How shame almost ruined a physician’s life [PODCAST]

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“I do want you all to know that shame is a very familiar brain track (like an 8-track tape, if you know what that is), but not one I am stuck in. The above experience of failing a class turned out to be amazing. I am now appreciative of how far I have come — of what I have learned, through much transformational therapy, mindfulness and coaching work.

I am lucky enough to have a choice in my thoughts and to not disengage. I don’t have to be stuck there. I can put it on speaker-phone with trusted individuals in my life. I can dedicate the work I do now to the memory of my patient and her family. I continue to heal and offer healing.

Life is really an amazing tapestry with short fibers, longer fibers, many colors and most of all — each thread woven to make a perfect whole. It is when we feel stuck that guilt and shame can get the better of us, impacting all areas of our life. I am sharing this very personal story to make a difference with those stuck in the negative talk and the feeling that the core of who we are is not worthy. Enduring shame is associated with depression, anxiety, PTSD and addiction. Shedding light into the dark areas of thoughts we keep secret make a huge difference.”

Robyn Alley-Hay is an obstetrician-gynecologist and can be reached at her self-titled site, Dr. Robyn Alley-Hay.

She shares her story and discusses her KevinMD article, “How shame almost ruined a physician’s life.”

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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 Robyn Alley-Hay. She’s a retired obstetrician-gynecologist, and she wrote the KevinMD article “She was dead: How shame almost ruined a physician’s life.” Robyn, welcome to the show.

Robyn Alley-Hay: Thank you, Kevin, and thank you for your work.

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

Robyn Alley-Hay: I was a graduate of the University of Kansas and then went on to OB/GYN residency at the University of Kansas, and then went into private practice. I practiced in a couple different private practices and loved my career. Most recently, I’ve retired from that career, and I’m now a physician coach, and also I nourished myself by working with some Tibetan Buddhists in a nonprofit.

Kevin Pho: Wonderful. And I want to talk a little about that transition into physician coaching. So what were some of the factors when making that decision from active clinical practice to coaching?

Robyn Alley-Hay: You know, I think I found coaching at a time when I felt stuck and when I was questioning. I was seeking, and I found coaching, and I just fell in love with it. I mean, that’s what I’ve been doing for years in my clinical practice. You know, with the women I was seeing, it was basically coaching, and I found that it was just a natural fit. So after falling in love with it, I decided to do it full time. I trained at an ICF-certified place, and currently I’m in training to become a specific physician coach. I just turned my sights toward physicians basically in the last couple of years. For the few years before that, I was doing general coaching, but my heart really goes to my colleagues, and I finally said, “OK, that’s what I’m focusing on.”

Kevin Pho: What are some of the common issues that you’re seeing physicians face in your coaching practice?

Robyn Alley-Hay: Oh, well, I mostly coach women, and there’s often this feeling of disempowerment, and I call myself an empowerment coach. Basically, women are wanting to go somewhere in their career or in their parenthood, or, you know, as a mom, and they’re just feeling disempowered or stuck about it, being able to look at things.

I mean, coaching is basically, you’re well and I’m your peer, and I’m going to ask you questions. That’s coaching. I’m going to ask you good questions, but I’m going to ask you questions that you answer yourself. A lot of it has to do with our blind spots and our limiting beliefs, and it’s looking at this side of your hand, and then turning it over and looking at that side of your hand, and looking at this again. People go through transformation and really see the power that they have after they’ve done several coaching sessions, so that’s just really gratifying.

Kevin Pho: Wonderful. Best wishes on your coaching practice.

Robyn Alley-Hay: Oh, thank you.

Kevin Pho: So let’s go into your KevinMD article now, “She was dead: How shame almost ruined a physician’s life.” Now, for those who haven’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Robyn Alley-Hay: Well, this is a story, and I consider myself a storyteller. Part of my recovery, my recovering as a perfectionist and a recovery from depression, has been sharing my stories. Now that I’m out of medicine, except for what I do with the nonprofit, I can say and tell my stories without worrying about the consequences. And this has been a story that has tripped me up in my life.

So it’s all about a woman who came from Mexico to my labor deck. I mean, it’s a long time ago, still impacting me. She came to my labor deck, and it was her fourth child, and she ended up dying in our care, after she had given birth in Mexico on dirt floors previously. It’s my journey with, I described how it was and how it haunted me, as far as going back to that scene again and again and again, and the negative impact it had in my life to not recognize that and to not talk about it and not process it.

Kevin Pho: So go into a little bit more detail, if you can. Tell me how that story did impact not only your life but your professional career as well.

Robyn Alley-Hay: Well, I think it was, you know, nobody said anything after she passed away. I mean, I was really clear, you know, what could I. I think everybody goes through this with a loss, and it’s really tragic when it’s a maternal loss. Now, that’s not tragic other times, but it’s really unexpected, let’s just say that. And I didn’t know what to do with that, and there was no, like, “Let’s talk about this. Let’s debrief this.” There was M&M, which was very uncomfortable: “You could have done this. You could have done that.” But there was really no “Let’s talk about it. Let’s talk about grief and how that impacts the physician.”

The person that came in to relieve me in the middle of trying to save this woman’s life and doing a cesarean hysterectomy was my husband, my ex-husband now. But I mean, I handed it off to him, as was appropriate in a residency, and we never even looked at each other. We never talked about it. I have no idea how he feels about that incident.

And I think it’s just something that was just like a, you know, when you’re recovering perfectionists. I think we’re all perfectionists in this profession, and then there’s this part of us that we’re told we’re not good enough along our training, and we’re told, “Well, that was good, but not good enough,” again. And so some of us are more prone to shame than others, but getting into that shame can be just a really dark, dark place to go, and that’s kind of what I describe in the article.

Kevin Pho: What are some of the things that you did to reconcile those feelings of shame, and how long did that take?

Robyn Alley-Hay: Well, I tell you, it wasn’t until I wrote this article that I really let it go. I mean, I was finally well enough to go, “OK, I’m going to share this story in case somebody else is experiencing something similar.” I ended up with postpartum depression with the birth of my third child in residency, and then I was actually suicidal at one point, about six years into my practice. I wouldn’t say it was all this; this was just a really good example of that “I’m not good enough, I feel shame for having made a mistake” kind of thinking. So that was kind of a long journey for me. You know, I practiced while I was there, but it was still not free, and not the created life that I have now.

Kevin Pho: So you mentioned that you couldn’t share the story until you were retired. Can you share some of the obstacles that prevented you from sharing that story while you were practicing?

Robyn Alley-Hay: You know, there’s always the fear of being sued, kind of. There’s this gagging, I think, that happens, where we can’t talk about it freely because of that fear. There’s the, you know, “What are my attendings going to be like?” If I would have written this back in my residency, what would my attending say about this and about me putting that out into the public? So it wasn’t really appropriate at that time. But the sharing part, for me, has been just really liberating, and I’ve heard from so many other people that have experienced the shame with, you know, deaths and complications that they’ve had in their practice.

Kevin Pho: And to be clear, how many years has it been since the incident and the time you wrote the story?

Robyn Alley-Hay: This was probably in 1993, so a long time. And just having the freedom to not have that come back at you, you know, like your program director is on the oral boards panel. You know, there’s all kinds of reasons why I kind of held that one in and didn’t say much about it.

Kevin Pho: So from what you know now about residencies currently, if young physicians go through a similar situation like that, has anything changed since the time that you went through this incident?

Robyn Alley-Hay: I hope so. And talking to some clients and other friends that are colleagues, not always. You know, I talked to somebody recently who there was a death of a patient, and nobody talked about it. They just went on. I mean, it was somebody they worked with, too, and they just went on with their work. Just like now with COVID-19, there’s no time to pause. You just go on with your work. And there are appropriate times to pause, but we just, I hope it’s better. I hope it’s better, and that’s, you know, what I’m all about, is bringing humanity to medicine in a cultural change.

Kevin Pho: For those physicians who unfortunately go through a similar event, what kind of advice do you have for them?

Robyn Alley-Hay: Well, I think go to your support systems in a way that you can appropriately share the story and how that’s impacting you. I think the worst thing that we can do when this happens is isolate. Shame is a really great isolator, and I think that’s why the story was with me so long, because I tended to internalize that and isolate. So it’s really a matter of reaching out, and reaching out to your colleagues when something like this happens for the support that they need, possibly seeing a counselor, or, you know, whatever is needed to support the person at that time.

Kevin Pho: So you talked about writing your story and how helpful that was, and I certainly appreciate that you shared that story with KevinMD. So go into a little more detail about that. How cathartic, how healing was it for you to share this story on KevinMD and have other people read it?

Robyn Alley-Hay: Oh, it was just really great, Kevin. I mean, I really appreciate having the space to do that. For me, I hadn’t even told my children about this. I have four adult children. I’d never talked to my ex-husband about it. My current husband, you know, I hadn’t really told him about the depth of my feelings and how much that would repeat, repeat, repeat. So really, there’s narrative medicine for a reason, narrative inquiry, and writing it down and knowing that possibly it would help another person know that they’re not alone was really, really important to me.

Kevin Pho: We’re talking to Robyn Alley-Hay. She’s an obstetrician-gynecologist, and she wrote the KevinMD article “She was dead: How shame almost ruined a physician’s life.” Robyn, what’s your take-home message that you want to share with the KevinMD audience?

Robyn Alley-Hay: We’re going to be in this period of time, once this pandemic is hopefully over, when there are going to be a lot of traumatized physicians. And I think the message is to care for each other and to not isolate. Reach out. There are groups now on social media. There are many coaches that can help. Just be the person that listens, if you need something outside your institution. So I would say, you know, “No, you’re not alone,” would be my message, and anybody who needs help, reach out.

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

Robyn Alley-Hay: Thank you, Kevin. I appreciate it.

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