Episode 32 Dr. Rana Awdish

Docs With Disabilities podcast episode 32, Rana Awdish, MD Director of the Pulmonary Hypertension Program at Henry Ford Hospital. Medical director of care experience, Henry Ford Health System. Author of "In Shock" University of Michigan Medical School Dep

Rana Awdish, MD, FCCP is the author of In Shock, a critically acclaimed, bestselling memoir based on her own illness. A critical care physician and faculty member of Wayne State University School of Medicine in Detroit, Michigan, she completed her medical degree at Wayne State in 2002 where she was inducted into the Alpha Omega Alpha national medical honor society, her residency at Mount Sinai Beth Israel in New York, and her fellowship training at Henry Ford Hospital where she serves as the current Director of the Pulmonary Hypertension Program. She also serves as Medical Director of Care Experience for the entire Health System. Dr. Awdish’s mandate as well as her passion is to improve the patient experience across the system and speak on patient advocacy at health care venues nationally.

After suffering a sudden critical illness, herself, she has devoted much of her career to improving empathy through connection and communication. She lectures to physicians, health care leaders and medical schools across the country. Her book has been integrated into the curriculum of medical schools and universities across the US and Europe. She was awarded the Speak-Up Hero award in 2014 for her work establishing a workshop-based program called CLEAR (Connect, Listen, Empathize, Align, Respect), which trains faculty and trainees in relationship-based communication skills utilizing improvisational actors. She was named Henry Ford Hospital’s Critical Care Teacher of the Year in 2016. She was named the National Compassionate Caregiver of the Year by The Schwartz Center as well as Physician of the Year by Press Ganey in 2017. She has been interviewed by The Times, The Telegraph, The BBC, NPR, the Today Show online, MedPage, Health Leaders Media, and Beckers Hospital Review. She has written for Harvard Business Review, the Huffington Post, as well as the New England Journal of Medicine. Her NEJM Perspectives article, A View from the Edge, went viral garnering over 120,000 views and is ranked in the 99th percentile for reach.

Read the Episode 32 transcript

Introduction

 

Dr. Lisa Meeks:

 

Doctors with disabilities exist in small but measurable numbers. How did they navigate their journey? What were the challenges? What are the benefits to patients and to their peers? What can we learn from their experiences? My name is Lisa Meeks, and I am thrilled to bring you the DocsWithDisabilities podcast.

 

Join me as I interview Docs, Nurses, Psychologists, OT’s, PT’s, Pharmacists, Dentists, and the list goes on. I’ll also be interviewing the researchers and policy makers that ensure medicine remains an equal opportunity profession.

 

 

 

Narrator: Jake Feeman:

 

Hello everyone, and welcome back to the Docs with Disabilities podcast. In today’s episode, we are honored to be joined by Dr. Rana Awdish. Dr. Awdish is the Medical Director of Care Experience for the Henry Ford Health System and the Director of the Pulmonary Hypertension Program at Henry Ford Hospital in Detroit. She is also the author of a best-selling memoir, “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope,” which chronicles her life-threatening battle with a sudden chronic illness. In this episode, Dr. Meeks and Dr. Awdish fold a discussion of that book and its themes into a wider conversation about empathy and connection in the medical field, and how increasing empathy among medical professionals can create a safer and more inclusive space for people with disabilities. We hope you enjoy.

 

Dr. Lisa Meeks:

So, we've kind of put forward this theory in the work that we've been doing, that individuals that have the lived experience of being on both sides, right on the other side of the bed, so as a patient and a physician, bring a level of empathy to the practice of medicine that might not otherwise be there. And we also kind of project this idea that you don't have to have been a patient necessarily to have a high level of empathy, but that being surrounded by individuals with this lived experience also helps the peers. So, the, the other residents, other students, other attendings in growing their empathy through the interactions that that person might have with the patient. And I'm wondering if you have found this to be true after your experience, that you had increased levels of empathy and how it's impacted not only your practice of medicine, but perhaps your peers or people in your circle?

 

Dr. Rana Awdish:

It's interesting, I think that it's very true that anytime you have a lived experience that it expands your scope of awareness of just the human experience in general, there's so much, in medicine that is about presenting a certain façade almost. And we don't often allow ourselves to be vulnerable within even our direct groups, our students, our residents, our fellows, our fellow attendings. And illness is a doorway into that, but really, the illness is a surrogate for vulnerability, right? And, you know, you have, in some sense, no choice but to be vulnerable and accepting of help, when you're acutely ill, you need the people around you to care for you. But what I've found is when you can accept that help and really have an open dialogue, about how we're really holding each other up as persons, you know, that by allowing someone to care for you and fill your needs and by accepting that help, and, and healing together, that, that that's a journey that you're then on that's nurturing for both parties. And illness lets you into that, but I think there are many ways we can be led into that, there are multiple doors, um, and our patients offer us those doors if we're willing to listen. I think often our family members offer us those doors. It's a matter of just being open to story.

Dr. Lisa Meeks

Yes, I absolutely agree. And you talk about this with the patients that sometimes the patients just want to be heard and appreciated and, and understood, and medicine doesn't always allow us time for that interactions for that, for that connection with the patient. But I think we need to be able to do that in order to effectively treat and understand where that person is coming from and so many examples that you give throughout the book of, you know, moments, not only when you provided care to someone, I, I know in the introduction of the book, there's this beautiful story of a woman that you were treating and the, this idea of hope and what, what she needed in that moment versus what medicine was trained to provide for her. And that's one place where that was evident. And then just, even in your own experience, if people had listened to you sooner, you know, that you knew your body, essentially more than other people. You of course have the experience of being a physician, but I think that that's true for so many people, whether they're whether they have medical training or not, that they really are the experts in their bodies and understanding when something is wrong. And we don't give enough credit to that, especially in emergency situations where we tend to take over, right, and, and quiet the voice almost of the person.

Dr. Rana Awdish:

Absolutely. And that's such an important point because you mentioned time as being, the limiting factor in that relationship. But I, I really wonder how much of it is about not wanting to cede authority and not wanting to hold the patient's knowledge in equivalent position to our own, their bodily knowledge, their awareness. I, I almost think that we dominate the interview with our medical language and questioning and our framework for extracting the history rather than receiving it, because it's about power.

Dr. Lisa Meeks:

Absolutely. And the idea that, um, we reduce people, right to labels, characterizations of what we've been taught. So, this even terms, the terminology that we use, somebody who's come in multiple times for some kind of unknown origin of pain, “frequent flyer” where there may be something that is very, very wrong, but we decide to quit listening after a while when we have made the decision about what is happening. Um, but absolutely, I mean that power differential is so big, both with patients and with students, to be honest. Um, and I know that one of the things I wanted to ask you about, wasn't planning to ask you about quite so quickly, but I do think it is incredibly important. And that is kind of the mental health and wellbeing of our learners right now. And, and that power differential is a big part of why I think people reach for perfection and cease to seek help or cease to admit vulnerability in that space.

 

Dr. Rana Awdish:

You know, medicine sort of set up this, this goal of equanimity[1], that imperturbability, that clinical, just stillness in the face of anything that's happening, that really asks us to suppress emotion. And when that's set out as this ideal, you know, never mind that it's probably a traditionally gendered, hetero-normative, ablest version of that. It's, it's really hard in a culture where, you know, the students are trying to become us and they're trying to acculturate into an environment that is telling them, you know, that's not the goal, feelings and working through them is not what we're here to do. We have to be the sturdy ship. And so, what do you do with that? You either feel like you're an outsider and that you're somehow damaged or more sensitive or not cut out for it, or you are brave enough to trust your internal wisdom and buck the system, and who has the power to do that? Who has the agency to do that? It's rarely students.

Dr. Lisa Meeks

It's rarely students and it's really easy to label a student a troublemaker or a student lacking professionalism when they do show emotion. I think one of my biggest concerns is that when students do express emotion in response to an event like death or a response to an acute presentation that the, that the label that we place on, on them as this unprofessional response in a clinical setting, when the response they're having is purely and simply just human to what they're witnessing. I, I worry about that, especially during this time where we're in a pandemic and they have experienced stressors, like none of us have experienced in the past.

 

You say in your book that you had distanced yourself from patients, the way you had been instructed to do this in training in the same way the team was doing, you had subscribed to the paradigm of medicine set forth by one of your mentors that advised you to “cultivate space and be sparing of yourself.” And that “connection begets loss, which in turn begets disillusionment and burnout.” So, this idea that if you allow yourself to feel right, you will become sad, and it will become too much, and you will become burnt out. And that you have to almost protect yourself against the emotional reaction or connection with your patient.

Dr. Rana Awdish:

That is what we were taught, I remember, you know, even the first moment that I heard it, uh, I was in the ICU, I was a resident in New York City, I may have been an intern and there was just a very heartbreaking case, it was a, a young mother who was dying of opportunistic infection associated with HIV. HIV was one of the reasons I moved to New York, I was, I was really, um, cognitively interested in the disease and the emotional impact was something I don't think I was prepared for, I was on the Lower East Side of Manhattan where, you know, our whole ICU could be patients who had one opportunistic disease or another and were vented. This patient, um, was dying and I was so moved by her relationship with her children and how she was trying to prepare them, and her relatives didn't want to take them in because they were concerned about infection and it was just this heartbreaking case. And I showed it in some way on my face, um, in my affect, and my attending very quickly said, "You know, there are too many of them and if you feel that way about each of them, you won't have anything left." And it was just this devastating sort of, you know, don't make it about each individual patient, don't let yourself feel each loss, there are too many more coming and you have to preserve yourself. I couldn't figure out how to do that, because so much of what I thought I wanted from medicine was about following the thread of that patient-doctor relationship and, and growing from it and feeling connected, and like I was helping, and I couldn't imagine doing all of that if I just stayed cognitive. But it was such a recurrent message that, you know, after a while you look around and you're like, "Well, that's what everyone's doing. I guess that's how they're all getting through the days."

Dr. Lisa Meeks

The environment, I think, shapes perception, which can be distorting, right? If, if that is what everyone's doing, and that's what you're taught to do, pretty soon, it becomes the norm. And then, you know, the emotion becomes the, the antithesis to the norm. And you talked about this later in the book about the impact of kind of this on training, this new generation of physicians and how we've essentially gotten to this, to this place where, you know, 40 to 50% of residents are burnt out. And in a high proportion of them have depressive symptoms that would lead us to believe that they're going to wind up with a diagnosis of depression if they were to be evaluated, but yet we see, so few of them seeking help. How much of this do you think is part of this environment that we've cultivated where we encourage people not to feel and not to make that connection?

Dr. Rana Awdish:

I think we have to bear a large responsibility for that. It is something we haven't modeled well traditionally; I am heartened to see that more conversations are happening now around mental health. There's great advocacy work happening in that arena. Even during, this last year of the pandemic, um, there was a real sort of democratization of seeking mental health in just our hospital where I was working. There were just set up times for pure processing groups to go and share with a clinical psychologist. It was just assumed you would need to do it, and that was really helpful, I think, in a lot of ways because you didn't have to seek it out, it was just there for you to utilize. And you could see the struggling of your peers in such a more visible way and that kind of shared vulnerability was so important for us and our healing because, you know, we would have... It was mixed groups often, so a nurse might share what was a really difficult code for her and the respiratory therapist might share their reflections and, you know, the trainees would get to see, "Oh, my goodness, all of these professionals that I admire are struggling through this." And it really helped to move us from what could have been post-traumatic stress into more of a post traumatic growth space, where we were able to reflect our strengths back to each other and say, "Oh my gosh, yes, of course that was heartbreaking. How could it not be? But do you see how you allowed your humanity to fill that space? You know, that, that patient would have been alone and not had human contact at their end of life were it not for you filling that space, and that took so much wisdom and strength." And we saw ourselves differently through each other's lenses, and I honestly believe we need more shared spaces like that, we need spaces we can come together in and share in a vulnerable way and build each other back up to keep going, because it's not something anyone can do alone.

Dr. Lisa Meeks

I can say that the amount of humanity that I experienced when-my mother obviously just passed away in the ICU, from COVID--and I, I found actually that the, the providers in the ICU were gracious and humane the nurses, the physicians, the respiratory therapists, It was as if the pandemic had provided some sort of correction, right to the field of medicine to say, we were at a breaking point before and now to survive we have to break down these barriers and become human. One possible benefit is that it no longer became viable to argue that people were not depressed and, or, you know, burnt out and, or anxious and, or just overwhelmed that there was no more arguing about this being a systemic issue and that institutions and the hospital systems had, no, option other than to address it head-on. And in that, it de-stigmatized it because it was impacting everyone, right? So, the no longer having to help seek, because the help is there readily available to you, which should be part of our model for trainees already, but that, because everyone was experiencing this together, and even though there was disparate impact that you cannot not be impacted. So, so essentially everyone could benefit from these types of services or shared experiences, or time to process that at least the pandemic did that, it brought it, it brought it home and forced medicine to kind of right the ship. And if you weren't doing that, you were going to lose providers on multiple levels, not just to illness, but to the stress, anxiety, and depression of what is happening right now. So, I think in that way that, the results of the way that we approach mental health is at least something that I hope carries over past, you know, the pandemic that we continue to do these things like bringing people together in shared spaces, which also helps with that connection to one another, just on a human level.

Dr. Rana Awdish:

I'm so glad that you felt like your mom had very humanistic care at the end of life because it- it's so traumatizing to lose a parent at all, and to have the layered grief of all of this. It's a lot. And I think what you describe is, you know, this phenomenon of really what happens when there's a collective trauma. And so, because the providers were experiencing the trauma of the pandemic at the same time as their patients were, at the same time as their nurses and respiratory therapists and students were, we were able to connect to our shared humanity, you know, in a way that we hadn't, and it's such a low bar, like, we have to acknowledge that, that, oh, also we are human. But that's literally where medicine is at right now, and it's from there that we can build back. Um, but we weren't even there, we were at superhuman levels of functioning with ridiculous ambition on a treadmill that we weren't even sure would take us to a place of fulfillment but was just this sort of progression through the academic ranks. And dismantling all of that to just say, "Wait, but what matters?" Was a beautiful thing, because I think what we all saw mattered was our connections. And, you know, we saw that early on, where we were so afraid to go in the rooms, we didn't know about contagion, there was PPE shortages, we were really limiting our contact out of fear of taking it home to our families, there was so much fear. And we were having conversations by phone that never should have been happening by phone because of visitor restrictions. It was really an incredible lesson in what we thought we were doing for our patients and families that was actually all about us and fulfilling our need to feel like a healer. And so, the first minute we could build that back in of really attending to our patients and their families and you know, providing touch and listening without rushing out of the room, that was the first thing we wanted to build back in because we missed it. And I don't think we knew that. I don't think we had at least as an acute of an awareness that we needed that as much as our patients did.

 

Dr. Lisa Meeks

From what I experienced, the humanity was just incredible in the nothing seemed rushed to me, which I think would be different if it had not been for the experience of the pandemic. I think people were taking their time to be human first and explain the medicine second and recognize that we were all in this together. I think to some degree, the pandemic, really challenged the kind of mindset of we know best, right? No one knew best things were changing daily, and that not being able to have the answer is a very uncomfortable space for most physicians and providers, but you had to get comfortable with it because it was just simply where we were at.

 

You talk about the superhuman approach. And that is one that I think prior to pandemic, that is one that really impacted, the inclusion of individuals with disabilities into this space of medicine, right? Whether it's unconscious or conscious bias of looking at a learner or an applicant who might have a disability that, that is visible and saying that person can never be a physician, they, somebody with a disability can cannot also fill this role of being the superhuman healer, and you talk about illness in your book and how illness is viewed as an aberrant state. You say “it's a town that we drive through on a journey home, but not a place to stop and linger. We pass through with gritted teeth is if it were a storm with no regard for the illuminating beauty of the lightning as it strikes, but those shattered moments that break our bodies also allow us access to wisdom that is normally hidden.

 

That really stuck with me and I thought this is part of the disconnect between medicine and providers that do have disabilities, we don't see those two as being able to coexist. And of course, when we don't allow for something to exist, we have two options. Either people don't enter the field of medicine that have disabilities, or they hide their disabilities when able. So, I took this, this section of your writing and a lot of the stories that you had in the book and applied it to the work that we're doing on kind of appreciating the experience of illness and appreciating the experience of disability. And I'm wondering how you've been able to apply kind of your experience in the work that you've done to this idea of coexisting illness and being a physician?

Dr. Rana Awdish:

You know, when I think about what I know, what I know to be true, what I genuinely believe, where my values are, so much of that knowledge has come through different channels, it hasn't come through my formal medical education or training, it's really come through either being very sick myself, having a chronic sort of remitting illness, having people I care about go through the trauma of illness, um, and navigating that. And then there's this other part of my knowledge that's really through art, and through reading and writing, and the things I can discover in that space too. And I think we've been so single-mindedly focused on knowledge as being book learning that we've devalued all the other kinds of awareness and knowing and different ways of seeing.

 

That has applicability in terms of medical humanities, as well as having more visibility of our own disabilities within the workplace. The hard part, I think, at least for me, is when, when I get acutely sick and I'm suddenly out, you know, because I need surgery, and I'm out for six weeks, it immediately places a burden on my colleagues. And we've sort of been taught that that is never okay, right? Like, think of the terms pulling your own weight, strong work. It's never about leaving work undone for someone else. That is not our culture. As much as we think about group work and group think and teams, it is still very much an individual burden that we bear.

 

And that's one place that I still feel shame creep up for me, that feeling of, "I can't do what I'm supposed to do, so somebody else has to do it." And until, unless and until, we can really integrate different senses of what people bring, and their value and their lived experience. Unless and until we can do that, I think people will still have shame when they can't meet the bar that's set so unreasonably high. And, you know, we have to look at ourselves too and look at the ways that we might unknowingly shame our colleagues. it's hard when everyone's working so hard and there is no capacity in the system, it all comes back to systems, right? And until we rebuild it so that it is more pliable, and it is more compliant and there is room to breathe so we don't feel like we're somehow overburdening each other, I think the shame will continue.

 

Dr. Lisa Meeks

That's such a good point. And this is thematic with my medical students and residents that they feel like they cannot step away. Um, I think especially with residents, it's interesting to hear you talk about it as someone who's, who has been in medicine for a while, who's not in training who has that autonomy to even have shamed creep in when something happens with you. And you could imagine if it's creeping into your space, the exponential impact that might be having on someone who is kind of vulnerable to what the attending or, or program is going to say about him, her or they, as they, look for the, the next level of training or fellowship or something of that nature. I hear this so often from, um, trainees who have mental health crises and it is often in the context of not taking that time to address their needs because they know that it is likely that many of their colleagues are experiencing the same thing. And even, even the way we talk about coverage, right, that the term jeopardy, I mean that in and of itself, it's like everybody's in jeopardy at some point, and not having system-based coverage that allows people to feel okay about leaving and that it won't place burden on, on someone else that there there's a floater that, that takes on that work or a PA or someone who comes in, who can carry some of that load. And you set this up so perfectly to talk about the issues in the system and what we've learned and how we might address some of these things.

 

I know you talk a little bit in your book about some changes that can occur in medical education and training. What do you think are some of the most egregious barriers that are system based that might, be removed or re-envisioned for a happier, healthier medical training?

Dr. Rana Awdish:

It's such a big question, my mind boggles. Um, you know what at the core of the question, I think, is the issue of vulnerability. I want us so badly to stop modeling this version of ourselves that is just competent and capable and never has a doubt, and, you know, hold that up as some ideal.

 

I don't think we have allowed others to see us as full humans, and I think freedom comes down to really being able to express your full humanity in, in different settings without fear of reprisal, medicine doesn't have that. I have such issues with the concept of professionalism as it relates to training, if we could drop one thing, it would make me very happy to really look at what we've called professionalism and see it for what it is, which, you know, I think is a very White supremacist notion of professionalism. It's very ablest, it's, it's very, um, enticing to systems to make you adapt to a kind of way of being that means you have no needs, right? Like it's a perfect chess move in a culture. But it doesn't serve us well, and it doesn't serve our trainees well and if we looked at what we really want from our future health care providers, I think we want them to be advocates, we want them to understand care in the context of a community, not individual health, but really public health. We want them to feel free to bring their full selves to work and for us all to be able to grow because of it. We want them to care for themselves when they need to be cared for, and we're not doing any of that now, and to create that space is going to take really radical change.

Dr. Lisa Meeks:

Absolutely, there's a great paper that came out about professionalism as a competency[2] and how that sets up individuals that experience a mental health crisis during training or have a chronic health issue during training. And, I agree with everything you've said, it, it definitely, it's a way of keeping people in place and keeping people compliant to a set of rules that already exist.

 

***

Dr. Lisa Meeks: I'm just curious if you do identify as having a disability?

Dr. Rana Awdish:

You know, it really varies by the day, it's, it's so interesting and it's probably something for me to look at more closely. Um, I haven't integrated that term into my sense of who I am, but if I'm honest about my limitations and how it affects my work, it probably is a, a label that I, I deserve, um, and should welcome and incorporate and learn from. I do think I fall prey to the same thing that we all fall prey to which is valuing the narrative of strength and resilience and recovery over the narrative of continued chronic illness and sort of a slow decline into whatever lays ahead for me.

 

I've learned, if nothing else, to accept where my body is at in the moment, to honor it and not to try to force it into a shape that it is not. And sometimes this acceptance goes too far. My most recent health illness was this past Thanksgiving when I needed emergency surgery and I had so gotten good at messaging to my body that pain was not necessarily a story that I needed to listen to, that I could accept the pain that was in my body and just not tell myself a story about it and what it meant, that I basically ignored a surgical emergency in my own body. And that's something I'm still unpacking. You know, how our, our ability to develop coping skills when we're chronically ill can actually be an advantage but it can also disadvantage us if we overcompensate.

Dr. Lisa Meeks:

Yeah. I think so much of it for my colleagues and peers and friends who have chronic illness is contextualized. And it's hard to take on that identity of being a person with a disability if at times you are not disabled and you're navigating life without any functional impairment and there's no need for accommodation or adjustment. But then other times you are.

Certainly everyone, comes to this space in their own time and with whatever, the formal or lack of formal title of disability that, that they're comfortable with.  I think was so many of my trainees that until there's a legal reason, right? Or a, you know, something comes to a head with their need to protect themselves and identify with usually it's the legal protections of being or identifying as a person with a disability-- that there's just such a resistance to do that. And it, and it makes perfect sense. I mean, everything that we've talked about today, it makes absolute perfect sense that it would be something that people wouldn't run to embrace.

On the other hand, I'm seeing this new generation of learners who are not only embracing this-but celebrating. It makes my heart happy. I'm sure it makes your heart happy. And we, you know, we see some of these, new trainees that come in with this mindset of unapologetically embracing, this part of their identity. I think this is the perhaps radical change we need. This generation or, across medicine to stand up and say, I'm done apologizing for being who I am. And honestly, whether that has to do with disability or race or sexual identity or gender expression or whatever it is to say, “I'm here, this is my authentic self, and I'm done, I'm done apologizing or hiding it to make you feel more comfortable.” So that's something that I've really enjoyed seeing. And I've seen it grow, to an extraordinary level over the last year, and whether that's due in part to the pandemic and people just deciding that it's time to reorganize priorities and, and to say, this is what I'm going to put my efforts into, it's been interesting.

Dr. Rana Awdish:

I just hope we can shift the system to accommodate that expression, because I so worry that the students are braver than the system that they are meeting. And they have so much to teach us, but we have to bend so far in that direction. We are so far from embracing that and, you know, that, that legacy persists.

Dr. Lisa Meeks:

And there's also no consistency between who will and will not embrace it. So, if it's GME, you know, even within the same institution, it's so program dependent and in UME it's so school dependent as to who is going to welcome, an individual and the narrative around what's okay and, and then the, the actual culture, that supports something, it can be different as well. So, I would imagine as an applicant, or as a trainee, it's very difficult to know where those actual safe spaces are because sometimes the words don't match the actions.

Dr. Rana Awdish:

And we will rely too much on their individual resilience and strength without building a system that has capacitance to absorb that, um, and they shouldn't have to navigate that, they shouldn't have to wonder where the landmines are and where they'll be considered unprofessional. It's a shame.

Dr. Lisa Meeks:

Absolutely. Absolutely. I love how you've described it, but the landmines and that is so true and learning to navigate those and that results in its own form of PTSD too, right? Especially when you don't know where they are. So, you're constantly on alert constantly on edge waiting for that to happen.

Dr. Rana Awdish:

Sure. It's, you know, it's microaggressions writ large, it's, "You don't belong," it's all of the messages that they receive that they're not cut out for it. And it's astonishing to me that a culture that supposedly is tasked with caring for the vulnerable and the sick and the injured, would shun so completely the notion that the human body is fallible, even amongst ourselves, it’s so fascinating how much we've kept that at arm's length.

 

Lisa Meeks:

It truly is.

 

I wonder one of the things that I ask at the end of the interviews is to speak to the individual who might be entering the pathway to medicine who has a disability. What type of advice might you give to this person entering this space that will need to be a little bit more protective of their health, whether that's physical or mental health, but who want to really contribute to medicine and feel the calling to this area?

Dr. Rana Awdish:

I think what I, what I genuinely believe to be true is that, you know, the human body is a difficult organ to inhabit and go about your life for a lot of people, it never quite does, mine never does what I want it to do. But having a disability, no one will likely sit you down and tell you that it is your superpower, but it is a superpower, because you will have a lens on things that you cannot imagine not having because you are in this body and you've experienced it, but that others won't have. And there are so many bits of wisdom and creativity and strength that you've gained through that, that might seem invisible from day to day, but are always accessible.

 

And I never saw that more clearly than during the pandemic when, the sort of whole world was struggling with the idea of, "But, but oh my gosh, there's a threat and my body is susceptible, and I have to make concessions and how is that going to work?" And everyone I know who had a chronic illness was like, "Yep, hand me the mask. Where's the hand sanitizer? I know what to do. I know how to stay home. I know how to keep my mind occupied. I know how to be still and wait and trust." And we have a skill set that is a superpower, but no one talks about it. And so, the more that you can tap into that innate wisdom, and bring that to your work, the more fulfilled you'll be and the more of an asset you'll be to medicine.

Dr. Rana Awdish:

One of the things that I've come to understand recently as I, you know, speak vulnerably about a lot of things from fetal loss to chronic illness, and, and my, my frequent ICU admissions is that, um, that, of course, there's an inherent vulnerability in sharing, and not everyone deserves our stories. And although we are all becoming advocates, we have to be really careful about how we choose to tell those stories, because there's a, there's a cost always, and what I've learned for myself is that a measuring stick for me is that if my healing can be disrupted, if I can be set back by someone's response to a disclosure, then I am not ready to share with that person, that my healing matters more and I have to know that I'll, I'll maintain that sense of wholeness after the disclosure, after the vulnerability. You know, I want so much, as we all do, to share stories that can illuminate things differently to give people a different point of view on things, but it can't come at the expense of our own wholeness and so, it should never feel performative. It should never feel like something that you're leveraging to, to make somebody see it differently. It has to come from a place of preserving your own integrity. And, and for me, that measure is, will this disrupt my healing if it goes badly?

Dr. Lisa Meeks:

That is such good sage advice. And I think probably needed for our audience, because I do think figuring out when, and how to share is important and you must always protect yourself and the only person that's going to look out for that, or that has control of that when you're sharing a story is really you. And That can be hard to navigate and understand when it's okay and when perhaps there might be some sort of negative, that results from, from that sharing. it's interesting because our conversation could keep looping back to other things that we've talked about. Right. To me, this kind of loops back professionalism, because you could actually be held to account for sharing something that makes absolute sense and could be beneficial in a space but is considered unprofessional. It's so interesting. And yeah. How do you know when this is? I really like the way you said, you know, we need to be clear how people are going to be evaluated for professionalism because it's not always clear and that's not always fair.

Dr. Rana Awdish:

No, it's so rigged. And, you know, there are things that you'll have to share that you can share in a fact-based way that can be less vulnerable. I think when I'm thinking about really sharing with vulnerability, it's about making sure the audience deserves that level of vulnerability. And, sometimes you'll find your colleagues won't, and sometimes you'll find yourself in a position where, as you said, sharing leads to you being labeled as unprofessionalism, because the system's rigged against vulnerability.

And, you know, there's a real shame in medicine that because we haven't been transparent about the humanness of the experience and all of our individual difficulties and doubts, that there is still a culture that takes pleasure in seeing when someone is "weaker" than them because it elevates them by comparison. And that might be the only time that person feels elevated, is if it's by someone else being described as weaker. And until we fix that, um, we have to be aware that our vulnerability can be weaponized against us.

To our guest, Dr. Awdish, thank you thank you so much for sharing your story, your experiences, and your knowledge with us and our listeners. We are so grateful for your thoughtfulness around creating a more empathetic future in the medical field, especially in the wake of this terrible pandemic. Thank you also to our audience for listening or reading along to this series. We hope you will subscribe to our podcast and join us next time.

This podcast is a production of the University of Michigan medical school Department of Family Medicine - M-Disability initiative. The opinions on this podcast do not necessarily reflect those of the University of Michigan Medical School. It is released under creative commons, attribution non-commercial, non-derivative license. This podcast was produced by Dr. Lisa Meeks and Jake

[1] a state of psychological stability and composure which is undisturbed by experience of or exposure to emotions, pain, or other phenomena that may cause others to lose the balance of their mind.

[2] Stergiopoulos E, Hodges B, Martimianakis MA. Should Wellness Be a Core Competency for Physicians? Academic Medicine. 2020 Sep 1;95(9):1350-3.