Falling in love during a pandemic: a medical scribe’s story [PODCAST]

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“Nowadays, I go on long walks through the city alone. I make dinner for one. When I go on bike rides, it’s a solo activity. I find comfort in myself, slowing down and making every small occasion a simple, peaceful one. I have a stronger sense of self, and through that, I have rekindled the fire that I felt during my first years of being in medicine. When I return home from the hospital, I don’t dive into the distraction of another person. Now, I write daily journal entries that help get my heart on a page, where I can set it aside and leave it be for some time before revisiting it. I put music on in my apartment, and dance and dance and dance. My new self-soothing methods aren’t perfect (none are), but at least they are now focused on nurturing and strengthening myself. No distractions, just facing my feelings head-on. It’s an art I am starting to get the hang of.”

Fae Kayarian is a medical scribe.

She shares her story and discusses her KevinMD article, “Falling in love during a pandemic: a lesson in self-soothing.”

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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 Fae Kayarian. She is a medical scribe, and she wrote the KevinMD article “Falling in love during a pandemic: a lesson in self-soothing.” Fae, welcome to the show.

Fae Kayarian: Hi, Dr. Pho. Thank you so much for having me. It’s a real honor and privilege to be able to talk to you and your audience today.

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

Fae Kayarian: Yeah, I’d love to. I actually grew up in rural southeastern New Hampshire, in a small town, and I always wanted to be a writer growing up, because I was really interested in exploring and understanding the human condition. So I wanted to write novels until I went off to high school. In high school, I was really fortunate to have an opportunity to go to New York City for a summer and explore health care and medicine, and I decided from that experience that I wouldn’t be a novelist; I’d be a neuroscientist, because neuroscience incorporated philosophy and sociology and biology, all the things that I really cared about.

So I went up to school in Boston, Massachusetts, as an undergrad, dead set on becoming a neuroscientist, untangling the brain, really understanding the human condition. And I did just that, because through Northeastern, I was able to work full time for six months at a time through our co-op system. I worked in a couple of labs at Harvard Medical School and a clinical lab at Beth Israel Deaconess Medical Center, and it was wonderful, because it affirmed my love for the brain, but it also gave me something else that I was looking for that I didn’t realize I was missing, which is the humanity in science, the clinical aspect of medicine that just gets me out of bed every morning, just flying out of bed, super excited.

So I realized that I love neuroscience, but I was really compelled by medicine, and through that transformation, I was able to get this really incredible opportunity working as a medical scribe at the Massachusetts General Hospital emergency department, which is where I’ve been working since graduating. I’ve been working there for the past two years, and I’m planning to matriculate into medical school this coming fall. Some people say it was a crazy transformation, from being a novelist to wanting to be a doctor, and I think it was just a natural progression, and a lot of doctors, I feel, have had the same type of experience. They love to write, they love to explore humanity, and it just was a really seamless transition. And medicine, as you know, is so interdisciplinary that even though I want to be in clinical medicine as a doctor, I’m still able to write, and I’m still able to explore the brain. So I feel so fortunate to find myself in a space where I can continue to do all the things that I love.

Kevin Pho: Wonderful. And there’s such a strong intersection between writing and medicine, because really, being a doctor and working in health care is really sharing stories and telling our stories. Now, I don’t have very many medical scribes on my show, so can you just tell us a little about that experience and what that’s been like over the last year or so?

Fae Kayarian: Yeah, I would love to. This is a topic that I’m really passionate about, because it has really transformed the way I have come to continue to love medicine, but also come to appreciate just how complicated our health care system is, and how important emergency medicine is, but just overall health care infrastructure.

Medical scribes are a really, really wonderful addition to any medical team, because, as we know, doctors help patients, but medical scribes help doctors. In the age of all this electronic medical record keeping and all this digitalization of medicine, a lot of the doctors’ responsibilities become very administrative. They get bogged down in writing notes. A lot of their focus is taken away from the clinical work and brought more toward the clerical work, which is fine, because that work is very, very important, but that’s not what they were primarily trained to do, and that’s not what motivates them to stay in medicine, for the most part. I remember my mom telling me one day a couple of years ago, “I went to my PCP, and I think he’s a good doctor, but I never saw his face, because he unfortunately had this machine that was right in front of him, because he had to write a really extensive note in order to meet the maximum reimbursement.” So that was one of the reasons I was really, really influenced to go into medical scribing.

A medical scribe is typically a professional for both the outpatient and inpatient setting. They are with the doctor, for the most part. This could either be in person, so they’re in a clinic sitting next to a doctor writing the notes, or now, because of COVID, telescribing has become very, very popular. They’re basically there watching the patient interaction unfold. They have been trained to hear and look out for certain things, to write down certain things. They write the full extent of the note, whether it’s someone in an outpatient neurosurgery clinic who’s coming in after getting coiled, and they have to write an extensive note about how the patient is feeling and the type of medication management that they’re undergoing, or in the emergency department, which is my wheelhouse. A patient comes in, we see the patient for maybe five to seven minutes, it’s a very, very quick interaction, but this patient may be intubated, or this patient may be in arrest. And so even though all of these outpatient settings call for very different types of note-taking, having a scribe there to take that documentation load off of the provider’s back, and allow them to move that thing out of the way that’s between them and the patient, I think is a very empowering thing. I felt very fortunate to be given the opportunity to allow providers to really do what they care about. So from that aspect, I feel like a really important part of the team.

And then secondarily, I think medical scribing, big picture, is about investing in our future. Most medical scribes want to be doctors. They want to be nurses, physical therapists, physician assistants. So by investing in medical scribes, we’re really investing in the future of health care, because it is such a transformative experience. And I’m there through it all. I see patient interactions, I’m in the room, I’m watching all of these procedures, I’m standing next to family members while their family is going through a really, really difficult time. I may not lay any hands on a patient, but I experience everything that a doctor is experiencing in that space, and it’s a very empowering place to be, and a very privileged one to be in, especially since I eventually want to be where that doctor is. But to look at it and be this observer is a really exciting place to be, especially so early on in my career.

Kevin Pho: Now, you’ve been a medical scribe for about two years now, and like you said, you’ve had an up-close view of our health care system. What would you say is the single most surprising thing that you’ve seen over the last two years about our health care system?

Fae Kayarian: Yeah, I have seen a very, very narrow sliver of our health care system, because emergency medicine is very special in the way that it’s almost as if you have a pulse on the health of your city. It’s very interesting socially and politically. It was really interesting, obviously, to watch my city unfold throughout the pandemic, because in emergency medicine, we’re first responders. We’re seeing things as they’re happening. But when certain political things occur, the emergency department has to prepare for mass casualty events, just in case something happens. So throughout the summer, during the George Floyd protests and associated protests, we had people come in because they were either hurt or they were in a psychological crisis.

During times when there is great turmoil, emergency medicine sees that, during times when you’re experiencing the secondary effects of the pandemic. We may not be in a wave right now, but people are still experiencing higher rates of alcohol use, of opioid use and associated overdoses. We’re still experiencing that. So something that I was really surprised to learn about the emergency room is that you are experiencing the most intense emotions of your city, and you’re responding to everything that is happening in a way that I feel is very, very intimate. And it inspires you to make changes in a way that isn’t just medical. You’re also advocating for patients at a systems level. So I’ve come to really appreciate that about emergency medicine, and know that it’s not just about providing medical care, but it’s about serving a city and all the things that it’s going through, both medically and psychologically.

Kevin Pho: Wonderful. Let’s transition now into the KevinMD article that you wrote earlier this year, and it’s titled “Falling in love during a pandemic: a lesson in self-soothing.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Fae Kayarian: This story was inspired by an initial interaction I had with a patient back in July. July was a special time, because it was the end of the first wave of COVID, and our emergency department felt like we were finally experiencing some type of relief. Our morale was a bit up, but we still had patients who were coming in and having a really, really hard time. There was this one patient in particular that kind of reset the way that I was feeling, and I carried his story with me throughout the next coming months.

He was a restaurant owner whose restaurant had gone under because of the pandemic. He just couldn’t make ends meet, and according to his wife, he had been smoking a lot more marijuana than he usually did, even smoking marijuana daily. And the day that he presented to the emergency department, he had started having these auditory and visual hallucinations, and he was really scared. So we brought him in, and my doctor pulled me aside. He’s like, “This is what we call cannabis-induced psychosis. This happens to people.” And he shared with me what was going on with this poor man, in the most compassionate way I’ve really ever had anyone deal with this. He said, “This guy’s just trying to make it day by day. He’s just trying to get by. He’s just trying to survive another day, trying to find comfort in something, and this is the way that he chose to do it. It may not be the best way for him, but he’s just trying to make it through another day.” And that really, really compelled me, the way that he was so compassionate and how kind he was to this patient, and I held that close to my heart for the next couple of months.

It was interesting, because while I was reflecting upon that, remembering that, it was around that time when I met this girl, and we started to date, and it was a lot of fun. We weren’t necessarily the right fit, and we didn’t have the same long-term goals, but there was a part of me that just stayed with this person. I didn’t think that it was going to work out in the long run, but for some reason, I just stuck around. I just stuck it out.

And as the year progressed, starting in November and December, when things were really starting to get really, really bad in the emergency department with COVID, people were coming in through the door with frights we had never seen. Just going to work, all I could really do was get up, go to work, come back home, and just sleep, because it was so emotionally taxing, and I was having all these terrible nightmares, and it was really weighing on me emotionally. But I was still in this relationship that was not fulfilling. There was some reason why I stayed in it, and I couldn’t articulate it at that point.

But the next month, when the relationship finally ended, which is what it should have done, and ended very cordially and very politely, I realized that the worst part of the breakup wasn’t necessarily the heartbreak of losing someone that I genuinely really cared about. It was that there was nothing between me and facing what I had to face at work. There was no intense romance. There was no source of energy that I could direct away from what I needed to face, which is the things I was experiencing at work, and really acknowledging them for what they were. And so I realized that my form of self-soothing, of finding comfort in all of this, just like that poor restaurant owner, was falling in love and being in this relationship that was fun and did feel good at the time. But I knew there was just something off about it, but I stuck with it, because I needed something to make all of it better.

And at first, I was really hard on myself, and like, “You shouldn’t have done this. You should have realized what was happening. You should have just faced these feelings head-on.” But then I remembered when my doctor, the doctor that I was working for, said, “You have to be compassionate. You have to understand that they’re just trying to make it another day.” And for me, it was a moment of great clarity, because not only did I realize what I had done, but I also realized that I’d never been in a global pandemic before. I’d never faced that adversity before, and instead of being judgmental toward myself, I should be compassionate and just understand that I’m trying to do my best, and all I can do is adapt and grow, and not be too hard on myself.

And that’s really the reason why I was motivated to write this piece: to say, look, we’re all experiencing something that’s really challenging and difficult. We may not be in the same boat, but we’re definitely in different boats in the same storm. Acknowledge how difficult it is for you, but also understand that you’re going to be self-soothing and trying to seek comfort in ways that may not be healthy for you initially. But as long as you understand that you’re trying to grow, and you’re trying to do something in the long run that’s really healthy for you, and find ways to self-soothe in a sustainable way, then that’s all you can do, and we just need to be compassionate toward ourselves.

Kevin Pho: We’re talking to Fae Kayarian. She is a medical scribe, and she wrote the KevinMD article “Falling in love during a pandemic: a lesson in self-soothing.” Fae, we’re now speaking at the beginning of April, and we’re in a much different place now than we were back in the middle of last summer. Tell me what the morale is, not only for yourself, but for the people that you work with in the emergency room, and also share some of the lessons that you’ve learned through your past experiences and through your story that you can share with other health care workers who also may have gone through emotional struggles as well.

Fae Kayarian: Absolutely. I think where we are now in April is a very different place than we were last April, obviously, but I think instead of just moving ahead with pure caution, there is a cautious optimism. Morale in the emergency department has moved from “Look, we just need to work as hard as we can, fight as hard as we can, and ultimately see results” to “We’re seeing results. We need to continue to work really hard, but we also need to celebrate how far we’ve come.”

I think, overall, in the grand scheme of things, COVID was very disastrous in terms of how we managed it. The scale on which we managed it, the ways that we communicated it, was not done well. But we have adapted, and at least within my emergency department, they have always focused on the well-being of patients and using that to drive our own well-being. So, for example, some of the doctors that I work with, they’ll tell me, “Hey, I know that most people don’t take lunch breaks, but you need to take a lunch break. Take care of yourself. By taking care of yourself, you’re taking care of patients. You’re doing this for patients.” Because they know that in order for you to be able to do your job, you need to take care of yourself. But as long as they pin that on “This is for your patients,” then, as health care professionals who are sometimes very, very empathetic, how can you say no to taking care of yourself in order to take care of someone else?

And so I think it’s been really wonderful to learn so early on that you have to advocate for yourself. You have to take care of yourself, make sure that you’re getting, physically and emotionally, the things that you need in order to be happy and fulfilled, but also remain healthy, so that you can continue to do that for other people.

And so I think the lessons that I’ve learned throughout this whole process have been to do things that are healthy, fulfilling, and meaningful for me. Especially after breaking up with this person that I really cared about, who ultimately wasn’t good for me in the long run, I learned how to experiment with ways to make myself feel better, to self-soothe, to get those healthy, fulfilling, meaningful things in my life. So I just experimented. “Well, does Netflix help me with feeling better? No. OK, that didn’t work. Let’s see what does. Oh, listening to podcasts about biking definitely helps. OK, so second time’s a charm. Does running help me? It used to help me. No, it doesn’t help me anymore. But long walks through this park? Yeah, that hits the spot.”

And so throughout this whole process, and especially through being encouraged by my mentors in the emergency department, you have to learn to build this emotional toolkit: what works for me, and how do they work for me? What do they fulfill, and what do they satisfy? And I realized that the reason why I latched on to this relationship was because, for me, in my life, love is the most important thing: love for my work, love for my family, for my friends, for my city. And so it really only made sense that I would latch onto this person and use this loving relationship as kind of an anchor for my self-soothing. And so I’ve just been using other approaches to love. I’ve been spending time socially distancing with friends, and that’s fulfilling that.

And so just developing this emotional survival toolkit, ways that you can fight these challenging experiences, has been really helpful, and I definitely didn’t appreciate how difficult it was to find things that really work, to build this robust repertoire of things. Now I have things in my back pocket, like walking and biking and listening to podcasts, that I can just naturally fall into, that I know are healthy ways to self-soothe, and that will hopefully carry with me throughout future challenges and adversity. But it’s also been really helpful to know that you’re not going to get everything right the first try. You don’t know everything that there is to know, and just being gracious with yourself and showing some self-compassion is really important. And it doesn’t all have to come from you. It could come from a therapist or a psychiatrist, just ways that you can build this little toolkit that you can always go to, where you can seek comfort and get the things that are important to you.

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

Fae Kayarian: Take-home message. This is kind of two-tiered. My take-home message, the first part, is that you are a work in progress. No matter if you are a medical scribe who’s just starting out, looking toward the future with these big, bright eyes, or if you’ve been an attending for the past 40 years and you’re seasoned and well regarded in your field, you’re a work in progress. Embrace that. Embrace how you are still growing and still learning, and understand that you are constantly going to be evolving, and that’s not a bad thing. You’re not going to know how to do something the first time around, or the second time, etc.

I wish that I had known that. I always thought that I was young and naive, but working through the emergency department, I am young, but I’m not naive. I’ve seen things. I’ve experienced things alongside patients. I’ve seen some of the greatest things that exist in health care, and I’ve seen some of the most devastating things, and I felt a lot of things along the emotional spectrum. And now it’s so great to have that mantra, “You are a work in progress,” because you’re working toward this goal of being your best, most healthy, fulfilled self. It’s all about giving yourself the compassion and space to figure yourself out as you go, but embrace the power of “Look at me as I’m growing. I’m doing my best. I’m staying aligned with the things that I care about. But I am a whole person who’s just growing and being built along the way.”

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

Fae Kayarian: Thank you so much, Dr. Pho. It was a pleasure.

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