Physicians aren’t all hanging in there. And that’s OK. [PODCAST]

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“Go ahead, give yourself permission, summon the compassion and grace you’d bestow on your best friend, and tell yourself, “This is the breadth of the human experience, and I’m only human.” There is immense beauty and strength in that vulnerability. I lied to myself for too long, couldn’t see the road ahead through the cracked glass until it, and I, in turn, shattered. Once those broken shards that obscured and distorted the path forward have been swept away, only then can the clarity of a stronger, more resilient soul begin to emerge.

I’m not back to normal, and it’s possible I may never get there. But each day, there are glimmers of hope that I might be closer to my true self than before — and that’s all I can ask for right now.”

Luyi Kathy Zhang is a palliative care physician and can be reached on Twitter @DrKathyZ.

She shares her story and discusses her KevinMD article, “Maybe we’re not all hanging in there. And that’s OK.”

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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 Luyi Kathy Zhang. She is a palliative care physician, and she wrote the KevinMD article “Maybe we’re not all hanging in there. And that’s OK.” Welcome to the show.

Luyi Kathy Zhang: Great, thank you. Thank you for having me. I’m excited to be here.

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

Luyi Kathy Zhang: I was born in China and came to the States at a very young age. Looking back, I think I always loved science. I can actually remember the covers of some books that I used to love, like the digestive system and diabetes, that sort of thing. So I guess I’ve always kind of wanted to be in science and in medicine. I went to medical school, trained in internal medicine, and became a hospitalist, and I loved being a hospitalist. But after a few years, I felt like something was missing. I thought, “I feel like I need to get a little bit deeper,” and I didn’t feel like I had the tools and the training that I wanted to have to be able to do that. So I went into fellowship for palliative care and hospice, and that’s what I do now.

I’m an inpatient-based palliative care attending at a safety-net hospital in New York City, and I love it. I can’t imagine doing anything else. In some ways, I’d always thought that. There were people saying, “Oh, medicine is a calling,” and I felt that, but I feel that so much more doing what I’m doing now.

Kevin Pho: So what are some of the specific things about palliative care that drew you to that specialty?

Luyi Kathy Zhang: I think one of the things is that it’s so interdisciplinary. It’s so intersectional. It goes across any specialty, right? Coming from your own specialty, you see death and dying and serious illnesses within medicine, within surgery, within neurology. But then when you get to palliative care, you see all of that. So in a way, it’s kind of like being a generalist, but for the end of life, that sort of thing. And I’ve always loved sitting with patients and hearing their stories, and it just felt like it was the right way to use me as a clinician, as a physician. I used to take trainings in conflict resolution and things like that.

And I love the fact that palliative care also focuses on self-care as the vehicle by which we deliver the best care for our patients, right? If we can’t manage our own emotions, if we can’t be the person that our patients need us to be, how do we really take the best care of them when they’re in such extremis, or they’re suffering, or they’re in pain, or their families are feeling the same thing?

Kevin Pho: You mentioned that you had some training in the past on conflict resolution. So how specifically does that come into play on a typical day or case in palliative care?

Luyi Kathy Zhang: That’s a good question. I mean, in palliative care or hospice fellowship, we don’t necessarily get conflict resolution training. But when patients are ill or dying, emotions get heightened, either by the patient or the family sometimes, and everyone has probably seen this. People get angry, really, really angry, which is OK. They’re in a system, and they’re facing something that they’ve probably never faced before. Sometimes we have to try to manage a situation where we’re like, “Hey, let’s try to see if we can come together,” or we’ll try to bring it back to the patient, right? A lot of people or families get caught up in the details or what they want, and sometimes one of the things that’s really helpful is to bring it back to what the patient wants, that we’re all here for the patient.

Kevin Pho: Let’s transition now into the KevinMD article that you wrote. It’s titled “Maybe we’re not all hanging in there. And that’s OK.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Luyi Kathy Zhang: Absolutely. I wrote that in January, February of this year, and that was the first winter with COVID, and the surge was going kind of everywhere. We had our first surge in New York, obviously, in March of 2020, and as a palliative care team, our numbers just went up like wildfire. I think we, at our highest, were like four times our normal list, and we had to get volunteers and all these people to help with the crisis that was going on. It took a real toll on me, as it did, I think, for so many of us. But I found myself in a place where I was so emotionally drained. I was in despair, the lowest part that I can think of in my life. I was having panic attacks and, probably what I would even say, some very dark, maybe even suicidal, thoughts. I went to a therapist and got the help that I needed.

When I wrote the article, it was probably around the tail end of my therapy. I was just finishing up, and I just thought, “If I could share maybe some of the realizations that I came to with whoever may be feeling the same way, then maybe that could help someone who’s going through the same thing or has gone through something similar.” So that’s kind of what I wanted to say, which was that I kept telling myself that I was OK. You hear people in the hospital, you ask them, “Oh, how are you doing?” “Oh, I’m hanging in there, hanging in there,” when in reality, I at least was falling apart. I was a mess.

And I think, for me, it was a disservice to not recognize how I was feeling. We say to our patients and our family members and the patients’ family members, “It’s OK to feel sad,” or “It’s OK to feel angry. It’s OK.” We normalize these things for our patients. But on the flip side, we say, “Oh, I have to be strong. I’m a doctor. I’m a clinician. I’m trained to be able to deal with these things,” when in reality, no one’s ever trained for a global pandemic, right? So that’s what I wanted to share, which was the thought that maybe we’re not all hanging in there, and that’s OK. And the sentence that I used was “It sucks.” I think, like, “It sucks, and that’s OK,” right? Right now it’s not going well, but I’m doing the best that I can, and that’s OK.

Kevin Pho: Like you said, a lot of physicians are trained to put up that wall and really not show any weakness. When you did show some of that vulnerability, when people asked you if you were OK, what were some of their responses when you said, “It sucks, and I’m doing what I can”?

Luyi Kathy Zhang: I had a lot of feedback from people who just felt like they were being seen, that they were feeling the exact same things, but they didn’t feel that they were validated enough to be able to feel that way, or that they could feel that way. Like you said, we’re so built into this system where, let’s say in medical training, if you do something wrong, it’s highlighted on rounds, right? That sort of thing. And so I had a lot of positive responses, even just from talking to people in the hospital, and even from writing the article, where people were like, “I’m so glad that you brought this up, because it’s something that’s affecting all of us, and it needs to be talked about.”

I still know some colleagues who have been affected, and they haven’t felt comfortable enough to seek help or go to therapy or that sort of thing. And I think that, again, goes back to the self-care and this notion of how we best take care of ourselves, our mental well-being, our emotional well-being, so that we can then go back to the hospital, to clinic, to the office, and help our patients the best way that we can.

Kevin Pho: You wrote this article earlier this year. Tell me what the situation is like now when it comes to clinician self-care, and contrast that to what it was like earlier this year.

Luyi Kathy Zhang: I think there’s certainly been a rise in awareness, certainly during the pandemic, especially as different pockets of the nation were going through it, right? At first it was in New York, and then parts of the Northeast, the Northwest, and then it went to the South. And I think everyone has kind of gone through this cycle of, “Oh, God, it’s here. It’s among us. How do we cope with this?” And then, how do we cope with the aftermath? When you’re in it, with the stress of it all, you don’t really notice, because you’re just running on autopilot. But it’s when you get a little bit more rest and the numbers aren’t as high that you’re like, “Holy crap, this is awful.”

I think the awareness helps. I think a lot of institutions and a lot of individuals are pushing for that type of program or awareness in their own hospitals, but I do think we have a long way to go. So it’s the start of, I think, a broader conversation that needs to continue, quite frankly.

Kevin Pho: So when you say that we have a long way to go, what specific things need to happen to further address this?

Luyi Kathy Zhang: Starting with even medical education and training, right? When I was in training, there were many times where I just felt like I couldn’t make a mistake. Otherwise, I would be reprimanded, or I would have my mistakes aired out to everyone else in the program. It would be embarrassing. But there were moments where I did feel supported. I did feel that someone was looking out for me. And that starts in medical school. It starts in training, all the way up to when we are working, with support from leadership, with support from the C-suite, and that sort of thing.

I think we just have to really talk about what’s happening to us, what we’re feeling, and why we’re feeling the way that we are, and champion the voices that are trying to make a change, that are trying to make things better for the people who do want to stay in medicine. Because there are a lot of us who, after this, are just like, “I can’t deal with it anymore. It’s too much.” And that’s not what really anyone wants going into medicine. You don’t think that you’re going to leave, but sometimes you have to do what you feel is best for you, and sometimes that’s not staying in medicine.

Kevin Pho: We’re talking to Luyi Kathy Zhang. She’s a palliative care physician, and she wrote the KevinMD article “Maybe we’re not all hanging in there. And that’s OK.” Kathy, for those clinicians who are burned out and thinking of leaving medicine, or who are in the depths of despair as you were earlier this year, what kind of specific, actionable advice do you have for these clinicians?

Luyi Kathy Zhang: What I realized in therapy, and it’s taken me a long time to get there, was being aware of what my own thoughts were, the things that I was saying to myself, things like, “I’m fine. I’m handling it.” I think that was such a breakthrough for me, because we’re so used to intellectualizing things. We’re academics, we’re smart, we take care of patients in life-and-death situations, and we’re so used to giving that we sometimes forget what it’s like to give for ourselves. So I think the awareness of what we’re doing, the boundaries, let’s say, that we’re not putting up, the safe boundaries for us, I think those are some actual things that we can do.

The things like in the article, “It sucks, and I’m doing what I can.” The “and” is validating that right now it’s not an ideal situation, and the latter part of the sentence is giving ourselves the grace and the self-compassion. I say, “I’m just muddling through. I’m doing the best that I can, and that’s enough.” Some days your best is seeing all your patients before noon and banging out all the consults, that sort of thing, and feeling on top of the world. And then other days, your best is just showing up at work, and that’s it, and that’s OK.

I think normalizing that experience, that we are humans, we obviously are going to be affected by everything that’s going on here, and that it’s OK sometimes to not be OK, but that there are avenues and channels that we could get supported. There are ways that we can get help, and it shouldn’t be stigmatized. I think that conversation is definitely changing, but there are still vestiges of it among all of us, I think.

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

Luyi Kathy Zhang: The takeaway message is really to take care of yourselves. It’s OK to feel all the things that you’re feeling, normalizing this experience, this wild, unprecedented, what, year and a half that we’ve had. And to check in on the people that you might see that might not be themselves, that might not be doing well, because we’re all in this together. So I would say that that’s what I’m hoping people will get from it.

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

Luyi Kathy Zhang: Thank you so much.

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