Life Lessons

Through no coordinated efforts on our part, 3 graduates from my high school arrived in New Orleans, LA to attend Xavier University of Louisiana.  When I describe my experience at Xavier to other people, I describe it as the first time I could be unapologetically myself.  It was so empowering to look out on the yard on any given day and feel empowered by people who looked like me striving toward higher education and positive service toward others.  Those four years became more important when re-entering the “real world”, remembering the support and guidance there, helped during the days when I was made to feel less than or underprepared or undervalued.

The fight for equality has been ingrained into my being for as long as I can remember.  My grandmother was not shy in sharing her experiences growing up and prepared me for what we now call micro-aggressions when I started elementary school.  I have no doubt this part of my informal education led me to medicine and then to public health, searching for my own way to level the playing field.  With the current events that have engulfed our country over the past several weeks, I have been struggling to articulate my thoughts and feelings as it relates our country and our profession.  Those feelings that range from anger to disgust to disappointment to despair.

My high school and college classmate, Ashley Harmon, a psychiatrist, made an eloquent statement the other day.  She captured some of those feelings.

“No one ever speaks to the complicity within the medical community that tolerates racism. Do my peers understand what it means to be called a Nig–r while providing care to patients? Do you know how it feels to be seen as subhuman and still provide excellent care? Do you understand how I have to remain silent and continue to be unbiased? Do you understand that because I am the defacto leader that I have to provide an example at all times? Do you understand how traumatizing that is? Do you know that medical schools do not teach people of color how to defend themselves? These institutions also do not teach our white peers to defend us either. Administrations look past the person and to the bottom line. Racism and bigotry scream silently down the halls of medical institutions. And we wonder why there are health disparities? The medical community has not even developed a coherent response when one of their own is harmed. How then could the medical community protect others?”

I asked Ashley if she would mind sharing more on this subject today.

1. Tell us about yourself.

My name is Ashley Harmon and I am a board certified geriatric psychiatrist. Most recently I have been working at a VA on an inpatient unit as an independent contractor but will be coming into the VA as a full-time physician in the fall of 2017. I have been quite mobile since graduating from my fellowship at University of Rochester in NY. I have been blessed to work in several different health care settings including nursing homes, assisted livings, inpatient psychiatry and emergency psychiatry.

2. What led you to the field of Psychiatry?

When I entered medical school, I initially thought I would pursue neurology since I had a fascination with the brain and how it functioned after working as an aid at an assisted living facility. I will never forget an elderly resident that I took care of. She was a God-fearing woman who never forgot her evening prayers, but she was heartbreaking because she forgot her children’s names. I also could not reconcile how this praying woman could become irritable in a moment’s notice and be an adept thief that could rival any professional. We often retrieved resident’s belongings from her purse. I wanted to understand what was wrong with her brain, and why she lost her memory. But as soon as I stepped onto a psychiatric unit during my clinical rotations, I was hooked. It astounded me that someone’s brain was powerful enough to shape their perception of reality and it was wonderful learn about the person behind the illness once their symptoms resolved. I felt that through psychiatry, I would work with the young and old, including those with dementia and try to improve their quality of life.

3. Can you elaborate more on your comments above?

The day I wrote this Facebook post I was quite frustrated and dismayed at the racial tensions and violence that were displayed in Charlottesville and the days after. I was especially alarmed that white supremacists had become so emboldened that they were proudly spouting their ideas and vicious rhetoric. This made me reflect upon the times, in various settings in which I had been called the n-word or my patients of color had to manage knowing another patient was using racist language. Though I deal with emotionally unstable patients, the majority will adhere to social norms despite their illness. And, the majority of cases where I had encountered racist language were not in the midst of psychosis or delirium. It reminded me of instances where even inside the walls of a hospital, a supposed place of healing, racial tensions could easily bubble to the surface. It is always below the surface, unspoken. If racists can proclaim their beliefs loudly in the streets, why must I remain silent in the halls of healing? Prior to taking a sabbatical from the VA, my team was dealing with a man who made racial slurs in front of others. Fortunately, this program had a policy in place to manage incidents like these so there was a feeling of empowerment. This is not the norm. But this made me think of other facilities where policies are not clear and in fact give no recourse for those who would be aggrieved, either patients or staff. And does this not reflect on the way we deal with race in a broader context? Essentially, what I have seen is the policy of reprimand without consequence. This can foster a sense of helplessness which can produce apathy. There is also an ethical argument to be made about not refusing to care for those who believe differently from you. But what if those beliefs could be harmful to others? I think this question becomes even more complicated when dealing with mental health. Ultimately, I believe health institutions encourage the silence because this is a difficult situation and hope it “goes away” along with the discharge of the patient. It is also true that this is the easy way out. But the experience never truly goes away for those who experience the insult. How do I protect my patients? How do I protect myself? Is no place sacred? Even in this place, where my patients of color are trying to obtain stability and healing, they had to deal with someone who thought of them in vile terms and less than human. Daily they had to interact with a person who speaks about them in vile terms, smile, and be appropriate, and all because this person hid behind the cloak of the name “patient”. And I realized that I have been taught to do the same. In all of my education and training, these issues had never been addressed in a formal manner or treated with any consistent seriousness. And I saw myself in the same boat as my patients. The ways in which we address culture and race can significantly impact patient outcomes or minority participation in the health care field. As providers, it can significantly impact our health and our spirit. So what are we to do?

4. How do you see change happening regarding racism in the medical profession?

Medicine tends to focus on patient outcomes (rightfully so) and there is a focus on racial/cultural health disparities. There is little in the medical literature that focuses on the experience of minority physicians nor is there much guidance in how institutions should instruct their providers to empower themselves or their colleagues in this matter. But if we are to truly address these concerns, they must first be discussed. They cannot be swept under the rug since it is indicative of a larger problem.  In medicine, we are taught that to address a problem, we have to first correctly identify it. We have to acknowledge that our peers and colleagues of color have experiences which can be emotionally unsafe and at times traumatizing. I believe we should begin to document the experiences of physicians/practitioners in terms of racist interactions so that we know how prevalent this experience is. Unfortunately, I believe that this experience is quite common and occurs at least once during the career of a practitioner of color. Once we catalog the frequency and quality of these experiences, we can begin to develop an appropriate response. Medical students should have appropriate training and enter into their careers armed with tools and confidence to take care of themselves and others. Though we may not be able to refuse care to patients, we should have a coordinated and consistent response across facilities that lets patients know that this behavior and rhetoric is not acceptable within healing institutions. Our brethren should be empowered alongside us so that we carry a forceful message that will scream louder than the silence of racism.

5. As you know, outside of large cities, some of us may be the only face of color in the department or in the office or hospital.  What advice do you have for our colleagues, those who encounter racism or witness racism in the work environment?

For now, I encourage my colleagues to consistently document these encounters and keep a log. Out of sight is out of mind. I believe that our counterparts may not actually believe that this occurs regularly and therefore does not warrant a coordinated response unless we have the data to prove it. Begin to approach administrators and ask them about what policies are already in place and gauge if they are open to improving these policies and re-educating staff on how to deal with these patients. We will be the only ones to bring this issue to the forefront. We will need to be the champions not only for ourselves, but ultimately for the ones we serve.

My favorite pastime growing up was reading.  I was the kid that looked forward to the summer reading list.  I usually made my way through the list and read a few more.  Each summer, I would challenge myself to something different… How many books could I read? How fast could I read one book?  How many books could I read at the same time? (I’ve done five, but 2-3 is a more workable number).

Generally, I have always preferred fiction since it allowed me an outlet from my everyday life.  I enjoyed the sense of adventure, the sneak peek into others’ lives and their trials and their triumphs.    If I have to pick a specific genre, historical fiction would be my favorite.  But I’ll read just about anything.  As an adult, I am always reading something, though depending on my work schedule it takes me considerably longer.  During residency, it was not uncommon for it to take me the better part of a year to get through one book. I often had to go back and re-read passages due to the infrequency of my leisure-reading schedule.  (I should be clear; I did plenty of medical reading!)

It should come to no surprise that when I found myself at a transition point, I turned to my old pastime for guidance.  (Though an avid supporter of the public library, it became increasingly difficult to get the books back on time…)  I went into a local bookstore chain and walked through the aisles, looking for a title that jumped out at me.  I found several books, sat on the floor and leafed through them until I settled on 4-5.  In the past two years, my tenacity for reading has been re-energized.  I have not reached to 60 books a year (or whatever the number is that successful leaders are supposed to read), but I’ve enjoyed this part of my journey.  As you can notice from the list below, more non-fiction has crept its way into my life…   I think I lost track of a few and these are in no particular order, but here’s my reading list for the past two years or so.

Fiction

The Cutting Season  Attica Locke

River, Cross My Heart Breena Clarke

The Twelve Tribes of Hattie Ayana Mathis

Lazaretto Diane McKinney-Whetstone

Happily Ever After Elizabeth Maxwell

Non-Ficton

Blink Malcolm Gladwell

I don’t know what I want to do, But I know it’s not this Julie Jansen

The Tipping Point Malcolm Gladwell

Drink More Whiskey Daniel Yaffe

The Bogleheads Guide to Investing Lindauer, Larimore & LeBoeuf

The Art of the Bar Hollinger & Schwartz

Lean In Cheryl Sandberg

Outliers Malcolm Gladwell

Real Estate Investing McGraw-Hill

The 4-hour Work-week Timothy Ferriss

The One Minute Millionaire Mark Victor Hansen & Robert G. Allen

1000 Dollars and an Idea Sam Wyly

When Things Fall Apart: Heart Advice for Difficult Times Pema Chodron

Currently:

The White Coat Investor James M. Dahle

The Post-Birthday World Lionel Shriver

There are many articles/books on financial well-being.  I am a novice and I don’t have anything earth shattering to impart here.  I would refer to the experts to tailor a plan to your exact needs. However, for me transitioning to a nomadic existence required some amount of fiscal forethought and I wanted to share that part of my journey with you.  Essentially, saving is not too unlike dieting.  Diet = less in, more out.  Saving = more in, less out.  Both require discipline and a small amount of sacrifice for an ultimate long-term benefit.  My habit of saving allowed me to have the confidence to feel comfortable pursuing a career doing locums and is also allowing me to volunteer in Kenya this fall.

I’ve always been debt adverse.  I don’t like to owe anyone, anything.  I’ve also known I wanted to be a doctor since a young age, so I started planning for college and medical school in middle school.  (Yes, I know…)  I knew my parents could not personally finance my education and I knew I did not want to accumulate a mountain of debt that was common with medical school graduates.  So, I set a goal to apply for and receive as much scholarship assistance as possible.  Therefore, I finished medical school with only a modest amount of student loan debt compared to the mortgages some of my colleagues acquired.

I enjoy saving.  However, residency training does not lend itself well to aggressively saving.  But, you can manage your spending to create minimal credit card debt.  During my fellowship year, I started actively saving.  Each month I siphoned off at least 25% of my check into a savings account.  I deferred my student loans, but I paid off the ACOG HELP loan that I applied for and received my fourth year of residency and I made the minimum payment on my credit cards.  I bought a car my first year of residency.  I had a 60 month lease, meaning I paid it off the last month of my one-year fellowship.  I did not then, nor I have I since, bought a new car.

After starting my first job, I continued saving.  I was paid bi-weekly.  From one check I transferred 25% to my short term savings account and from the second, I transferred 25% to my long term savings account.  I set up automatic payments to cover the minimum payment to my student loans to avoid any fees or an increase in interest rates due to missed payments.  After I covered my monthly expenses, I used whatever I had left to pay-off my credit card debt.  Once I paid off my credit cards, I doubled, then tripled my student loan payments, making sure the additional amounts were applied directly to the principal.

Remember my two savings accounts?  Once the short-term account balance equaled my student loan balance, I paid it off in a lump sum.

Voila! Debt-free!

I continued to grow my long term saving account until I felt it could cover me for at least 6 months if I were unemployed.

Take Aways:

1. Establish a habit of saving.
2. Pay off timed loans first, high interest/credit card loans second, low interest/student loans third.
3. Be a Realist. Understand your financial strengths and weaknesses.
4. Minimize non-essential spending, but still enjoy life.
5. Debt-free = Freedom.

I recently posted about physician burnout and what role the system plays in our overall satisfaction with our careers.  As professionals, we are trained to handle complicated medical situations, as Ob/Gyns we often deliver news that affects two patients.  Counseling a woman through a stillbirth or fetal demise never gets easier. In discussing one such patient in a meeting a few weeks ago, the office social worker asked, what do we do to cope?  To whom do physicians talk to manage their stress and emotions during difficult times?  I must admit, as a group we do not prioritize this area well.  Too often, we hear of physicians who abuse drugs and alcohol or even commit suicide when the pressure to perform, to strive toward perfection gets too great and the support is not enough.

While doing locums full time, my friend graciously offered to house my belongings in her basement.  She is a psychologist working specifically with undergraduate and graduate students. With any highly regarded university, that produces excellent graduates and professionals, students arrive on campus highly motivated and prepared to succeed.   To say the least, the demands of college curriculum can be daunting. Across the country, medical school admission standards are high and require disciplined study habits.   As physicians, most of us were once these same ambitious college students who kept late hours, ate erratically, exercised infrequently, not placing enough emphasis on our personal well-being.  These habits we create while training are often the habits we continue when practicing.  These habits are not always healthy or easily broken.

Today, we talk with Dr. Leslie Leathers about the mental health conditions she believes are particularly pertinent to young professionals, warning signs and viable coping mechanisms.  As we spend most of our days caring for others, it is just as important to dedicate the appropriate time and attention to ourselves.

1. Tell us a little about yourself.

I am from North Carolina originally, and growing up in my Black American, middle-class, Christian family, certain values were instilled in me. Values most pertinent to our topic today include the pursuit of formal education, collectivist ideals, and helping others. These values were a natural fit with the field of Counseling Psychology with its emphasis on helping people improve their quality of life while acknowledging and respecting multicultural realities. I moved to Baltimore for my job doing psychotherapy with university (undergraduate and graduate) students. This position entails a specific focus on supporting students of color. It’s a privilege to be able to support students as they begin to navigate young adulthood. As a woman of color who benefited from wisdom and guidance of professionals who came before me, it is particularly gratifying to be able to provide support to students of color as they pursue their higher education goals and work to improve their quality of life, both in the short and long-term.

2. In counseling professional students, are there any common themes that you can address?

One theme that leaps to mind is the pressure to succeed and secure employment in academia where job applicants far outnumber available positions. Another theme is learning to manage (what are often) new levels of stress adaptively.

3. For friends and loved ones, are there any warning signs that indicates someone needs professional support?

Significant changes in ones’ behavior may indicate the need for extra support. For example, increased irritability in someone who usually is easy going or social isolation from someone who typically is outgoing and social. Someone could begin shirking responsibilities or, alternatively, one could start taking on more commitments in an attempt to distract oneself from one’s experience of distress. Additionally, one could experience distress somatically and emphasize physical aches and pains. A more complete list of potential signs may be found at

https://www.nami.org/Learn-More/Know-the-Warning-Signs

4. Different cultures intersect with mental health differently and recently, conversations around racism, mental health and self-preservation have been more common in popular media and on college campuses.  How has your work contributed to increased awareness and strengthened relationships across campus?

There does seem to be a groundswell of momentum to acknowledge and redress patterns of inequity. My own direct work with, and indirect work in support of, students who represent diverse backgrounds has benefited from this momentum. One thing we know from research is that students who feel marginalized within a campus environment can benefit immensely from having distinct spaces that are affirming of their marginalized identity/ies. My work contributing to such spaces on my own campus have been among my most valued work experiences to date.

5. What resources do you recommend for someone who is feeling overwhelmed?

Well, being a psychotherapist, who at various times in my life has also been a therapy client, I wholeheartedly recommend therapy. A couple of good resources for assistance identifying a therapist are

http://www.apa.org/helpcenter/index.aspx

and

https://therapists.psychologytoday.com/rms?utm_source=PT_Psych_Today&utm_medium=House_Link&utm_campaign=PT_HomeTopB_find

That said, there are a number of other strategies one might try. For instance, engaging in regular self-care that nourishes the important parts of oneself is often helpful. Prioritizing commitments and determining the limits to one’s control within a specific circumstance may help alleviate excess pressure that can lead to feeling overwhelmed. Although it is often hard to do so, it can be very helpful to remember that we are all human and doing the best we can considering the resources and knowledge available to us at a given time. If we’re feeling overwhelmed, that may just be a signal that we need to improve our existing resources/strategies or try to acquire some new ones. Here is a link to a list of apps that could be useful in bolstering or adding to existing strategies for managing distress:

https://psychcentral.com/blog/archives/2013/01/16/top-10-mental-health-apps/

Finally, social support, whether from one’s best friends, gym buddies, spiritual group or leader, family, etc. can help one feel connected to a community and/or to something(s) greater than oneself. None of the aforementioned resources/strategies are mutually exclusive and there often is a process of trial and error in figuring out what works best for you. So, if you find that one strategy or combination of strategies does not work for you, know that it may take some time to identify your own unique path to good mental health maintenance.

Traditionally a very private person, writing a blog is a little uncomfortable to me.  I usually am very guarded about what I share and with whom.  I spent several months agonizing over my next step.  I actually liked my job overall, but I knew it wasn’t taking me in a direction I wanted to go…  I talked at length with a friend and co-worker, as to why I couldn’t be satisfied with a good job.  I wanted something more, something different.  With all the online job searches and networking receptions, cold calls to potential mentors and advisors, I still couldn’t find the right fit.  I was faced with the decision to stay until I discovered the right fit or ask another question. Is it possible to create my own position, forge the path to be my own boss?  When I was trying to decide if I could leave the cruise ship for the kayak, I decided to test the usefulness of the “machine”.  I googled it!

“Should I Quit “ led me to some interesting sites.  One of the most useful, included a quiz, entitled “Should I Quit”.  How helpful!  The quiz itself didn’t tell me anything I didn’t already know, but the lovely free emails that followed were quite informational.  Scott’s personal journey, which included worldwide travel, definitely inspired me.  Just by happenstance that spring, I was asked to write a blog for a professional organization, for which received some positive feedback.  So, when I opened Scott’s email about blogging as a personal discovery process, I figured I’d at least consider it.  I also loved the title of his website “Live Your Legend”.