in their questions are actually working in the same hospital

9:10

where somebody close to them died, so

9:12

the sensory awareness is just on

9:14

tilt for them. I'm going

9:16

to preface this question by saying we are

9:18

not going to have a neat and tidy solution

9:21

for this, but I wonder if we can use

9:23

one of those questions as a starting point.

9:25

There's no neat and tidy solution to most

9:27

things, especially grief, but feelings are

9:29

messy, and I think part of the desire

9:32

for a neat and tidy answer is part

9:34

of the problem, because we want it

9:36

to be perfect so then we can do it. But

9:38

really, in a lot of ways, you just need to be

9:41

and see where you go from there.

9:43

Yeah, this is why I love your work so much,

9:45

in your presence in the world, because you're like, well, this

9:47

shit's missed. It's messy, Like we can't

9:49

make it anything but messy.

9:51

Okay. So here is the question, dear

9:54

doctor Golden Meghan. I'm an inpatient

9:56

PA trying to balance the grief of the traumatic

9:58

loss of my father, followed by that of my relationship,

10:01

as well as the grief and loss and hardship

10:03

brought on by the pandemic in my daily work

10:05

life. I'm so tired from carrying

10:08

this weight twenty four to seven. I

10:10

have a counselor, but I feel I could do more to

10:12

compartmentalize or otherwise find

10:14

some relief. Is there a way

10:16

to honor my deep feelings but also find

10:18

reprieve? How do I care for

10:20

myself in a world that requires so

10:23

much of my energy?

10:25

I chose this question on purpose

10:28

because it has so much jammed into it, right,

10:31

so many layers and layers and layers,

10:34

and I feel like it's really indicative of what's happening

10:36

in medical facilities all around the country.

10:38

So where do we start.

10:41

It's interesting because you could say, oh, This feels

10:44

like a complex story, but in a lot of ways,

10:46

it's everybody's story, right. I think people

10:48

forget that healthcare workers have

10:50

the life experiences that everybody

10:52

else has gone through that have been challenging over the

10:54

pandemic, like being a mother, being

10:56

a partner, being a caregiver, having

10:59

family members get sick and die, and then

11:01

on top of it, I have to go to work every

11:03

day on the front lines and help everybody else.

11:05

Right, So there's like that added stressor

11:08

which seems like enough to people, but we have

11:10

all the other stuff.

11:11

Too, right.

11:12

But I'm guessing that you know, in

11:14

a lot of ways, it's really good that she goes

11:16

to counseling already, because I think that's a

11:19

big thing that's hard for people in general

11:21

in healthcare to ask for help, to

11:23

admit they need help, and they really hate talking

11:25

about things. So having a place

11:27

for that that's just for you is really important.

11:30

I think in a lot of ways, we try

11:33

really hard not to have feelings

11:35

in the workplace and to pretend that somehow

11:37

there's this big difference between work

11:39

and home and everything like that, but it's

11:41

all together, and you're the same

11:44

person going into work it's just you

11:46

have to deal with the things at work, and so,

11:48

you know, I think it's important to give yourself space

11:51

and time to acknowledge what you're feeling as much

11:53

in the moment as you can. I think it's really

11:55

hard in healthcare because that's

11:57

a privileged time and able

12:00

to pause at all. But honestly, like

12:02

reflecting on what you feel in your body, reflecting

12:05

on what feelings are actually having and being

12:07

okay with also having feelings while

12:09

you do the job, I think is a really important

12:12

thing. So obviously it's great to have

12:14

a space to talk about with the therapist and process

12:16

and all of that, but the time before your

12:18

next appointment is important too, which

12:20

is like, how do I deal day

12:22

to day without just like pushing

12:24

my emotions down until that one hour once

12:27

a week, And you really need to give yourself

12:29

space and be okay like having

12:32

a full range of feelings. So I think a

12:34

lot of healthcare workers have struggled with things

12:36

like anger and

12:38

not knowing whether like being angry makes

12:40

you a bad doctor or PA or

12:43

nurse or any other person on the health care

12:45

spectrum. And you know, I think you

12:47

can be angry, and that feeling

12:49

can be valid and you can still do your job

12:51

well. And I think it's important that we get

12:54

used to holding both things and knowing

12:56

when we have time to do whatever

12:58

we need to do, to let our selves acknowledge

13:01

that we are a human being with feelings

13:03

and have to do our job at the same time.

13:05

Yeah, I love that, and it reminds me of something

13:08

earlier we had on the co founders

13:10

of the New York's end Center for Contemplative

13:12

Care on and they work

13:14

with physicians, they work with people in healthcare, and

13:16

they said, like, I don't believe it

13:18

when you say I don't have time to

13:21

acknowledge my own feelings, sit in my own humanity.

13:23

They're like, yes, you're busy, but you

13:26

have thirty seconds,

13:28

right, And sometimes I mean it

13:30

seems like it's not enough. But

13:32

what they pointed out was like thirty

13:35

seconds many times a day becomes fifteen

13:37

minutes, and fifteen minutes of allowing your

13:39

own humanity to yourself will

13:41

make a dent in that pressure. It's

13:44

not going to solve anything, like none of this is

13:46

like a super easy solution here. But what

13:48

I hear you really saying, Jesse, is like there

13:51

is power in acknowledging your humanity,

13:54

even if it is a split second as

13:56

you're moving from one room to the next, to be able

13:58

to say I have feelings about this. You have

14:00

feelings about this, and I don't have time for them right now,

14:02

but I want to notice for myself that I see them for

14:05

sure.

14:06

I think that we spend too much time assuming

14:08

that all things coping take hours.

14:11

Like if I'm going to tell you to have feelings or

14:13

cope with something, you need to whip out a yoga mat

14:15

and do like a forty minute class. Right, that's

14:17

impossible for most people most of the

14:19

time. There are different things you can do

14:21

that take less time that are really helpful.

14:24

Healthcare workers really like things like deep breathing

14:27

because you walk the stairs between patients.

14:29

You have the time gelling in and out

14:31

of a room before you have to see the

14:33

next person to take the second and like

14:35

actually change your breathing patterns to calm

14:38

yourself or acknowledge how you're feeling,

14:40

or give gratitude for what you just experienced,

14:43

if that's helpful for you. I think we don't stop

14:46

enough to think about the good things in our

14:48

day or the privilege of our job. We often

14:50

get really caught up in the hard thing of our job,

14:52

and so trying to just do that in

14:54

the quick amount of time that you have.

14:56

You're right, it sort of just.

14:57

All adds up to being less than you

15:00

know, maybe ideal in the world, but much

15:02

better than nothing, and much better than only having

15:04

that once a week time in counseling, which

15:07

most people don't even have, because that's a privilege

15:09

to be able to fit into your schedule,

15:12

and also to not feel scared

15:14

to do that in the first place in healthcare.

15:17

So I think you're right, just kind of all

15:19

kind of comes together as much as you can.

15:21

Yeah, it really doesn't. And I just want to pull

15:23

out that one little bit that you said, not only is

15:25

it a privileged to find the time to go to therapy,

15:27

but because we're working against that idea

15:30

that having emotions on the job makes

15:32

you less professional, less

15:34

skilled at your work, like that is a big thing that we want to

15:37

name here too. That can feel really scary

15:39

to even acknowledge that

15:41

you're wrestling with this stuff because of that culture

15:43

of perfectionism that we see so much.

15:45

So I love that you're like, you can't just whip

15:48

out a yoga mat and I think we often use all of

15:50

those things that you just mentioned. We often like they're

15:52

often positioned as these cure alls, like if you would

15:54

only practice gratitude and journal for fifteen

15:56

minutes about all the things that you love about your life,

15:59

that everything would up sucking so much.

16:01

And that's like, that is not what those

16:03

tools are for. Those tools are not to remove

16:06

suckage. They're to help you navigate,

16:08

manage, and support yourself inside this

16:10

really really difficult situation.

16:13

And for me, like the language that I use around that

16:15

is like, this is helping you acknowledge the reality

16:17

of the situation, and acknowledgment

16:19

is very powerful medicine.

16:21

Yeah, I mean, I think that's a problem with a lot of

16:23

framing around coping skills

16:26

or especially like resilience, is this

16:28

feeling that it's somehow your fault

16:30

that you're not surviving in a broken

16:32

system, And when people suggest

16:34

doing things that can help you, it feels

16:37

like they're saying, come on, like fix yourself,

16:39

like yeah, wornything else is fine, work

16:41

harder, figure it out, like you should be fine.

16:43

Yeah, But really what we should be saying is

16:46

the system, specifically in healthcare, but

16:48

in a lot of ways, is very very

16:50

broken, and culture change takes

16:52

time, policy change takes time.

16:55

Any other sort of systematic change is

16:57

going to take time. And if you want to survive

17:00

in a truly broken system, even as it

17:02

attempts to heal, you have to

17:04

figure out how to do that yourself, and it

17:06

requires some individual

17:09

coping to do that. It doesn't mean something's

17:11

wrong with you. It means that you're reacting

17:13

normally to a really bad situation.

17:16

And if you want to still be in healthcare,

17:19

you have to figure out how to deal. And you know,

17:21

I'm not exempt from that by any means.

17:23

Like I think it's important for people

17:25

to realize, like just because I

17:28

preach like things around coping skills

17:31

and burnout and things like that doesn't mean I'm

17:33

really great at all the stuff myself.

17:35

Like I've really spent a lot of time

17:38

over the pandemic trying to figure out

17:40

what coping skills actually work for me

17:42

and don't feel like that, like I'm just doing

17:44

something to do it, And like I

17:46

spend a lot of my energy like coping

17:49

with others and having the support

17:51

of other people, And when that got taken away in the

17:53

pandemic, it was a lot of like, oh,

17:56

what do I actually like to do myself that

17:58

actually still feels good in this way

18:00

that going to dinner with a friend might. And

18:02

it's been a lot of work and I'm still working on

18:04

it, and you could ask way therapist and she'd probably

18:07

tell you I'm okay sometimes.

18:08

And struggle a lot.

18:10

But I think it's important that people realize that

18:12

even though I know these things, it doesn't

18:14

mean that I do them all the time. And we spend

18:17

a lot of time in medicine assuming

18:19

like, well, I can, I should be able to take care of

18:21

that myself, like I understand disease

18:24

or I understand mental health, I should be able

18:26

to figure out how to deal with this, And honestly,

18:29

you shouldn't because I actually am

18:31

an expert in this particular area

18:33

and I can't. Right, So it doesn't matter

18:35

what you know. It matters how it gets applied

18:38

and how other people point out things to you

18:40

that you might not even realize are going

18:42

on.

18:42

Yeah, I love this. There's actually a Twitter thread of yours

18:45

where you I think you started it, where were

18:47

like, okay, physicians, let's

18:49

talk about the things that we would tell our patients to

18:51

do, but we don't do ourselves. And there's this whole

18:53

long thread of like I don't I never drink

18:56

water, I drink only diet soda, I don't get

18:58

enough sleep, like I never moved from my like

19:00

all of these things like remembering your humanity

19:03

in there and this is not I think there's so much

19:05

perfectionism baked into the healthcare

19:07

industry, right like, I must do this

19:09

correctly or I won't. Like, oh, come on, like

19:11

you are still human and you

19:13

are still a catastrophe in progress,

19:16

just like all of us.

19:18

I mean, medicine like recruits those people.

19:20

Yeah, in a lot of ways.

19:21

So it's like it's a process that is like let's

19:24

start out with the people who are most

19:26

likely to be perfectionists and then make it harder

19:28

for them by judging them for having anything

19:31

that's outside of perfection or making them

19:33

feel judged for having anything outside

19:35

of perfection. And achievement and perfection

19:38

become this thing that carries throughout

19:40

but probably did and most people who went into

19:42

healthcare's life before that, because

19:44

you have to go into a process

19:47

of applications where not everybody gets in,

19:50

and there's all this competition up front, and

19:52

the competition makes you feel like you have to be

19:54

perfect, and that just continues

19:56

on and on and on, especially if you stay at

19:58

academics.

19:59

Yeah, yeah, I love that perspective there,

20:01

that through that whole rigorous

20:04

process of getting into the field, because

20:07

we have that culture of stoicism

20:09

and perfectionism that we are actually like

20:11

selecting for that. And then you

20:13

put these people who are selected to run that

20:15

way, to hold themselves to really high standards, to

20:17

suppress their feelings because of multiple reasons,

20:20

and we put them into a highly emotionally

20:22

charged situation over and

20:24

over and over again. And then I

20:27

just don't think we can be surprised when people.

20:28

Break, especially not people who mostly

20:31

wrote application essays about how they want

20:33

to help people, right Like, the people

20:35

that are the best at what we do

20:38

care a whole lot, and that's really

20:40

hard to keep doing and not

20:42

break. And you don't want to find

20:44

ways to only keep the people in healthcare

20:47

that are fine with no feelings

20:49

and don't break, right like, you want to keep

20:51

those people.

20:52

So we have to do better.

21:01

Welcome back to friends. We have been talking with

21:03

doctor Jesse Gould on the reality of being

21:05

a healthcare professional with real human

21:07

feelings inside a profession that

21:10

doesn't actually value human feeling.

21:13

Let's get back to our conversation. I

21:15

think this sort of brings us around to the

21:18

big picture environment that a second

21:20

listener question ushers us into.

21:22

Debbie wrote in how do we change things

21:25

in healthcare? As a frontline worker,

21:27

we need our managers to understand that we

21:29

are not machines. We are human and

21:31

need to be heard and understood and rewarded.

21:34

I get it that managers have numbers and

21:36

goals to meet, and we have patients, but it's the

21:38

frontline clinicians who do the work. We're

21:41

the ones who face the trauma of treating COVID patients

21:43

head on, seeing the horror unfold. We

21:46

can't just keep going as if nothing has

21:48

changed. We've changed. How

21:50

do we change the system so more value is

21:52

placed on our well being? I

21:55

think a shift has begun. Workers want

21:57

more. I see that, but I guess for now

21:59

we just have to say stand up for ourselves. So

22:02

I love that line in there in this question, how

22:04

do we change the system so that more value

22:06

is placed on our well being? And

22:09

you touched onto this a little bit, but if

22:12

we widen that lens out, how

22:15

do we start forcing

22:17

a change in a system that was

22:19

broken before the pandemic. Those

22:21

fault lines are really glaring and exposed.

22:23

Now how do we even start?

22:26

Yeah, I mean I've thought somewhat about this, in

22:28

part because in one of my roles in the hospital,

22:30

I've had to interface a lot with like

22:32

administration and try to argue

22:35

for the need to invest in these things. And

22:37

I think it's very frustrating because

22:39

we ultimately have different goals,

22:42

right, Like, I think when you're a frontline

22:44

clinician, your goal is to help

22:46

the patient as best as you can, and

22:49

you're really focused on them. Once

22:51

you get higher and higher up in mezine,

22:54

you're dealing with people who are

22:56

really concerned about the bottom line and

22:59

really concern and about money, and ultimately

23:02

you realize just how much our

23:04

healthcare system is actually a system

23:06

that's built on financing instead

23:09

of the people that it's taken care of,

23:11

and that itself can be pretty disheartening.

23:14

But I do think there are ways where

23:16

you can make arguments acknowledging

23:19

those values that maybe not your values,

23:22

but are the values of the system to

23:24

get what you want.

23:25

Right.

23:25

So, for example, depression

23:28

is the number one cause of disability worldwide,

23:31

which means it costs the system

23:33

a lot of money to have a lot of depressed

23:35

doctors because you don't go to work,

23:38

or nurses or whatever. You don't go to work, you

23:40

can't be as productive, you might have errors.

23:43

All of these things are true, and there's data

23:45

that backs it up, and I think

23:47

hospital systems are becoming more

23:49

aware of it because of COVID

23:52

and how many people have been speaking out about

23:54

their mental health in COVID and

23:56

realizing that they can't just give

23:58

you a pizza party or like a lecture

24:01

on wellness until you like, we're done,

24:03

that's all we're doing, that's all we care about the end, or

24:05

just give you access to an employee access program

24:07

and realize that's not enough either. And

24:10

so I do think there is a way to

24:13

advocate for what you need or what

24:15

you're missing while still appealing

24:18

to a value that might not be your

24:20

value, but is the value that might get

24:22

things done. Unfortunately, you have to do that

24:24

sometimes. So I think that's really important.

24:26

And at the same time, I do think you can

24:29

make small changes, like in your teams,

24:31

in the people that you're supervising,

24:34

in the way you interact with other people, that can

24:36

make a big difference. So, you know,

24:38

I talked a bit about how we don't talk about feelings,

24:40

but we don't even say like it's okay

24:42

to make mistakes, or that was hard or that was challenging,

24:45

or of course you don't have an answer to that

24:47

and you don't know, we don't know, right, and modeling

24:50

that for people having conversations about

24:52

why it's hard to say that stuff you don't

24:54

even have to talk about, like mental

24:57

health conditions. Right, we just need to start

24:59

changing the conversations

25:01

around struggle and why

25:04

it might be hard to do this job. And

25:06

some of that can happen on a

25:08

team level or a supervisor level, and

25:11

then it can get to higher and higher

25:13

levels, sort of as a bottom up

25:15

approach to changing how we talk about

25:17

this stuff.

25:18

And once you do that.

25:19

At the same time, hopefully they hear your

25:21

advocacy and they hear the things you want

25:23

and they start making changes. But I do think

25:26

you can make some changes just by having

25:28

real conversations.

25:30

Yeah, absolutely. I mean, we started out this the

25:32

first half of the show talking about telling yourself

25:34

the truth in these moments, letting

25:36

yourself be human, letting yourself having these feelings.

25:39

And I love what you just brought in there about like we can

25:41

start having these conversations in our teams

25:45

at the nurses station, you know, in supervision,

25:47

to just start normalizing

25:49

what's actually happening, Like we're

25:51

not talking about anything like earth

25:53

shatteringly new, We're talking about let's

25:56

name what's actually in the room, and

25:58

start claiming our humanity as normal

26:01

and healthy and challenging in these situations.

26:03

This is really a grassroots

26:05

movement of the people who are in the front

26:07

lines doing the work starting to tell the truth to themselves

26:10

and to the people around them. And I also

26:12

love that you brought in like let's borrow

26:15

from the c suite. Let's borrow from

26:17

higher up admins. They do have a balance

26:20

sheet at the end of the day, and there

26:22

is economic benefit to valuing

26:24

people's humanity and their limits.

26:27

And I think you know, whether you take on that role

26:30

or not, Like if you pick up that flag and you decide

26:32

to go after that or not. I think

26:34

that's something that we want to start really talking

26:37

about, is the economic

26:39

reality of denying people their humanity,

26:42

not just in the medical world but all around the

26:44

entire globe. But that we do have to

26:46

speak the language of finances, and how do we start

26:49

understanding that denying people their

26:51

humanity costs us. It costs

26:53

us financially, it costs us in community

26:55

building, it costs us in all of the public health crises

26:58

that we have currently unfolding. Interruptive. You

27:01

know, I started this our conversation out by like

27:04

saying, we're never going to have a solution for the

27:06

hot mess of all of this. And I still

27:09

believe that. I still believe we're not talking about a

27:11

solution here, but I do think we're talking about

27:13

a way forward from here

27:16

without collapsing into the despair of the hot

27:18

mess. But how do we really

27:20

start to change the

27:22

culture. One of the things

27:24

that I picked up from your work, there's

27:26

this great quote from you that says, the mental

27:28

health system is broken. You can't

27:30

fix it by breaking yourself. And

27:34

I think that's a really interesting sort

27:36

of closing point for us

27:38

in all of these things that we've talked about. So tell

27:40

me a little bit about that statement, and if

27:42

there's a message you want to

27:44

dictate to the world in this in

27:46

this moment about I don't know

27:48

everything we just talked about.

27:50

I mean, I think in a lot of ways we

27:53

neglect mental health in all conversations.

27:56

So the reason why it's not in the financial

27:58

conversation is people forget it and don't

28:00

put it there or think it's not relevant. Or

28:03

we're seeing all these people leave jobs

28:05

and they don't talk about the fact that it's because

28:07

of burnout or mental health. It's just like, oh,

28:09

staffing or these like procedural things. And that's

28:11

very true. But at the same time, you have

28:14

to call it what it is and say people are choosing

28:16

themselves over a job that takes

28:18

it out of them. Right, we have to have

28:20

mental health in these conversations or

28:23

we're really missing out and we're not advocating

28:25

enough for ourselves. We're just going to keep jumping

28:27

jobs until we find a place that maybe

28:30

is a little bit better with it, right, And I

28:32

think you know when I said that

28:35

we can't fix it by breaking ourselves,

28:37

I meant over the pandemic,

28:40

I've seen therapists really

28:43

try to just take every single

28:45

patient that they possibly can to

28:47

make up for the need. And there's a

28:49

huge need, and there's always going to be a huge

28:51

need, and the need keeps increasing and will

28:53

after the pandemic. But you talk

28:55

to therapists and they're like, well, I started

28:57

working in the evenings. I took back all my you

29:00

ask to come back from before. I

29:03

am working on weekends now, and now

29:05

I'm sad. Like, turns out that

29:07

has a big effect on me too, because I

29:09

don't have free time anymore, and I'm holding

29:11

all this stuff for other people. And as much

29:14

as you want to try to help

29:16

in every single way you can, which

29:18

is what we do in our jobs, in so many ways,

29:21

there's only so much as a human in

29:23

a broken system that you can do without

29:26

realizing that you really need to step

29:28

back and put yourself first. Like, you

29:30

can do what you can do, but there are limits to what

29:32

you can do because you're a human being, And

29:35

so as much as you are an advocate

29:37

or a caring person about how broken these things

29:39

are and how much you want to change them, there's

29:41

a space for that. But in

29:43

the same breath, there's also boundaries

29:46

and a way to have space for you. And

29:48

we neglect the second part because we really

29:51

want to do the first part right, But

29:53

you don't do the first part right unless you do

29:55

the second part.

29:56

Yeah, I think that's a really beautiful end

29:58

note for our time together in a life lot of ways,

30:00

this is a lifelong pursuit we're talking about,

30:02

right, like this exploration of how

30:04

do we do the work we're called to do without losing

30:06

ourselves in the process. So

30:09

ordinarily at the close of the show, I ask

30:11

you where people can find you when we are absolutely going to do

30:13

that, But first I would also love some ideas

30:16

where physicians and other healthcare workers

30:18

can go for support. What are your like

30:20

maybe top two or three places

30:22

that you would recommend right now.

30:24

So you know, in a world of misinformation,

30:26

it's always helpful to go to places that you know

30:28

are consistently good and putting out good

30:30

information. So I always go to like big

30:33

organizations when that's the case. So often

30:36

that means going to like the American Foundation for

30:38

Suicide Prevention, who has website on

30:40

healthcare worker mental health thrive

30:42

By. The Huffington Post also has a huge

30:44

website it's called like all In for

30:46

Heroes, I think, and they have

30:49

all these resources collected.

30:50

Most of them.

30:51

Medical organizations also have that too,

30:53

So you could go to the AMA, you can go to the Double

30:56

AMC and they all have these kind of like wellness

30:58

hubs and they're probably the kind of thing where

31:00

you're listening to me, you're rolling your eyes and saying

31:02

like, did you just give me more stuff.

31:04

To read and do?

31:04

But at least it's there, you know. And I think

31:07

the people who started things like the

31:09

Physician Support Line, which is staffed

31:11

and it's all psychiatrists and staffed voluntarily,

31:15

they made that over COVID.

31:16

They're wonderful humans. You can use that.

31:18

I know that that's limiting to then only

31:20

physicians, and I know nurses who are trying

31:22

to start the same thing for nurses.

31:25

I think there are some places that still

31:27

offer free therapy if you're in healthcare,

31:30

and those places like Emotional PPE

31:32

or Therapy AID are also quite good

31:34

because it's national and you can find some people

31:36

who are willing to give you some free sessions,

31:38

particularly you know, in the situation where your workplace

31:41

is and doing that too. And I think all those

31:43

people really care and are

31:45

trying their best to give you access

31:47

to what they know exists. And obviously

31:50

we could do better, and obviously we need more things,

31:52

but those are the best that we have right

31:55

now.

31:55

I think, yeah, they're sort of the starting places

31:57

for what we mentioned earlier in

31:59

the show. About starting to link up with

32:01

others and find places where you can tell the truth.

32:04

Right, It is a little bit overwhelming to be like,

32:06

oh, now I need to go to the AMA site and search through

32:08

all of this like I have fourteen seconds. But again,

32:11

like even just starting that practice of telling

32:13

the truth to yourself and maybe finding

32:15

one or two other places. I actually love your

32:17

Twitter feed for this, so let people

32:19

know where they can find you online.

32:21

I'm at doctor Jesse Gould.

32:23

I spelled JESSEJSSI because

32:25

I was a high maintenance child that didn't say

32:27

there was an I in Jessica, so that's why

32:29

it's spelled that way. I also have that same

32:31

as an Instagram handle, and then anything

32:34

I write is on my website, which is just

32:36

like doctor jessegold dot com.

32:38

But I think that can be helpful for people because

32:40

I've written a.

32:40

Lot on this particular topic, including

32:43

from my own experience and being

32:45

a burned out for an out expert.

32:47

Yes, I think that's the powerful thing here

32:49

is that you know what you're talking about. You're not just some

32:51

talking head from the C suite telling

32:53

people to do things for their mental well being so

32:55

that they can be even more productive

32:58

on the job, but this is actually something you

33:00

live, and I am so glad to have had

33:02

this time with you, my friend. People. We will link

33:04

to everything that Jesse just

33:07

recommended and a couple of extras in the show

33:09

notes coming up next your weekly

33:11

questions to carry with you and how you can

33:13

send in your question for us to use on the

33:15

show. Don't miss that part, friends, we will

33:17

be right back each

33:27

week. I leave you with some questions to carry

33:29

with you until we meet again. It's

33:31

part of that whole. This awkward stuff

33:33

gets a lot easier with practice thing, and

33:36

I definitely want you to

33:38

practice now. This week, doctor

33:40

Jesse Golden, I talked a lot about telling

33:43

yourself the truth and then

33:45

telling other people the truth. I mean, honestly,

33:47

this is not anything that has to do only

33:49

with the healthcare industry. This is something

33:51

that I feel like I spend all of my time

33:53

talking about the importance of telling yourself the truth

33:56

and finding somebody else to share that truth

33:59

with. It's important to find

34:01

connection inside the

34:03

catastrophe. So this

34:06

week, for your questions to carry with you, your

34:08

homework assignment is to

34:10

tell yourself the truth about

34:12

one thing. I don't

34:14

care what it is. I

34:16

don't care how you tell yourself the truth, whether that

34:18

is in the thirty seconds between clients

34:20

or patients or two year old

34:23

tantrums like I don't care what it is, but find

34:25

one thing and tell yourself the truth

34:27

about it, and then just see

34:29

what happens. I want you to be a

34:31

good observer of what happens

34:33

when I tell myself the truth. Yeah,

34:37

and then extra credit.

34:39

I don't know.

34:39

I don't know that I want to use extra credit because I don't

34:41

want to tap into your perfectionist achiever

34:43

thing here when we're talking about burnout.

34:46

But if you want to do an additional

34:48

thing, find one other

34:50

person to tell

34:52

the truth too. It doesn't have to be a

34:54

big life altering thing that you

34:56

share. It could be just like you know, I really don't

34:59

like Kale. Find

35:01

one other person to share the truth with and see

35:04

what happens. This

35:07

is also a good time for me to remind you that

35:10

I really do want to hear if you don't like Kale or whatever

35:12

you need to spell the truth about. But this is also a

35:15

Q and a show, and

35:17

I want your questions. You

35:19

can ask me anything you'd like. You can bring me your clinical

35:22

questions I'm trying hard to be a good friend.

35:24

Frustrations you are, I'm overwhelmed with the

35:26

pain of the world. Questions. We got a lot

35:28

of those. Let's talk it all

35:30

out, friends, Call us at

35:32

three two three six four three

35:35

three seven six eight and leave a voicemail.

35:39

If you missed it, you can find the number in the show notes

35:41

or visit Megandivine dot co. If

35:43

you'd rather send an email, you can do that too, right

35:45

on the website Megandivine dot Co. We

35:49

want to hear from you. I

35:51

want to hear from you. This

35:54

show, this world

35:57

needs your questions Nowather.

36:00

We can make things better even

36:02

when we can't make them right. You

36:07

know how most people are going to scan through their podcast

36:09

app looking for a new thing to listen to, and then

36:11

they're going to see the show description for here after

36:13

and think, I want to talk about that stuff. Things

36:15

are hard enough. This is

36:17

where you come in your reviews.

36:20

Let people know it really isn't all that bad.

36:21

In here.

36:23

We talk about heavy stuff, but it's in the service

36:25

of making things better for everyone. So

36:27

everyone needs to listen. Spread

36:30

the word in your workplaces, in your social world

36:32

on social media, and click through to leave a review,

36:35

Subscribe to the show, download episodes,

36:37

send in your questions, want

36:41

more Hereafter. Grief education doesn't

36:43

just belong to end of life issues. Life

36:46

is full of losses, from everyday

36:48

disappointments to events that clearly divide

36:50

life into before and after. Learning

36:54

how to talk about all that without cliches or

36:56

platitudes or simplistic think positive

36:58

posters is important skill for everyone.

37:02

Find trainings, workshops, books and

37:04

resources for every human trying to make their way

37:06

in the world after something goes horribly wrong

37:08

at Megandivine dot Co. Hereafter

37:13

with Megan Divine is written and produced by me

37:15

Megan Divine. Executive producer

37:17

is Amy Brown and Elizabeth Fozzio,

37:20

Edited by Houston Tilley. Music provided

37:22

by Wave Crush,