Good Life Project - Choosing Not to Die, When Doctor Becomes Patient - Dr. Rana Awdish

Episode Date: February 26, 2018

Dr. Rana Awdish wanted to be a doctor from her earliest memories, and worked to become an ICU physician. But, when she found herself 7-months pregnant, being admitted to the hospital spiraling into multiple organ failure, the near-death experience, followed by a two year medical odyssey would forever change her.Dr. Awdish's understanding of both what is was to be a patient, and how the relationship between doctor and patient could radically affect the experience and even outcome of a patient was transformative. This harrowing journey and her awakening to a profoundly different way to practice medicine is detailed beautifully in her memoir, In Shock.Dr. Awdish is now the Director of the Pulmonary Hypertension Program at Henry Ford Hospital in Detroit and a Critical Care Physician. She was recently named Medical Director of Care Experience for the Health System and awarded the Speak-Up Hero award in 2014 for her work on improving communication, as well as the Critical Care Teaching Award in 2016.-------------Have you discovered your Sparketype yet? Take the Sparketype Assessment™ now. IT’S FREE (https://sparketype.com/) and takes about 7-minutes to complete. At a minimum, it’ll open your eyes in a big way. It also just might change your life.If you enjoyed the show, please share it with a friend. Thank you to our super cool brand partners. If you like the show, please support them - they help make the podcast possible. Hosted on Acast. See acast.com/privacy for more information.

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And it's the fastest-charging Apple Watch, getting you 8 hours of charge in just 15 minutes. The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. I was unrecognizable to myself. You know, in a course of 12 hours, I went from dinner with a friend to someone who had multi-system organ failure, who was on life support and not expected to survive. So today's guest was living her life, doing great work in the world as an ICU physician. At seven months pregnant, she found herself out to dinner with a friend in excruciating pain. What unfolded over the next 24 hours was horrifying. She found herself whisked into emergency surgery, but then admitted really into the wrong part of the hospital.

That led to devastating circumstances and set in motion a two-year medical and personal odyssey that would end up profoundly changing both her own life, her own physical well-being, and her take on what it means to be a physician, what it means to take good care of yourself, and what it really means also to be in service of your patients. She's also summed up and really beautifully illuminated this entire journey in her new book, In Shock. Dr. Rana Adesh is my guest today. Really excited

to share this conversation with you. So before we dive into today's beautiful conversation, super quick update in case you didn't catch it on the last Thursday episode last week, we're always working on exploring ways to bring you more of what you want and less of what you don't want. So we've been looking to and listening to trends and realized that we'd love producing two shows a week, but it's been creating a bit of overwhelm for a lot of people. And we're all about ease, not overwhelm. So with that, we made a decision to put our Thursday show on hiatus, at least for the spring. And starting this week, I'll be sharing any longer sort of thought pieces as essays on various places

around the interwebs. And we'll be adding in a super short, literally three minute GLP news and tips for better living spot at the beginning of our Monday jams, where I'll just share short and sweet updates about what we're working on, fun adventures, many shout outs, cool discoveries, or links. And that'll just be a super quick touch in the beginning of our Monday shows now. Speaking of which, in today's GLP, quick news and tips for better living. As I record this, I'm camped out in a little Airbnb in Burlington, Vermont. That's why the tone of the mic might sound a little different to you. With my wife and daughter, and we're sneaking in a bit of soggy snowboarding. So sad. It's so warm here. And tomorrow we'll be touring Burton's 10,000 square foot R&D and

snowboard prototyping workshop. As a maker and a boarder, you don't even know how excited I am. It's not just the double shot latte from Uncommon Grounds. If you ever get a chance to hit Burlington, be sure to sign up for the Burlington tour. But the bigger, better living quick tip here is make time to do things that light you up. If you aren't intentional about it, you'll default to being reactive. And that means for most people, it will never happen. So this week, challenge yourself to create a single opportunity to spend undistracted time with someone you can't get enough of or do an activity that makes you feel amazing. Put it in your calendar and make it sacred. And in good life news, our quick little news update here is, don't know if you've heard,

but we just reopened enrollment for this year's Camp GLP. Every August, our beautiful community comes together from around the world for three and a half days of laughter, learning, growth, and play. Just 90 minutes from New York City. We're already more than half sold out. And now you can get a $200 super early bird discount for a bit longer. Learn all about it at goodlifeproject.com slash camp or check the link in the show notes. Okay, that's it for today's GLP quick news and tips for better living on to the rest of our show. I'm Jonathan Fields, and this is Good Life Project. One of my fascinations is you seem to be

that rare person who, like at the age of five, knew why she was here. Yeah. I wanted to be a doctor from the first second I remember wanting to be anything. And really it was this idea that there was this hidden well of knowledge that you could, you know, fill yourself with and then use it to help people. I just thought it was beautiful and so purposeful and combined science, which I thought was fascinating, with people. Once I saw that, I sort of couldn't imagine anything topping it. Yeah. And to be aware of that at such a young age also is pretty extraordinary. Because I'm trying to remember, your parents weren't in the practice. Because normally if I had this conversation, I'd be like, oh, well, you've got parents or grandparents where it was like it was in the family DNA. But it wasn't for you.

It was just early exposure in a completely random way, it sounds like. It was. It was, you know, my first memory of it was when my brother got very sick with epiglottitis. His airway had swollen shut. And my mom just sort of reported these vague things to the pediatrician over the phone. I was in kindergarten. I remember her on the phone. And he was drooling and he was sort of gulping air, and she was very clear that he was leaning forward onto his hands. And as soon as she said that, the pediatrician said, get him to the emergency room. I'll meet you there. And that idea that these things that we were observing meant something so clear to him was like this beautiful distillation to me of science. And sure enough,

he was right. He could tell from those three things. And it wasn't until later when I went to medical school that I learned that epiglottitis is really identified by that leaning forward drooling. And now we have a vaccine for it. No one really gets it, but my brother nearly died of it, but for this pediatrician. Yeah, that's amazing. So from that moment forward, were you just kind of, did you just know this was your path? I mean, was there a point in the earlier days where you're like, ah, it's kind of interesting, but it's not for me, or you just knew? So what I had a tendency to do was deep dives into things that fascinated me. So in undergraduate, I was very interested in the nervous system.

I wanted to know every sort of pathway and I studied neuroendocrinology as an undergrad major, which I think like four people do. It's not really a thing, but I was fascinated. And that led to a fascination in prion diseases. There was this outbreak of like mad cow disease. Do you remember that? That was a thing when I was in undergrad. And so I studied that in grad school. You couldn't go on a date with me in my early 20s without me telling you that your hamburger was going to kill you and how it would kill you. I was obsessed. And so I had these little tangents into micro areas of medicine, but it was always medicine. It was my first love. So, and I guess fair to say also, and we'll sort of, we'll deconstruct this a lot. It was my first love. And I guess fair to say also, and we'll deconstruct this a lot, it was your perception of what medicine was.

So you go to school, you're doing your deep dives, and you end up in medical school, unsurprisingly. Tell me about that experience for you. I think I probably felt about medical school how other people feel when they meet their rock idol, right? When they go to a concert and they get to go backstage. That was medicine to me. It was something that I had dreamed about getting behind that curtain for so long that to be there, I just wanted to soak it all in. It felt like a secret society, right? Like there were rituals, there were words that were different. We had a secret language that other people didn't understand. There were norms of behavior that were different. And those first two years were really trying to be the person who I thought I should be to be a doctor. Yeah. Did your expectation of what med school would be like meet the reality of what it was like for you? That's an interesting question. So I thought it would be incredibly hard and it was. I thought it would be challenging to master that amount of content

and it was. And I thought that it would change how I saw the world and it did. So I think in a lot of ways, it met my external perception of what it would be like. But of course, there were a lot of surprises. Yeah. Among those two, what do you think were sort of the bigger ones? The prioritization of disease over people. I knew that studying medicine was about learning what could go wrong with the human body, but I didn't expect that to be so disconnected from the human aspect of it. I felt that we were almost engaged in this love affair with the diseases, that they were talked about in reverential tones. They were objects of fascination. They were cool. We pursued them. And lost in all of that, I think, was the toll that it takes on the people who bear the diseases. That was absent from the conversation.

And so when we would learn to take a history from somebody, we would take the history by asking really directed questions that were meant to get us to the place, the destination, the disease. We didn't receive a history from people. We didn't sit and listen as it unfolded. We tried to corral people into the pens that we had constructed. And that at the time felt right. It was the only thing I knew how to do, but it was in retrospect that I think I realized that there was just this lack. Yeah. And I would imagine so much of that also, especially in the early education days, is designed to try and create as much certainty as quickly as possible. To the extent that in the context of medicine, you can, having to learn, embody, incorporate massive amounts of information to create some sort of framework or formula, which just kind of makes it like, okay, let's

check these boxes. It's pattern recognition. Right. And there's got to be a certain just survival basis for that to a certain extent too. So graduate med school and you end up going into practice. Is it internship and then residency, right? Internship? So our internship and residency was combined.

I did that here in New York. And then fellowship training is additional training that you do afterwards. And I did that in pulmonary and critical care. Again, these sort of micro deep dives into things that I was fascinated with. So I came to New York because at the time I was really interested in HIV medicine. and this was where it was happening. And that, you know, all of my

patients who had HIV at the time were in the ICU. They were really critically ill. And that, you know, was a fascinating place to me. And that's where I stayed for my practice. So you're in this setting where you're surrounded constantly by super high risk, super high concern. What's the benchmark for somebody to move from sort of like a different part of the hospital to be designated ICU? Like, okay, it's time for them to be ICU. It's really when they require minute by minute monitoring. People who can't be left alone in a room because they may change so quickly that no one would notice. And so you really need to have your

eyes on them all the time. Usually that means multiple organs failing, needing machines to support your breathing or your kidneys or any sort of life support. Yeah. Curious, what was it about that environment for you that was so interesting? It felt like medicine distilled to its purest to me. So you really saw the disease in its fullest expression, and you got to intersect with people at this very critical moment in their lives, which felt like a tremendous honor to me that you could be there when someone was

suffering and help them through it by virtue of your medical knowledge. And that was really what I focused on. So at the same time, when we zoom the lens out, what else is happening in your life? Not sure what you mean. But your context, what else? Because you got married at some point. Oh, so when I moved back to New York, when I moved from New York to Michigan is actually when I got married. So- So eventually, so you did your residency in New York and then head back to Michigan. Yes.

Okay. And that's where I met my husband. I was still in my fellowship when we met. It was the first year of my training. And we met actually in a bookstore in Michigan. I had gone in to purchase a book and couldn't find it on the shelf and it was sitting on his table. And it was a Haruki Murakami book who I was obsessed with at the time. And when I saw it, I sort of couldn't stop talking about Haruki Murakami and that's how we met. That's awesome. Crazy lady in the bookstore. That's me.

I'm assuming he was a Murakami fan also. No. No kidding. So he didn't know how the book was there. He thought someone had left it. And of course I could have it. He actually thought I was lying that I wanted the Haruki Murakami book. He thought it was a pickup line.

Yeah. That's awesome. So you meet him and you're back doing your fellowship in Michigan, become pregnant. And this is where the story gets really shaken up along with your life and your worldview and view on medicine. So tell me what happens. You're somewhere around seven months pregnant. Yeah, so like a good doctor, I actually had tried to time my pregnancy to interfere the least with my training. So my pregnancy was time to coincide with the end of my fellowship. And it did. I was seven months pregnant. And it wasn't an easy pregnancy, but it was my first pregnancy. So I didn't know any better. I had some swelling. I thought all pregnant women swell. But one day over dinner, this terrible pain came on and it was unlike anything I had

ever experienced before. And I knew immediately that whatever that pain was, if it was going to continue, it would kill me. It was completely clear. Could you identify where it was coming from at that moment or no? It was in my abdomen on the right side. And it was high up enough that I wasn't worried about the baby. It didn't feel like low abdominal pain. It was very high. I couldn't imagine what it was because the pain was so severe. It just didn't seem like anything that I knew could be. It was worse than everything I could think of. And it was hard to imagine the possibilities of what could cause a pain that bad. I didn't have a differential for it. I was just able to list things that could cause abdominal pain, but not that kind of pain. So when it started, I called my husband and I didn't want to worry him. So I gave him some circuitous sort of, I think there's a problem. I don't know. Can you drive me to the hospital? And by the time we got to the hospital, I was dying. And that didn't take long to get there. So what had happened was

that there was a tumor in my liver that burst. We didn't know there was a tumor in my liver, so we couldn't have known that it was there to burst. We didn't know there was a tumor in my liver, so we couldn't have known that it was there to burst. And when you get to the hospital, so you present as a woman who's seven months pregnant in severe pain. So the first approach is not looking for a tumor in your liver. And when I approached the hospital as a pregnant woman with abdominal pain who was vomiting, I was triaged away from the emergency room to labor and delivery. And that decision was made by a hospital security guard who encountered me coming out of the car into a wheelchair, noticed I was pregnant, and diverted me essentially away from the level one trauma center that I was targeting. And I remember just looking at my husband and saying, you know, just so you know, for later, that's going to be the decision that kills me. It was the policy for the hospital that

anyone over 24 weeks pregnant would be diverted to labor and delivery because they could better tend to the baby. Right. And we should also add, this was your hospital. Yes. And by your intention. Oh, absolutely. So you knew the policy, this was a policy-driven institution. Absolutely. You know, I work for an institution that values safety. And safety at scale means policies that drive behavior because individual behavior

can be very random. But I trusted our hospital. I'd seen us do things that I didn't think anyone else could do. And I drove by a series of hospitals to get to my hospital, believing that what I had was life-threatening enough that I had to be there. So when security guard makes a determination that, no, you're going to labor and delivery, not emergency, did you just know that this is the way this hospital functions? There's no, like, don't even try and argue or what? My years of training, my medical certainty that I had an intra-abdominal catastrophe that was going to kill me still didn't give me credibility in my mind to argue with a policy. So you end up in labor and delivery, but knowing this whole time there's something else going on. And so it became really

just from the moment I got there saying, call surgery, call surgery, call surgery, because everyone's orientation was on the baby. So it was, you know, the first thing was trying to strap something around my abdomen, which you can imagine if you've had a tumor rupture into your belly and you're in horrible pain from the blood that's spreading and shifting your organs, having a strap placed around that is not comfortable. And I tried to wriggle out of it. And I sort of got these looks like, are you crazy? Don't you care about your baby? At that moment, that wasn't my concern. You know, I felt that I was dying. And, you know, the only way I can describe it is to really say it felt like you wake up and your house is on fire and you just want to get out. You don't think about everybody else. You

just know you have to get out. Yeah. So what happens next? So things happened pretty quickly. My lab started coming back and we could tell from the lab results that I'd lost all of my blood volume, that my liver was failing, that my kidneys were failing. We didn't know why, but again, pattern recognition, the pattern of my lab results suggested that I had something called HELP syndrome, which affects pregnant women, so that fit the pattern. You have elevated liver enzymes, which I did, low platelets, which I did, and a low blood count. And so that was the presumptive diagnosis, just from that pattern. So everyone became very concerned about the baby. They looked with ultrasound. And although there had originally been detectable fetal heart tones, when they looked with ultrasound, the heart wasn't beating.

And I could see that because I could read the ultrasound. I looked at the screen. You were still fully lucid and present. I was. And aware of everything going on around you. And having your background, you understand everything. I was. But I was in shock, literally. So I had such little circulating blood volume that it felt a little bit like this bubbly drunkenness.

You know, just not completely able to focus, but still very alert. It's a strange feeling. And at that time, because I know at some point in here also, you were starting to be given morphine for the pain, which also morphine in late-term pregnancy. Were the doctors around you aware of the fact that you were so present and aware of what was going on around you? Yes, because every doctor who approached me, I tried to talk to as a doctor. So I gave my symptoms in doctor language. I wanted them to see me as one of them. I couldn't identify as a patient.

It felt very uncomfortable to me. So I was trying to run differentials with them. I was trying to interpret my lab values with them. It's like you're part of the team. I was, but not in a good way. Like I should have abdicated that role, but I couldn't. It was who I was. I was reading my own ultrasound, right?

Yeah. So where do we go from there? So I saw that the baby's heart was in beating and I said that out loud. And the resident couldn't recognize that on the screen. He hadn't had enough training. So he said to me, can you show me where you see that in this sort of anxious way? And that was one of those moments that everything froze for me because I really had this feeling that he wasn't seeing me as a person, as a mother who had just lost a baby,

as someone who was terrified and dying and in hemorrhagic shock. He was only seeing the pathology. And I recognized myself in that, but I also found it terrifying that I wasn't being seen because somewhere in my head, I felt like if I was going to survive that night, I was going to survive it because the doctors cared enough to try as hard as humanly possible to get me through it. And I worried that he didn't see me and therefore couldn't care. So that was a moment of terror, but it didn't last long because I was immediately sort of wheeled into the operating room for a crash C-section and an exploratory laparotomy because they had to open my abdomen to get the baby out, and because it was a crash C-section

and they would do a large vertical incision up and down, they could look and see what was causing the pain. So at this point, they knew there was something else going on. And were they at that point aware of the fact that it may be something beyond this sort of like what? The HELP syndrome. The HELP syndrome. that was still the assumption but they were looking for what could have triggered it in a sense so was there a piece of my bowel that had ruptured open was there an infection was there

bleeding they didn't know so things happened really quickly in the operating room. The goal when you're doing a crash C-section is to get the baby out in under two minutes. So you can imagine it's rush, rush, rush. So someone was pouring antiseptic fluid on my abdomen so they could do a quick incision. They were supplying oxygen. They were trying to get more access because I couldn't be resuscitated with the one IV that I had. There hadn't been time yet to call for more blood. So they were just giving me fluids. And really within that first minute, I could hear the anesthesiologist say, we're losing her. And that got my attention. While you're aware.

Yeah. And so I tried to sort of orient myself and survey the room and try to see, were they losing me? And my memory of that moment is of seeing myself on the operating table. So having that sort of experience of leaving your body. And I felt as if I was floating and very light and looking down at what was happening. And it was in that moment that I realized I didn't have the pain anymore. And I heard him say it again. We're losing her. Her blood pressure is 90. And I could see they were rushing to get another line. And in that moment, I just had this sense of a complete truth, like a knowledge that I knew that I didn't know how I knew it, that if I chose to, I could leave everything that was there. I could leave that pain. But if I did leave that, I had to leave it all.

Life, husband, family, everything, practice. So it was choosing whether to live or die effectively. Yeah. But it felt, it was presented as, do you choose to go back for the pain? It was, that was the decision I had to make. If you go back, there's going to be all of that pain. That was the decision I had to make. If you go back, there's going to be all of that pain or you can have complete peace. And that's really what I felt in that moment was this complete peace. I had no interest in whether that person I was looking at survived. I was completely detached from the outcome of that surgery. It was this really indescribable feeling of feeling so small

and yet so expansive, like you're part of everything, but still like nothing. Do you remember intentionally making the choice to go back to the pain? I don't. I remember the choice and then I remember waking up in the ICU. It's so interesting also because you're a woman who is so accomplished and fiercely oriented towards the pragmatic and the scientific. And to sort of have this moment drop into almost any lens, could be called spiritual, drop into the middle of this. How do you sort of just breathe into this? How do you experience that? Do you try and look for some rational explanation for it or you just say, this is what happened?

You know, it gave me such a sense of peace that I was able to carry forward through what ended up being, you know, a very long illness, that it was such a gift. Because in some way, I couldn't be afraid of dying because of that experience. And it was almost the first thing that I wanted to talk to anyone about. You know, when I got off the ventilator, everyone, of course, felt they needed to break the news that the baby had died. And I was kind of like, yeah, yeah, but I've got to tell you guys something. There's this thing that happened and I need you to know about it because A, I'm worried I'll forget, but B, I'm worried I'll die and I won't get to tell you. This thing happened and I felt so safe and there was nothing to be afraid of. And it's one of those things where even as you're

saying it, you know you sound crazy because if I had somebody else tell me, you know, it's just something you experience and you have that feeling and that feeling is real. Yeah. It just becomes your truth. Yeah, exactly. So as you were sharing, you survived that initial surgery and eventually emerged back into consciousness. But it's also not like, you know like the hours later you're in a recovery room, the anesthesia wears off and you just wake up. This was not your process. No. My early memories were really of feeling as though I'd been dredged up from the bottom of a lake. The resuscitation efforts that first night meant that in the operating room, I gained more than 40 pounds in a matter of hours just from fluid and blood products.

So I got 24 units of blood from other people to replace my own. That's replacing all of my blood three times. My kidneys failed, so I wasn't urinating. So all of that fluid was staying inside of me. There was nowhere for it to go. And I kept needing more because we didn't know it at the time, but I was still bleeding into my liver. So my blood pressure was always low and I was always in shock from that. I had a stroke because of course, when my circulating blood volume was so low, my brain just wasn't perfusing well. So I saw everything in duplicate and it was really disorienting. I couldn't hear from the fluid congestion. So while I emerged from, you know, that medically induced coma, I was unrecognizable to myself.

You know, in a course of 12 hours, I went from dinner with a friend to someone who had multi-system organ failure, who was on life support and not expected to survive. I know there's a moment that you've shared where you talk about a colleague, I think, and maybe people weren't aware that you were, because you were intubated, so you couldn't communicate that you actually were awake and aware of what was going on around you. They kind of turned the corner and started to poke in, saw you, and then basically somehow couldn't deal with it maybe and turned around and walked out. Yeah, there's a lot of vulnerability in that sort of exposure in those moments. I think we visit people when they're sick because we want

to be there for them. But I was really in bad shape. And so I think people came by thinking, oh, she's sick. Let's see if she's okay. And then I was just this grotesque representation of what I had been. And so quickly, it's disorienting for people. I remember, you know, when my hands were first freed, just trying to feel the perimeter of my body just because I couldn't see myself. So I thought I could feel what I look like. And I literally encountered my face like at the edge of the pillow. It was three times bigger than how it had been. I was just this balloon of fluid. And it's one thing when you're a physician, I think, to see your patients ill, but when you see your colleague, that's really grounding in a way that can be difficult.

Yeah, I would imagine. And you were also aware of the conversation that was happening around you by fellow professors and fellow professionals. Talk to me about that a bit because that made it really, I mean, through your recovery, which lasted years actually, from that initial awareness

through continuing awareness, that made a powerful impact. Shocking to me that I never fully understood how much our patients can hear us. You know, having rounded in the ICU for years at that point, if I saw a patient on a ventilator, I spoke freely about the medical aspects without ever thinking what was landing in their consciousness. And as a patient, I heard the rounding team. I heard the nurses. I heard conversations within my family, all perfectly clear. And I think because you have a heightened sense of awareness too, because

adrenaline, you're dying. So your body's like, pay attention. Everything's a threat. You remember it. And you don't have an outlet for it because for me, I was intubated. I had the tube in my throat. I couldn't speak. So you have no way of processing it.

You know, normally you can have a conversation. You can get your piece of the puzzle answered, but it was all very one-sided. So to hear the rounding team describe, she's been trying to die on us and just thinking, well, no, that's not true at all. Why would you say that? There's nothing that my body is doing that's trying to die. I'm trying not to, to be represented in that way and made to feel as though I was an adversary of the care team. It was preposterous to me, but I couldn't say anything. So I'm sure my heart rate shot up. But those moments were so instructive because really it was this lesson that I needed.

I needed to know how much I wasn't thinking about my proximity to patients and how much what I said mattered, even at moments where I couldn't imagine that it could. And these were also some things that you recall yourself saying to patients because it was just standard practice. So it wasn't like, how could you? It's like, oh, wait, I've said those exact same things and done those exact same things because that's just what we do. Right. So imagine you're totally indignant and angry and then you're like, I've said that. Like, I can't even be. That's what we all say. Why do we say that?

And so you're having this whole, like, existential crisis really about your profession because you're seeing it in action from the perspective of a really helpless patient. And you've been the other person every other time in this equation. So you do start to recover and move out of the most critical elements post-surgery. But again, this is not just, hey, a couple of weeks, we're all good, and then good for life. Yeah, it took some time. The first step was really my organs slowly recovering. So my kidneys started working first, and then I started shrinking from all the blood volume, so I was a little more mobile. I got off the ventilator. I could breathe on my own. I was able to work with physical therapy and relearn walking, which was very hard because of the stroke. I would walk into the wall

a lot, but I made it out of the hospital to recover more completely at home. The bleeding that I had had in my abdomen had just completely rearranged my organs. So the thing that took the longest to recover was my liver because it was just smushed into a sliver on the other side of my body. And that huge blood collection that was there had to stay there. There was nothing to do about it except to let it shrink very slowly. So that took almost a year for it to shrink enough that my liver became normal again. And it was actually then that we found the tumor that had ruptured because we were able to get a CAT scan. And that was the big surprise because when we found the tumor that ruptured,

a year after that first night, we found that there was another tumor. And so everything that had happened could have happened again. And we wouldn't have even known what had happened the first time. Yeah. I mean, I can't even imagine, especially in that moment, knowing that, okay, it's now a year later. And for the first time now, I understand why this entire sequence of events was set in motion. I understand what happened. And because of that, we're able to actually now have a diagnostic, which lets us see, oh, there's something else. Yeah, it was wonderful in the sense that it was clarity, but it was very difficult to wrap my brain around because, you know, you write a narrative, you lay it down, and it becomes like the road you travel, and it's your story, and that's

what happened. And then to know everything you thought about it wasn't true. You have to almost rebuild it. And, you know, in essence, I had misdiagnosed myself, right? Like I was there looking at my lab values. I came to the same conclusion everyone else did. I held onto it and it was wrong. And when we learned the right diagnosis, it was completely clear. And so it was, you know, self-doubt and doubt of medicine and, you know, another existential crisis all over again. Also, you're sort of facing this thing that sort of not a doctor, but I mean, was one of the questions also, well, if this other thing was sitting there late in this entire time at any given moment during the last year, could this too have ruptured and sent me back into the same place, but now recovering and not like fully? It was one of the hardest things for my brain to process

that I had just survived this by the skin of my teeth and it could have all happened again. And that threat, I mean, I remember looking at the cat's can at those tumors and just thinking, my God, like the havoc that you wrought and it could have all happened again. And for me to have survived that first night, everything had to have gone perfectly. The right people were there. There's no question. And I just didn't think I would have gotten that lucky the second time around. I didn't think I'd be in the right place at the right time with the right people and it was like looking at, you know, a death sentence. So finding those tumors meant that the part of my liver with

the tumors in it had to come out and that's a huge surgery. I think it was a seven-hour surgery. And because there had been so much blood around the liver, it had to be chipped out with a chisel because it had calcified like a rock. So my poor surgeon, God bless him, sat there for hours just chipping away at it. Was that calcification causing you pain, ongoing pain? Because I mean, it's like having something immobile inside of the middle of your body. Every time I would breathe, it would shift. So it was like a rock breaking within you. I'd gotten used to the pain. It just became part of my day. But that was a relief. When I finally had that surgery and I could breathe pain-free, it felt like a miracle.

So you have the surgery, successful. You come into a more full recovery. And it shakes up not just your physical body, but also really the way you look at the way that medicine is practiced and physicians are trained. Yeah, in the best possible way, in the worst possible way, I think it rocked my perception of medicine. So everything that I had esteemed about it,

I was now doubting and I loved it. I was passionate about it and And I loved it. I was passionate about it. And suddenly everything about it felt wrong. I couldn't watch someone examine a patient without feeling like they were violating their body. Everything felt like we weren't putting the patient at the center of it. And we weren't paying enough attention to how they felt and we weren't present for their suffering. And I had this reorientation and I think in some ways an over-identification as a patient that made it very hard to be a doctor. And I think I lived in that middle world for a while of really feeling like I was a patient who was wearing a doctor costume. What is it about being trained as a doctor? Because I can't imagine the field only attracts dispassionate people. That's not what it is. There's something about the training that teaches separation of emotion from analytic. Talk to me about this a bit. that that's where we should be practicing from. And it really starts at the very beginning of training that we're taught that for physicians to be trustworthy and a calming presence in the

lives of their patients, that they have to adopt this sort of imperturbability that nothing bothers you, that you've seen everything and you can handle it. And with that comes a dispassionate disconnectedness, because you can't see emotion in front of you and tend to it if you are staying in that impervious realm. How much of that is about trying to make the patient feel safe versus working in a profession where pain and suffering and sorrow and loss and grief and death are a regular part of it and trying to protect you as a physician, as a provider of healthcare too, because I guess like is part of the underlying assumption here that if you were to open yourself to that, not only would you no longer be objective, but you would kind of be destroyed yourself. I definitely bought into that line of reasoning. I don't think it was presented to us as fact

that these were self-protective barriers. It was presented to us as a model for what to be. But over time, I think we rationalized it and said, of course we have to be this way. Because that other thing that we could be where we're present and connected and empathizing with it's a myth, that we have to have barriers between ourselves and our patients to protect us. They're not actually the grounding, stabilizing force that they were billed to be, right? If you don't connect to your own emotion, whether it's about your own sadnesses or the sadnesses in front of you, you can't process it. If you just pretend it's not happening, then you bury it. And I think physicians have a long history of burying things that are hard.

We don't do it in healthy ways. What we didn't have a model for was how to be present for the suffering and have it not deplete us. Nobody showed us that. That wasn't something we talked about. We were presented with one model. And because every single person in that medical school wanted to be part of this group, they wanted to be a physician, they wanted that to be their identity, they adopted it because there wasn't an alternative that was presented. It sounds like that also, that leads to suffering not only for the patient, because as you described earlier in our conversation, the training is you end up becoming much more focused on the condition, the disease, and not having the empathic relationship that is so critical and better outcomes. We now know from all, you know, a lot of sort of like recent science. And at the same time, I guess what's newer for me also is that, and it's really interesting to hear you share that, you know, well,

of course it makes sense that if you're constantly confronted as a physician with all of this potential for deep emotion and loss and you're, you somehow like, it's not, it's going somewhere inside of you. It doesn't just dissipate. And I would imagine even if you hit a point where you felt like you could, you literally could largely dissociate from it, that that awareness of that capacity alone must be something that would lead to a lot of inner struggle. Absolutely. And for people who go into a profession to help, to accept dissociation from the human aspects of things, what is that?

Yeah, it seems like the exact opposite of what you're there for. So then you have these national conversations about resilience and medicine and joy and work and burnout and attrition and suicide. And you look at all of that and you can track it right back to how we were trained. So this becomes a cause for you. I thankfully was able to find a way not to just remain a patient in my head and to start to think critically about what would need to change for us to be different. What would need to change for us to actually be able to have a relationship with our patients where we could be present for the suffering and not be depleted by

it? And what resources would have to be in place and what would they look like and sound like and who would they be? So I made that really part of my healing in a sense, because once I saw how broken it was, for me, I couldn't leave it that way. It seems like a central part of that for you also was that patient care and provider self-care are both critical elements of successful patient outcomes and also successful long-term career and happy physicians. There's this trend. I don't want to call it a trend because I hope that it lasts forever, but right now it's a trend in medicine of mindfulness practice. Because I think so much of what we're realizing is that if we are not settled in ourselves, if we're not present, really in the place where our feet are, looking at the person that we're with and noticing not just what they say to us, but how they say it, the subtleties, the words they use, the narrative they use to describe

what's happening and how it intersects with their life, their illness and that dance. If we can't be present to receive the story, we can't serve the patient. We can't be present to receive the story. We can't serve the patient. We can't be the physicians that we want to be. And it really does start there in my mind. It starts with just what do we need as physicians to have presence that's settled and ready to receive our patients? How do we take care of ourselves well enough to do that? How, when you start to develop in your mind this alternative model for physicians to take care of themselves, to become more mindful, more present, more aware,

in the name of both their own flourishing and their patients. You practice within the context of a vast, large, generations-long installed culture of medicine. When you start to share these ideas beyond your own shifting lens, how does that land? I was very nervous about sharing my observations because medicine in many ways is a family. And it felt like there were things that you talked about in the family, but you didn't talk about it with other people

because it was private. And effectively you're saying somebody was wrong. Yeah. I think what gave me permission to do that was because every failure I felt I was part of, I had done everything that I had seen done. I was no different. And I also could trace it back. I saw the root cause of why it happened. And so in a way, I saw a path out for all of us.

I didn't feel that any of the things that happened to me were from a place of someone wanting to harm me emotionally. I felt like no one had the tools because I didn't have the tools. I wanted the tools too. What were the tools? Let's find them. But the great thing about having this sort of awakening is there are so many people who already had this awakening and they've been doing the work. And so as soon as you voice it, you have all these people saying, me too, me too, me too. And let me show you what I've done in this area. You know, I'm not innovating anything.

I think I'm bringing together communities of people who've been working in this area and hoping that in aggregate our voice is louder than each of our individual voices. Yeah. And that's in fact become, it sounds like a large part of what your professional life is now, is sort of advancing these ideas. Yeah. It's become really important to me to tell my story honestly and dissect as much as possible for people why I think we are where we are and where we could go that's different and sort of chart a path forward that's authentic and rebuilds all of us in the process. I have another curiosity, which is, so as we sit here, you have a book out called In Chalk, which tells this entire story in incredible detail. It's gripping, upsetting, and ultimately hopeful. I'm really curious what it's like for you to know at the earliest times of your life,

this is what I want to do, build a career around it, go through the process of being a critically ill patient, coming back, reentering. And you are on every way, shape, or form. You are a medical professional. You just finished a memoir. A little different training to do that. So I'm really curious, actually, how was it for you to revisit everything that you've gone through and also to become a writer, to write a really powerful and very truthful, honest, raw memoir?

You know, I had two rules for myself going into it. One was that I was going to tell the truth. And I was going to do that regardless of how it reflected back on me, that there was no point in doing it if I wasn't going to be truthful. And the second rule was when it was an exploration, I think, of what my experiences were. And there's this wonderful grace that comes with just allowing yourself to sit with an experience and sink into it, sink into the memory of it, and look at it through all the different lenses that are available to you when you're looking at something in retrospect with the knowledge of what's come after it. And it was really a process of discovery for me. I didn't know what the story would be. Halfway through, I thought I was done. You know, I didn't have a sense of trajectory of the story because it was my life. And so it was a process of discovery. Do you feel like the process of writing a memoir will in any way change the way you practice or teach?

I'm at, you know, my most basic sense of myself is someone who's transparent. I'm the same person as a physician, as I am at home, as I am as a mom, as I am as a friend. I don't have separate silos for things. I don't have things I tell some people and not others. I'm just me. And that's really important to me. And so as much as I probably should be panicking that all of the details of my life are out and my patients will read it and my aunts and it's very intimate

and it's personal, it's also my truth. And that feels okay to me that I would share that with the hope that maybe we can all understand each other better. And maybe it also serves as an example of a willingness and an ability for somebody who is healthcare professional to actually stand in their own humanity in a public way, and that it'll be okay. To own it. There's this thing, it was popularized at the Cleveland Clinic, called the failure bow, that when you make a mistake, you stand in front of people and you name it and you take a bow and everyone applauds. And it's one of the most beautiful things I've ever seen because it's so rare in life to say, I've made a mistake. I'm sorry, and I'm owning it, and to still get love back.

And I feel like in that way, that's what this book is. Medicine's made a mistake. I was part of that. I see it. I'm sorry. So as we sit here having this wonderful conversation, the name of this is Good Life Project, so if I offer that

phrase out to live a good life, what comes up? You know, for me, there's so much beauty in everything. It's one of those truths that can sound almost cliche that I think when you're faced with losing your life, you really do see the magic in everything. And just being here for any of it, you know, it's a good life. Thank you. Thank you. Thanks so much for listening and thanks to our fantastic sponsors. If you love this show, please support them. They help make the podcast possible. Check out the links in today's show notes.

And don't forget, by the way, to grab your spot at this year's Camp GLP. It's an amazing way to step out of your life every day out of the frenzy and just spend time reconnecting with who you really are, meeting amazing new friends and learning a ton along the way. And if you've been waiting, be sure to register now to lock in your $200 super early bird discount. Learn more at goodlifeproject.com slash camp. See you next week. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist,

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