A nontraditional approach to fear and stress [PODCAST]

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“Like 9/11, we have a new reference point touching everyone on the planet: life before COVID-19 and life after. Regardless if you get it or don’t, the unknowns and secondary consequences are scary. Life before COVID was scary, too, minus the urgency.

Before COVID, we sensed the weight of living on a sick planet. We felt powerless to change the tide of forces affecting our lives for the worst. We normalized the slow spiral down the drain of political divisions, economic inequality, costly health care, deteriorating education, unreliable information, and unsustainable living. We let our existential fear buzz like a refrigerator’s white noise.

COVID innocently shines a floodlight on our curious collective permissiveness. It illuminates silent fear.”

Ruchi Puri is an obstetrics-gynecology physician and can be reached at her self-titled site, Ruchi Puri, MD.

She shares her story and discusses her KevinMD article, “COVID illuminates silent fear.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Ruchi Puri. She’s an obstetrician-gynecologist, and she wrote the KevinMD article “COVID illuminates silent fear.” Ruchi, welcome to the show.

Ruchi Puri: Hey, Kevin. Thanks so much for having me.

Kevin Pho: So we’ll get into your article a little bit, but first off, can you share your story and your journey to where you are today?

Ruchi Puri: Yeah. You know, in a lot of ways, I have the typical eclectic background of other nontraditional medical students. For me, that included, one, before going to medical school, having a sense that not everybody gets better with allopathic medicine. So there was a real curiosity for me before medical school around a more effective path to healing, and I think a lot of my life has been really curious about other holistic modalities of health and how other cultures and communities do it.

The other side of my career track was really doing a lot of global health and international work. I think that was born out of being a first-generation Asian American, where I saw the paradoxical nature of our Asian culture, the Indian culture, with American culture. Then I naturally became curious that, wow, everybody’s been uprooted from somewhere coming to America, and those communities find a way to do things well and effectively, and there’s no one right way. I think those two things created a lot of convergence of where I’m at today and the things that I feel very passionate about in terms of having a more holistic paradigm and approach to understanding illness and healing.

Kevin Pho: So let’s go a little bit deeper. Tell me a little about this practice that you’re talking about.

Ruchi Puri: Well, I ended up studying Ayurvedic medicine, Chinese medicine, and other modalities of spiritual healing, as well as a lot of what’s going on in the neuroscience around trauma. I saw that all those things were really relevant to women’s health and how we approach pregnancy, conception, infertility, and all the transitions that women go through. I’m hoping to marry all of those together in a really concise, simplified way to help women optimize their approach to their lives, and not just their lives, but also the challenges that come up for women during their reproductive transitions. So it’s really creating more of a polymath perspective to health and healing.

Kevin Pho: Can you give some specific examples of how you can incorporate these nontraditional approaches into an obstetrics-gynecology practice?

Ruchi Puri: Yeah. I think one of the things that needs to happen for us across the board, in the allopathic or medical paradigm that we all trained in, is a model shift or paradigm shift that really legitimizes emotions and belief patterns in their impact on health. I think we kind of superficially learn this in medical school, about lifestyle and stressors, but it doesn’t really translate into how we relate to patients and understand illness, and how much of illness is born out of the environment that we’re in, the past, and when we’re not really present with our feelings and what’s happening for us emotionally, and what thought patterns or belief systems we create when we go through adverse situations. It does translate into our health outcomes.

I think COVID’s really teaching us that right now. A lot of the things that feel biologically scary from COVID are just part of it, and then a lot of the fear from COVID itself is showing up when we see patients, in how we relate to them, and in how we’re showing up in our own jobs right now. You know, I think the progressive burnout that we’ve been seeing in the health care system lives in this milieu of stress. So I think the other healing traditions already naturally understood that, and it just needs to become more legitimized in how we look at all of it.

Kevin Pho: So that transitions nicely to the KevinMD article that you wrote, “COVID illuminates silent fear.” Now, for those who haven’t read that article, can you walk my audience through it and maybe share the story of why you decided to write it?

Ruchi Puri: Yeah. I actually took a little bit of a hiatus in the beginning of the year. I was doing a lot more to expand my understanding, a little deeper understanding, of Ayurvedic medicine. I was in India, and I was doing a lot of my own ancestral family trauma stuff while I was there. When I came back, it was a few days before the shutdown happened in San Francisco. I realized a lot of what I was learning about trauma, adversity, and the psycho-emotional aspects of how I was showing up in life became really relevant when I was interacting with my colleagues in the hospital, and even with patients. A lot of the practices that I was doing for myself to stay grounded and keep up with the stress of what was going on, when I was showing up for my, whatever, 18-hour and 24-hour shifts in the hospital, were becoming very relevant. I was using a lot of what I was doing for myself with patients.

So that became a real opportunity to break down and articulate a process of working with fear in general. I thought that was something really useful, low-cost, and effective to, one, put on people’s radar screens, but also give them a little bit of a how-to to deal with this present moment and the fact that there’s a lot of fear right now, because we don’t know. Back in March, we really didn’t know. We had some data coming out of China and other Asian countries, but there was just a lot of: How do you sit in the fear of the unknown?

That became the catalyst for the article, because I was just going through this movement over and over with patients, right before going back for a scheduled C-section, or in the acute stress of coming into the hospital, which had this perception that it was dangerous to be in the hospital because you could get COVID. I saw that when we unpacked that fear and just took that time during the patient interaction to presence the emotional experience of the patient, a lot of things relaxed. Things that normally become a little bit difficult and challenging, that could potentially be fraught with a lot of relational difficulty, and even what happens in OB where it just boils over, just weren’t happening. Really taking this time in the beginning to presence this emotional stuff paid off in the outcomes that I was experiencing, both with my patients as well as my colleagues, because we’re an interrelated dynamic in the hospital. Nobody’s moving around in a vacuum. We all affect one another.

Kevin Pho: Now, what are some specific techniques that you use to address these issues, both with patients and your colleagues?

Ruchi Puri: I think everything begins with restoring an inner awareness, or a sense of self-contact or attunement to myself. So I’m talking to you right now, and maybe it’s stressful for me, but if I’m aware of what’s happening in me, that I’m here, I’m talking to this large audience, then already I can ground myself in the truth of my experience and let some of that move. So really, it begins with awareness of what’s physically happening in me, in terms of the sensations that I’m noticing within my body, where I can feel open and spacious. I’m not talking too fast. I’m taking my time, so I’m in my rhythm.

Then it’s feeling what’s actually going on with patients. I think we all have these moments where we walk in and we go, “Oh gosh, this is going to be tough,” or, “This person’s really scared.” But then we just want to get to the business of the physical stuff, like, “OK, we’re going to go back to the OR now,” or, “Your blood pressure’s up,” or, “We have to deal with this problem.” We don’t really address that this person’s not fully in relationship with me because of whatever is going on for them, and we don’t ask. We just kind of get down into the business of things.

So I think, one, it begins with this inner awareness of what’s going on for me physically, emotionally, and mentally, and where I feel kind of centered in myself. Then it’s recognizing that for the patient, and then taking the time to actually check in with them, like, “Hey, what’s going on? This feels a little bit off.” Then it’s inviting them to actually come back into their body, share what they’re feeling, and see what’s actually true in the moment, like, “You’re not going to die if you come into the hospital. The hospital is actually pretty safe right now.” So it’s unpacking a lot of that stuff. In a general, broad way, I would say that’s how I go about it, at least in the acute inpatient setting.

Kevin Pho: We’re talking to Ruchi Puri. She’s an obstetrician-gynecologist, and she wrote the KevinMD article “COVID illuminates silent fear.” Now, in this article, you talk about the different types of fear and how we can address them, especially during the pandemic. So can you maybe elaborate on some of the fear, both explicit and not-so-obvious fear, that a lot of us are dealing with during the pandemic?

Ruchi Puri: Yeah. I think this is the interesting story about trauma that we’re in right now, where we don’t realize that there’s a spectrum. Fear is not fear in and of itself. Fear shows up kind of like a color palette: There are many different flavors of fear. So I could be anxious, I could feel terror, or I could just be a little bit afraid. And that fear has a longevity to it. So maybe you’re coming into the hospital for a really basic procedure that shouldn’t be a big deal, but if you’ve had other difficult experiences with the medical system, or have a family member who had a bad experience in the medical system, then when you come in, your experience in that moment is actually disproportionate to the circumstances of that moment.

So I think that’s part of really understanding our emotional complexity: In the present time, things can feel a lot bigger and more intense on an individual level than what really speaks to the actual situation and what other people are actually experiencing. So I would say that’s one way that the fear is both explicit and implicit.

I think it’s also understanding that we’re historically a society that doesn’t honor emotions. Like, whoever told you that your emotions matter? We’re told to be strong and suck it up, so we don’t really legitimize our emotional experience; it’s a sign of weakness. As a result, most of us have disconnected or dissociated from our experience of feelings, especially fear, and we’re numb to it. I think there’s a lot of numbness because we haven’t historically been taught that these are natural, normal, good things that happen, and, because they’re part of our natural process, how do we work with them, how are we informed by them, and, actually, how are they a resource for us?

So I talked about some of that in the article as well. Fear in and of itself is not a bad thing; it’s actually a very intelligent thing. We have many adaptive mechanisms for the short term. They’re just maladaptive in the long term. They get in the way of us really being resourced, having good solutions to problems, and really meeting the moment that we’re in, when we’re in that heightened state of stress, emotional stress.

Kevin Pho: You mentioned earlier that the allopathic model of care doesn’t address the holistic vision of the patient. Now, for those clinicians who are interested in perhaps exploring nontraditional approaches to address this, where do you suggest that they start?

Ruchi Puri: Yeah. I think this is part of the challenge that we’re in right now. You know, there’s a lot of information overload. I think many of us even feel like, “God, just to keep up with the medical journals and what’s happening in our specialties is quite a bit.” Then when you open up to everything that’s in the personal development space and all these different healing modalities that are out there, it’s pretty exhaustive. So I think where people need to begin is actually with themselves, noticing, “Gosh, what’s going on in me? Where do I find a resonance, or where do I find I’m drawn to?” Whether it’s mindful-based practices, or whether it’s a curiosity around, “Wow, what is all this Chinese medicine stuff about?” or, “What is all this Ayurvedic medicine about?” just pick something where there’s a natural resonance.

I feel like a lot of what my work has become about, and what my writing is coming to be about, is teasing out what’s essential and what the principles of healing are that we see across these different traditions, and distilling them down into something that’s simplified and accessible, but that really sees, “Oh, all these traditions hold this in common, and there’s something to it, because they’ve been around for thousands of years.” So I would say, yeah, this is part of the information overload challenge that we’re in. I feel like my work is starting to become more a part of that, more about speaking to: How do I get things in a distilled, simplified, and meaningful way that translates into how I show up and do my job?

Kevin Pho: So when researching these other approaches, how can we determine what’s legitimate, what’s evidence-based, and what works? You mentioned information overload. How can we sift through and determine which of these approaches, which of these studies, is something that physicians can really trust?

Ruchi Puri: Yeah. I mean, I think this is a problem in our own academic literature, whether we’re trying to figure out hydroxychloroquine and COVID: When do you give it, when is it useless, and when are we giving it and thinking it makes a difference when it probably doesn’t? So I think this is, again, an across-the-board challenge that we are facing in medicine and in information: What’s true?

I think this is where expanding this perspective comes in. When does something feel coherent? When does it land? What’s my process of discernment? It comes not just as an intellectual movement of weighing logical data in my brain. The more that I have self-contact with my feeling about something, like, “Wow, this feels like there’s something to it,” I can feel that it resonates physically in me, and then I use my intellectual power of discernment, like, “Oh, I would like to see more data about this,” or, “There’s actually no harm in me trying to cultivate coherence with my patient and coherence with myself. What’s the downside of that?” Even if there isn’t a great body of data, we can start to try certain things that have a very limited downside but potentially a strong upside, to have an experience of, “Oh, this makes a difference.”

Because I think, in the absence of a broader perspective, of an understanding of what a whole is as a human being, meaning that I’m not just my DNA, but I’m my DNA in relationship to my environment, which is the people and the food I eat, and that it’s unique and specific to me, and that my experience isn’t going to be the same as all these other people’s experiences, then we can slowly start to unpack these next layers of complexity by having our own inner, grounded sense of, “There’s something to this, and I’m going to hold this lightly,” or, “I’m going to be open-minded and be curious about it,” and then go from there.

Because I think, with what we’re talking about now, to have it really be precise and refined and accurate, I mean, we have to really revamp a lot of how we approach data, data science, and even how we design studies and understand studies. You know, 20, whatever, 30 years ago now, even the NIH started the National Center of Complementary and Alternative Medicine. Because we have this limited perspective of how we look at and understand health, as if it’s this linear thing when it’s not this linear thing, it really undermines how we collect and look at data. This is part of our learning process now, this discernment.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Ruchi Puri: Yeah. I think that we’re in an unprecedented time of change. I mean, maybe every century humanity goes through these big shifts, and we’re in changing times and transition times. I would caution us to not feel helpless. We actually, through our own experience, our own personal work, and our own digestion of what we’re believing, how we’re feeling, and how we’re showing up, if it already is in a hopeless, disempowered way, then that’s what we will be. We are the system that we create, and therefore we can affect the system by being our own change. So when we can do our own personal work, see how we’re showing up, and model the very thing we would like to see in our patients, there’s a lot of energy that gets freed up, and we learn to actually show up and work in our lives, be in our lives, in a more sustainable way, instead of, I think, the self-sacrificing movement that many doctors know.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Ruchi Puri: Thank you.

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