Amanda: Hey guys. Welcome back to the podcast. I'm Amanda.
Laura:I am Laura
Kendra: And I'm Kendra.
Amanda: And just a reminder, if you work regular night shifts, if you have access to an iOS, Computer or iPad or anything like that, Lumos is still doing their ongoing study on the technology that can help correct some of our shift work problems with circadian rhythms.
So scroll down in the show notes and check out that link there. But for this podcast, we are excited. Because we have a special guest in real life. It is May, this is being released after that, but in real life this month is May, which is mental health month. So we are honored to have Dr. Michelle Chestovich joining us to talk about physician mental health and in particular, physician suicide.
Michelle knows this topic intimately as her life was forever changed after her sister's tragic death. So trigger warning, we will be talking about. Depression, physician suicide, those sorts of things. But Michelle is a family doc, mom coach for physician moms, and a physician wellness advocate. She has her own podcast, which I love called ReMind Yourself Podcast.
Welcome, Michelle. Thanks for joining us.
Michelle: Thank you so much for having me. I really appreciate this opportunity.
Kendra: Well, Michelle, thanks for coming on today and just want to recognize how brave it is to talk about the situation, but also we wanna honor you for the work that you've done, just to be an advocate for physician wellness. So tell the audience a little bit about yourself, your training, your family, kind of what your coaching niche is.
Michelle: Perfect. Yes. Thank you. So I am living in St. Paul, Minnesota. I've been a family physician for 20 years. I went to the University of Minnesota for medical school and did my residency at a local hospital. And I had my first son, my first child when I was in my third year of residency. Subsequently had three more within four years.
So I had four babies in six years. So I really know what it's like to try to like, keep balls in the air and feel like my hair is on fire. So, you know, I was doing pretty much full-spectrum family medicine. I was doing deliveries for 17 years and again, with children at home and trying to work part-time, I just really know what it's like to have all that kind of flux. And you know, people say like, well share your burnout story. I'm like, which, which one should I share? Because there've been so many times that I've hardly had my head above water. And then I would try the things, get more sleep, get more exercise, maybe an extra date night cuz that ought to fix it, right?
And I'd get my head above water and then I'd slowly sink back down. And as a primary care doc, I really believe in prevention all day long. I'm talking to my patients about moving their body and eating healthy foods and getting sleep, and I'm also just a little feisty. So I'd go to these extra meetings that were tagged on at like seven in the morning, and I would say to my colleagues, “Hey, Who here is getting enough sleep, who's exercising?” right.
So my physician advocacy for wellness goes way, way back. But again, in my journey and my struggles over the years, I realized this is really a problem. Like I am hardly keeping it together and I'm telling other people how to take care of their lives. That's really fascinating and rich. So probably about five years ago, I think I started working with a coach and I realized like, oh my goodness, this is like, This is the key to the universe in order how to feel better, how to be able to advocate for myself to feel empowered as you women know and as all your listeners know.
So then I became a coach and started helping. I said to my husband after about a month, I said, oh my goodness, my people need to hear this. We don't know this. We didn't learn this about the brain in medical school. So I really, and wanna become a coach and like share the word and yell it from the rooftops, is what I say.
So that's sort of how my journey began and. As you alluded to, I'll just bring it up right now. Unfortunately, my advocacy for physician wellness had like gasoline poured on my fire in that. Two years ago, I lost my baby sister, Dr. Gretchen Butler, to suicide, and after she died, I mean, certainly we were devastated and heartbroken.
We had no idea that she was struggling so tremendously. And after she died, I realized we lose 300 to 400 physicians per year in the United States to suicide. And people aren't talking about it. And women are at two and a half times the risk as our general peers. And so ever since she died, basically a week later, I was saying to everybody, you guys, we are all at risk.
Not only is important to take care of ourself, but it's actually paramount. It's vital that we take care of ourself because we are in a high risk profession. So, you know, my advocacy for suicide awareness began a week after my sister died. I did a podcast, you know, kind of announcing this horrible tragedy.
But she cheers me on along the way, and the work of raising awareness is helping people. The work that you are doing is certainly helping people because I think it begins, number one, raising awareness, and number two, normalizing that we too are human and we can have problems with our brain. Just like we can have kidney stones and back problems, our brains can get sick too, and in fact, we're at higher risk for such things.
Kendra: Yeah. That's amazing to hear. One week after that tragedy that you were just on that bandwagon advocating and just knowing that her legacy is gonna carry on in your work. But just in that most vulnerable time, you were reaching out to us, your colleagues, saying, “Listen guys, this is a real thing. I'm in the middle of it and I need to share the story.”
So if you wouldn't mind telling our listeners a little bit about your sister's story.
Michelle: Yeah. Thank you so much. Gretchen was a total badass. I mean, everybody loves her. People who met her just for, you know, maybe one rotation in medical school reached out after she died and said she was amazing. She was the one who was always kind.
She was always the one pulling people in. I had a bad day. She realized that I was having a bad day on service. And she walked over to my house that night and brought me some tulips. I mean, so like this is just sort of the epitome of the big heart that my sister had. But more than that, she was an amazing athlete, an amazing student.
She was sort of that all around woman that everybody would just like love to be around. And what I think is super fun is that she was also the one who brought the fun. You know, unfortunately when she died, it devastated my entire family and my daughter said, “How could this happen? She was the fun one.” Because when we'd have get-togethers for the 4th of July, it wasn't enough to just, you know, get together and have the theme.
Like, we gotta have games, we gotta do all this stuff. And in medical school she went to Creighton University and. She would, you know, invite people over on Friday night, but just getting together on a Friday night to have like pizza and beers wasn't enough. She would say like, okay, hey, this week we're doing the Western theme.
So she just was, just a delight, always just a ray of sunshine. And she gave so much, but more than just her amazing ability as like a human. She was the most loving mother to three kids. She met her husband. So your listeners would love this cuz you know, emergency physicians, and I know you have other listeners as well, but emergency physicians are pretty badass.
So my sister took a couple years off after college and went to Colorado and she was a ski patroller, a copper mountain. She met her husband there. She was phenomenal. You know, she grew up being a snowboarder, but then it's like, well, I suppose I should probably ski again because I'm gonna be a ski patroller.
And she did like tele-skiing. I mean, so again, like this woman is just phenomenal. So she met her husband. They fell in love. They went to Omaha so she could go to medical school where again, she received top marks and all of, you know, again, I don't love to, like laud all the awards because I think we need to get away from that.
But like, this is a woman who got all the awards. She was the top of her class in medical school. She did radiology residency at the University of Minnesota. Was like, you know, resident of the year, teaching resident of the year, chief resident faculty, teacher of the year. Like she was phenomenal. And like all the awards around her showed that clearly that's not enough. But back to her favorite profession, if you will, was being a mom. So she had three young children that unfortunately she left behind and she was. She just loved it. And again, she made everything fun, like going in the backyard and like swimming in the kiddie pool with popsicles.
Not enough. Let's get out to like the hurdles and like, let's do an obstacle course and then like end in the pool. She was super fun and she loved her children more than anything. And again, this is like my town cry. Not only are we all at risk, but number two, children aren't gonna save us. As a family physician, I took care of many, many patients over the years with depression and anxiety, and they would fill out their PHQ-9, and the bottom question would be like, you know, sometimes they have thoughts of hurting themselves.
So I would dig in like you all do, and say like, okay, so tell me about this. Like, do you have a plan? What are your thoughts? Well, I would never do it because of my children. I used to believe that. Mm-hmm. Children will not save us. So, That is my, one of my clear messages to me because you know what? This can happen very suddenly.
So this is a woman who was like 110% in her life, right? She didn't know that she was running fast toward a cliff, if you will, right? Yeah. Even the day she died, she did not know that she was gonna be dead that evening. It's devastating. So again, what can we do to take care of ourself? I love to say you wouldn't go rafting down the Grand Canyon without a life jacket, an oar, a plan.
So what is our plan to take care of ourselves because we are careening down the rapids in the Grand Canyon, if you will, in our profession. So that's what I have to say about that. She was amazing. I miss her every day. She was, when I call her my baby sister, I should probably not, she was 36 years old when she died, but I was 11 when she was born.
So I was like her little mama growing up. And then we became, you know, dear close friends. And the fact that I didn't know, the fact that her husband didn't know the fact that her siblings were all physicians didn't know. And we have the most loving, caring family again, is another reason that we need to double down on taking care of ourself and checking in with our colleagues regularly.
Laura: So did she ever struggle with depression or anything like that, that any of you guys were aware of before this happened?
Michelle: Yeah, that's a great question. When she was younger, she had had some depression, but I would say anxiety, it was sort of more the flavor that she ran with over the years. And, you know, after her youngest was born, Who was 18 months when she died, she went back to work like right away.
Her son had bilateral cleft lip-palate, so she was super stressed about that during her pregnancy. Knew that there was gonna be a lot of challenges coming up for this little tiger. And I said, so are you–she was, you know, an attending now, right? At a level one trauma center doing radiology. She had done a breast fellowship as well.
I didn't mention that? Which she loved. But she was said, you know, after her baby was born, I said, so are you gonna take like the full 12 weeks this time? She's like, “Oh no, I can't do that. I can't do that. We gotta go back.” So I think she went back after like four to six weeks.
A week later she called me and said, “I don't know if I can do this anymore. She's like, I'm so terrified that I'm gonna make a mistake. I just can't focus. I'm terrified. I don't think I can do this job anymore.”
I said, “Gretchen, it sounds to me like you've got, you know, postpartum anxiety and I'd love you to see one of my colleagues.”
So she got in and saw one of my partners, started on medication, saw a therapist. And then, you know, a week or two later, she said, “Oh my goodness, I feel so much better. Like, so much more in control.” And I believe she was still on medications when she died. I don't think that she had been seeing a therapist anymore, but she wasn't alluding to the fact that things were getting worse.
Amanda:Right.
Michelle: In retrospect you can maybe notice a few things, but this was during the pandemic. This was March, 2021. But we had just been vaccinated. We were just gonna come back together as a family because as a family we're, we were all afraid we were gonna kill my parents, right, because we're all working in medicine.
We did the Zoom, Thanksgiving, the Zoom Christmas. We had just been vaccinated and I was so excited to be able to like hang out with my sister again, take her kids for the weekend so she could get a break. So I think that contributed, isolation contributed. Certainly. It wasn't just one thing, but I do think that her anxiety was ramping up.
Her husband, again in retrospect, noticed that she was more worried. The last time I spoke with her was three days before she died, and it was the first time I heard her use the word burnout. She said, I'm so stressed and overwhelmed, I can't do this job anymore. And she had just come off a call weekend. So again, Sleep deprivation is a huge problem for our brains.
She had just come off a call weekend where she had been working like 36 hours at a level one trauma center. You, ED docs know this, right? Yeah. She's reading hundreds of scans, making life or death decisions. Does this person go to the OR or not? She was exhausted, so then it would be like midnight and she'd be like wrapping up all this stuff.
Then her little one would be awake, so she was getting like a few hours of sleep. Woke up at 6:00 AM the next day to start again, so I talked to her on Tuesday night. She had just come off this call weekend and she said, “I am so exhausted. I have a headache. I'm nauseous. I can't even think straight.”
I said, “Sweetheart, you've had like six hours of sleep in the last several days. You need to call in sick tomorrow.” “I can't. We're short at work.”
Laura: So, and this, this is, this is such an important point here that. We're short at work is not a good excuse. It's just It's a horrible excuse.
Michelle: Exactly. And And I get it that we can't call in all the time when we're tired. Oh, when you're sick, tired in your bones, and you just can't even imagine going on. You know what?
People will figure it out. And again, with all the emotions that came after she died, certainly it's devastation, but that anger comes up too. And I raged at her: “Seriously, sweetheart. Like you couldn't call in one day.” And that now the whole damn schedule for the whole year is you're not in it forever, forever, forever, forever.
And so like, I get it and I'm not, you know, I'm not saying she would be here had she taken that day, but it's just like that cumulative fatigue. With, you know, she had acute on chronic sleep deprivation with three little ones at home, and then that call weekend put her over the edge. Another word of caution that I love to share with people, because her red flag warning was the week before that she was gonna be on this last call weekend.
She said to her colleagues, Hey, the interventional radiologists split their call weekends. Would anyone be willing to split this call weekend? And then it was crickets. And so she just got in there, but this is a woman who never asked for anything, so it's very, very subtle. And yet I want people to be aware if all of a sudden people say like, “I just can't do it.”
Like ask some more questions. How are you doing? Right. Yeah. What's going on? So she was exhausted that last week and what really breaks my heart. The other thing going back to the mom thing, is that she was supposed to go on spring break the following week and she was looking forward to that, but she was feeling so bad because she all of a sudden had the idea because my mother reached out to her and said, “Hey, I'll keep the toddler.”
Toddler doesn't want him to go to the beach. Gretchen said, “Am I a horrible mom to leave Ollie at home that week?” I said, oh my goodness. Toddler does not wanna go to the beach. You go with your husband and kids and have a great time. She said, “I just feel so guilty leaving him for a week,” and three days later, she left everybody forever.
Right. So your brain isn't working right, right. When you're described and you're anxious and you think you have to do everything for everybody.
Amanda: Yeah. Well, and just for everyone out there, there's always going to be more stuff. There's always gonna be staff shortages. There's, unless we start drawing our own boundaries, no one's gonna do it for us.
I waited 15 years for some white horse to come running in, like, no, stop picking up extra shifts. Never happened. Not once. And it never will. So, no, it's just an awful way to learn that lesson. I hate that.
Michelle: It, it totally is. Which is again, why I tell the message, and I'm like, you guys, if you can't do it for yourself to set the boundaries, you know, work with you all right?
Like, or come up, there are hundreds of physician coaches out there, or non-physician coaches, but we, physician coaches understand very intimately what the heck that you're dealing with and why it's so hard, how we've been socialized to say yes, and how we, you know, get brainwashed into thinking we're not a team player.
All this. Bs, right? So like if you need someone to help you be able to set those boundaries and say, no. I tell you what, we're all in trouble. And my sister, I had just started coaching. I had just started my podcast a few weeks before she had died and she's like, “I love listening to your podcast. I listen to when I'm folding laundry.I know I need to say no, and I need to learn how the feel, the feels.”
She was kind of like joking about it, but before she died, I remember one other, we had this beautiful conversation, that last conversation, and she kind of calmed down. She's like, “ I know that I need to like work on some of these stress things.”
She's like, “Michelle, you need to like help the medical students with this like, People need to learn this earlier.” So like I think that's another lesson from her to all of us that like, yeah, we can help the people out working and we can start earlier too, so.
Amanda: Well, the other thing too, like did her hospital shut down the day after?
No. It freaking kept going.
Michelle: No. Even started on that whole whole thing. Right? I mean, it was so dramatic. Right? And like, I think, I mean, they sent out a message. I'm sure people were upset, but I'm like, what is different? What are you doing differently? Are you still having these radiologists work these crazy long shifts?
Because she was never gonna be the one to say, I can't do it. She worked with seven dudes. And she always–she was brilliant. You know, the chief of her department was like, she was the most brilliant one. I knew she was gonna be the chair someday. He's like, “I would've done anything for her.” He loved her like a daughter.
He said, I would've done anything for her if she needed less time. I said, but she wasn't gonna ask. I know.
Amanda & Laura: Right, right, right.
Michelle: Yeah. So we do need to empower people to ask for what they need and not feel bad about it, and yet, no, it didn't shut down. It kept going and.
Amanda: But it's just so funny that yeah, we think we can't take a day that the whole place is gonna shut down or something. It doesn't, it keeps going. Yeah. So we have to put our own mental health and physical health and just ourselves in general as a priority.
Michelle: Absolutely. It's, it's so important, which actually makes me, I don't know if I can segue into this, what we were gonna talk about yes. Why I reached out to you. I mean, you guys have an amazing podcast.
It just so happened that I was out working in the yard the other day. I'm like, I need to listen to a podcast. For some reason, yours was teed right up, which again, I believe that the universe and you know, spirit guides like, give us what we need to hear. So I started listening to it and it was a new episode on shame.
And at one point, one of you said, I think that shame is probably behind a number of physician suicides, and I stopped it right there. I'm like, that's exactly it. My sister went into a shame spiral before she died, and it happened because again, she's a perfectionist. She's gotta do it right. Her biggest concern was making a mistake, and earlier in the week I found out about this after she died, she had been told about an inconsequential mistake that she had made.
Someone in the ICU, a new attending came on and noticed something. She went back and looked at the scan. Oh indeed. I read it incorrectly. One little thing, and so she went and did an addendum like she's supposed to–that devastated her. She came home that night. That was the night I spoke with her. She was just all out of sorts.
Her husband said she came home and said, “I don't think I can do this anymore. I need to get a new job.” And she reached out to me so upset, which I spoke to. So she, again, it was a minor thing, like it didn't affect the patient at all. But she was devastated because again, I think her anxiety had been building.
She heard about this, went into a shame spiral. Unfortunately, the day she died, a senior colleague of hers publicly shamed her at a staff meeting.
Laura: What?
Michelle: She went into a tailspin is what I think happened. She finished up her day and then she went sideways and her brain just couldn't come out of it, unfortunately.
Laura: Oh my word. And this this, this is. I don't know. I, I talk all the time about how we are in a system of narcissistic abuse and it creates this perfectionism in us because we're so afraid of messing up because we will, you know, we have all seen this happen to people where there is public shame and–people, shame has no place anywhere in the medical system, this is not okay. It is not okay for you to call out people in this way and make them feel horrible about themselves. This is not okay. This is not good medicine in any way, shape or form. And to to follow up on. Something you said earlier, like she just, it sounds like she had a perfect storm of-
Michelle: That's exactly what I call it. It's a, I call it the perfect storm or the imperfect storm, whatever. It's this horrible combination of just like all of the things, and then again, this man didn't make her die, but I feel like he lit the match that day.
Laura: Sure, sure did. Like she's postpartum, she's exhausted, she's overworked, she's a perfectionist, and not asking for help.
I, I will-in full disclosure, I have been suicidal a couple of times during my career, and there is a very, very clear correlation between lack of sleep and suicidality. If you have extreme lack of sleep, your brain is just like, I need to rest however I can rest, and it becomes irrational. You become, you come to this point where you're like, it's not even like thinking about the consequences of what you're considering doing.
It's like, no, really, the world would be better off without me. That is where that brain goes, and that is always a lie. That is always a lie. This is never a good idea. You can always go, go work at Costco, go like go to the beach for two months. You do not need to be a doctor to be a worthy human being. You do not need to do this.
You do need to stay alive, and for those of us who don't struggle with that, or haven't struggled with that-your role is to help watch for the people who may be at risk, because this affects all of us. Every, every physician who commits suicide not only leaves behind a wake of destruction and tragedy and sadness and patients who needed them and family who needed them, and kids who needed them, but they increase the reality, the they increase the risk that other people will commit suicide. This is a documented phenomenon that suicide is contagious, and there's nothing, there is just nothing that suicide makes better. There's just nothing.
Michelle: Yeah, I would agree 110%. And because I'm so vocal about raising awareness and I'm so vocal about how sleep deprivation was a huge contributing factor to my sister's death, I've had no less than a dozen women reach out to me and say, it was almost me. It was almost me when they've been sleep deprived. So again, like, Hey, let's think about the medical system, right?
Like even like the residency hours, like they changed them to like 80 hours a week. Like, are you kidding me? That's freaking crazy. Truckers and pilots have work hour restrictions because they don't wanna kill people, right? So we have patients that we're taking care of, and what about ourselves? Being awake for 24 hours is a blood alcohol equivalent per the c CDC of 0.1 in my state that's above the legal limit.
So like, and if the organization, even if that's the standard, you can ask yourself people, what works for me? I'm a gal who needs a lot of sleep, so like, but everybody's different. But like if you're up all night delivering babies, perhaps just because the standard is that everybody operates the next day, you can ask yourself, is this working for me?
And start to set some boundaries and be the one who is the example of, “Hey, I'm taking care of me because number one, patient safety.” Everyone loves to hear that: patient safety. And number two, because I wanna keep doing this. I want this to be sustainable. I wanna enjoy my life. Yes. I'm an amazing, brilliant physician and I have a life outside of that.
So to your point, yeah, your brain is lying to you when it's saying everyone would be better off without you, you probably need a break. And it's hard and scary to do, but people are around to help. Right? There's this physician support line, there's 988. I still always tell my patients like, call 9 1 1 if you think you're gonna like, jump off a bridge.
Now there's 988. Even better. That's helped thousands of people come up with a plan. Because it's a big problem and there is contagion, right. I think last year in Minnesota we lost eight to 10 physicians to suicide. And again, it's not like in the news, it's, I mean, I guess after Gretchen died, we had some stuff on the news, but it's because people come behind the scenes to tell me.
So again, most people don't know, like who's keeping track of this. I'm like, where's osha? If we lost eight people in an Amazon warehouse, OSHA would be like, what the hell's going on? Shut this warehouse down. We gotta figure this out. No one's coming to save us. You know, to Amanda, to your point. So we have to save ourselves and each other.
Now again, I don't wanna like tell someone who's really struggling, like, pull yourself up by your bootstraps. That's a bunch of bs, right? But just to know that we're at risk and that we're struggling, let's normalize it. How can we look out for each other? Right? To Laura's point.
Laura: Yeah, and, and remember, it's your brain. Your brain is telling you it needs something. You're in a situation where your needs have not been met. There is no shame in having these feelings. There's no shame in experiencing this. What happens that's really irreparable though, is when it's acted out. So, Let's stop. If anybody is,
Michelle: My sister and I, I have another sister and like after Gretchen died, we're like, she would be so mad if she woke up and knew what happened.
Like she would be so mad She would, right? She would not choose this. It wasn't a choice. People like, it's such a selfish choice. I'm like, are you kidding me? She was like in a burning building and had to get out.
Laura: Yes. Oh
Michelle: Unfortunately. Got to that point. But let's get help before you're at that point, cuz then your brain doesn't even know what the hell it's doing anymore.
Laura: It is not a rational decision and it, if you, if anybody listening to this, if you ever hear someone say that it's a selfish choice, please shut that down because it is not what people like judgment is really just, it's not a choice. Helpful, but most certainly not helpful here. It is not a choice. It is a brain dysfunction because of things not being taken care of, like they needed to be taken care of.
Amanda: Yeah.
Michelle: And we're all laying down that kindling. You know, I talk about Gretchen, how she had this imperfect storm or this fire that just happened, right? But we all like, look at your life. Where is it that you're like laying down kindling or, you know, preparing?
I didn't, I don't wanna say we're preparing for the imperfect storm, but we all have things that happen. Right. Different stressors that come our way. You know, call weeks, that sort of thing. So it's like, how can we take care of ourselves so we don't get to that point where all of a sudden it's just that horrible conflagration.
Laura: Yeah. So what do you think some of the biggest obstacles that physicians face are regarding their mental health currently?
Michelle: Yeah. Such a good question, and I love we're talking about this during mental health awareness month number one. I think it's stigma, right? Like, There's still a lot of stigma, so I always like, okay, it's mental health.
It's brain health, right? Like we wear red during October for heart health. Let's start talking about our brains people. It runs the show. So let's just start talking about it and normalizing it. When I tweak my back, I'm like, who's your favorite, you know, sports chiro or you know, therapist that you see, like, let's talk about it.
Like who's your therapist? Who are you seeing, who's your coach? Like, how many milligrams of sertraline are you on? Right? I mean, we, I don't mean to be like, Flip about it, but like, we're all on the struggle bus of life, and like we all need help and it's not a problem. So number one, there's stigma.
There's also stigma in the culture of medicine in that for many people our licensure used to ask questions about whether or not you've ever had problems with mental health issues. So have you ever suffered from anxiety or depression in Minnesota? Last year we changed the licensure to: are you currently able to take care of patients? Which makes so much more sense because like mm-hmm. Why are we not asking about like diabetes? Like is your blood sugar under control? Are you on insulin? Like we're, it's very stigmatized towards the brain, right? The brain stuff.
Amanda: Right.
Michelle: But here's what I'll tell you.
A lot of us docs run towards anxiety, right? And like it can help us get stuff done, but it can flip over pretty easily. And depression is a thing too. We're humans. We can get depression, but it can be treated. And if you're being treated, that that's what we need to do in order to take great care of our patients, is take care of ourselves.
So they shouldn't be penalizing us for getting help. So again, I'm not sure how many states have changed the licensure wording, but certainly hospitals still have different licensure, or not licensure, but different wording that when you wanna apply for privileges, right. So I think that that's another thing that has contributed.
I, on my podcast last week, had a psychiatrist come on. She's like, I'm gonna debunk these myths right now. You are not gonna lose your job if you go to a doctor and start a medication that has nothing to do with anything. That is, if you're well treated, you don't ever need to. Even if there are questions, you don't need to answer because you are doing just great.
Right? But of course it helps to change the language. Getting help is super good and I think if we just normalize it like, oh, I'm not gonna lose my job. I think so many people worry about that. But I'm again, that squeaky wheel–like lose your job or be dead. I don't know, like. I mean,
Laura: right, right. Exactly,
Michelle: But like again, a non-healthy brain can't rationalize that.
I mean, so I think that that's another thing. There's stigma and also we're doctors. Who are we to be needing to be fixed? And again, when we're perfectionist in the top of the game and kind of quote unquote the best at everything, we start to have a lot of self-recrimination. Like, oh my gosh, you just suck it up.
Come on, try a little harder. Just like that old narrative that is not helpful. Like I shouldn't need help, which is a lie. People, we are humans and our bodies sometimes, often need help.
Amanda: Absolutely. Yes. Well said. We'll link to the Medscape article from the 2023 findings. One of the biggest barriers that doctors had in seeking mental healthcare was the stigma of depression says something about me personally, and just the whole system doesn't allow us to be vulnerable. So that's it's, I love that you said that because that's exactly what the statistics are showing too, is that we don't seek help for ourselves because we make it mean something just dramatic. Like you guys, we have secondary traumatic how, what is that trauma again?
Vicarious trauma.
Michelle: Trauma, yes.
Amanda: All the time. It's, it's absolutely insane that we don't have the same support built in that like a professional athlete has. Like, are you kidding me? Right now we really are dealing with life and death.
Michelle: Hundred percent access. It's my mission. And I imagine your mission as well to like totally like normalize this. And I think coaching is helping, realizing like, hey, I can get help, but like, I think it should be at a point where like, welcome to this organization, here's your parking card, here's your badge, here's your coach or your therapist that you're gonna meet with every other week.
Because we deal with trauma. I mean, in the emergency department, you know way better than I, it's traumarama all the time. And who helps us process this? Nobody, we shove it down and then you're like coding another young person who was in a tragic accident. We hear the wail of the mother who lost somebody that affects us, compassionate, brilliant physicians, and we deserve help. So again, I think just saying like, Hey, we should all be having a therapist. Like it should just be normal, I think. I mean, seriously, emergency department. You should just probably have a trauma therapist number in your back pocket and just like be seeing 'em every other week.
Amanda: Yeah, it's, yeah. There is nothing like the feral cry of a mom who has just lost, like, it's like, even when you say that, there's stuff I haven't worked through. I know. Yeah. It's like it's ready to come.
Michelle: It's real. I mean, I don't go into all that, but when I heard my sister die, I had that cry and I collapsed people like, how did you tell your children that your sister died?
I'm like, they saw me collapse. You know, wailing. So, yeah. Yeah.
Laura: I, I just wanna add one thing. I was recently on a plane and I was watching “The Sisterhood of the Traveling Pants,” and one of the characters in that movie, her mother had committed suicide. And really it doesn't play out like the mom's story, it plays out the daughter's story. And when, you know, when she's a teenager, she's at a soccer camp and kids are like getting care packages and she gets a note from her dad and and the other kids are like, “oh, my mom does this. My mom does this. What does your mom do?”
And she said, “Nothing.”
And people, we don't wanna be the nothing, no matter how bad life seems.
Michelle: Yeah. And we have,
Laura: We don't wanna be the nothing.
Michelle: We don't wanna be the nothing. And we have such high expectations of ourself in all areas of our life. We wanna be the top doctor. We wanna be the best mom. We wanna like keep up with all the other moms and what they're doing.
But here's what I'll tell you is your kids just want you. It was just Mother's Day this last weekend. And you know what these kids want-a mom. They have an amazing dad, so like to at least shine a little bit of beautiful light on it. It's been two years.
We're still all heartbroken, and yet we've had a lot of healing. And Gretchen's husband Mike was a, is a phenomenal father, and these kids are doing really well. I mean, he got them in therapy right away. So these kids are like learning now to talk about their feelings. You know, he's like, they're at higher risk now for when they're older.
I said, “Mike, they come to you and say, dad, we need to talk about our feelings.” I said, that's amazing. Skills that you're teaching your children. Unfortunately, it's come from this, but they've been even offered to help classmates of theirs who lost a mom, unfortunately, in school this year. And my nephew went around and he hugged everybody, everybody's sobbing. He hugged everybody and he said, “This is so sad, and it's gonna be okay.” Which I think is pretty brilliant for a nine year-old. But the point is to lo to just reiterate what Laura has to say, like–we don't wanna be nothing. If you're struggling and you just need a break, please tell somebody today.
Reach out.
Amanda: Yeah. And don't forget that you were an incredible person before you were ever a doctor. What does it matter if you never go to work again as a doctor? Who cares? Nobody cares.
Michelle: Yeah. It doesn't matter. Mike after Gretchen dies, “Like, I wouldn't care if we lived in a cardboard box and we were pumpkin farmers.Like, I just want her.” You know, his partner in life. But we get, get so tied up in who we are. Like we lead with, I'm a physician. It's like, hey, how about we start just practicing? This is who I am. I'm Michelle.
Amanda: Yeah, I'm Amanda. Right. Nice to meet you.
MIchelle: What do you enjoy doing or what are you doing this summer?
I mean, I get it that it's part of our culture that we so identify with our profession, particularly physicians, but maybe we can realize like we are amazing humans outside of that. When we take that hat off, we're still pretty badass.
Amanda: We're so much more than all of our labels that we put on ourselves.
We've we're infinitely more than that. You regularly coach physician moms. What are a couple of the most common issues that come up and how do you, what are some helpful tips that if somebody's facing the same thing they could use today?
Michelle: Yeah. Yeah, I love what I do. I get to help people who wanna feel better, which is a park ride from like primary care medicine.
But a lot of times people come because they are spending too much time outside of work, you know, doing the free labor, finishing their notes five to 20 hours a week. And they're avoiding conversations with people because they, they all come and say like, I don't like conflict. And so we learn how to have conversations and feel empowered, you know, by their feelings.
But a lot of it is learning how to set boundaries and not feel like a narcissistic a-hole and learn to say like, what do I want? Because again, we've been socialized to like people please and make everybody else happy and we forget about ourselves. And so I help. Empower women to like say like, okay, what is it that I wanna do?
Do I, do I love operating when I've been up all night? Or can I say no? And right. As you folks know, that's uncomfortable at first, but we can learn to allow an uncomfortable emotion. Like, do you wanna be uncomfortable now or do you wanna be uncomfortable later? Like, you're gonna be uncomfortable, so at least you can choose when you wanna do it.
So I just teach like the basic skills that you folks teach. But a lot of it has to do with boundaries and people pleasing and perfectionism kind of squashing all those perfectionist fantasies down. And just like building up too–we've also loved all the external validation that we get as students.
I love getting those gold stars and the accolades. Like, you're so smart, you're so great. And now out in the intending world, it's like am I doing a good job? And then we get the patient satisfaction scores, don't even get me started on that.
And then we, we think that that's how we are as a physician. So I really love teaching people the concept of like fanning your internal flame. Right? Love, like it's an inside job. Love that. Appreciation and feeling confident. That's all an inside job, but like no one teaches us. So that, that's sort of the work that I do and people all of a sudden feel more in control of their life.
They're trying to control everything around them and they're just harried and exhausted and all of a sudden they can like take a breath and just like chill out a little bit and realize, oh, I'm doing an amazing job and I can enjoy my life. Just very similar I imagine to the work that you folks do.
Amanda: Yeah, totally.One, one example that I like to tell clients is like, but if nobody starts changing this, nobody sees an example of what's possible. So if even if you're not doing it for you, start creating those boundaries so it becomes acceptable for us all to create those boundaries, becaue we all, just like Laura loves to talk about, we are caught in this narcissistic system of abuse, and we're going to have to start showing examples of how we're not gonna tolerate this anymore. So I,
Michelle: One hundred percent. Yeah, I agree. I would say like the system is freaking broken. We don't need to wait for us to change to feel better. We can start to feel better. Mm-hmm. And then it's the ripple effect.
And then I just imagine all these women linking arms and we are gonna be the change. We are gonna say, this is unacceptable, this stupid system that like, you know, shames in its teaching and like demands more from us. The other thing I say is the medical system's running on the backs of altruistic doctors.
Amanda: Hundred percent.
MIchelle: We're seeing the jobs of like two people and nobody but us could do it. But like we have to stomp our foot and say, enough–this is what I am capable of doing. And figure it out. People figure it out. I dunno, Our colleagues do the same and then everyone just exactly. Which is what I love-that ripple effect is huge. I teach someone how to get their notes done more quickly and efficiently, and then they're teaching the fellows, and then the residents and the med students are saying, oh, she's getting outta here at the end of the day and her work is done. I want that.
Amanda: Well, the thing is, you and I and Laura and Kendra, we didn't create the staff shortages.
We didn't create all these problems, but yet we somehow feel like we're responsible for. That's cra that's not right. That's not right.
Michelle: Fixer. We gotta fix it. If only I tell people we could be seeing patients 24 7. The amount of patients is like the ocean. Yeah, we can't do it all. So we can take really good care of the people in front of us and everyone just can get in line.
And I don't know what the solution to that is, but let's take care of us so we can continue to take care of people. Because if your job, look at your job listeners. Look at your job right now. Is it sustainable? For the next one year, five years, 10 years. If not, please reach out. These women have an amazing program.
They want to help you. We need to figure out how can it be sustainable so we continue to take great care of the patients. That's the funny irony is, “I gotta take care of all the people,” but then they burn out crispy and then they're the hell out. Which again, if you need to get the hell out to save your life, please do. But it would be good to have some physicians around, especially women physicians like or pretty amazing.
Amanda: We are, we have really good statistics. Yeah. So how do people, I know that you have resonated with tons of listeners. How do they get in contact with you?
Michelle: I am on Instagram, not a ton, but @mamadoclifecoach, and I have a website, www.mamalifecoach.com-can find me there. My podcast. Remind Yourself, have a listen. If you really want to like, shake your core and then share it with your administration, episode number 11 entitled Exhaustion is the one that I was talking about before that I did the week after Gretchen died. And it resonates with people-like you can hear it in my voice that like this is a, a cry for all of us, that we all need help.
Amanda: Thank you so much.
Michelle: Yeah, I'm around. Yeah, I, I love, I love the work that I get to do and I'm so grateful for colleagues like you who are also doing this work-because again, we're banding together and we just keep linking arms. More and more physicians are joining on and saying, enough is enough. You know, we don't have to tolerate this toxic system anymore..
Amanda: Any further closing thoughts before we close out?
Michelle: I will end with what I really like to say is because again, we've been socialized to take care of everyone else and we feel really guilty, but I love telling people to listen to the heart.
The heart feeds itself first. The first artery off the heart goes to itself. And we women in medicine need to realize that in order to take care of our patients and our children and our families and so on and so forth, that it's not selfish to take care of ourself. In fact, it's vital. Second thing I say about the heart's a little cheesy, but like, diastole is vital.
Rest is vital. We've been socialized and we need to work, work, work all the time. As you know, you see those rhythms. If there's nothing diastole, there's a problem. And that too can happen in our life. So I just like to like end with, you know, the heart, teaching us how that we can take care of ourselves and like, find a coach, find a friend, find a therapist.
Help is available and you're not alone. And thank you ladies for inviting me on.
Kendra: Thank you so much. Thank you Michelle, so much. That is definitely this is going to be one of those podcasts that is definitely going to, like you said, cause someone to stop gardening at the moment and pause and that's kind of why we do this.
We do want to encourage people to pause, pause. You know, on your life. Pause those thoughts. Pause. Just take a minute, and I'm so thankful for you, Michelle, using this. Just tragedy in your family as a place where you are bringing humanity back to medicine and just the realization that you went through this and that is now your sounding board.
What an amazing way to honor your sister and her legacy and just keep going. So thank you. For every day waking up and just, getting enough strength for today, putting one foot forward and just keep moving forward. So thank you very much.
We, honor you today.
Michelle: Thank you–I really appreciate it and it is an honor to be able to speak about my sister and she's a very strong spirit. She whispers in my ear all the time. Keep talking, keep talking. And when women come up to me at conferences and send me messages like, your sister saved my life. I'm like, way to Gretch. You know, I wish you were here. And thank you for the work that you continue to do to help women realize like we're all at risk.
Kendra: And thank you listeners today for joining us. Also, we have c m e available, so if you wanna claim c m E for listening to this amazing, powerful podcast, scroll down to the bottom of the show notes and click on the link.
So until next time you are whole, you are a gift to medicine and the work you do matters.
