With Houston still feeling the effects of Hurricane Harvey, and Hurricane Irma gunning towards Florida, how can we help and learn from those on the ground? In this episode, we have Dr. Jean Robey and today she talks about her writings and some insights into the extreme burden of being a physician. She talks about whether it’s worth it and whether this path is really something you want to get into.
Hurricane Harvey, a Category 4, hit Texas on August 25, 2017. Its devastation will continue for a long time. And all of the men and women on the ground, in and around Houston helping those in need, need your help. If you're listening to this and you're in a situation where you can get on the plane or get in a car and go help, then please do.
If you're part of the club like AMSA, Premed AMSA, or Pre-SOMA and there is a sister club at the University of Houston, reach out to that club. Find out what they need, what you can do, what you can send, who you can send, and help. And another hurricane is hitting Florida. Please help. The people on the ground need you.
[04:05] Why Jean Writes as a Physician
Jean admits, “I'm scared we will not be enough and help will run out.” This is a piece Jean wrote about the recent Hurricane Harvey in Texas. For her, writing suddenly became so much a part of doctoring.
She recalls a time being so stressed out and she stopped writing. She didn't realize these were connected because she wasn't enjoying doctoring anymore. That's because she had nothing to write about. And this means not being able to get close to her patients. As soon as she aimed to have something to write about which meant getting close with patients, she just felt more fulfilled about her interactions, her life, and her career.
So the writing happens because it has to happen. But Jean says it's not just writing notes. She really writes them from start to finish otherwise it will evaporate and she will lose that very kernel that excites her. She also describes having that tingly feeling while writing things down. And usually this touches people. As much as possible, she writes and gets it when it comes hot off the press and she gets these moments when she's with patients.
[06:30] Dealing with Burnout and Elevating Humanity
I asked her whether this is her way of approaching burnout and Jean explains how she is a problem-solver.
Then she adds what if you went to work, addicted to something deeper that you can only access because of the privileges and the privacy of being a doctor? It's not about exposing patients. But she has this idea that she doesn't know enough about life or herself. And if that's true, she's actually looking for them to tell her about life and herself. Because patients have other experiences and they have other perceptions. So Jean gets fascinated by this idea. She likes how she's building constantly on her thoughts. She relates this to doctoring where you mature as you practice.
Jean says you can almost immediately see it in a patient where they are in their personal evolution. And that's because you've seen it a thousand times in a thousand renditions, but it's not quite repetitive. There's some detail about it that adds to a little nuance and she's fascinated by this. Like a crazy raccoon, Jean is collecting little trinkets. Then whey they give her the chills, she just wants to share them. She wants other people to take the shortcut and have a piece of it.
Jeans mentions this controversy about getting someone's consent if you're going to expose them and talk about their privacy. But she does the stories in a very composite way or generic way. This way, she can evade the details. But some of the details matter. Nonetheless, she never writes a story that's going to push the human being down.
And in a lot of these times, even when horrible or tragic, Jean describes the stories have something in it that's really honorable and victorious. There is conflict, but the resolution always airs on the side of being human. The stories are not made up. They are purely human. But Jean explains the need to lure people so they can access it. A lot of the stuff we feel actually can't be spoken very clearly.
[10:20] Rekindling that Passion for the Job
Jean believes doctoring is a calling. And in that calling, we hear society ask for leadership. And we hear society asking people to be thoughtful, intelligent, and compassionate. They ask them to lead when no one knows what to do or no one is brave enough to know what to do. Every time she goes to work, Jean is not saying she doesn't get tired or she would rather be doing fun things, but she aims to make a difference. She aims to save a life.
Jean also shares her personal motto of “There is universal good. Evil doesn't dissipate. It gets pushed around.” She adds that if we are people of valor, we will seek out that hard thing and try to iron it out. And try to start a solution an fix a problem. In medicine, what we really want to champion is people that don't mind fixing problems. They want to fix problems and be in charge of fixing those problems. So if you seek out the thing that keeps you from burning out, you need to seek the ideas of these two things, Jean says. Try to help. Just try to do what you can with what you got and just try to take care of the universal needs. Moreover, Jean shares this idea that if you're going to participate, make it worthy of you waking up and doing it.
[13:50] Dealing with Patient Entitlement
Jean thinks that if your intentions are noble, the math will add up correctly over time. Jean also believes that the good guys win. Things can get difficult but you have to draw the lines, know your intentions, and stand firm for principles. It's not about servicing them. But making them understand how this is hard for them. Acknowledge what they're trying to do. But recognize their evolution. Begin to develop a relationship with them.
Jean tends to do some “canned” things whether or not the patient is willing to cooperate. But in the end, the patient will usually change their mind. So when you engage patients and they're pushing back, that behooves us to try to understand why. Make them understand you care for them and that you dedicated your entire life to try to take care of them. And that you will always be there whether they show up or not.
[18:20] Putting Others First Before You
Jean personally believes this idea of doctoring being part of the priesthood. They need nothing. They want nothing. They own their souls and salvation to the church of medicine. She didn't initially understand how this was all possible. Humans as we are, we're going to have families. We're going to have diseases. We're going to have wants. So how do you marry the church of medicine?
She explains that the intention was that we would make ourselves whole. Engage the extreme task of taking on this responsibility, this obligation, this duty, and this calling. Then prepare our families where oftentimes, someone is in more need than they are.
While there is truth to this, when it becomes not true is when the balances have been tipped and it becomes dysfunctional or unhealthy. For instance, if your child is sick or your husband is dead or you are suffering, then you need to back off from this role and responsibility. You are no longer able physically, mentally, and time-wise to carry the extreme burden. Jean further explains that when you're in this field, you're accepting a little bit of the unusual extremes. And when you look at quality of life for a physician and work-life balance, Jean believes we're pushing back against the idea that you were supposed to get everything. All the time. All the attention. All the love. All your duties. That said, you can't push all the way back. Physicians are never going to be nine to five. Even holidays. It never dawned on Jean that she could have a holiday hour. Doctors don't get holidays. They get coverage and they trade. And that's just the way they're able to continue what human existence is. There's no break. It's not like death or disease decide to take a break on Sunday or Saturday. So Jean thinks that when society is asking more of them, it's right to respond with “Yes, I'll give you more. But when I need something, I want you to be able to give that to me. And while I'm giving you so much, I need you to honor me. Because I am doing something that many won't do. I am giving of you and the family around me. Because when I come in and write checks, I write checks against my account and against my children and my husband and my marriage and my extended family. I ask them all, and they have been farmed this way.”
As doctors you show up. You're the leader of the show. You tell them what the problem is and how you're going to fix it. You tell them how they're going to help you help them fix this. As doctors, you are picked to walk into a room and just decide you're going to be go-to guy. From there, there's going to be plenty of other people at the table. But someone's going to have to calm everyone down, organize stuff, figure out what you need and where to get it. Sign the paper. And take responsibility. And a lot of times, Jean thinks we're not given enough credit as physicians because that is sort of a social contract.
[25:01] What You Can Learn from Disasters
What fascinates Jean about first responders is how they know how to act. They know how they use what they've been cultivating this whole time – their knowledge, connections, know-how to solve multifaceted problems. She has seen physicians who immediately organized a place, a time, and crew. They would immediately place phone calls to pharmacy reps and companies and tell them what they need. And they've created a complete treatment plan for disaster. She saw them really try to hone in, deal with and prioritize what they're seeing. They were able to make long term plans. She describes this as being physician-like. You deal with the acute problem and then try to make up long-term problem for rehabilitating the tragedy.
As physicians are going to different tragedies, they may start to feel overwhelmed both emotionally and physically. They can't justify recharging when there's so much suffering around. Also, because in this mindset of creating a treatment plan for all the people, Jean thinks that inside somewhere, something cracks.
Jean says these physicians, as well as other nurses and other volunteers. talk about dying inside a little bit. They're dying because they just can't do enough. So with the idea that hope is going to run out, Jean says help is not going to stop coming. And even if you're not there, you can send money and try to do what you can do to help. But she says what we really need to do is feed that positive energy that lets that responder respond. Feed that energy that validates that response. Give the responder validation and encouragement. This tells them that you see them and while you may not be able to directly help them or be there, you can feed into that energy somehow.
Another thing they want to hear is that the outreach is not going to end. And that people know that what's happening in Harvey – they still can't find people. And it's still wet. There are homes that are still four feet under. Just a few inches less than the maximum because the water didn't drain away or go anywhere. And even those homes that have dried up would mean six months of renovation. It's school year and it's a holiday coming up in four months.
And whatever they can garnish is not enough to make a day. So when we look at how we're going to react in Florida or continue to care for Harvey or any tragedy in America, we need to be able to do acute planning and long-term planning. The society around us also needs to feed into energizing and continuing to fund and help that long-term planning. Katrina was a great example of how that recovery took years. A lot of people had to relocate. And that was difficult too. A lot of physicians on the ground right now feel it's already too much. And they were getting short on day 2. They knew, because they knew how to take care of long-term problems, that there was going to be a day 200 and a year two.
[30:45] Addressing Physician Suicide
As physicians, we also have our own little hurricanes in life and Jean sees physician suicide as a challenging topic. These are very driven and introspective people. For some reason, got seduced by the idea of getting into medicine and tackling that incredible mountain. Take that beast and put them in a crucible. Some of them tried three times trying to get in to medical school. Or they tried once and thought this is what they wanted. They get there and realize it's not what they wanted. Then maybe what they were looking for is now gone because medicine is changing. And they don't know how to respond to that change. There are so many possible variables. But this beast that comes in and finds themselves not knowing how to weigh their value or measure up to expectation. And not knowing how to feel both worthy of being someone's doctor and being someone's doctor and colleague.
Jean explains that something happens in their mind and then suddenly they're not just good enough and they're not right. They're too deep. And now they're suffocating and they just want release. They just want to stop hurting. And the problem is we're not really good about seeing our colleagues drowning.
So it's the last place physicians look. You don't look at your colleagues that have gotten this far and done so well. So many times, Jean has read so many stories whey they didn't click. We think they're okay, but they're not, because we don't see that part of them. And as a culture in medicine, we need to tell our students and trainees that we're not looking for you to be perfect. We're not looking for you to fill this ultimate doctor mold that you're supposed to fit in. There's room for all sorts of doctors in doctoring.
[34:50] As Doctors, We Are Evolving!
Jean adds that what is wanted from you is that you're genuine and your very specific personality. It's okay for you to not be doctor so and so, or do it that way. There's no absolute kind of win or fail. And you're growing. Years after graduation and you're still an evolution. For Jean, part of engaging a patient helps her grow. She's becoming the very doctor that will retire every single day. She has worked all her life to get there but relatively speaking, it's only fifteen to thirty years that she will be doing this. Not that the identity changes but she's going to stop focusing on this at some point. She's in and she's out. And in that period of time, she's going to evolve as a person, not just as a doctor. And as she evolves as a doctor, that means she didn't come in whole. And if she had thought at any moment that as she was supposed to be good enough as a novice, she would have quit too. But she didn't. She didn't assume she was going to be perfect.
Moreover, Jean stresses that it doesn't matter how smart you are or how prepared you are. The day they take the training wheels off and you are on your own is the biggest nerve-wracking day. And that day extends into the biggest one to five years of your life. There's no one else to check off to and there's no one else to validate your thought process and your decision-making. That first patient that you are attending for is like your first baby. Then you begin to realize you need to fly now. Then you come and fly.
Listen to colleagues and ask for advice. Then you keep your growth going. But Jean says that the first moment you own it all, the decision, the plan, the outcome and the responsibility and interaction, you own it all. There's no one to come in and rescue you. That moment is part of an evolution that takes the entire career. Jean admits she still gets nervous and she says you're supposed to get nervous. And she still second guesses a lot of the things. She'd still go to her colleagues and they'd still discuss cases until they agree on things. But you have to be humble and be around people who allow you to be humble that way. In the grand scheme of things, medicine in infantile. We're just scraping the surface.
Jean thinks a lot of medicine needs to be flexible so we can adapt to more knowledge. Always mean well and always do well. And in the long run, when you look at why suicide happens, you can see we're in a culture where we continue to think doctors are somehow perfect. We think we have been perfect from the very beginning. But Jean says they're not looking for that. Instead, they're looking for potential when hiring doctors. If they're calling on their colleague, they're looking at growth in their potential. And if they retire, they're looking to see that they've fulfilled their potential.
So if you get into trouble, ask for help. If you feel pressure, maybe rethink. Although Jean thinks suicide is something deeper and it escapes logic. Jean has talked with those who have done it. She describes them as telling not of love anymore but more of how diseased they were.
[41:10] As Students, How Do You Keep on This Journey?
Jean some overachievers were susceptible to hearing that being a doctor was hard and they would go and climb that mountain. Maybe they weren't gifted or called that way but they just saw the mountain and wanted to achieve it.
Now, there's so much on the other side of that balance that makes it distasteful. Students aspiring to be doctors are looking for a calling, and doctors tell them it's a job. So Jean wants to inspire those noble people who have gifts. And by their nature and their drive, they can walk into a room and accept the challenge. They accept the extreme burden in exchange for the intense and indescribable intimacy of being gifted someone's vulnerability.
Patients come in and you get the privilege to ask them anything you want. It's meant to direct your treatment plan and understand their illness. They tell you the truth and they just open themselves up. If they resist, you can always turn the key and tell them you need the information. But people are looking for connection too. So they come back and they come back constantly to try to dig deeper into themselves and the problem.
So Jean says what we want to do is to encourage and attract that kind of applicant. People come to you asking for help and saying, “Now what?” You've got to have resources and answers. You need to plan on plans and plans and plans for months and years. And that's valuable to you, because you suddenly get close to something indescribable. You suddenly get close to what she describes as the “ethos of medicine” – human connection, really honest, and really vulnerable. And that connection just tells you about you. Finally, it just takes that insanely exquisite moment and you're so glad you were of that position and profession. Because that's the only way that you would have had that moment.
[45:10] Go Help! They Need Your Support
If you're in a situation where you can pick up for a little while and go help, whether it's a day or two or two weeks, go do it and help. Don't just do it for the application, but do it to support fellow humans in need.
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