[00:00:00] Dr. Jessica Singh: Welcome to the Holistic Physician Coaching Podcast. I'm your host, Dr. Jessica Singh. This podcast explores physician health, wellbeing, and fulfillment, embracing all aspects of the human experience. Just as in medicine where a single interaction can transform a life, this podcast is grounded on the belief that each coaching conversation has the power to inspire, heal, and bring about meaningful change.

In this episode, I have the privilege of coaching. Mary. This is our fourth coaching session together. Mary is a family medicine intern from the United States. Welcome, Mary

Dr. Mary: Good to be here, Jessica.

Dr. Jessica Singh: It's been a couple of weeks since we last had a coaching session. What's coming up for you today?

Dr. Mary: Hmm. In terms [00:01:00] of medicine and working, it honestly has been a pretty good couple weeks. In terms of personal things, it's been pretty sad. I had my grandfather who passed a week ago today. So just kind of working through some grieving while working in the hospital too.

He passed away in the hospital. So there's been, I think, some lingering emotions with that. But, to be with family and he was on life support briefly, so I was able to be there and be there for my family. And now just transitioning back, I suppose.

Dr. Jessica Singh: I am so sorry for your loss. I can't even imagine how difficult that must be knowing he's in a hospital while you're working in the hospital.

Dr. Mary: Yeah, it was a lot of checking my phone and checking in with family and I'm sure lots of people maybe you can relate to listening that when you're like the [00:02:00] only medical knowledge person in your family and there's not a lot of hospital health literacy people really rely on you to explain things going on.

And so me calling the nurses station, trying to look to, so information to the family and also working around the hospital too, it was a not a lot. I felt grateful that I had the knowledge to be able to help and give insight. Ultimately he passed from what I would call a medical mismanagement which I think has been the hardest part of it all emotionally.

So, , we're working through that. But otherwise grateful to be a doctor and working in the hospital right now. And honestly, in terms of work life balance, cannot complain.

Dr. Jessica Singh: Well, first of all, just grieving in general, and then secondly, having it happen from a medical error. Do you feel like you have the resources you need in order to process through this grief, or is this something you'd like to [00:03:00] explore?

Dr. Mary: I think I'd like to explore it. I feel like I do have the support but So I feel like I, I'm just gonna have to work through with time and opening up more, I think to friends who are more medically inclined, who can understand the situation because, it's good to grieve with family, but unfortunately, like I don't want them to have a negative memory of his hospital experience. But definitely is important I think, for me, in terms of grieving to open up about it to other people.

Dr. Jessica Singh: What do you think might be most beneficial to you in terms of coaching, in terms of further exploring this grief? Ideally, what about it would you like to explore in our session together?

Dr. Mary: I am

not quite sure. I'm not sure if the topic goes of letting go blame is something we could explore. 

Dr. Jessica Singh: What about it specifically is impacting you of letting go with blame? Can you tell me more about [00:04:00] that?

Dr. Mary: Mm-hmm. Yeah. I'm just feeling a lot of a lack of control, like a frustration in the care that my grandpa got. And of course, you can't go back back in time and change what happened. Of course, no one in healthcare means to cause harm. I think very, very rarely would that ever be an exception.

But no one in healthcare, I believe, would ever try to cause harm. So, I'm trying to not unfairly blame people who took care of him and letting it go. Forgiveness essentially.

Dr. Jessica Singh: What do you feel like may need to be addressed in order to actually do that? In order to be able to not blame or let go?

Dr. Mary: I'm not sure. I often intellectualize grief, you know, like that's a coping mechanism that's probably common in doctors but I've done more research like on the error that was made and is this a common thing? Was this mistake that was made [00:05:00] essentially a combination of medications I believe that should not have given? Was that protocol was it not? I haven't really, fully come to understand if it was part of protocol or not, but knowing that it is not an uncommon combination and that there are known, but it's rarer side effects that happened for my grandpa, has helped me to give some grace, I think to the healthcare team. So that's one way, at least I have broached trying to work blame and letting go and, and giving forgiveness is knowing that it's maybe not a known side effect that they knew of or that, you know, it was not intentional, but I'm not sure how else to approach it.

Dr. Jessica Singh: What would the letting go of blame and being able to forgive mean to you?

Dr. Mary: It would mean healing. I feel like holding onto blame or any type of emotions, especially with someone's passing, with an event that [00:06:00] you can't go back in time and change only is destructive to your psyche. So being able to let go of blame and even anger I think that would be resolution of grief and healing.

Dr. Jessica Singh: As you think also, 'cause you had mentioned about your family too, and not wanting them to have a negative memory. how do you feel the letting go of the blame or grief? You had mentioned why it's important to you. What about it may be important to you as you relate to your family?

Dr. Mary: I feel especially the past week with my family, I feel responsible to give them a positive outlook on the way he passed. Some, you know, peace of mind and to be able to look back on the experience and not have the feelings that I do, essentially, I kind of wanna protect them from the knowledge that I have, honestly, or the feelings that I have. And so for me to be able to let go [00:07:00] of blame and just be able to of let my grandpa pass pass peacefully in my mind, honestly I think is essential for me to be able to look back at this from my own experience and not have a lot of these emotions come up again and be able to talk about it with family and not have my own anger coming up in it too. It would be important me to be able to just be with my family and grieve peacefully.

Dr. Jessica Singh: Where are you feeling the grief?

Dr. Mary: My eyes are very steamy. Like I feel it in the back of my head, my forehead just, yeah, my face, my head.

Dr. Jessica Singh: And what other emotions are you feeling?

Dr. Mary: Feeling regret. I know I was not on my grandpa's healthcare team, of course. I wasn't taking care of him in the hospital. I was in a completely different state. But I feel [00:08:00] regret because my grandpa was in his nineties. My grandparents had asked me to be their medical power of attorney, which he was able to make decisions for himself almost to the end. And so my grandma was there to help. So I didn't have much that role, but in my mind I feel responsible that he wasn't DNR and so that there were more intervention done than I would have wanted for him or really, I think anyone with medical knowledge would.

Dr. Jessica Singh: And where are you feeling this regret?

 What do you think may be helpful for you? Just in terms of thinking about the feelings where they are in your body in terms of mobilizing them?

Dr. Mary: Deep breaths. [00:09:00] That I'm not really breathing very deeply at all. Very shallow, kind of holding it all in.

Dr. Jessica Singh: And so what would the breathing bring to you?

Dr. Mary: Yeah, release relaxation.

Dr. Jessica Singh: I know we had talked about this before, but in a much different context about grounding with the breath, but as you think about where you are right now, how would you like to practically ground in the breath and use the breath to help mobilize these feelings?

Dr. Mary: Breathing right now. Remind myself to take some deep breaths and exhale all the way. I guess remembering too, trying just breathe throughout the day. In particular, maybe I'm home today and I feel like when I'm [00:10:00] home and when I get moments of rest when my mind is able to settle, that's when I start to grieve again. So I'm just letting myself feel it and then breathe through it. 

Dr. Jessica Singh: If you'd like to take a couple of deep breaths together and ground that insight into action. And I'm happy to offer that if you'd like.

Dr. Mary: I love that.

Dr. Jessica Singh: So just sit together for a few moments in silence and stillness,

 honoring your grandfather's life,

 inhaling deeply.

 Visualizing the lungs filling with air, abdomen expanding and [00:11:00] exhaling completely.

Continue breathing at your own pace and do three or four deep breaths together. And as you breathe in and breathe out, just observing emotionally what your, what the breath is mobilizing for you, if even any letting go or releasing is happening.

 Perhaps inhaling a deep nurturing breath, sustaining life, bringing energy,

[00:12:00] and as you exhale seeing if it's possible to allow yourself to let go of any attachments to any thoughts, feelings, or emotions.

 Observing just a few more moments of silence,

honoring your grandfather, his life.

And everything that you are [00:13:00] going through and processing at this moment

 very slowly. When you feel ready, go ahead and open your eyes.

 What did you notice during that activity?

Dr. Mary: I felt like I was able to release the regret, tension that was in my stomach.

Dr. Jessica Singh: Can you tell me more about what you observed with the breathing?

Dr. Mary: Mm-hmm. I love grounding 'cause I, I don't, maybe this is just me, but I feel like sometimes I get like a little tingly, like my shoulders get a little tingly, I get like little goosebumps. So I feel like that in my shoulders kind like on my scalp too. And then I felt, and I still feel just less tension in my abdomen.

Like I'm not holding [00:14:00] things and kind of like activating my abdomen, but just soft belly. I.

Dr. Jessica Singh: And so we have about another 27 minutes or so together, and just thinking about where would you like to go from here?

Dr. Mary: Well, we can't solve grief in one session, so that's okay. I feel like we could definitely talk about how work has been going as well. I know last time we talked about a lot of the frustration and tension and anxiety that I get whenever I'm in the hospital for 13 hours a day and trying to get home. But I'd like to report some success that I've had. It has been I think the last week we, last week and a half on my inpatient rotation, there was a lot of until 5, 5 30 till sign out or, try to get notes done and admit people pretty late in the day. But I caught myself mindfully breathing a few times. Very [00:15:00] proud of myself, then also enjoying myself at the end of the day. And many people enjoying the things that made me wanna be a doctor which is the whole intellectual pursuit of what's going on and getting to have that experience and work work with patients and a little more independent with that.

So, yes, enjoy. Overall was like predominant.

Dr. Jessica Singh: So sometimes after breathing, there's just this steeper level of clarity and stillness as you know very well. And so by asking, where would you like to go from here, obviously you're more than welcome to continue to explore grief and processing. I know this shift came for you, and so I just wanna honor and respect that.

That's all.

Dr. Mary: Oh. Thank you. I think I had a shift, so, okay. I can be more positive now and I

want to be in that headspace. 

Dr. Jessica Singh: Sure. And so that shift, you've talked [00:16:00] about it sounds like a big shift compared to last time.

Dr. Mary: Yeah, can explain it. I think it's partly just the shift in perspective, like we've talked about on multiple different scenarios of, okay, you know, you're here rather than being miserable about it or blaming my senior or blah, blah, blah, you know, taking the time to enjoy it and think of the good and being more mindful in the moment. Can't say I was like perfectly mindful and I'm like to scatter brains orders and write a note here and then change something for another patient, but I enjoyed it a lot more. Yeah, happy shift.

Dr. Jessica Singh: And I know you had also, in terms of perspective changing and having a plan of mentally preparing yourself. Last time we had talked about the preparation you would do for the longer days, and you had mentioned that shift in expectations. [00:17:00] So it's been a shift in perspective, and what else do you feel like you've been doing now or you've been more aware of now?

Dr. Mary: Mm-hmm. Hoarding snacks early on, especially on like the weekends when our cafeteria is pretty scanned. I caught myself maybe subconsciously applying what we were doing. Just like getting a bag and I'm very lucky with my residency we get free food, I will say that. So we have the privilege of just grabbing a bag and then hoarding snacks if you want.

So I was doing that with some fruit shakes and protein bars and some fruit when I was gonna be there long, or I was anticipating at least changing my expectation that I'm gonna be there long. It was something that we talked about so that helped. And then actually eating and reminding myself to eat before I'm like starving. So that was a good, a good other application.

Dr. Jessica Singh: The next question I'm going to ask, feel free not to answer it. What would you say you've gained [00:18:00] or what insights from this experience that you've just had, do you think you may be able to apply to now this other situation you're feeling of wanting to grieve, let go of blame and let go to heal?

Dr. Mary: It's a good connection between the two, thinking. I guess the answer's pretty clear in my mind. But more so acknowledging what I cannot control as in changing the events of my grandpa's passing or bringing him back, et cetera, all those things.

And instead choosing to let my mind well on the good of his life the positive positive things about his passing. For instance, everyone in my family like me who was outta state, my grandma, his wife all his children, and then the rest of my siblings and cousins were all able to be there before he passed.

And [00:19:00] we took off life support, which I know is 100% what he would've wanted. So focusing on that and the good of those beautiful experiences. yeah.

Dr. Jessica Singh: And how may you think you might support yourself when you're noticing those feelings of blame, regret or anger, anything that's coming up?

Dr. Mary: Mm-hmm. Well, I can't say that I'll always be able to anticipate when I'm having a low time. One of my friends calls it grief spasms. She had one of her grandparents pass not long ago and told me to expect these grief spasms where I just, it hits you all of a sudden. I think that is a very accurate description. Whether that happens at work or at home, just letting them happen without resisting. Letting myself feel it out. I don't know if there's anything [00:20:00] physical necessarily that.. When I feel terrible emotionally or like I'm sick, take a bath so I could, if I'm alone, take a bath is a strategy that's popped in my mind. But otherwise just letting myself feel the grief and let myself cry and not care if i'm gonna look puffy-eyed or whatever. 

Dr. Jessica Singh: So allowing the emotions to express themselves in whatever form needs to come out at that time, whether you're at work or at home.

Dr. Mary: Yeah, exactly.

Jess: Obviously, like you said, you can't predict when these emotions come, but when they start creeping up, how will you be able to listen to them and allow them to express themselves rather than to not listen to them? 

Dr. Mary: I feel like to shun the thoughts and [00:21:00] shun grief is maybe temporarily an okay solution, but it's not going to let myself fully grieve. And so I'm I'm going to have to confront the emotions and let them pass through at some point. So, yeah, allowing myself to be human and feel grief and sadness and even some of the negative blame and regret, but like, letting those pass through and not holding onto them or trying to push them aside until a more convenient time, I suppose.

Dr. Jessica Singh: How have you been able to honor what's been coming up for you, especially in the last week with the demands of your busy schedule at work?

Dr. Mary: Mm-hmm. I honestly, at work, have not let myself fully feel the feelings when I'm there. I can like, I'll feel like a spasm coming on and then I'll just try to like distract myself pretty quickly. And I have the benefit of when work is [00:22:00] fast paced, then it distracts my mind in general. But I would like to let that not be the case. Trying to run from the feelings is not ideal because then I come home and then it all comes out at once, and then my home time is just me delivering and being sad and crying and which needs to happen. But I would like it to be less overwhelming, I think. 

Dr. Jessica Singh: When you say you would like it to not be that way to not be able to address these at work in the way that that may be happening, what way would you like it to be?

Dr. Mary: It's difficult I think with clinic. So I'm actually this past week off the inpatient side now, and I'm on clinic facing side. And then a week from now I'll be back at the hospital. I feel like it's hard with clinic because you are one-on-one with patients and if you look like you've been crying and that's just, I dunno, maybe socially fapa [00:23:00] in Western society to look like you've been crying, I guess, in front of other people and makes me feel awkward. But there is times when I am not facing the patient every day. So letting those times be moments where I can grieve and be open. I'm very comfortable with my coworkers and my nurse that I work with. So talking to them about it, letting that be something I guess that is more known. I don't think anyone in my clinic actually knows that my grandpa passed.

Dr. Jessica Singh: Do you feel like sharing with colleagues that you feel comfortable with sharing will be a value to you?

Dr. Mary: Yeah. Yeah, definitely. I think I avoid that because then I don't wanna cry or I just don't wanna be sad or address the emotions. But I think that I need to do that.

Dr. Jessica Singh: What do you think that would bring to you?

Dr. Mary: It would help me to feel the feels at work and have [00:24:00] someone know about it. I think that there's that's an important thing just to have human connection with grieving, to not feel alone. And even maybe get some insight from my co-residents or nurses or people who've had similar instances and any advice that they can offer too.

Dr. Jessica Singh: This is also coming up from what we had discussed in our last session in terms of, last time the word that came was masking almost. And this time it's allowing the emotions to show. So obviously this context is so different in the context of grief, but what you had shared last time was almost grieving, not being at home with your son in a way and letting those emotions.

You had said last time when we had done that verbalization dialogue, it was the first time you said you had done it out loud. And so, it sounds like the self-awareness and acknowledging the emotions you're feeling at the time they're happening is important for you.

Dr. Mary: [00:25:00] Yeah.

Part of my one of my values, I guess, is being, you know, transparent and not like you have to hide parts of yourself around others. So I feel like maybe that is where part of this desire to share my emotions with others in grief and to be able to just express how I feel and and cry if I want to at work comes from is just not wanna have to mask things or put on a show and pretend that I'm okay to others.

Dr. Jessica Singh: What do you feel like would be most useful in our remaining time together to help support you with this?

Dr. Mary: Maybe just setting some clear goals or maybe just have me saying out loud what I am going to do to feel the feels at work and at home too. At work, especially clinic this coming week. And I actually [00:26:00] have one night where I will be in the hospital doing a night call shift. Opening up to, coworkers, colleagues and my, like my nurse in particular who I love just opening up to them about having these feelings of grief and just letting 'em know like, Hey, passed I need your help, you know, or something. Asking for help if I need it, or just explaining. If I'm not feeling happy. 

Dr. Jessica Singh: In what ways does asking for help when you need it look like?

Dr. Mary: Hmm, I'm not good at asking for help. But I think in this scenario asking for a timeout, maybe, especially on nights. I can anticipate having some grief spasms, particularly because we rotate on the ICU patients, and I feel like statistically if someone were to pass in our care, [00:27:00] usually on nights and then that team is the one who deals with the situation.

So if for some reason there's a similar situation and I just need to have a time out, letting my co-resident know.

Dr. Jessica Singh: And realistically thinking about residency and you used the ICU as an example, what might a timeout look like?

Dr. Mary: Mm-hmm. I was just visualizing going to the bathroom and crying, honestly. Or maybe just going back to the team room. Yeah, pretty much that. I can't think of any other more private space than we have a good team room. And having that just to hide away from.

Dr. Jessica Singh: So letting the emotions express.

Dr. Mary: Yes.

Dr. Jessica Singh: And so once you let these emotions express, [00:28:00] which is a timeout, is there anything else you think you might like to do in the timeout that may be beneficial to you?

Dr. Mary: First thing that came to mind to me is saying a prayer, I'm a spiritual person. I think discussed this already. So that would be, I think, a nice ritual for me.

Dr. Jessica Singh: So saying a prayer. And why is grounding in that spirituality important to you?

Dr. Mary: Probably that's the core of how I cope with death grieving is my faith. Like a lot of relate to that. So that's where I can draw my healing and this understanding the sense out of death.

Dr. Jessica Singh: May I ask or also share something that's just coming to me as you're talking? And if this resonates with you, great. If it doesn't, have you ever heard of the pause?[00:29:00] 

Dr. Mary: No.

Dr. Jessica Singh: So there's this nurse who popularize this, but the pause was actually a ritual largely researched at Virginia Commonwealth University in their ICUs, and they actually did a research study on this. And so it's at the time of passing any member of the care team, whether it's a doctor, a nurse, or a social worker, anybody, they basically just ask for a moment of silence, hence the name of pause.

And so it's non-denominational, but universally human. And they show that just even at the end of a code or patient death that doing this actually brought a lot of peace and helped with the grieving process. That's what they found in the study. And so, as you had talked about letting the feelings express themselves, the difficult situations you may have at night, and also the prayer, it just came as something that if you'd like to look into, I'm happy to share a resource with you.[00:30:00] 

Dr. Mary: Yeah, I love that. Thank you.

Dr. Jessica Singh: We also did the breathing today. Is that something you think you might find valuable to you as you think about moving forward and expressing those emotions? And if so, how?

Dr. Mary: Definitely. So I'm linking it with a timeout or a prayer, I think. Definitely would be beneficial to me and even if I don't have the ability to have time myself.

Dr. Jessica Singh: On that note, I know this plan was for maybe when a grief spasm came, but do you feel like these actions, in terms of sharing more with your colleagues, allowing emotions to express themselves, taking the time out, do you feel like these are things that you may be able to utilize otherwise?

Dr. Mary: Definitely. [00:31:00] And kind of along with sharing the idea of the pause, I know I've had multiple of my co-residents express dissatisfaction with our ability to talk with each other and kind of cope around death and patients who've died and not giving time to pause and allow any emotions to be felt around that.

So I feel if anything, it's a good opportunity to maybe set some type of ritual atleast for myself and maybe some of my interns, if not the program, but opportunity to help some other people with the process of grief. 

Dr. Jessica Singh: So raising awareness for yourself, and empowering yourself, and in turn, empowering those around you.

I know this isn't exactly a smart goal, but in terms of just the last question, like ground the insight into action, how frequently do you think you [00:32:00] might wanna utilize any of the things we've talked about in your everyday life?

Dr. Mary: Mm-hmm. Well, as a spiritual, religious person, I definitely could be better about prayer. I feel like I've let that kind of fall to the wayside in days when I am very busy in the hospital. So using that personally as more of a regular healing ritual. Yeah, in terms of maybe more broader, just being more open with my co-residents and coworkers who are usually very, very open with me, but being more open with them about things that are going on in my life in general, and allowing myself to be helped in those situations.

Dr. Jessica Singh: And how would you like to remind yourself of these things? Do you feel like there are any barriers or challenges that may come up for you in doing this every day?

Dr. Mary: Mm-hmm. Primarily the barrier [00:33:00] right now with sharing my grief is just my dislike of crying in front of people. I think the dislike of opening up, I think I've mentioned that a few times. Like I feel like I'm an open person, but when it comes to like the rawness of life and opening up, it's never easy. So I can definitely see that being a barrier, having the desire which happened actually last sunday. My grandpa passed on Friday, and then Sunday was the first day I was back. There were circumstances coming up that were, I would say triggering, but I didn't say anything, because I didn't want have a grief spasm in front of residents.

Dr. Jessica Singh: When that happens, and obviously you're the one in that situation and you know better than anyone else, whether it's appropriate or right for you to express or not express to share or not to share, what is something that you think may help you if a barrier comes?

Dr. Mary: If it feels like the right time and It feels like the right people who [00:34:00] would honor the feelings that I'm having and it's a safe space then knowing that other people also deal with grief and that this is important conversation for all of us to be able to share with each other, I think that that alone, like my desire for other people to open up to me more, I think should be a good theater to get over my fears.

Dr. Jessica Singh: What was your takeaway from the session today?

Dr. Mary: Hmm. It was perfect that I needed to sift through own strategies with grief. And even just talk out loud how I experience or don't allow myself to experience grief. That's something that I, again, I don't think I've really vocalized to myself honestly. So good take away that there are good, healthy opportunities to allow myself to grief wherever I am. And then, but there's also I think, some opportunities to help others open up on my program about death and grief.[00:35:00] 

Dr. Jessica Singh: Yeah. I know there's a lot of thought that you put into this, that people put into this before a coaching session and it's common when major life events happen that are unexpected on the priority list we're the priority of choosing a topic to be coached on happen. And so just, coaching is just an open door to allow whatever surfacing for you to come.

Dr. Mary: I had been very undecided, really had no idea. So this was, I think, absolutely the right thing. So thank you, Jessica, for creating the space.

Dr. Jessica Singh: Thank you so much, Mary.

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