[00:00:00] 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.

Dr. Jessica Singh: Today is my fifth coaching session with Dr. Mary. Dr. Mary is a family medicine intern in the United States. Welcome Dr. Mary.

Dr. Mary: Thanks for having me.

Dr. Jessica Singh: This is a special situation because I have been away for the past six weeks. We haven't had a session together in seven weeks, which is longer than what I'd normally [00:01:00] ever do. I wanted to just acknowledge the time that passed and say thank you for your understanding 'cause I had the opportunity to go to a program and I just grateful for your acceptance and for healing.

And so I wanted to ask you what has come up for you from our coaching sessions that you've been more aware of in the past seven weeks?

Dr. Mary: The past seven weeks have been busy and has included some long hospital days as well as some night rotations. So I think the coaching session in particular where we talked about anxiety over being in the hospital for long periods of time has helped me to be more accepting and less agitated near the end of the day.

Yeah, more accepting and less frustrated with the situation. So that's been very helpful.

Dr. Jessica Singh: And so in our coaching, just big picture relationship, we're having 10 sessions together and we're actually at the halfway [00:02:00] point.

And so I wanted to just acknowledge that and also ask you, now that you've experienced coaching, where do you feel like you might want to leverage and utilize the support from coaching and the remaining time together? 

Dr. Mary: It's been really helpful with just processing my emotions in the different milestones of being a new mom and being a new intern too. And it's crazy that we are in the spring now and I'm approaching the end of intern year. But yeah, I feel like going forward, and particularly today my thoughts are just kind of, again, focusing on new milestones and emotions with balancing being a mama, being an intern, more of the ups and downs in the waves.

Dr. Jessica Singh: Can you name some of the emotions that you're experiencing?

Dr. Mary: Well, I feel like anxiety is something we've gotten to talk about a lot, which has been very helpful. We've discussed it in the past few [00:03:00] sessions. Today i, in the spirit of having some night rotations and more thinking about exhaustion, more of an experience, I guess, than an emotion, but it feels emotional too.

I'm not sure how and where coaching will take us today with the topic of exhaustion, but I know lots of people can relate in residency. But yeah, I've been feeling rather not burnt out necessarily. We've had really good discussions on burnout and I don't feel like emotionally that. It's the exhaustion is making me feel more hard or numb to patients or more like, less empathetic. But in terms of my get up and go, I feel like it's lacking as of lately.

Dr. Jessica Singh: What aspects of your life do you feel like the get up and go is lacking that you would like to not lack?

Dr. Mary: All of [00:04:00] it pretty much, but well, I guess one example besides having more energy at work was this past weekend my husband and I got a babysitter to do um, a date and we went to a yoga class, which so much of me was just like blah, I don't know. I'm think I'm too tired. Let's just push back to like, who knows how many months from now to have the time and the opportunity to do a date night again. But we did it and it was great and it was energizing and it, I was very happy that my husband pushed me to go. 

Dr. Jessica Singh: So in terms of thinking about, obviously we had discussed anxiety, like you mentioned, and now this exhaustion, which we will obviously explore today. Where would you like to see yourself either at the end of this coaching session or after our coaching relationship at the close of it? How would you like to see yourself?

Dr. Mary: With other sessions, having some [00:05:00] at least a shift in thought process to kind of cope with exhaustion. I don't expect to feel energized necessarily. 'Cause you know, sleep is obviously one of the solutions to that. But I don't know.

Honestly, I'm curious to see where we'll end up at the end of the coaching session. I'm not quite sure.

Dr. Jessica Singh: Can you tell me more about what it is about the exhaustion that you would like to address?

Dr. Mary: That is I think the hard question. But specifically how exhaustion is impacting personal life outside of work. Motivation to do things and then also like my mindset at work especially clinic lately, I feel like I've had a few days where I just feel very disorganized, even though I have prepped, but my brain is just slower maybe, or certain feelings of like being rushed, maybe are affecting me more, or [00:06:00] yeah overall feeling like my performance at clinic has been not as good as it has been due to fatigue.

Dr. Jessica Singh: And what does that bring up for you? Realizing that you're in this body, seeing you behave a certain way, seeing yourself and knowing that maybe I'm not at my best because of the exhaustion I'm experiencing.

Dr. Mary: It's frustrating because I can't just flip switch. I mean, some people like take caffeine pills, you know, or whatever you need to do to deal with it. I try to avoid the caffeine honestly. Like I don't drink coffee or sodas or anything. So it just makes me feel a little helpless, I think.

Dr. Jessica Singh: What about this specific emotion experience of exhaustion is important for you that needs to be addressed now and beyond now.

Dr. Mary: It makes me feel out of control, but more in the sense of like, I am not doing my best. Not [00:07:00] failing necessarily, but maybe in certain moments I could be doing better or succeeding better if I was well rested and, also, I guess emphasizing again, the feeling of frustration and out of control that I have little say over my schedule that then dictates my not so great sleep schedule sometimes. So just overall I think the wanting mindset, I suppose, to change around the fatigue, the exhaustion. Yeah, just wanting to not feel so out of control.

Dr. Jessica Singh: It sounds like there's two elements of the control. One is the feeling the exhaustion, and going through it naturally without anything. And the second is, you had mentioned a couple of times the schedule having a lack of autonomy.

It feels like a lack of control. And you would use the word powerless before, right? Or helpless.

And so when you think about your values, who you are as a [00:08:00] human being, as a person, how would you ideally like to navigate through this exhaustion?

Dr. Mary: In a healthy way, I think; in a practical way. I guess in an independent way, like I said, not wanting to have to live off of caffeine and in a way where my, number one value, like, family being the center of my value system of my life; wanting to focus on my exhaustion, not impacting my you know, family.

Dr. Jessica Singh: It sounds like you want to be in control in your response to exhaustion, which you don't have control over the situations causing exhaustion, but you want control over how you respond to it.

Dr. Mary: Yes.

Dr. Jessica Singh: And so when you think about that, I know at the beginning you were like, I'm curious as to where this session's going to go. Well, [00:09:00] Dr. Mary, at the end of the session, what would be successful to you? How would you determine if this coaching session was successful?

Dr. Mary: Mm-hmm. Having less frustration, feelings of helplessness kind, all the negative connotations around fatigue that we've been discussing. And ultimately, even though I'm tired, maybe seeing it impact my family less.

Dr. Jessica Singh: I acknowledge that this is also tricky, right? Because a lot of the things you're talking about in terms of the causes are exhaustion are again external. And so as you think about having less of an impact of the exhaustion, for instance, of your family and figuring out how to respond in a healthy way, what do you see as needing to happen?

Dr. Mary: Well, sleeping more, but that's not necessarily always, again easy. Maybe [00:10:00] strategizing in an actionable way, strategizing so that I'm going to bed like the moment my son is going to bed, somehow adjusting the schedule if possible, so that I am getting as much rest as possible. And I suppose kind of a similar theme from prior sessions is just being mindful of my emotions and shifting my mindset whenever I am feeling really run down, exhausted.

Dr. Jessica Singh: How would you like to even acknowledge the current mindset you have? How do you see this happening?

Dr. Mary: Well, I feel like right now well I had a nap recently, so I'm not in the exhausted mode. I'm post-call, I was on nights last night and the night before. But yesterday I was pretty exhausted and struggling. And my mindset in those moments is more kind of anger at the system, I guess, if anything. Again, this feeling of like [00:11:00] helplessness, but more just upset, that we do this to ourselves in medical training and I feel like it's seen as more of a rite of passage. Certainly people need to be working in the hospitals at night, but do we need to do it the way that we do it, especially to residents?

Dr. Jessica Singh: How have you been processing these emotions or even acknowledging them? 

Dr. Mary: Venting to co-residents, I think pretty much. Yeah, just commiserating with the co-residents and I fully acknowledge that my program is not as bad as some. I can't imagine like being, I don't know, internal medicine, anesthesia or just program by program. I know everyone has their own challenges and struggles and having 24 hour call and we don't have 24 hour call. We just have night rotations. But we still like to complain and I still like to complain. And when you're tired it's feel like it's not as bad as other people have it because you still [00:12:00] are frustrated and upset with the system.

Dr. Jessica Singh: So one of the points you had made earlier was wanting to shift to a space of having a healthy response to exhaustion. And you had just shared that one of the things that you're doing right now is sharing with co-residents, with colleagues, venting together. And so I wanted to ask you what benefits that brings you and is it bringing anything else to you that may not be beneficial?

Dr. Mary: I feel like there's strength in sharing your experience with others, especially when my family has no concept of what it's like working a night shift at all, let alone flipping your schedule constantly or being on nights for a prolonged period of time. It's definitely therapeutic to discuss it with my co-residents and be able to simmer in the exhaustion and express our frustrations about the system that makes us stay up and not [00:13:00] be with our families or not be there for bedtimes and things like that, and, you know, the impact it makes on our spouses too, family, all of that. So it definitely helps. It may not be helpful sometimes when I'm talking to seniors, I feel like maybe certain people are more jaded than others and more jaded about program stuff like how the schedule used to be. " You know, back in my day it used to be worse." That kind of thing. Even some of our attendings talking like that. But I think overall, I think it should be talked about and we shouldn't just ignore the exhaustion feelings and the satisfaction because that's pivot to making change in the program.

Dr. Jessica Singh: So having that acknowledgement and feeling listened and heard, to at least about your experience of the system and the exhaustion you're experiencing, seems like a key part of having a healthy response to this.

Dr. Mary: Yes. Yeah.

Dr. Jessica Singh: And when you think about the [00:14:00] frustration that you experience towards the system and the way residents are treated and often not treated well, I guess when you think about, again, your overall sense of purpose and sense of calling, 'cause we had discussed this earlier with the frustration you were experiencing on long days, what insights from that, what beliefs do you feel that might help carry you through this frustration now towards the system and nights?

Dr. Mary: Well, for one, that it is still a privilege and blessing to take care of people at all times of the day. Um, often our critical admissions come in the night, which is good learning, good experience. Especially last night I had a pretty critical patient that ended up going to the ICU, which was really it felt like an empowering experience to have handled the situation well. So that was [00:15:00] rewarding in that sense. And I mean, I do believe that I have a good program and really truly our night schedule I can't think of a way to make it better. There have been recent changes that made our night schedule a lot better. It's just still hard on interns. So I believe that this is one of the better schedules and still is hard when I'm tired to think that.

Dr. Jessica Singh: So grounding in the gratitude of being a doctor, caring for critical patients, the learning experience, acknowledging that your program, despite what it is still maybe better than others

Dr. Mary: Yeah. Yeah, exactly.

Dr. Jessica Singh: Is anything else coming for you in terms of... 

Dr. Mary: Those are the two big ones that, and I mean, just my belief that I am meant to be a doctor and that I find enjoyment. Even though last night was stressful, it felt satisfying. [00:16:00] I've had multiple nights like this where I've gone home and I felt good even though I'm exhausted, I am, , smiling, feeling good about what I've done.

Dr. Jessica Singh: How does the feeling good, even though you go home exhausted, how does this feeling good show up for you? How do you experience that?

Dr. Mary: You often ask me like where I feel it and I feel like have a vivid memory, I guess from like a month or so ago, driving home from the hospital and the sun is coming up and I'm going home, but feeling light like in my chest and my shoulders and feeling I don't know, maybe a little lightheaded 'cause I'm tired, but feeling satisfied, feeling grateful for the opportunity to take care of people and accomplished and yeah, just feeling like my profession is rewarding.

Dr. Jessica Singh: And how does that compare to even beginning at this conversation when you were describing the frustration?

Dr. Mary: Well, I think it's pretty much on the polar opposite spectrum 'cause in the frustrated moments I'm like, is [00:17:00] this worth it? This is taking me away from my family. Hard on my son who likes to nurse at night and not have a bottle. You know, it's hard on my husband who's now the only person responding to my son in the middle of the night. It's mainly number one when I'm exhausted at work and not feeling fulfilled, I suppose more so in the daytime when I notice it's affecting my family or just me mental health wise.

Dr. Jessica Singh: May I offer something to you and see if you find it valuable? I know that conversation we had in coaching a couple sessions ago about the long days and dealing with the frustration involved you verbalizing out loud and visualizing the self-talk. And I know you had said it was powerful for you because you hadn't done that before.

And in this case, even though you are getting to share your experience with your colleagues, would you find it valuable [00:18:00] to visualize yourself in that situation of having that, the thoughts that come and how you may wanna navigate through them in a way that aligns more with how you'd like to feel?

Dr. Mary: Well, I am kind of reflecting I feel like these emotions come most in the morning after I wake up from nights or the day after when I'm at clinic driving home, it's been a long day or at clinic and I'm feeling worried that maybe my fatigue is gonna harm someone. I feel that way in clinic sometimes where like, oh, I didn't think of this, or, oh, I forgot to look at this lab. Or, you know, one of my performance isn't perfect. 

Dr. Jessica Singh: You said feeling, what did you say?

Dr. Mary: Feeling like worried that I'm gonna like harm a patient, you know, not intentionally of course, but because of my exhaustion, because I don't do something perfectly in clinic or I forget to look at a lab or I think it. Giving one [00:19:00] medication but another was better and things like that. Just not doing things perfectly.

And I I've never really thought that out loud, but it's definitely one of the biggest, frustrations I think is I feel like the fatigue is inhibiting my performance sometimes, like my ability to become a good doctor and then my ability to be a good mom. That is probably the root of the anger.

Dr. Jessica Singh: So thinking about these two topics, right? The fear of the exhaustion and pairing your ability to function as a physician and as a mother, where would you like to go from here? We have about 15 minutes left of this coaching session. What would be most meaningful or helpful to you in navigating these?

Dr. Mary: I feel like tactics or strategies are often similar, and I think that's for good reason. But would like to go from here maybe audibly expressing some counter arguments in my brain and I think is probably the most [00:20:00] helpful. I can't think of much else in the moment, you know, 'cause so much of it the anchor and frustration. But I guess also acknowledging that I am my worst critic and I'm hardest on myself, and so when I feel like I'm being a bad mom or I'm being a bad clinician, 'cause I'm tired is likely being unfair to myself. I'm sure my husband would agree.

Dr. Jessica Singh: What would your non-critic self say to you when you're feeling this way? I.

Dr. Mary: It would say, for instance, with any mistake that I make in clinic, " I'm not meant to be perfect right now. And if anything, this is building endurance for other days when I have exhaustion not related to nights. There will always be days when people have to work and work through fatigue. Especially when you have to use your brain [00:21:00] at a moderate to high level like physicians need to do. So, this is good training in general. When I have future babies, when I'm tired, there's always going to be reasons that kids are gonna keep me up. And I don't have to be perfect. You know, there are residency, at least right now. There's always checks and balances and people who can help me out." So I guess those two main thoughts don't have to be perfect. And this is not necessarily an isolated experience, I'm gonna have to just adapt and get used to being tired. Not every day necessarily. And then maybe that's the other thought process is this is not going to be every day all the time, nor as a fully practicing physician later, I won't have this schedule forever.

Dr. Jessica Singh: So can you summarize, I think there were four, right? There are different counter arguments in your brain. Can you summarize what they were just for you to anchor them?

Dr. Mary: I'm not supposed to be perfect right now, nor probably ever. [00:22:00] And working through exhaustion isn't a way a reality for the future and good practice, if anything. And this won't always be my schedule, nor will it be like every day as a full blown physician. It will get better, I guess.

Dr. Jessica Singh: I also heard not being perfect

and the last thing I heard was having checks and balances right now as a resident.

Dr. Mary: Yes, that's true. 

Dr. Jessica Singh: How would you like to remember these counter arguments, implement them. Every time you know, it comes up, the frustration comes up. How are you going to anchor onto these insights that you've just obtained?

Dr. Mary: I just had the random thought of writing them down and then putting it in my little like ID badge thing, like a little laminated thing for my badge. I don't know, but that way it's always with [00:23:00] me. and then I can remind myself and I'll read them as maybe a regular little mantra.

Dr. Jessica Singh: Would you like to just write them down now? So if you want to take a minute on a piece of paper, maybe it doesn't have to be perfect for the ID badge, but if you'd like to take a moment before I know the memory goes also 

Dr. Mary: That's a really good idea. I'll write it down. Okay, I'm gonna read them to you actually. It's way better than what I had just said. Rambling before. You can cut that out even. so I wrote four bullets. I do not have to be perfect. Not now, not ever. I have people looking after me and my patients. I'm not alone in this, and this is not forever nor every day. And this is making me a better doctor mom. That's more in the sense of like conditioning training, whenever I'm always gonna be tired with kids waking up at night.

Dr. Jessica Singh: How does it feel to [00:24:00] see this in writing on your phone?

Dr. Mary: That's surprising actually.

Dr. Jessica Singh: In what way?

Dr. Mary: Well, especially the last line. This is making me a better doctor mom. That's something I had not foresee to come to a conclusion.

Dr. Jessica Singh: What is it bringing up for you?

Dr. Mary: Good feelings of hope and feeling more empowered than helpless. Because I can really reframe my thoughts that these days when I'm very tired are making me stronger, I guess cliche maybe a little, but but making me more conditioned, more used to this experience, able to think critically and be a better doctor mom.

Dr. Jessica Singh: Obviously you just mentioned all these skills and attributes. In what other ways do you see yourself becoming a better doctor mom? 

Dr. Mary: Not letting [00:25:00] myself become burnt out and jaded because ultimately that's what I fear and that will make both my mothering, my aura at home, my, happiness that my children see less, you know. I'll be an unhappy person. And then as a physician, you know, which is something I don't want to happen, especially. I want this to be the right career for me.

Dr. Jessica Singh: How do you anticipate overcoming any obstacles or challenges to remembering these counter arguments that you have written down on your phone?

Dr. Mary: Well, I definitely see days where I'm gonna read my little note card on the back of my ID and be like "blah, blah, blah, i'm tired now and I'm frustrated and frustrated with the system. I wanna be home", X, Y, and Z. So, always keeping my husband involved in these thought processes. He is my best [00:26:00] pep talker. Again, being open with my co-residents and expressing it in the moment if I'm with someone and maybe, a strategy that I've been trying to do better with but still could definitely improve is taking a pause, letting myself to be mindful and feel the frustration. Like maybe a breathing meditation and then keep on keeping on.

Dr. Jessica Singh: And how would you like to positively reinforce, half celebrate when you are able to do this, when you're able to have these counter arguments and shift yourself. How will you acknowledge and honor and celebrate?

Dr. Mary: I think it will just feel good. I dunno. And like the mornings coming off of nights when I feel light and happy and proud of my work, even though I'm tired in spite of fatigue. Yes. I don't know, maybe just a mental pat on my back or something .

Dr. Jessica Singh: It sounds more of like a general enhanced awareness of a 

Dr. Mary: Yeah. And [00:27:00] maybe I'll throw in a prayer of gratitude, like something brief .

Dr. Jessica Singh: And so I know we're coming to the close of this coaching session. What would you like to acknowledge yourself for today?

Dr. Mary: I just wanna, I acknowledge the feeling that I have right now, which is hopefulness and again feeling like I have more control over my experience as a resident and my capabilities at home, even when I can't control difficult schedule and not much sleep . But that I've already also come three quarters of the way through intern year, and it will gets better, so I hear so yeah. Gratitude, feeling, feeling grateful, feeling hopeful.

Dr. Jessica Singh: And would you like to close this coaching session by sharing the gratitude prayer, the one you had mentioned that you'd like to use your positive reinforcement?

Dr. Mary: And by prayer I mean like a prayer, if that's [00:28:00] okay. Father, i'm grateful to be for blessing my mind and body to be able to work through fatigue and, 

Dr. Mary: using these experiences hard as they may be, to become a better person, to become a better caretaker for those around me and be able to help future physicians and other working women and all people in similar situations.

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

Dr. Mary: Thank you, Jessica. 

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