This is here After, and I'm your host, Megan Divine. Each week we tackle big questions from doctor's, therapists and other helpful folks that let us explore how to show up after life goes horribly wrong. This week, it's all about burnout in health care. How do you keep showing up to do the work when the work is breaking you. It's another episode where we speak directly into the abyss my friends with our special guest and hilarious burnout tour guide, doctor Jesse gold Well. We do talk a lot about the health care industry specifically in this These themes of exhaustion and self advocacy are important for everybody, so stay tuned. We'll be right back after this first break. Before we get started, one quick note, While I hope you find a lot of useful information in our time here together, this show is not a substitute for skilled support with a licensed mental health provider or for professionals revision related to your work. Hey friends, So one of the main goals of this show is to give voice to what's really going on inside the health care field. We're always talking about the importance of mental health and reaching out for help, but the helpers are human too. In an industry that prizes stoic detachment as a form of high achievement, being a real human being with feelings and limitations is seen as a liability a lot of the time. That's especially true in the hospital setting, where the fast paced and demanding workload can make even the most committed helper feel like they have to sacrifice themselves on the altar of the bottom line. Dr Jesse Gold is an assistant professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis. She's a nationally recognized expert on healthcare worker mental health and burnout, particularly during the pandemic. She writes regularly for the popular press about mental health stigma, and medical training. That is a giant mouthful of professional street cred, all of which to say that doctor Gold knows her stuff when it comes to mental health challenges facing the health care industry itself. Dr Gold isn't afraid to speak into that complex, messy, very very human space of being called to care for people while at the same time feeling like you're falling apart. Jessie, my friends, welcome to the show. Thanks for having me. So I want to open with something that you wrote in Forbes magazine last year. You wrote, quote, here's something we don't say out loud as health care professionals enough. We have reactions, feelings, and emotional responses. We feel angry and depressed and anxious. We have worries about what's going on in the world right now and how it affects our patients. We also have feelings about what we see and experience on a shift, and those feelings often catch us off guard. Our emotions are suppressed and held inside because we are supposed to be stoic caregivers. So that mouthful just just as a starting point, what do you see as one of the main issues unfolding for health care workers right now? I mean that whole mouthful is mostly a way to say that we're told and taught not to feel. Really, it's the way to survive, it's the way to deal with what we see day to day, and it ends up being a way that we then get burnt out and said in a bigger way because we pushed down a lot of feelings and we pushed down our reactions, and it just becomes not a space we feel safe being in and then it's kind of all compounds until it's much worse than I think that's a big problem with healthcare in general. But right now with everything that's been going on in the pandemic and everything that people have been exposed to, and how different the workspace has been. You know, it depends on what phase of the pandemic, but certainly like more risk to yourself or your family, different lacks of resources in different ways because of staffing or even just simply like resources like beds. I think, much more death than usual on a day to day in what you're seeing, and so you have this additional, compounded hard workplace on a baseline mental health situation that's not ever really been great for health care workers. And so it's kind of a perfect storm in a lot of ways. And the feelings part is a big part of it, because we just don't have a culture that talks. We don't talk about any of it, and so you feel really alone and that makes it a lot worse. Yeah, I think it's just it's such a hot mess, right It was a hot mess before the pandemic. Like none of these none of these things we see erupting right now they're not new. It's like we had a system that was already broken, was already fractured in part because of of what you were just mentioning, like this culture of stoicism, this this idea that having human emotions is somehow unprofessional. Yeah, I mean, I think in a lot of hot mess is a decent way of describing it. And it's like an extra hot mess now, I suppose, But I think you know, I've heard someone say that the fault lines are what you see through COVID, which is like these things that have been brewing under the surface but just get much more exposed with all of the additional stresses of COVID, and I think this is definitely one of them. And our culture and health care is horrible. I mean, we've lived in a group where you know, you're prioritizing not sleeping, not eating, like really prioritizing the other person, you know, the patient, over yourself. There's a lot of conversation around like if you show emotion in a patient room, like are you taking away from what that patient is experiencing. So you spend a lot of time trying to learn not to react to things or that it's normal to go from a person dying in one room to a conversation about like eating or something kind of just generic in another. And that's just what you do. And it's a weird culture and not a culture. We talk enough about how weird it is either and that makes it hard. Yeah, I think that's a really interesting point you bring up about, Like even if there wasn't this sort of professional training cultural model of the stoic attending, right, like, you don't want to take away from the person in the room by showing your humanity because then it's, oh crap, like now we're talking about me. We don't want to hijack the situation in the room. But I think one of the things that's really happened is we've made that an either or situation instead of a continuum. You are completely impenetrable, which doesn't do so great for your clients and patients anyway. Or to use hot mess again, you're a hot mess and you're taking away from from what's in the room at the time. And I think having these conversations is how we create that middle ground of how do we be full humans showing up to do this work with the boundaries and the ethics that are in place for us, but also not at the cost of our own humanity and our own relationships and our own lives for sure. And I think in a lot of ways, if you ask patients like they would be okay if you showed emotion, it's different to show emotion over something that requires emotion and would be an empathetic gesture to show emotion that it is to just be emotional all the time and not make it like a space that feels safe for patients to talk at all. Right, that's very different. And I think we worry that once you like tip over, you're all the way over, and it's just really not like that. And I think a lot of times I've heard from people where their doctor has like actually cried with them or sat with them through something that it's been a really meaningful experience. But if you take that from the doctor's side, they'd be like, why would I ever do that? That's horrible, Like nobody would like that. That's not something I'm allowed to do. There's a very different perspective on what we want or what we think we're supposed to be doing. It's interesting that you brought up that, like basically the if I start crying, I'll never be able to stop. Thing in the medical world as well. I mean, I hear this a lot with people who are having a really hard time navigating super challenging life. Things are like, I can't start crying because I'll never be able to stop. And that is such a product of our emotion of verse culture as a wider social culture, and also again in the in the medical industry. So this actually sets us up really well for the first listener questions that I wanted to get into, if you're ready, sure, I actually asked my audience for questions. I told them while you were coming on the show, I wanted to get a lot of questions from people really working on the front lines. And I can tell you that like, question after question after question after question was basically asking the same thing, how do I handle my own grief knowing how I have to show up day after day and take care of other people. For some of the people who sent in their questions are actually working in the same hospital where somebody close to them died, so the sensory awareness is just on tilt for them. I'm going to preface this question by saying we are not going to have a neat and tidy solution for this, but I wonder if we can use one of those questions as a starting point. There's no neat and tidy solution to most things, especially grief. But feelings are messy, and I think part of the desire for a neat and tidy answer is part of the problem, because we want it to be perfect so then we can do it. But really, in a lot of ways, you just need to be and see where you go from there. Yeah, this is why I love your work so much, in your your presence in the world, because you're like, well, this ship's missed this it's messy, Like we can't make it anything but messy. Okay, So here is the question, Dear Dr Golden Megan. I'm an impatient p A trying to balance the grief of the traumatic loss of my father, followed by that of my relationship, as well as the grief and loss and hardship brought on by the pandemic in my daily work life. I'm so tired from carrying this weight. I have a counselor, but I feel I could do more to compartmentalize or otherwise find some relief. Is there a way to honor my deep feelings but also find reprieve How do I care for myself in a world that requires so much of my energy. I chose this question on purpose because it has so much jammed into it, right, so many layers and layers and layers, and I feel like it's really indicative of what's happening in medical facilities all around the country. So where do we start. It's interesting because you could say, oh, this feels like a complex story, but in a lot of ways, it's everybody's story, right. I think people forget that healthcare workers have the life experiences that everybody else has gone through that I've been challenging over the pandemic, like being a mother, being a partner, being a caregiver, having family members get sick and die, and then on top of it, I have to go to work every day on the front lines and help everybody else. Right, So there's like that added stressor which seems like enough to people, but we have all the other stuff too. Write But I'm guessing that you know, in a lot of ways, it's really good that she goes to counseling already, because I think that's a big thing that's hard for people in general in health care to ask for help, to admit they need help, and they really hate talking about things, So having a place for that that's just for you is really important. I think in a lot of ways, we try really hard not to have feelings in the workplace and to pretend that somehow there's this big difference between work and home and everything like that. But it's all together, and you're the same person going into work. It's just you have to deal with the things that work, and so, you know, I think it's important to give yourself space and time to acknowledge what you're feeling as much in the moment as you can. I think it's really hard in healthcare because that's a privileged time, um and being able to pause at all, but honestly, like reflecting on what you feel in your body, reflecting on what feelings are actually having, and being okay with also having feelings while you do the job, I think is a really important thing. So obviously it's great to have a space to talk about with the therapist and process and all of that, but the time before your next appointment is important to which is like how do ideal day to day without just like pushing my emotions down until that one hour once a week, and you really need to give yourself space and be okay, like having a full range of feelings. So I think a lot of health care workers have struggled with things like anger and not knowing whether like being angry makes you a bad doctor or pia your nurse, or any other person on the health care spectrum. And you know, I think you can be angry and that feeling can be valid and you can still do your job well. And I think it's important that we get used to holding both things and knowing when we have time to do whatever we need to do, to let ourselves acknowledge that we are a human being with feelings and have to do our job at the same time. Yeah, I love that, and it reminds me of something earlier we had on the co founders of the New York's Center for Contemplative Care on and they work with physicians, they work with people in healthcare, and they said, like, I don't believe it when you say I don't have time to acknowledge my own feelings, sit in my own humanity. They're like, yes, you're busy, but you have thirty seconds, right and sometimes I mean, it seems like it's not enough. But what they pointed out was like thirty seconds many times a day becomes fifteen minutes, and fifteen minutes of allowing your own humanity to yourself will make a dent in that pressure. It's not going to solve anything, like none of this is like a super easy solution here. But what I hear you really saying, Jesse, is like, there is power in acknowledging your humanity, even if it is a split second as you're moving from one room to the next, to be able to say I have feelings about this, have feelings about this, and I don't have time for them right now, but I want to notice for myself that I see them for sure. I think that we spend too much time assuming that all things coping take hours. Like if I'm going to tell you to have feelings or cope with something, you need to whip out a yoga mat and do like a forty minute class, Right, That's impossible for most people most of the time. There are different things you can do that take less time that are really helpful. Health Care workers really like things like deep breathing because you walk the stairs between patients. You have the time jelling in and out of a room before you have to see the next person, to take the second and like actually change your breathing patterns to calm yourself or acknowledge how you're feeling, or give gratitude for what you just experienced, if that's helpful for you. I think we don't stop enough to think about the good things in our day or the privilege of our job. We often get really caught up in the hard thing of our job, and so trying to just do that in the quick amount of time that you have, You're right, it's sort of just all adds up to being less than, you know, maybe ideal in the world, but much better than nothing, and much better than only having that once a week time in counselang which most people don't even have, because that's a privilege to be able to fit into your schedule and also to not feel scared to do that in the first place in healthcare. So I think you're right, just kind of all kind of comes together as much as you can. Yeah, it really doesn't. And I just want to pull out that one little bit that you said, not only is it a privilege to find the time to go to therapy, but because we're working against that idea that having emotions on the job makes you less professional, less skilled at your work. Like that is a big thing that we want to name here too. That can feel really scary to even acknowledge that you're wrestling with this stuff because of that culture of perfectionism that we see so much. So I love that you're like, you can't just whip out a yoga Matt, And I think we often use all of those things that you just mentioned. We often like they're often positioned as these cure alls, like if you would only practice gratitude in journal for fifteen minutes about all the things that you love about your life, that everything would stop sucking so much. And that's like, that is not what those tools are for. Those tools are not to remove suckage. There to help you navigate, manage, and support yourself inside this really really difficult situation. And for me, like the language that I use around that is like this is helping you acknowledge the reality of the situation, and acknowledgement is very powerful medicine. Yeah, I mean, I think that's a problem with a lot of framing around coping skills or especially like resilience, is this feeling that it's somehow your fault that you're not surviving in a broken system, And when people suggest doing things that can help you, it feels like they're saying, come on, like fix yourself, Like where else is fine? Work harder, figure it out, like you should be fine. But really what we should be saying is the system, specifically in healthcare, but in a lot of ways, is very very broken. And culture change takes time, policy change takes time, any other sort of systematic change is going to take time. And if you want to survive in a truly broken system, even as it attempts to heal, you have to figure out how to do that yourself, and it requires some individual coping to do that. It doesn't mean something's wrong with you. It means that you're reacting normally to a really bad situation, and if you want to still be in healthcare, you have to figure out how to deal. And you know, I'm not exempt from that by any means, Like I think it's important for people to realize, like just because I uh preach like things around coping skills and burnout and things like that doesn't mean I'm really great at all the stuff myself. Like I've really spent a lot of time over the pandemic trying to figure out what coping skills actually work for me and don't feel like that, like I'm just doing something to do it, And like I spend a lot of my energy like coping with others and having the support of other people, and when that got taken away in the pandemic, it was a lot of like, oh, what do I actually like to do myself that actually still feels good in the same way that going to dinner with a friend might. And It's been a lot of work and I'm still working on it. And you could ask my therapists and she'd probably tell you I'm okay sometimes and struggle a lot. But I think it's important that people realize that even though I know these things, it does I mean that I do them all the time. And we spend a lot of time in medicine assuming like, well I can, I should be able to take care of that myself, Like I understand disease where I understand mental health, I should be able to figure out how to deal with this, And honestly, you shouldn't because I actually am an expert in this particular area, and I can't, right, So it doesn't matter what you know, It matters how it gets applied and how other people point out things to you that you might not even realize are going on. Yeah, I love that. There's actually a Twitter thread of yours where you I think you started it. We were like, okay, physicians, let's talk about the things that we would how our patients to do, but we don't do ourselves. And there's this whole long thread of like I don't I never drink water, I drink only diet soda. I don't get enough sleep, like I never moved from my desk, like all of these things like remembering your humanity in there and this is not I think there's so much perfectionism baked into the health care industry, right, like I must do this correctly or I won't. Like, oh, come on, like you are still human and you are still a catastrophe in progress, just like all of us. I mean, medicine like recruits those people in a lot of ways. So it's like it's a process that is like, let's start out with the people who are most likely to be perfectionists, and then make it harder for them by judging them for having anything that's outside of perfection or making them feel judge for having anything outside of perfection and achievement and perfection become this thing that carries throughout but probably did in most people who went into healthcare. Is life before that, because you have to go into a process of applications where not everybody gets in and there's all this competition upfront, and the competition makes you feel like you have to perfect and that just continues on and on and on, especially if you stay in academics. Yeah, I love that perspective there, that that through that whole rigorous process of getting into the field because we have that culture of stoicism and perfectionism that we are actually like selecting for that. And then you put these people who are selected to run that way, to hold themselves to really high standards, to suppress their feelings because of multiple reasons, and we put them into a highly emotionally charged situation over and over and over again. And then I just don't think we can be surprised when people break, especially not people who mostly wrote application essays about how they want to help people, right like the people that are the best at what we do care a whole lot, and that's really hard to keep doing and not break. And you don't want to find ways to only keep the people in healthcare that are fine with no feelings and don't break right like you want to keep those people, So we have to do better. Welcome back friends. We have been talking with Dr Jesse Gold on the reality of being a healthcare professional with real human feelings inside a profession that doesn't actually value human feeling. Let's get back to our conversation. I think this this sort of brings us around to the big picture environment that a second listener question ushers us into. Debbie wrote in how do we change things in healthcare? As a frontline worker, we need our managers to understand that we are not machines. We are human and need to be heard and understood and rewarded. I get it that managers have numbers and goals to meet, and we have patients, but it's the frontline clinicians who do the work. We're the ones who face the trauma of treating COVID patient's head on seeing the horror unfold. We can't just keep going as if nothing has changed. We've changed how do we change the system so more value is placed on our well being? I think a shift has begun. Workers want more. I see that, but I guess for now, we just have to stand up for ourselves. So I love that line in there and this question, how do we change the system so that more value is placed on our well being? And you touched onto this a little bit, But if we widen that lens out, how do we start forcing a change in a system that was broken before the pandemic? Those fault lines are really glaring and exposed. Now, how do we even start? Yeah, I mean I thought somewhat about this in part because in one of my roles in the hospital I've had to interface a lot with like administration and try to argue for the need to invest in these things. And I think it's very frustrating because we ultimately have different goals, right, Like I think when you're a frontline clinician, your goal is to help the patient as best as you can, and you're really focused on them. Once you get higher and higher up in messin you're dealing with people who are really concerned about the bottom line and really concerned about money, and ultimately you realize just how much our healthcare system is actually a system that's built on financing instead of the people that it's taken care of, and that itself can be pretty disheartening. But I do think there are ways where you can make arguments acknowledging those values that maybe not your values, but are the values of the system to get what you want right. So, for example, depression is the number one cause of disability worldwide, which means it costs the system a lot of money to have a lot of depressed doctors because you don't go to work, or nurses or whatever. You don't go to work, you don't you can't be as productive, you might have errors. All of these things are true, and there's data that backs it up, and I think hospital systems are becoming more aware of it because of COVID and and how many people have been speaking out about their mental health in COVID and realizing that they can't just give you a pizza party or like a lecture on wellness and tell you like we're done, that's all we're doing, that's all we care about the end, or just give you access to an employee access program and realize that's not enough either, and so I do think there is a way to advocate for what you need or what you're missing while still appealing to a value that might not be your value, but is the value that might get things done. Unfortunately, you have to do that sometimes. So I think that's really important. And at the same time, I do think you can make small changes, like in your teams, in the people that you're supervising, in the way you interact with other people, that can make a big difference. So, you know, I talked a bit about how we don't talk about feelings, but we don't even say like it's okay to make mistakes, or that was hard or that was challenging, or of course you don't have an answer to that and you don't know, we don't know, right, and modeling that for people having conversations about why it's hard to say that stuff you don't even have to talk about, like mental health conditions. Right, we just need to start changing the conversations around struggle and why it might be hard to do this job. And some of that can happen on a team level or a supervisor level, and then it can get to higher and higher levels sort of as a bottom up approach. To changing how we talk about this stuff. And once you do that at the same time, hopefully they hear your advocacy and they hear the things you want and they start making changes. But I do think you can make some changes just by having real conversations. Yeah. Absolutely. I mean we we started out this the first half of the show talking about telling yourself the truth in these moments, letting yourself be human, letting yourself having these feelings. And I love what you just brought in there about like we can start having these conversations in our teams at the nurses station, you know, in supervision, to just start normalizing what's actually happeneding, Like we're not talking about anything like earth shattering Lee New We're talking about let's name what's actually in the room, and start claiming our humanity as normal and healthy and challenging in these situations. This is really a grassroots movement of the people who are on the front lines doing the work starting to tell the truth to themselves and to the people around them. And I also love that you brought in like, let's borrow from the c suite, let's borrow from higher up admins. They do have a balance sheet at the end of the day, and there is economic benefit to valuing people's humanity and their limits. And I think you know, whether you take on that role or not, Like if you if you pick up that flag and you decide to go after that or not. I think that's something that we want to start really talking about, is the economic reality of denying people their humanity, not just in the medical world but all around the entire globe. But that we do have to speak the language of finances, and how do we start understanding that naying people their humanity costs us. It cost us financially, it costs us in community building, it costs us in all of the public health prices that we have currently unfolding and interrupting. You know, I started this our conversation out by like saying, we're never going to have a solution for the hot mess of all of this. And I still believe that. I still believe we're not talking about a solution here, But I do think we're talking about away forward from here without collapsing into the despair of the hot mess. But how do we really start to change the culture. One of the things that I picked up from your work, there's this great quote from you that says, the mental health system is broken, you can't fix it by breaking yourself. And I think that's a really interesting sort of closing point for us and all of these things that we've talked about. So tell me a little bit about that statement and if there's a message you want to dictate to the world in this in this moment about I don't know everything we just talked about. I mean, I think in a lot of ways we neglect mental health in all conversations. So the reason why it's not in the financial conversation is people forget about it and don't put it there, or I think it's not relevant, or we're seeing all these people leave jobs and they don't talk about the fact that it's because of burnout or mental health. It's just like, oh, staffing or these like procedural things. And that's very true. But at the same time, you have to call it what it is and say people are choosing themselves over a job that takes it out of them. Right, we have to have mental health in these conversations or we're really missing out and we're not advocating enough for ourselves. We're just going to keep jumping jobs until we find a place that maybe is a little bit better with it right. And I think you know, when I said that we can't fix it by breaking ourselves, I meant over the pandemic, I've seen therapists really try to just take every single patient that they possibly can to make up for the need. And there's a huge need, and there's always going to be a huge need, and then need keeps increasing and will after the pandemic. But you talk to therapists and they're like, well, I started working in the evenings, I took back all my patients who asked to come back from before. I am working on weekends now, and now I'm set. Like, turns out that has a big effect on me too, because I don't have free time anymore, and I'm holding all this stuff for other people. And as much as you want to try to help in every single way you can, which is what we do in our jobs in so many ways, there's only so much as a human in a broken system that you can do without realizing that you really need to step back and put yourself first. Like, you can do what you can do, but there are limits to what you can do because you're a human being. And so as much as you are an advocate or a caring person about how broken these things are and how much you want to change them, there's a space for that. But in the same breath, there's also boundaries and a way to have space for you. And we neglect the second part because we've really want to do the first part right. But you don't do the first part right unless you do the second part. Yeah, I think that's a really beautiful end note for our time together. In a lot of ways, this is a lifelong pursuit we're talking about, right, like this exploration of how do we do the work we're called to do without losing ourselves in the process. So ordinarily, at the close of the show, I ask you where people can find you, and we are absolutely going to do that, but first I would also love some ideas where physicians and other healthcare workers can go for support. What are your like, maybe top two or three places that you would recommend right now? So you know, in a world of misinformation, it's always helpful to go to places that you know are consistently good and putting out good information. So I always go to like big organizations when that's the case. So often that means going to like the American Foundation for Suicide Prevention, who has website on healthcare worker mental health thrive By. The Huffington's Post also has a huge website is called like all In for Heroes, I think, and they have all these resources collected. Most of the medical organizations also have that too, So you could go to the A m A, you can go to the Double A m C. And they all have these kind of like wellness hubs, and they're probably the kind of thing where you're listening to me, you're rolling your eyes and saying like did you just give me more stuff to read and do? But at least it's there, you know. And I think the people who started things like the Physicians Support Line, which is staffed and it's all psychiatrists and staffed voluntarily, they made that over COVID their wonderful humans. You can use that. I know that that's limiting to then only physicians, and I know nurses who are trying to start the same thing for nurses. I think there are some places that still offer free therapy if you're in healthcare, and those places like Emotional PPE or Therapy Aid are also quite good because it's national and you can find some people who are willing to give you some free sessions, particularly you know in the situation where your workplace is and doing that too. And I think all those people really care and are trying their best to give you access to what they know exists. And obviously we can do better, and obviously we need more things, but those are the best that we have right now. I think, Yeah, they're sort of the starting places for what we mentioned earlier in the show about starting to link up with others and find places where you can tell the truth. Right, it is a little bit overwhelming to be like, oh, now I need to go to the m A site and search for all of this, like I have fourteen seconds. But again, like even just starting that practice of telling the truth to yourself and maybe finding one or two other places. I actually love your Twitter feed for this, so let people know where they can find you online. I'm at Dr Jesse Gold. I spelled Jesse j s s I because I was a high maintenance child that didn't say there was an e in Jessica, so that's why I spelled that way. I also have that same as an Instagram handle, and then anything I write is on my website, which is just like Dr Jesse gold dot com. But I think that can be helpful for people because I've written a lot on this particular topic, including from my own experience and being a burned out for an out expert. Yes, I think that's the powerful thing here is that you know what you're talking about. Your not just some talking head from the c suite telling people to do things for their mental well being so that they can be even more productive on the job. But this is actually something you live, and I am so glad to have had this time with you, my friend. People. We will link to everything that Jesse just recommended and a couple of extras in the show notes coming up next, your weekly questions to carry with you and how you can send in your question for us to use on the show. Don't miss that part, friends, We will be right back each week. I leave you with some questions to carry with you until we meet again. It's part of that whole This awkward stuff gets a lot easier with practice thing, and I definitely want you to practice now. This week, Dr Jesse Golden, I talked a lot about telling yourself the truth and then telling other people the truth. I mean, honestly, this is not anything that has to do only with the health care industry. This is something that I feel like I spend all of my time talking about the importance of telling yourself the truth and finding somebody else to share that truth with. It's important to find connection inside the catastrophe. So this week, for your questions to carry with you, your homework assignment is to tell yourself the truth about one thing. I don't care what it is. I don't care how you tell yourself the truth, whether that is in the thirty seconds between clients or patients, or to year old tantrums like I don't care what it is. But find one thing and tell yourself the truth about it, and then just see what happens. I want you to be a good observer of what happens when I tell myself the truth. Yeah, and then extra credit. I don't know. I don't know that I want to use extra credit because I don't want to tap into your perfectionist achiever thing here when we're talking about burnout. But if you want to do an additional thing, find one other person to tell the truth too. It doesn't have to be a big life altering thing. That you share. It could be just like you know, I really don't like Kale. Find one other person to share the truth with and see what happens. This is also a good time for me to remind you that I really do want to hear if you don't like Kale or whatever you need to tell the truth about. But this is also a Q and a show, and I want your questions. You can ask me anything you'd like. You can bring me your clinical questions. You're I'm trying hard to be a good friend, frustrations, You're I'm overwhelmed with the pain of the world questions. We got a lot of those. Let's talk it all out, friends. Call us at three to three six four three three seven six eight and leave a voicemail. If you missed it, you can find the number in the show notes or visit Megan divine dot c O. If you'd rather send an email, you can do that too. Write on the website Megan Divine dot c O. We want to hear from you. I want to hear from you. This show, this world needs your questions. Together, we can make things better even when we can't make them right. You know how most people are going to scan through their podcast app looking for a new thing to listen to, and then they're gonna see the show description for Hereafter and think I want to talk about that stuff. Things are hard enough. This is where you come in your reviews. Let people know it really isn't all that bad. In here we talk about heavy stuff, but it's in the service of making things better for everyone. So everyone needs to listen. Spread the word in your workplaces, in your social world on social media, and click through to leave a review, Subscribe to the show, download episodes, send in your questions, want more Hereafter. Grief education doesn't just belong to end of life issues. Life is full of losses, from everyday disappointments to events that clearly divide life into before and after. Learning how to talk about all that without cliches or platitudes or simplistic think positive posters is an important skill for everyone. Find trainings, workshops, books and resources for every human trying to make their way in the world after something goes horribly wrong at Megan Divine dot c. O. Hereafter with Megan Divine is written and produced by me Megan Divine. Executive producer is Amy Brown, who produced by Tonya Jujas and Elizabeth Fasio. Edited by Houston Tilly and studio support by Chris Huron. Music provided by wave Crush,

This is here After, and I'm your host, Megan Divine. Each week we tackle big questions from doctor's, therapists and other helpful folks that let us explore how to show up after life goes horribly wrong. This week, it's all about burnout in health care. How do you keep showing up to do the work when the work is breaking you. It's another episode where we speak directly into the abyss my friends with our special guest and hilarious burnout tour guide, doctor Jesse gold Well. We do talk a lot about the health care industry specifically in this These themes of exhaustion and self advocacy are important for everybody, so stay tuned. We'll be right back after this first break. Before we get started, one quick note, While I hope you find a lot of useful information in our time here together, this show is not a substitute for skilled support with a licensed mental health provider or for professionals revision related to your work. Hey friends, So one of the main goals of this show is to give voice to what's really going on inside the health care field. We're always talking about the importance of mental health and reaching out for help, but the helpers are human too. In an industry that prizes stoic detachment as a form of high achievement, being a real human being with feelings and limitations is seen as a liability a lot of the time. That's especially true in the hospital setting, where the fast paced and demanding workload can make even the most committed helper feel like they have to sacrifice themselves on the altar of the bottom line. Dr Jesse Gold is an assistant professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis. She's a nationally recognized expert on healthcare worker mental health and burnout, particularly during the pandemic. She writes regularly for the popular press about mental health stigma, and medical training. That is a giant mouthful of professional street cred, all of which to say that doctor Gold knows her stuff when it comes to mental health challenges facing the health care industry itself. Dr Gold isn't afraid to speak into that complex, messy, very very human space of being called to care for people while at the same time feeling like you're falling apart. Jessie, my friends, welcome to the show. Thanks for having me. So I want to open with something that you wrote in Forbes magazine last year. You wrote, quote, here's something we don't say out loud as health care professionals enough. We have reactions, feelings, and emotional responses. We feel angry and depressed and anxious. We have worries about what's going on in the world right now and how it affects our patients. We also have feelings about what we see and experience on a shift, and those feelings often catch us off guard. Our emotions are suppressed and held inside because we are supposed to be stoic caregivers. So that mouthful just just as a starting point, what do you see as one of the main issues unfolding for health care workers right now? I mean that whole mouthful is mostly a way to say that we're told and taught not to feel. Really, it's the way to survive, it's the way to deal with what we see day to day, and it ends up being a way that we then get burnt out and said in a bigger way because we pushed down a lot of feelings and we pushed down our reactions, and it just becomes not a space we feel safe being in and then it's kind of all compounds until it's much worse than I think that's a big problem with healthcare in general. But right now with everything that's been going on in the pandemic and everything that people have been exposed to, and how different the workspace has been. You know, it depends on what phase of the pandemic, but certainly like more risk to yourself or your family, different lacks of resources in different ways because of staffing or even just simply like resources like beds. I think, much more death than usual on a day to day in what you're seeing, and so you have this additional, compounded hard workplace on a baseline mental health situation that's not ever really been great for health care workers. And so it's kind of a perfect storm in a lot of ways. And the feelings part is a big part of it, because we just don't have a culture that talks. We don't talk about any of it, and so you feel really alone and that makes it a lot worse. Yeah, I think it's just it's such a hot mess, right It was a hot mess before the pandemic. Like none of these none of these things we see erupting right now they're not new. It's like we had a system that was already broken, was already fractured in part because of of what you were just mentioning, like this culture of stoicism, this this idea that having human emotions is somehow unprofessional. Yeah, I mean, I think in a lot of hot mess is a decent way of describing it. And it's like an extra hot mess now, I suppose, But I think you know, I've heard someone say that the fault lines are what you see through COVID, which is like these things that have been brewing under the surface but just get much more exposed with all of the additional stresses of COVID, and I think this is definitely one of them. And our culture and health care is horrible. I mean, we've lived in a group where you know, you're prioritizing not sleeping, not eating, like really prioritizing the other person, you know, the patient, over yourself. There's a lot of conversation around like if you show emotion in a patient room, like are you taking away from what that patient is experiencing. So you spend a lot of time trying to learn not to react to things or that it's normal to go from a person dying in one room to a conversation about like eating or something kind of just generic in another. And that's just what you do. And it's a weird culture and not a culture. We talk enough about how weird it is either and that makes it hard. Yeah, I think that's a really interesting point you bring up about, Like even if there wasn't this sort of professional training cultural model of the stoic attending, right, like, you don't want to take away from the person in the room by showing your humanity because then it's, oh crap, like now we're talking about me. We don't want to hijack the situation in the room. But I think one of the things that's really happened is we've made that an either or situation instead of a continuum. You are completely impenetrable, which doesn't do so great for your clients and patients anyway. Or to use hot mess again, you're a hot mess and you're taking away from from what's in the room at the time. And I think having these conversations is how we create that middle ground of how do we be full humans showing up to do this work with the boundaries and the ethics that are in place for us, but also not at the cost of our own humanity and our own relationships and our own lives for sure. And I think in a lot of ways, if you ask patients like they would be okay if you showed emotion, it's different to show emotion over something that requires emotion and would be an empathetic gesture to show emotion that it is to just be emotional all the time and not make it like a space that feels safe for patients to talk at all. Right, that's very different. And I think we worry that once you like tip over, you're all the way over, and it's just really not like that. And I think a lot of times I've heard from people where their doctor has like actually cried with them or sat with them through something that it's been a really meaningful experience. But if you take that from the doctor's side, they'd be like, why would I ever do that? That's horrible, Like nobody would like that. That's not something I'm allowed to do. There's a very different perspective on what we want or what we think we're supposed to be doing. It's interesting that you brought up that, like basically the if I start crying, I'll never be able to stop. Thing in the medical world as well. I mean, I hear this a lot with people who are having a really hard time navigating super challenging life. Things are like, I can't start crying because I'll never be able to stop. And that is such a product of our emotion of verse culture as a wider social culture, and also again in the in the medical industry. So this actually sets us up really well for the first listener questions that I wanted to get into, if you're ready, sure, I actually asked my audience for questions. I told them while you were coming on the show, I wanted to get a lot of questions from people really working on the front lines. And I can tell you that like, question after question after question after question was basically asking the same thing, how do I handle my own grief knowing how I have to show up day after day and take care of other people. For some of the people who sent in their questions are actually working in the same hospital where somebody close to them died, so the sensory awareness is just on tilt for them. I'm going to preface this question by saying we are not going to have a neat and tidy solution for this, but I wonder if we can use one of those questions as a starting point. There's no neat and tidy solution to most things, especially grief. But feelings are messy, and I think part of the desire for a neat and tidy answer is part of the problem, because we want it to be perfect so then we can do it. But really, in a lot of ways, you just need to be and see where you go from there. Yeah, this is why I love your work so much, in your your presence in the world, because you're like, well, this ship's missed this it's messy, Like we can't make it anything but messy. Okay, So here is the question, Dear Dr Golden Megan. I'm an impatient p A trying to balance the grief of the traumatic loss of my father, followed by that of my relationship, as well as the grief and loss and hardship brought on by the pandemic in my daily work life. I'm so tired from carrying this weight. I have a counselor, but I feel I could do more to compartmentalize or otherwise find some relief. Is there a way to honor my deep feelings but also find reprieve How do I care for myself in a world that requires so much of my energy. I chose this question on purpose because it has so much jammed into it, right, so many layers and layers and layers, and I feel like it's really indicative of what's happening in medical facilities all around the country. So where do we start. It's interesting because you could say, oh, this feels like a complex story, but in a lot of ways, it's everybody's story, right. I think people forget that healthcare workers have the life experiences that everybody else has gone through that I've been challenging over the pandemic, like being a mother, being a partner, being a caregiver, having family members get sick and die, and then on top of it, I have to go to work every day on the front lines and help everybody else. Right, So there's like that added stressor which seems like enough to people, but we have all the other stuff too. Write But I'm guessing that you know, in a lot of ways, it's really good that she goes to counseling already, because I think that's a big thing that's hard for people in general in health care to ask for help, to admit they need help, and they really hate talking about things, So having a place for that that's just for you is really important. I think in a lot of ways, we try really hard not to have feelings in the workplace and to pretend that somehow there's this big difference between work and home and everything like that. But it's all together, and you're the same person going into work. It's just you have to deal with the things that work, and so, you know, I think it's important to give yourself space and time to acknowledge what you're feeling as much in the moment as you can. I think it's really hard in healthcare because that's a privileged time, um and being able to pause at all, but honestly, like reflecting on what you feel in your body, reflecting on what feelings are actually having, and being okay with also having feelings while you do the job, I think is a really important thing. So obviously it's great to have a space to talk about with the therapist and process and all of that, but the time before your next appointment is important to which is like how do ideal day to day without just like pushing my emotions down until that one hour once a week, and you really need to give yourself space and be okay, like having a full range of feelings. So I think a lot of health care workers have struggled with things like anger and not knowing whether like being angry makes you a bad doctor or pia your nurse, or any other person on the health care spectrum. And you know, I think you can be angry and that feeling can be valid and you can still do your job well. And I think it's important that we get used to holding both things and knowing when we have time to do whatever we need to do, to let ourselves acknowledge that we are a human being with feelings and have to do our job at the same time. Yeah, I love that, and it reminds me of something earlier we had on the co founders of the New York's Center for Contemplative Care on and they work with physicians, they work with people in healthcare, and they said, like, I don't believe it when you say I don't have time to acknowledge my own feelings, sit in my own humanity. They're like, yes, you're busy, but you have thirty seconds, right and sometimes I mean, it seems like it's not enough. But what they pointed out was like thirty seconds many times a day becomes fifteen minutes, and fifteen minutes of allowing your own humanity to yourself will make a dent in that pressure. It's not going to solve anything, like none of this is like a super easy solution here. But what I hear you really saying, Jesse, is like, there is power in acknowledging your humanity, even if it is a split second as you're moving from one room to the next, to be able to say I have feelings about this, have feelings about this, and I don't have time for them right now, but I want to notice for myself that I see them for sure. I think that we spend too much time assuming that all things coping take hours. Like if I'm going to tell you to have feelings or cope with something, you need to whip out a yoga mat and do like a forty minute class, Right, That's impossible for most people most of the time. There are different things you can do that take less time that are really helpful. Health Care workers really like things like deep breathing because you walk the stairs between patients. You have the time jelling in and out of a room before you have to see the next person, to take the second and like actually change your breathing patterns to calm yourself or acknowledge how you're feeling, or give gratitude for what you just experienced, if that's helpful for you. I think we don't stop enough to think about the good things in our day or the privilege of our job. We often get really caught up in the hard thing of our job, and so trying to just do that in the quick amount of time that you have, You're right, it's sort of just all adds up to being less than, you know, maybe ideal in the world, but much better than nothing, and much better than only having that once a week time in counselang which most people don't even have, because that's a privilege to be able to fit into your schedule and also to not feel scared to do that in the first place in healthcare. So I think you're right, just kind of all kind of comes together as much as you can. Yeah, it really doesn't. And I just want to pull out that one little bit that you said, not only is it a privilege to find the time to go to therapy, but because we're working against that idea that having emotions on the job makes you less professional, less skilled at your work. Like that is a big thing that we want to name here too. That can feel really scary to even acknowledge that you're wrestling with this stuff because of that culture of perfectionism that we see so much. So I love that you're like, you can't just whip out a yoga Matt, And I think we often use all of those things that you just mentioned. We often like they're often positioned as these cure alls, like if you would only practice gratitude in journal for fifteen minutes about all the things that you love about your life, that everything would stop sucking so much. And that's like, that is not what those tools are for. Those tools are not to remove suckage. There to help you navigate, manage, and support yourself inside this really really difficult situation. And for me, like the language that I use around that is like this is helping you acknowledge the reality of the situation, and acknowledgement is very powerful medicine. Yeah, I mean, I think that's a problem with a lot of framing around coping skills or especially like resilience, is this feeling that it's somehow your fault that you're not surviving in a broken system, And when people suggest doing things that can help you, it feels like they're saying, come on, like fix yourself, Like where else is fine? Work harder, figure it out, like you should be fine. But really what we should be saying is the system, specifically in healthcare, but in a lot of ways, is very very broken. And culture change takes time, policy change takes time, any other sort of systematic change is going to take time. And if you want to survive in a truly broken system, even as it attempts to heal, you have to figure out how to do that yourself, and it requires some individual coping to do that. It doesn't mean something's wrong with you. It means that you're reacting normally to a really bad situation, and if you want to still be in healthcare, you have to figure out how to deal. And you know, I'm not exempt from that by any means, Like I think it's important for people to realize, like just because I uh preach like things around coping skills and burnout and things like that doesn't mean I'm really great at all the stuff myself. Like I've really spent a lot of time over the pandemic trying to figure out what coping skills actually work for me and don't feel like that, like I'm just doing something to do it, And like I spend a lot of my energy like coping with others and having the support of other people, and when that got taken away in the pandemic, it was a lot of like, oh, what do I actually like to do myself that actually still feels good in the same way that going to dinner with a friend might. And It's been a lot of work and I'm still working on it. And you could ask my therapists and she'd probably tell you I'm okay sometimes and struggle a lot. But I think it's important that people realize that even though I know these things, it does I mean that I do them all the time. And we spend a lot of time in medicine assuming like, well I can, I should be able to take care of that myself, Like I understand disease where I understand mental health, I should be able to figure out how to deal with this, And honestly, you shouldn't because I actually am an expert in this particular area, and I can't, right, So it doesn't matter what you know, It matters how it gets applied and how other people point out things to you that you might not even realize are going on. Yeah, I love that. There's actually a Twitter thread of yours where you I think you started it. We were like, okay, physicians, let's talk about the things that we would how our patients to do, but we don't do ourselves. And there's this whole long thread of like I don't I never drink water, I drink only diet soda. I don't get enough sleep, like I never moved from my desk, like all of these things like remembering your humanity in there and this is not I think there's so much perfectionism baked into the health care industry, right, like I must do this correctly or I won't. Like, oh, come on, like you are still human and you are still a catastrophe in progress, just like all of us. I mean, medicine like recruits those people in a lot of ways. So it's like it's a process that is like, let's start out with the people who are most likely to be perfectionists, and then make it harder for them by judging them for having anything that's outside of perfection or making them feel judge for having anything outside of perfection and achievement and perfection become this thing that carries throughout but probably did in most people who went into healthcare. Is life before that, because you have to go into a process of applications where not everybody gets in and there's all this competition upfront, and the competition makes you feel like you have to perfect and that just continues on and on and on, especially if you stay in academics. Yeah, I love that perspective there, that that through that whole rigorous process of getting into the field because we have that culture of stoicism and perfectionism that we are actually like selecting for that. And then you put these people who are selected to run that way, to hold themselves to really high standards, to suppress their feelings because of multiple reasons, and we put them into a highly emotionally charged situation over and over and over again. And then I just don't think we can be surprised when people break, especially not people who mostly wrote application essays about how they want to help people, right like the people that are the best at what we do care a whole lot, and that's really hard to keep doing and not break. And you don't want to find ways to only keep the people in healthcare that are fine with no feelings and don't break right like you want to keep those people, So we have to do better. Welcome back friends. We have been talking with Dr Jesse Gold on the reality of being a healthcare professional with real human feelings inside a profession that doesn't actually value human feeling. Let's get back to our conversation. I think this this sort of brings us around to the big picture environment that a second listener question ushers us into. Debbie wrote in how do we change things in healthcare? As a frontline worker, we need our managers to understand that we are not machines. We are human and need to be heard and understood and rewarded. I get it that managers have numbers and goals to meet, and we have patients, but it's the frontline clinicians who do the work. We're the ones who face the trauma of treating COVID patient's head on seeing the horror unfold. We can't just keep going as if nothing has changed. We've changed how do we change the system so more value is placed on our well being? I think a shift has begun. Workers want more. I see that, but I guess for now, we just have to stand up for ourselves. So I love that line in there and this question, how do we change the system so that more value is placed on our well being? And you touched onto this a little bit, But if we widen that lens out, how do we start forcing a change in a system that was broken before the pandemic? Those fault lines are really glaring and exposed. Now, how do we even start? Yeah, I mean I thought somewhat about this in part because in one of my roles in the hospital I've had to interface a lot with like administration and try to argue for the need to invest in these things. And I think it's very frustrating because we ultimately have different goals, right, Like I think when you're a frontline clinician, your goal is to help the patient as best as you can, and you're really focused on them. Once you get higher and higher up in messin you're dealing with people who are really concerned about the bottom line and really concerned about money, and ultimately you realize just how much our healthcare system is actually a system that's built on financing instead of the people that it's taken care of, and that itself can be pretty disheartening. But I do think there are ways where you can make arguments acknowledging those values that maybe not your values, but are the values of the system to get what you want right. So, for example, depression is the number one cause of disability worldwide, which means it costs the system a lot of money to have a lot of depressed doctors because you don't go to work, or nurses or whatever. You don't go to work, you don't you can't be as productive, you might have errors. All of these things are true, and there's data that backs it up, and I think hospital systems are becoming more aware of it because of COVID and and how many people have been speaking out about their mental health in COVID and realizing that they can't just give you a pizza party or like a lecture on wellness and tell you like we're done, that's all we're doing, that's all we care about the end, or just give you access to an employee access program and realize that's not enough either, and so I do think there is a way to advocate for what you need or what you're missing while still appealing to a value that might not be your value, but is the value that might get things done. Unfortunately, you have to do that sometimes. So I think that's really important. And at the same time, I do think you can make small changes, like in your teams, in the people that you're supervising, in the way you interact with other people, that can make a big difference. So, you know, I talked a bit about how we don't talk about feelings, but we don't even say like it's okay to make mistakes, or that was hard or that was challenging, or of course you don't have an answer to that and you don't know, we don't know, right, and modeling that for people having conversations about why it's hard to say that stuff you don't even have to talk about, like mental health conditions. Right, we just need to start changing the conversations around struggle and why it might be hard to do this job. And some of that can happen on a team level or a supervisor level, and then it can get to higher and higher levels sort of as a bottom up approach. To changing how we talk about this stuff. And once you do that at the same time, hopefully they hear your advocacy and they hear the things you want and they start making changes. But I do think you can make some changes just by having real conversations. Yeah. Absolutely. I mean we we started out this the first half of the show talking about telling yourself the truth in these moments, letting yourself be human, letting yourself having these feelings. And I love what you just brought in there about like we can start having these conversations in our teams at the nurses station, you know, in supervision, to just start normalizing what's actually happeneding, Like we're not talking about anything like earth shattering Lee New We're talking about let's name what's actually in the room, and start claiming our humanity as normal and healthy and challenging in these situations. This is really a grassroots movement of the people who are on the front lines doing the work starting to tell the truth to themselves and to the people around them. And I also love that you brought in like, let's borrow from the c suite, let's borrow from higher up admins. They do have a balance sheet at the end of the day, and there is economic benefit to valuing people's humanity and their limits. And I think you know, whether you take on that role or not, Like if you if you pick up that flag and you decide to go after that or not. I think that's something that we want to start really talking about, is the economic reality of denying people their humanity, not just in the medical world but all around the entire globe. But that we do have to speak the language of finances, and how do we start understanding that naying people their humanity costs us. It cost us financially, it costs us in community building, it costs us in all of the public health prices that we have currently unfolding and interrupting. You know, I started this our conversation out by like saying, we're never going to have a solution for the hot mess of all of this. And I still believe that. I still believe we're not talking about a solution here, But I do think we're talking about away forward from here without collapsing into the despair of the hot mess. But how do we really start to change the culture. One of the things that I picked up from your work, there's this great quote from you that says, the mental health system is broken, you can't fix it by breaking yourself. And I think that's a really interesting sort of closing point for us and all of these things that we've talked about. So tell me a little bit about that statement and if there's a message you want to dictate to the world in this in this moment about I don't know everything we just talked about. I mean, I think in a lot of ways we neglect mental health in all conversations. So the reason why it's not in the financial conversation is people forget about it and don't put it there, or I think it's not relevant, or we're seeing all these people leave jobs and they don't talk about the fact that it's because of burnout or mental health. It's just like, oh, staffing or these like procedural things. And that's very true. But at the same time, you have to call it what it is and say people are choosing themselves over a job that takes it out of them. Right, we have to have mental health in these conversations or we're really missing out and we're not advocating enough for ourselves. We're just going to keep jumping jobs until we find a place that maybe is a little bit better with it right. And I think you know, when I said that we can't fix it by breaking ourselves, I meant over the pandemic, I've seen therapists really try to just take every single patient that they possibly can to make up for the need. And there's a huge need, and there's always going to be a huge need, and then need keeps increasing and will after the pandemic. But you talk to therapists and they're like, well, I started working in the evenings, I took back all my patients who asked to come back from before. I am working on weekends now, and now I'm set. Like, turns out that has a big effect on me too, because I don't have free time anymore, and I'm holding all this stuff for other people. And as much as you want to try to help in every single way you can, which is what we do in our jobs in so many ways, there's only so much as a human in a broken system that you can do without realizing that you really need to step back and put yourself first. Like, you can do what you can do, but there are limits to what you can do because you're a human being. And so as much as you are an advocate or a caring person about how broken these things are and how much you want to change them, there's a space for that. But in the same breath, there's also boundaries and a way to have space for you. And we neglect the second part because we've really want to do the first part right. But you don't do the first part right unless you do the second part. Yeah, I think that's a really beautiful end note for our time together. In a lot of ways, this is a lifelong pursuit we're talking about, right, like this exploration of how do we do the work we're called to do without losing ourselves in the process. So ordinarily, at the close of the show, I ask you where people can find you, and we are absolutely going to do that, but first I would also love some ideas where physicians and other healthcare workers can go for support. What are your like, maybe top two or three places that you would recommend right now? So you know, in a world of misinformation, it's always helpful to go to places that you know are consistently good and putting out good information. So I always go to like big organizations when that's the case. So often that means going to like the American Foundation for Suicide Prevention, who has website on healthcare worker mental health thrive By. The Huffington's Post also has a huge website is called like all In for Heroes, I think, and they have all these resources collected. Most of the medical organizations also have that too, So you could go to the A m A, you can go to the Double A m C. And they all have these kind of like wellness hubs, and they're probably the kind of thing where you're listening to me, you're rolling your eyes and saying like did you just give me more stuff to read and do? But at least it's there, you know. And I think the people who started things like the Physicians Support Line, which is staffed and it's all psychiatrists and staffed voluntarily, they made that over COVID their wonderful humans. You can use that. I know that that's limiting to then only physicians, and I know nurses who are trying to start the same thing for nurses. I think there are some places that still offer free therapy if you're in healthcare, and those places like Emotional PPE or Therapy Aid are also quite good because it's national and you can find some people who are willing to give you some free sessions, particularly you know in the situation where your workplace is and doing that too. And I think all those people really care and are trying their best to give you access to what they know exists. And obviously we can do better, and obviously we need more things, but those are the best that we have right now. I think, Yeah, they're sort of the starting places for what we mentioned earlier in the show about starting to link up with others and find places where you can tell the truth. Right, it is a little bit overwhelming to be like, oh, now I need to go to the m A site and search for all of this, like I have fourteen seconds. But again, like even just starting that practice of telling the truth to yourself and maybe finding one or two other places. I actually love your Twitter feed for this, so let people know where they can find you online. I'm at Dr Jesse Gold. I spelled Jesse j s s I because I was a high maintenance child that didn't say there was an e in Jessica, so that's why I spelled that way. I also have that same as an Instagram handle, and then anything I write is on my website, which is just like Dr Jesse gold dot com. But I think that can be helpful for people because I've written a lot on this particular topic, including from my own experience and being a burned out for an out expert. Yes, I think that's the powerful thing here is that you know what you're talking about. Your not just some talking head from the c suite telling people to do things for their mental well being so that they can be even more productive on the job. But this is actually something you live, and I am so glad to have had this time with you, my friend. People. We will link to everything that Jesse just recommended and a couple of extras in the show notes coming up next, your weekly questions to carry with you and how you can send in your question for us to use on the show. Don't miss that part, friends, We will be right back each week. I leave you with some questions to carry with you until we meet again. It's part of that whole This awkward stuff gets a lot easier with practice thing, and I definitely want you to practice now. This week, Dr Jesse Golden, I talked a lot about telling yourself the truth and then telling other people the truth. I mean, honestly, this is not anything that has to do only with the health care industry. This is something that I feel like I spend all of my time talking about the importance of telling yourself the truth and finding somebody else to share that truth with. It's important to find connection inside the catastrophe. So this week, for your questions to carry with you, your homework assignment is to tell yourself the truth about one thing. I don't care what it is. I don't care how you tell yourself the truth, whether that is in the thirty seconds between clients or patients, or to year old tantrums like I don't care what it is. But find one thing and tell yourself the truth about it, and then just see what happens. I want you to be a good observer of what happens when I tell myself the truth. Yeah, and then extra credit. I don't know. I don't know that I want to use extra credit because I don't want to tap into your perfectionist achiever thing here when we're talking about burnout. But if you want to do an additional thing, find one other person to tell the truth too. It doesn't have to be a big life altering thing. That you share. It could be just like you know, I really don't like Kale. Find one other person to share the truth with and see what happens. This is also a good time for me to remind you that I really do want to hear if you don't like Kale or whatever you need to tell the truth about. But this is also a Q and a show, and I want your questions. You can ask me anything you'd like. You can bring me your clinical questions. You're I'm trying hard to be a good friend, frustrations, You're I'm overwhelmed with the pain of the world questions. We got a lot of those. Let's talk it all out, friends. Call us at three to three six four three three seven six eight and leave a voicemail. If you missed it, you can find the number in the show notes or visit Megan divine dot c O. If you'd rather send an email, you can do that too. Write on the website Megan Divine dot c O. We want to hear from you. I want to hear from you. This show, this world needs your questions. Together, we can make things better even when we can't make them right. You know how most people are going to scan through their podcast app looking for a new thing to listen to, and then they're gonna see the show description for Hereafter and think I want to talk about that stuff. Things are hard enough. This is where you come in your reviews. Let people know it really isn't all that bad. In here we talk about heavy stuff, but it's in the service of making things better for everyone. So everyone needs to listen. Spread the word in your workplaces, in your social world on social media, and click through to leave a review, Subscribe to the show, download episodes, send in your questions, want more Hereafter. Grief education doesn't just belong to end of life issues. Life is full of losses, from everyday disappointments to events that clearly divide life into before and after. Learning how to talk about all that without cliches or platitudes or simplistic think positive posters is an important skill for everyone. Find trainings, workshops, books and resources for every human trying to make their way in the world after something goes horribly wrong at Megan Divine dot c. O. Hereafter with Megan Divine is written and produced by me Megan Divine. Executive producer is Amy Brown, who produced by Tonya Jujas and Elizabeth Fasio. Edited by Houston Tilly and studio support by Chris Huron. Music provided by wave Crush,